Contact: Denise Holden ext. 7338

e-mail: [email protected]

1. Summary and Purpose

1.1. This report provides Members with information about the issues brought to the attention of the Committee and the action taken as a result of this referral. The report sets out the inquiries received, the source of this inquiry, action taken and recommendations for further action. Where appropriate comments have been included and copies of briefings or other information attached.

1.2. The approach adopted provides the route through which Patient and Public Involvement Forums (established in 1 December) and other partner organisations (Hampshire district councils, NHS bodies, voluntary and independent sector providers and organisations that are representative of social care service users and carers) can raise issues with the Committee.

1.3. Where inquiries raised with the Committee are already subject to monitoring or other performance management activities the action taken will be focused on the local resolution of inquiries through appropriate sign-posting to the agency best placed to respond.

1.4. Where an issue cannot be satisfactorily resolved between the parties concerned then the Committee can consider options for further action.

1.5. The recommendations included in this report support Aim 5 of the Corporate Strategy (Improving Services) through the overview and scrutiny of health services in the Hampshire County Council area.

2. Recommendations for Action

2.1. Diagnostic and Treatment Centres: the Committee continues to follow the introduction of the new centres and the impact that they have on local services to ensure that these services are accountable to local people.

2.2. Patient and Public Involvement: the Committee notes action taken to establish working relationships with the Forums.

· Area meetings are arranged for the afternoon of 8 September (Mid and South West Hants), morning of 27 September (South East Hants), morning of 29 September (North Hants).

· Any member wishing to attend any or all or these meetings should contact Denise Holden.

2.3. Redevelopment of Queen Alexandra Hospital and services in south east Hampshire: This issue is included as a standing item on the Committees agenda

· The Committee monitors the public consultation being undertaken by Fareham and Gosport PCT. Dates of the public meetings to discuss the two options put forward by the PCT are set out below.

· The Committee responds to the formal consultation on the future of health services in Fareham and Gosport. Full details of the proposal can be found on

· The Committee receives a copy of the independent assessment of health needs being Commissioned by the local NHS

2.4. Beyond Healthfit: The Committee receives the response to the issues raised with the Strategic Health Authority and monitors the progress of refocusing leadership and any associated locality plans carefully.

2.5. Out of Hours Services: The Committee is provided with an up-date on progress with the establishment of out of hours services at its next meeting, including a response to the additional issues raised by members regarding services in the south west Hants area.

2.6. Differential Tariffs: The Committee writes to the Strategic Health Authority setting out its expectation in terms of access to information requested and timeliness of response.

2.7. Foundation Hospitals: The Committee continues to monitor progress with the applications for Foundation Hospital Status from NHS Trusts in its area. Additional information has been received from SUHT in relation to the proposed governance arrangements and service development strategy. Copies can be obtained from Denise Holden

Section 100 D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents that disclose exempt or confidential information as defined in the Act.

File Location

None

Hampshire County Council: Health Review Committee: 27 July 2004

Inquiries Received and Action Taken

Hampshire County Council Annexe A

Health Review Committee: 27 July 2004

Beyond HealthFit: Letter to Strategic Health Authority

Comments on `Beyond HealthFit' Presentation: Health Review Committee Meeting 25 May 2004

I am writing in response to the paper presented to Hampshire County Council Health Review Committee on 25 May. The comments set out below draw on a number of themes highlighted in a lengthy discussion on issues raised in response to the presentation and are supported by the health overview and scrutiny Chairmen from Portsmouth City Council and the Isle of Wight Council. For ease of reference we have arranged these under the same headings used in the explanatory overheads.

It is important to stress that these comments are not an attempt to cut across the internal management arrangements of the NHS. The structural changes set out in `refocusing leadership' are for the Strategic Health Authority and PCTs to determine. The financial challenges facing the local health economy are however significant and it is clear that action will have to be taken to address the underlying financial deficit of £50 million. Where this has an impact on service delivery the health overview and scrutiny committees will have an interest in the changes proposed.

The points that we are raising will help members understand how `refocusing leadership' will contribute to shaping health services in Hampshire and the Isle of Wight in the future: in particular the roll out of the `HealthFit' programme which has significant implications for health service configuration across our respective populations.

