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Purpose and Summary

This report sets out the key areas for the work programme of the Health Review Committee (the Committee) in 2004/05.

It builds on the approach adopted in the paper `Developing and Effective Overview and Scrutiny Plan', which was considered by the Committee in July 2003.

This has subsequently been discussed with NHS Trusts and Primary Care Trusts across Hampshire as well as lead members and officers in district and borough councils. Comments were also invited from Community Health Councils prior to their abolition in December 2003.

Feedback from these meetings has confirmed the appropriateness of the work strands agreed by the Committee and identified further topics that may be included in the review programme agreed by the Committee.

Recommendations for the programme of reviews to be undertaken the Committee in 2004/05 are included. These take account of the commitment of the Committee to regularly assess the planned review programme to ensure that it:

· Has the capacity to influence and improve the service under consideration

· Is timely and relevant to local health services

· Deals with issues not under review elsewhere

· Does not duplicate other scrutiny or performance monitoring activities

The recommendations included in this paper support Aim 5 of the Corporate Strategy (Improving Services).

Background

In July 2003 the Committee published `Developing an effective Overview and Scrutiny Plan: Report on progress and next steps'. This document described the approach of the Committee to the new responsibilities for the overview and scrutiny of health in Hampshire.

A number of considerations informed the approach adopted. These included:

· The regulations and guidance relating to the scrutiny of health and new arrangements for patients and public involvement in the NHS.

· A commitment to work collaboratively with partner organisations

· An emphasis on improving and influencing the delivery of services

· The need for a flexible work programme, able to respond to proposals to change or vary NHS provision and referrals from patients and public involvement forums (P&PIFs) or other partner organisations

The Committee identified three strands of work to support the overview and scrutiny function. These were:

· Reviews of health services: thematic and cross cutting, the review programme considered specific topics and identified opportunities for improvement. The initial programme of review , agreed in early consultation with key stakeholders, was the `Health of our Children and Young People'. Two specific areas of work were identified for completion in the 2003/04 financial year: children looked after and the health of school age children. This work identified areas for improvement in these services including health equality considerations and was delivered within the required time frame.

Two additional areas of work were identified for a potential areas for review in 2004/05: mental health of children and young people and access to therapy in schools. The appropriateness of proceeding with these two further review topics need to be tested against the criteria set out in 1.5 above.

· Health Inquiries: provides the route through which all partner organisations (Hampshire district and borough councils, NHS bodies, voluntary and independent sector providers and organisations that are representative of social care services users and carers) could raise issues of concern with the Committee.

Where inquiries raised with the Committee are subject to performance monitoring or other evaluation information is sought from the agency best placed to respond. If an issue cannot be satisfactorily resolved through this route then the Committee will consider the scope for further action, including inclusion in the review programme.

· Responses to proposals to vary or develop NHS services focused on formal consultation from NHS organisations for substantial change in service delivery. The approach outlined included the criteria against which such proposal would be assessed.

Regular reports have been made to each Health Review Committee meeting on progress with each of the work strands.

In early autumn a programme of visits was arranged for the Chairman to meet with NHS bodies to introduce the Health Review Committee and the approach that had been adopted. This was extended to include the health and scrutiny leads in the districts and boroughs across Hampshire. Feedback on the approach of the Committee was invited at these meetings together with information about issues that affected the health of local people.

Comments received broadly supported the work strands identified by the Committee particularly the emphasis on partnership working. In addition a number of potential topics for review were highlighted by partners as being of particular local interest.

To make the best use of the resource available to the Committee potential review topics were assessed against the criteria identified. A number of the issues highlighted by partners were subject to other review or included in national targets and programmes. Others are likely to be the focus of specific consultation in the coming year. As such they are not suitable for inclusion as review topics at this point in time.

Proposed Work Programme for 2004/05

The three strands of work originally identified provides a flexible framework through which the Committee can provide informed comment and feedback about issues affecting the health of local people. This will be retained for 2004/05 and modified to take account of issues raised with the Committee in 2003/04. The proposed work programme will therefore comprise:

1. Reviews of Health Services

It is recommended that the review programme for 2004/05 retains the focus on the health of children and young people and undertakes an in-depth review of access to therapy in schools with particular emphasis on speech therapy services. The scope for local improvement to these services has been highlighted in a recent investigation into a complaint made to the County Council. Cllr McNair Scott will lead this work.

In addition the review of the health of school age children identified the scope for further investigation into the arrangements for the administration of medication to children at school. It is therefore recommended that further work is undertaken to establish if there is scope for the Committee to influence these arrangements in Hampshire.

The review of the Mental Health of Children and Young people will be deferred whilst work takes place across health and social care with respect to `Every Child Matters', Children's Trusts and the National Service Framework for Children. It is also anticipated that action will be initiated across localities in Hampshire in response to `HealthFit' proposals. This decision will be reviewed in 12 months.

Access to foot care for people with diabetes is an issue referred to the Committee. Initial investigations suggest that there is variability in the provision of this service across Hampshire. There is a clear evidence base supporting the need for this service and significant scope for the Committee to influence local service provision. It is recommended that this is included as a review topic for 2004/05. The lead member will be Cllr A Dowden.

Additionally district and borough councils may have a specific local interest in a particular issue that can influence or improve the health of local people. In recognition of this member leads will be contacted and invited to indicate where work is in hand to progress local health scrutiny initiatives. These will be drawn to the attention of the Committee. If there is further benefit to be gained from arrangements to delegate the Committee's overview and scrutiny powers for a specific project then this proposal will be put forward for consideration by the Committee.

2. Health Inquiries

A number of issues raised with the Committee are the subject of national or local performance monitoring arrangements. These include:

· Access to primary care services, including waiting times to see a GP or other health professional; access to NHS dental care; out-of hours services; advice provided by NHS Direct.

· Services for older people, including care in hospital, support to carers, delayed transfers of care, access to respite care and co-ordinated mental health services

· Adult metal health services including people with challenging behaviour, people with dual diagnosis, liaison between mental health and acute services

· Links with public health agenda and the prevention of ill health including social exclusion and deprivation, links with educational underachievement and ill health, influencing health through LSPs

It is recommended that the Committee continues to be briefed on local action taken with respect to these issues and receives regular up-dates from partners on progress against targets.

3. Substantial variation or development in NHS provision

Other issues raised by partner organisations are likely to be the subject of formal consultation by the NHS in the short or medium term as the `HealthFit' strategy rolls forward across localities. These include:

· Maternity services: lead member Cllr McNair Scott

· Services for children (including mental health services): lead member Cllr P Dickens

· Services for older people: lead member Cllr A Dowden

· Emergency services; lead member Cllr B Bayford

· Cancer services: lead to be determined

The Committee has already identified leads for each of these areas with the exception of cancer services. It is recommended that these be maintained and a member lead for cancer services identified.

One health related area identified, the fluoridation of water, may not come from the NHS but could be of significant interest to local people. Joint arrangements for considering any proposal of this nature will be required.

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Recommendations

· The Committee approves the proposed programme of work as set out in section 3

· Members with an interest in contributing to the planned reviews contact the Health Review Manager by 14 April

· Members interested in cancer services contact the Health Review Manager by 14 April