Item 6

Discussion Points for HealthFit

I am writing on behalf of the Hampshire County Council Health Review Committee in response to the HealthFit discussion document launched in late January.

Although the direction of travel and key drivers for change are clearly set out in the document the Committee remains unclear about the way in which these will be translated into action across the localities identified.

A number of factors are coming together which, when linked with the vision set out in `HealthFit', could have substantial implications for the way in which NHS services are provided to local people. It is essential that patients, the public and other key stakeholders are fully engaged in considering and planning these changes within the localities identified.

Previous `Healthfit' documentation has placed specific emphasis on the need for local engagement, particularly in relation to phases three and four of the `HealthFit' process. The intention to develop options for change through the involvement of local patients, communities, staff, clinicians and other partner organisation is strongly supported by the Committee. This engagement provides confidence that any proposals subsequently put forward for formal consultation would demonstrate genuine contribution and input from the communities affected.

You will be aware that we have asked previously for copies of these locality plans and information on the way in which local people were able to feed into this process. `HealthFit' rightly acknowledges that difficult decisions may need to be made if NHS care is to sustainable for the future. Major service reconfiguration is implied in a number of the proposals discussed. It is essential that the public, patients and other key stakeholders are able to contribute to the further development and refinement of these strategies in line with the requirements set out in Section 11 of the Health and Social Care Act. Throughout the discussion document there are references to the role of the voluntary sector, other service providers and the responsibilities of local people. It is not clear how this engagement will be taken forward across the localities affected. The section relating to cancer services (see page 46) was the only one to include additional information on the way in which users would be involved.

We are concerned that the locality plans we have received are very variable in form and content, particularly with respect to the way in which patients and the public have been engaged. This matter needs to be addressed as a matter of urgency to ensure that there is clarity and responsibility within localities for ensuring that Section 11 requirements have been appropriately discharged. At the present time the Committee is not confident that this is the case across all localities. The section on patient and public involvement at page 54 simply describes the new system, not how it will inform the HealthFit process.

The document notes the challenges of taking this agenda forward but does not include any assessment of the risks. The difficult financial position (pages 50) makes it clear that there is an expectation that the solutions put forward will cost less than now and make a contribution to cash releasing savings (see page 56). It would be helpful to understand where responsibility for achieving these targets rests within the localities.

It would also be helpful to have confirmation that the PCTs consider the balance between acute provision and community/primary care is correct. Building capacity in primary and intermediate services is a key area for delivery and the current document has a strong focus on acute care with little detail of how changes here may impact on the communities affected.

In this respect it would be useful to know if consideration has been given to the scope for integrated working across health and social care service providers.

Other general points include:

· Have the planning assumptions underpinning the discussion document taken account of the anticipated demographic changes within the population (e.g. new communities in south east Hampshire).

· What are the links with the changes in primary care and the new contract arrangements for GPs, including out-of-hours care.

· What impact will Foundation Hospitals have on the locality proposals.

· Is there scope for applying the notion of a single system approach to some of the management support services across Trusts within a locality (e.g. personnel, financial services).

· Are the levels of investment in acute care currently planned affordable and sustainable given the current financial deficit in the health economy.

· How will work be taken forward where services cross more than one locality area.

Specific Points relating to the document include:

1. Para1.4 includes reference to cancer services. Our understanding was that was to be taken forward separately. It was not the focus of any local consultation we were aware of. How will these proposals now move forward, taking account of section 11 requirements .

2. Para 1.6 Is the SHA satisfied that there is a clear process for engaging with the public and patients across the communities affected. The action plans developed must be underpinned by robust involvement.

3. Para 2.1 refers to community engagement. We have written previously to reaffirm our expectation that we would be involved in the approach to formal consultation and it is helpful to have this reinforced. We are keen to engage in the discussions about whether a proposal is substantial or not.

4. Page 20.E Is it correct that it is envisaged that we will move from 5 to 2 neonatal intensive care units. It is not clear what is meant by the statement on page 58 that there is `an urgent need to address the capacity of neonatal intensive care in Southampton'. Are there implications for accessing these services in the north of the County? What factors will inform the need for there to be high dependency and special care provision outside the centres identified.

5. Page 22 (sustaining maternity services). Is this inferring that there may be a reduction in midwifery-led units across the county? How will this process be managed across localities

6. Page 26 & 27 J, K L M& N. This is an area where there needs to be strong partnership working. Each of the services seem to have a strong medical focus. Other partners in the statutory and voluntary section also have a key role to play in the delivery of these services.

7. Page 26 K What work is in hand to deal secure the views of children and young people. Access to these services for looked after children is an issue we will be highlighting. L refers to children in special circumstances. Findings from our review of Children Looked after indicate that issues such as registration with a GP and transfer of information to be addressed. This must happen on a multi-disciplinary basis.

8. Page29- Mid and SW Hants Is the locality able to deliver the emerging standards from the NSF. We also note that page 58 makes reference to the long term sustainability of maternity and paediatric services in this locality. This is an issue that is likely to be of intense interest to local people.

9. Page 29- What is a virtual hospital

10. Page 29 Are there particular implications for the provision of acute paediatric support in the north east of Hampshire

11. Page 33 Inter-organisational collaboration It would be helpful to have further information about the work in hand to secure seamless care for emergency care provision. When will the work programme be available.

12. Page 34 Single point of access& triage How will the two other localities be engaged in providing a single point of access. This seems to cut across the intention to provide a consistent response across the county and IoW. Also we have picked up a number of concerns about the out of hours services in some areas. Will this be addressed in the new arrangements

13. Page 34 Hospital at night What evidence and consultation process is underpinning this proposal and when will the implementation process begin

14. Page 34 Out-of- Hours OOH is a key priority. How will the SHA assess the effectiveness of arrangements put in place by PCTs

15. Page 34 Alternatives to admission What role is envisaged of the voluntary sector in providing an alternative to acute admission. How will consistency be in response across the area be secured.

16. Page 34 Emergency Transport What are the responsibilities of patients in relation to emergency journeys. Will this be accompanied by a clear and consistent investment in public information/awareness.

17. Page 35 Changes to provision at SUHT and WEHT Is this an option that is supported by local people.

18. Page 35 There needs to be clear definitions about the interpretation of terms such as minor injuries, surgical emergencies and associated terms, including the way that the public understands the term A&E.

19. Page 36 Ports & SE Hants The SHA is aware of the concerns that the Committee has raised regarding the provision of health services in south east Hampshire. Will local people be regularly apprised of progress with this work. Will the views of local people be fully taken into account when deciding the way forward

20. Page 36 What is the risk that the QA redevelopment will not completed within this timeframe

21. Page 40 The need for investment in community and primary care provision is particularly important if the strategic vision for older people is to be realised

22. Page 41 Mid & SW Hants We welcome the acknowledgement of our role

I do hope that these points are helpful in informing the way in which the next stage of the `HealthFit ` process rolls forward. This is a complex and significant programme that will affect a significant proportion of the population across Hampshire and the Isle of Wight. Although there are a number of key factors driving this process it is essential that changes made are able to deliver modern, effective and accessible health care to local people.

The Hampshire and Isle of Wight joint committee will be meeting latter this month and will consider the responses from the individual overview and scrutiny committees. If there are further comments that we would wish to make collectively I will write to you again.