You will be aware of a number of issues that have previously been raised with you in relation to `HealthFit' and other initiatives such as the introduction of independent sector treatment centres and Foundation Hospitals. These have included the need for planning processes to involve local people, service users and other key stakeholders, concerns about the integration of clinical staff teams and the challenge of achieving a balance between acute, community and primary care provision.

The specific points and questions we would wish to raise include:

1. Diagnosis of the System

· We have noted the difficult financial position of the health economy and the need for action to be taken. In this respect we would support direction set by `Refocusing Leadership', however the challenge of running the same number of organisations through an integrated management team must not be underestimated. We remain of the view that fewer organisations are required if the full benefits envisaged are to be achieved.

· The emphasis on primary care suggests that changes in commissioning will not take place until next April at the earliest. This remains a source of concern given the financial pressures facing the system.

· It would be helpful to understand the additional action being taken with acute trusts and the ambulance trust to contribute to the resolution of the current financial position. As importantly we would wish to have confirmation of any action being taken in relation to mental health services and services for older people to reduce the current deficit and promote more cost effective, streamlined commissioning that has a real potential to shift services (e.g. chronic disease management) from acute to community settings.

· A number of services have implications that go beyond the clusters proposed and will affect all of Hampshire and the Isle of Wight. How will these be managed and what will the role of the SHA be in providing leadership across the system.

· Is work in hand to improve engagement with clinicians and ensure that they are in accord about the changes required.

· Is there scope for pooling of support services, such as pay, accommodation HR and others, which are required across all NHS organisations on a wider basis than the clusters suggested, to create further economies of scale.

2. Refocusing Leadership

· Some of the clusters proposed cut across LSP areas or local authority boundaries. This would seem to be at variance with the evaluation of options that is set out in 4.7 of the `Refocusing Leadership' document considered by the Health Authority at its last meeting. We are aware that this point has already been flagged as a source of concern by a number of localities or other stakeholders and would ask that the Health Authority carefully considers these comments when deciding the final form of clusters to deliver the cost improvements required.

· Linked with the above point, and noting that the proposed cluster populations range from approximately 210, 000 to 550,00 (based on 2002 figures)- what would the Health Authority consider to be the smallest and largest populations able to secure the commissioning leverage envisaged.

· Will the arrangements impact on joint commissioning if there is significant variation in the size of the clusters.

· You will be aware of our support for LSPs. A number of PCTs have built very effective links with their communities. How will PCT involvement with LSPs and other local initiatives be safeguarded in the proposed arrangements?

· Will the clusters envisaged be aligned to move seamlessly to Foundation Communities should these be introduced in the future.

· How will joint working on improvement plans and other initiatives that involve a range of different service providers be safeguarded.

· Could the Health Authority provide further information on patient flows in PCTs in Hampshire and the Isle of Wight.

· The clusters proposed vary from the localities set out in the `Healthfit ` discussion document. Is it envisaged that these clusters will provide new localities for driving HealthFit or will these remain as previously defined.

3. Clinical Services Transformation

· It would be helpful to have confirmation of that the 5 areas identified in `HealthFit' will continue to be the focus of service reconfiguration. In Hampshire we have only seen one locality development plan to date and that was in the early stages of drafting. This included surgical services as a specific area of action. If `Beyond HealthFit' will include additional services we need to be advised of this at the earliest opportunity.

· Is there further information on progress with the production of the locality plans and the reconfiguration of services that will result from their implementation? If not what is the anticipated timeframe for producing these. We will need to have this information in order to come to a view on the need for formal consultation.

· Our understanding is that early action will be taken in relation to maternity and neonatal services across the area but with specific reference to mid and south Hampshire. We have raised a number of issues regarding these services previously and would appreciate early confirmation of any plans to change provision in these key areas.

· There will be issues outside `HealthFit' that will be part of the service transformation process. It is essential that these proposals are consistent with section 11 duties and properly discussed with the relevant OSCs to determine the appropriate consultation process.

The final point that we would wish to add is our willingness to contribute to developing the governance arrangements of the new clusters whatever form you determine they should take. The challenges of working across different Boards and professional groups within any cluster arrangement agreed are significant and we are keen to support any process that will secure and support a locality presence in these arrangements.

Hampshire County Council Annexe B

Health Review Committee

Strategic Health Authority response to comments on `Beyond HealthFit'

Re: Comments on `Beyond HealthFit' Presentation: Committee Meeting 25 May 2004.

Thank you for your letter of 2 June 2004, in which you highlight some issues raised in response to my presentation. I shall answer your questions in the order you have raised them.

Diagnosis of the System:

With regards to the challenge of operating the same number of organisations through integrated management teams, we will of course closely monitor the impact of this new initiative, but we believe it is appropriate that Primary Care Trusts (PCTs) remain statutory organisations for a number of reasons, not least that new national initiatives can be integrated more swiftly into their operational structures.

Discussions around changes in commissioning arrangements are currently underway. A key milestone in the Beyond HealthFit Programme is the work with PCTs to develop proposed lead commissioning arrangements by September 2004. This work as you rightly point out is imperative to delivering an effective and affordable health system.

Clearly, the challenging financial position in Hampshire and the Isle of Wight has required all organisations to develop and implement detailed recovery plans. Moreover, I can confirm that as part of the clinical transformation component of Beyond HealthFit, there are a number of whole system initiatives that will, when taken forward with service users, carers and staff, result in a shift services out of the acute sector into a community setting.

The SHA recognises its leadership role in addressing a wide range of issues and to this end has developed a work programme for the next two years. We hope to share this with you as soon as possible.

Each locality has been tasked with engaging clinicians and the wider community in planning service changes. The SHA is asking for evidence of these engagement arrangements through their Locality Delivery Agreements. Moreover, the SHA is actively promoting the ongoing development of clinical networks and forums as a means of enhancing principle engagement.

There is undoubtedly scope for pooling support services. In fact, one of the work streams within the SHA Beyond HealthFit Work Programme is to review the potential for operating shared services across Human Resources (HR), Estates, Information Technology (IT), Transport, Procurement and Finance. This work will be led by the SHA Director of Finance and one of the PCT Chief Executives.

Refocusing Leadership:

The SHA recognises the importance of the linkages between National Health Service (NHS) organisations and Local Strategic Partnerships (LSPs). The SHA took these features into account when deciding upon final PCT clusters. The PCTs will remain single statutory entities and continue to have flourishing arrangements with their local LSPs. Indeed it is very important that local initiatives are not adversely affected by these proposals.

We have however, listened very carefully to the views expressed by all partners in arriving at the conclusion that we should not establish clusters which cross unitary authority boundaries. At our Board meeting in June 2004, therefore the following clusters were approved:

· A single management team for Fareham and Gosport PCT and East Hampshire PCT.

· A single management team for North Hampshire PCT and Blackwater Valley and Hart PCT.

· A single management team for Eastleigh and Test Valley South PCT, New Forest PCT and Mid Hampshire PCT.

· A single management team for Southampton City PCT.

· A single management team for Portsmouth City PCT.

You raise another important question with regard to the range of population required to secure commissioning leverage. In some respects this is a difficult question to answer, as I would contend that this very much depends on the nature and scale of the service being commissioned. Some services are best and appropriately commissioned at a practice level, whilst others can only be commissioned for a population of over two million. The development of commissioning is rightly a key element of the Beyond HealthFit work and we will, if you would like, share with you outline thoughts on the future of commissioning as they emerge.

One of the benefits of single integrated management teams is that they have the flexibility to adapt quickly to any new changes in the future.

The SHA will require new PCT clusters to develop cluster based Improvement Plans and Financial Recovery Plans. We also require the original HealthFit localities to develop Locality Plans which address broader strategic changes.

Because the SHA deals primarily with aggregated Data, any request for further information regarding patient flows will need to be made directly to the local PCTs.

With regards to the proposed clusters, please see my response above.

Clinical Services Transformation:

The SHA is ensuring that localities focus primarily on the five clinical areas identified in the original HealthFit project. They are working on detailed project/workplans as part of the SHA requirement for locality delivery agreements. You will be aware that Beyond HealthFit is broader than the original areas. Therefore, more clinical areas are included and these will contribute significantly to financial balance. For example, these will include services in chronic disease management, the modernisation of diagnostic services and the reconfiguration of surgical services.

The SHA will encourage localities to share their draft project/workplans and these will comprise of their Local Delivery Agreements with their local Overview and Scrutiny Committee (OSC). The SHA is expecting these signed agreements by September 2004.

I also attach for your information, a copy of a presentation that will form the foundation of a Board Report to be considered at the July meting of the Strategic Health Authority. This sets out in more detail the rationale and underpinning work programme for Beyond HealthFit.

We can confirm that there is a priority to look at how the health services in Hampshire and the Isle of Wight should strengthen neonatal care and to understand the effect that this will have on midwifery and paediatric services. This piece of work will require suitable dedicated project management with appropriate patient and public involvement from the start. The SHA has already established neonatal, midwifery and child health networks to look at new models of care to inform how neonatal, paediatric and maternity services should be linked.

The SHA continues to take every opportunity to remind localities of Section 11 duties and I understand that Denise Holden spoke with Locality Directors on June 28^th to reiterate this message.

In the early stages of the developing plans for governance arrangements for the new clusters, the SHA will ensure that the OSCs are offered copies at the earliest opportunity. It is intended that these will be agreed by September 2004.

I hope this is helpful, please do not hesitate to contact either myself or Richard Samuel if any of this remains unclear.

Hampshire County Council Annexe C

Health Review Committee

Joint Hampshire and Isle of Wight Overview and Scrutiny Committees: Letter to Strategic Health Authority; 14 July 2004

`HealthFit' and `Beyond HealthFit': Communications with Overview and Scrutiny Committees in Hampshire, Isle of Wight Portsmouth and Southampton

I am writing in my capacity as Chairman of the Joint Committee of Health Overview and Scrutiny Committees in Hampshire to express our collective concern with the way in which the Strategic Health Authority is communicating and responding to issues raised by ourselves and others in relation to `HealthFit' and its successor strategy `Beyond HealthFit'.

You will be aware of our views on the ambitious programme of service configuration that `HealthFit' set out across 5 key clinical areas. Indeed the formation of this Joint Committee was in anticipation of the need for each local authority to be able to respond to any proposals to vary or change these services across Hampshire and the Isle of Wight that moved beyond our individual boundaries. To date no such proposals have been received, despite requests for further information about the way in which change and consultation will be taken forward.

The lack of clarity regarding the status and scope of the locality plans, as the vehicles for delivering the vision set out in HealthFit, underlines our unease about the way in which the process is being driven forward. Portsmouth City Council, Southampton City Council and Hampshire County Council Health Overview and Scrutiny Committees have repeatedly asked for information on the way in which communities and key stakeholders are engaging with locality leads in developing plans for service reconfiguration. This has included input from our officers with respect to the duties placed on the NHS by section 11 of the Health and Social Care Act. Despite the fact that the HealthFit timetable identified the need for plans based on full community engagement to be produced last summer we have seen only one draft plan, which included little detail of actual proposals and scant or no information about patient, partner or public involvement.

On the Isle of Wight the locality planning process is more advanced, nevertheless it was the Island's Scrutiny Committee that took the lead in organising a series of meetings to involve and inform local stakeholders about proposals to change service provision, although this was speedily followed by NHS consultation. The outcome of this process and the recommendations from the Committee relating to outstanding issues and action to be taken was sent to the Health Authority in January 2004. To date no response has been received.

Our disquiet about the lack of clarity regarding to the process through which HealthFit (in the form distributed for discussion by the Health Authority last January) would be translated into action across Hampshire and the Isle of Wight has been sharpened by the subsequent programme set out in `Beyond HealthFit'. This appears to move away from the five distinct clinical areas identified in HealthFit towards clinical transformation in more diffuse areas such as surgery and critical care. In addition whole system reconfiguration of acute services is introduced as a solution to the challenges facing the NHS in Hampshire and the Isle of Wight. No reference is made to the way in which the needs of our respective populations will be identified to inform and shape these plans as they emerge or the means by which changes in acute service configuration will be balanced with the provision of other less specialised local services in community and primary care settings.

If the expectation is that the locality plans, as well as demonstrating the involvement of local communities and key stakeholders, will include information about the needs of different populations, patient flows and the balance between acute and emergency services then it would be helpful to have this confirmed and a timetable for taking this work forward. The model emerging in the south east area, of an independent assessment of the health needs of local communities and a review of how these can most effectively be provided across primary community and acute care, is one we would strongly support. Where service reconfiguration transcends localities there needs to be clear leadership in taking proposals forward, underpinned by continued partnership working and stakeholder engagement.

The continuing deterioration in the financial position of the local health system, with the underlying deficit now estimated at £69 million, needs to be addressed and the openness of the Health Authority in identifying this challenge is appreciated by the Committee. There does however seem to be a real tension emerging in the vision set out in `HealthFit' and the need to achieve the savings targets identified, with the emphasis shifting towards financial recovery. This does not change the fact that any service reconfiguration, whatever the driver, must take account of the views of local people and key partners and is additional to engagement with the relevant Overview and Scrutiny Committee(s) where changes may be substantial.

The Overview and Scrutiny Committees in Hampshire and the Isle of Wight remain committed to working constructively with the NHS to secure high quality, effective health care for local people. Collectively and individually we will continue to give weight to the effective of patient and public engagement in any proposal referred to us for formal consultation.

It is also essential that we have a more effective channel for communicating with the Health Authority and locality leads. In particular we would ask that the Health Authority considers how the timeliness and content of responses can be improved. The reply to our letter of the 2 June is a case in point. Although sent electronically the previous evening I did not see this correspondence, which contains a number of points that require further clarification, until it was tabled at our meeting on the 7 July. The lack of response to the recommendations made by the Isle of Wight Scrutiny Committee referred to above is a further example of delays in communication that need to be addressed. It would be helpful if we could have your thoughts on how an improvement in communication can best be achieved by 12 August.

Hampshire County Council Annexe D

Health Review Committee: 27 July 2004

Summary Report of the NHS Confederation Conference: 23to 24 June 2004

This is the key conference for NHS managers and non-executive board members. Keynote speakers covered a range of topics from the extension of the `choice' programme through to the future role of the voluntary sector.

Full Conference proceedings will be available from the end of July, and will be available on request to members of the HRC.

New targets for the NHS include a public health focus, chronic disease management and a total maximum waiting time from first referral to treatment. Further details are included at Attachment A and the full document can be found on

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4084476&chk=i6LSYm

Other areas discussed by delegates included

· Continued trend towards decentralisation

· Action to address gaps in health service delivery and the needs of local populations

· An equity audit that gives particular weight to the needs of black and minority ethnic groups evidence-based action and shared targets with the NHS and other local organisations.

· The notion of patient obligation

· Increased public confidence in the NHS different approaches to commissioning

· Human resources in the NHS

· Governance and partnership working.

The conference was supported by a large exhibition of organisations working with and for the NHS. Local interest included Rhyhursts (preferred provider for the Lymington Hospital PFI project, the Healthcare Commission, the Access Partnership (speech and language therapy in schools), Kings Fund and Dental Practice Board.

The conference provided useful networking opportunities and the chance to identify good practice elsewhere.

Attachment A to Annexe D

NHS Improvement Plan: Executive Summary

1 Over the past seven years the NHS in

England has been on a journey of major

improvement. After decades of under investment,

the NHS has begun to turn itself

around, with unprecedented increases in the

money it can spend. As its budget has grown

from £33 billion to £67.4 billion, the average

spending per head of population has gone

up from £680 to £1,345.

2 That money has increased the capacity of

the NHS to serve patients. It has helped give

faster and more convenient access to care.

Access to GPs, accident & emergency care

(A&E), operations and treatment is improving

with every passing year. Quality is also

improving, as is the range of services

available to the public.

3 These improvements have been made

possible by steady increases in the number of

NHS staff, who are even more focused on the

personal care of individual patients and better

enabled to do so. The growth in money and

staff numbers has been matched by an

unprecedented period of growth, expansion

and modernisation in the buildings, equipment

and facilities available to care for patients.

That in turn has enabled the NHS to provide

better quality care to patients, with safer and

more effective treatment, better surroundings

and services that better suit their lives. The

NHS today is fairer as a result. The NHS is

now ready to ensure that care is much more

personal and tailored to the individual.

4 The next stage in the NHS's journey is to

ensure that a drive for responsive, convenient

and personalised services takes root across

the whole of the NHS and for all patients. For

hospital services, this means that there will be

a lot more choice for patients about how, when

and where they are treated and much better

information to support that. For the millions

of people who have illnesses that they will

live with for the rest of their lives, such as

diabetes, heart disease, or asthma, it will

mean much closer personal attention and

support in the community and at home.

5 Complementing that drive for a high-quality

personal service for individual patients when

they are ill, there will be a much stronger

emphasis on prevention. Death rates from

cancers, heart disease and stroke are already

falling quickly. The NHS will take a greater and more effective lead in the fight against these big killer diseases. It will lead a coalition to stop people getting sick in the first place and

to make in-roads into inequalities in health.

6 In taking forward these reforms, the NHS

will continue to learn from other healthcare

systems. This will enable the NHS to continue

to improve its performance as it aspires to

world class standards, where it is not already

achieving these. In the next stage, there will

be a stronger emphasis on quality and safety

alongside a continuing focus on delivering

services efficiently, fairly and in a way that is

personal to each of us. By 2008, the NHS in

England will be seen increasingly as a model

that other countries can learn from.

Laying the foundations

7 The investment and reform initiated in July

2000 by The NHS Plan has delivered for

patients. It is a track record of success, which

gives the confidence to support further

investment and further reform. The money and

the changes promised in The NHS Plan just

four years ago have been made a reality for

patients, the public and the taxpayer. Those

who argued that the NHS was beyond reform,

were profoundly mistaken. The NHS has

demonstrated that its enduring principles can

prosper in the new century.

8 At the core of this plan lies a continuing

commitment to the founding principles of the

NHS: the provision of quality care based on

clinical need, irrespective of the patient's ability

to pay, meeting the needs of people from all

walks of life. The programme is instilled with

a resolve to ensure that the NHS meets the

expectations of all people in England: enabling

and supporting people in improving their own

health; meeting the challenge of making a real

difference to inequalities in health; staying the

course and supporting those with conditions

that they will live with all their lives; and quickly

treating people with curable problems so that

they can get on with their lives and live them

to the full.

Offering a better service

9 The NHS Improvement Plan sets out the key

commitments that the NHS will deliver to

transform the patient's experience of the

health service over the next four years. As part

of this the experience of waiting for hospital

treatment will change dramatically.

10 In 1997 patients waited up to 18 months for

treatment - after seeing a GP, after seeing a

consultant, and after diagnostic tests. Those

times have fallen and now the maximum wait

for an operation is nine months and the

maximum wait for an outpatient appointment

is 17 weeks. When this programme has

been delivered in four years time, the 1997

maximum wait of 18 months for only part of

the patient journey will have been reduced to

18 weeks for the whole journey. The previous

long waits for GP referral, outpatient

consultations and tests are included in that

pledge. In four years' time, waiting times for

treatment will have ceased to be the main

concern for patients and the public.

11 With much shorter waiting times for

treatment, "how soon?" will cease to be a

major issue. "How?", "where?" and "how

good?" will become increasingly important

to patients. Patients' desire for high-quality

personalised care will drive the new system.

Giving people greater personal choice will

give them control over these issues, allowing

patients to call the shots about the time and

place of their care, and empowering them to

personalise their care to ensure the quality

and convenience that they want.

12 From the end of 2005, patients will have

the right to choose from at least four to five

different healthcare providers. The NHS will

pay for this treatment. In 2008, patients will

have the right to choose from any provider, as

long as they meet clear NHS standards and

are able to do so within the national maximum

price that the NHS will pay for the treatment

that patients need. Each patient will have

access to their own personal HealthSpace on

the internet, where they can see their care

records and note their individual preferences

about their care.

13 With waiting times no longer the main issue, the NHS will be able to concentrate more of its energies on providing better support to people with illnesses or medical conditions that they will have for the rest of their lives. The Department of Health is also committed to a radical, far-reaching and ambitious approach to making a real difference to the quality of life of people who live with illnesses every day. While the way we think about the NHS is often dominated by the easy to understand model of people with diseases being treated and cured, a very significant number of people are living their lives with conditions that can't yet be

cured. Diabetes, heart disease, asthma, some

mental illnesses and many other conditions

are medical problems that most people live

with from the time they are diagnosed.

14 The NHS will minimise the impact of these

conditions on people's lives and provide

people with high-quality personal care. It will

enable and support people in managing their

conditions in a way that suits them, avoiding

complications, maximising their health and

helping them to live longer lives. It will also

improve people's care closer to home - through specialist nurses and GPs with a special expertise in their condition - which will lead to fewer emergency admissions to hospitals which cause anxiety for patients and their families and are a poor use of hospital resources. The Expert Patients Programme - designed to empower patients to manage their own healthcare - will be rolled out nationally, enabling more people to take greater control of their own care and to listen to themselves and their own symptoms, supported by their clinical team. The new GP contract provides cash incentives to GPs who work with their teams of nurses, social workers, the voluntary sector and other professionals to ensure that people are given the high-quality personal care they need to minimise the

impact of their illness or health problem.

15 Having reduced waiting to the point where it is no longer the major issue for patients and

the public, the NHS will be able to concentrate

on transforming itself from a sickness service

to a health service. Prevention of disease and

tackling inequalities in health will assume a

much greater priority in the NHS. With the

NHS working in partnership with others and

with individuals to support people in choosing

healthier approaches to their lives, real

progress will be made on preventing ill health

and reducing inequalities in health. Death

rates for the under 75s from heart diseases

and stroke will be reduced by at least 40% by

2010 and death rates from cancers will be

reduced by at least 20%. Suicide rates will be

reduced by 20% (from a 1997 baseline). The

forthcoming public health White Paper will set

out a comprehensive programme to tackle the

major causes of ill health, including obesity,

smoking and sexually-transmitted infections.

Making it happen

16 A much wider choice of different types of

health services will become available to NHS

patients, to enable personalised care, faster

treatment, personal support for people with

long-term conditions and better social care.

17 For hospital care, NHS Foundation Trusts

will, by 2008, be treating many more patients.

NHS patients will also be able to choose from

a growing range of independent providers, with their diagnosis and treatment paid for by the NHS. To support capacity and choice, by

2008, independent sector providers will

provide up to 15% of procedures on behalf of

the NHS. The Healthcare Commission will

inspect all providers, whether in the NHS or in

the independent sector, to ensure high-quality

care for patients wherever it is delivered.

18 In primary care, the NHS will be developing

new ways of meeting patients' needs closer

to home and work. New flexibilities will enable

PCTs to commission care from a wider range

of providers, inlcuding independent sector

organisations, to enhance the range and

quality of services available to patients.

The Department of Health will also work

with other government departments and local

authorities to develop better ways of meeting

people's broader health needs.

19 Greater flexibility and growth in the way

services are provided will be matched by

increases in NHS staff and new ways of

working to meet patients' needs. By 2008 the

number of staff working for the NHS will have

increased significantly. In primary care GPs

will increasingly be working with more diverse

teams, including GPs with a special interest

and community matrons, to enable patients'

needs to be met in new ways in the community

rather than in hospital. Staff will be given more

help to train and learn new skills, with their

career progression supported by the NHS

University (NHSU). This flexible working to

deliver more personalised and user-friendly

care for patients will be rewarded by better pay

for NHS staff.

20 Information systems will be put in place to

enable patients to choose more convenient

and higher-quality personalised care. By 2005

an electronic booking service will make it

easier for patients to arrange appointments

that suit them, and electronic prescribing will

make it easier for patients to obtain repeat

prescriptions for their medicines. NHS Direct,

NHS Direct Online and NHS Digital Television will enable people to communicate with health professionals and these services will also support people in making changes that will improve their own health. An individual personal care record will enable health professionals to have easy, rapid access to patients' medical histories at any time of the

day, supporting better diagnosis and treatment

and reducing errors. The technology will also

enable patients to have more influence over

how they are treated, with a new personal

facility called HealthSpace enabling them to

record for health professionals what their

preferences are about the way they are

cared for.

21 Financial incentives and performance

management will drive delivery of the new

commitments. The new system of payment by

results will support the exercise of choice by

patients, improve waiting times for patients

and provide strong incentives for efficient use

of resources. This system will be fully

operational and delivering for patients in 2008.

At the same time, Primary Care Trusts will be

developing further incentives to enable GPs

and their teams to deliver ever higher quality

care to patients in a way that is most

responsive to their needs. This will include

incentives to support care for people with long-term conditions.

22 As money, control and responsibility are

handed over to local health services, the

communities that they serve will be given

greater influence over the way that local

resources are spent and the way that local

services are run. Within a framework of clear

national standards, power will continue to

move swiftly to Primary Care Trusts and to

NHS Foundation Trusts. There will be far

fewer national targets for the NHS. Local

services will set their own stretching targets,

reflecting the local circumstances, ethnicity

and inequalities of the communities that they

serve and the local priorities of the people who

use them. Performance management

arrangements will be aligned with this new

system, giving the incentive of greater freedom

from central regulation and inspection to NHS

organisations that serve patients and their

communities well.

Conclusion

23 The NHS Plan reforms and investment

are transforming the NHS, with dramatic

improvements in key areas. Tackling the two

biggest killers, cancer and coronary heart

disease, has been a priority over the past four

years and mortality rates are already falling

rapidly.

24 Less than four years into the period covered

by the 10-year NHS Plan, the new delivery

systems and providers are expanding capacity

and choice. As these new ways of working

really take hold across the whole system, the

dividend will be a higher-quality service with

even faster access to care. A new spirit of

innovation has emerged, centred on improving

the personal experience of patients as

individuals, and this is now taking root in the

NHS.

25 The foundations for success are now in

place and it is time to move on. Improving care

for people with long-term conditions and

helping people live healthier lives are essential

next steps in our drive to improve the quality of care for everyone. Over the next four years the culture of waiting which has long been a

feature of the NHS will be replaced by a

personalised approach to care. Appointments

will be booked with the GP and the maximum

time from GP referral to the start of treatment

will be down to just 18 weeks, with many

people being seen much quicker than this.

26 NHS Foundation Trusts will be free from

Whitehall control, enabling new ways of

involving local people, local staff and local

patients in the running of their hospitals. New

treatment centres run by the NHS and the

independent sector will offer fast and

convenient treatment that will provide patients

with real choices. Primary Care Trusts will

control over 80% of the NHS budget and they

will use this financial muscle to secure the best

possible deal for each and every patient that

they serve. Patient choice will be a key driver

of the system and resources will flow to those

hospitals and healthcare providers that are

able to provide patients with the high-quality

and responsive services they expect.

Independent inspectors will provide patients

with assurance of the quality of care wherever

it is delivered. There will be a much stronger

emphasis on prevention, keeping people

healthy and avoiding the need for medical

care in the first place.

27 In 2008, England will have a very different

health service from the one it has today. It will

retain all those qualities that sustain such

commitment from the people of England. It will

be an NHS which is fair to all of us and

personal to each of us by offering everyone

the same access to and the power to choose

from a wide range of services of high quality,

based on clinical need not ability to pay. The

changes set out in this document will mean,

for the first time, that the system will work with and support those professional instincts of the NHS's dedicated staff and ensure high-quality personal care for patients. It will reward the NHS for these efforts, take away the barriers to doing the right thing and make it easier for dedicated doctors, nurses and thousands of other NHS staff to follow their calling to cure and to care. A modern NHS, equipped and enabled to respond quickly to people's needs, will mean that the obstacles to what people want from the NHS are torn down and that excellence becomes the norm for clinical staff and managers alike. The NHS is set to thrive again by properly meeting the needs of patients and the public. The NHS Improvement Plan: Putting People at the Heart of Public Services details the next steps in this journey.

Hampshire County Council Annexe F

Health review Committee: 27 July 2004

Comments on Foundation Hospitals; SHA Response

Re: Additional information relating to Foundation Hospital applications:

Thank you for your letter of 19 May, in which you raise some specific points regarding Foundation Hospital applications. I will address each of your concerns in turn.

1. Management of funding flows to support new models of care:

You are correct in your assumptions that Foundation Trusts will use the Payment by Results (PbR) funding process to invest in service improvements for patients. Unfortunately, under the planned arrangements for the management of Foundation Trusts, the Strategic Health Authority will have no formal responsibility to influence these investments, this responsibility will rest instead with the Independent Regulator. Clearly, in addition to the role of the Regulator in this process, the corporate governance arrangements of the Foundation Trusts will ensure that such investments will be needs led rather than financially driven.

In terms of PCT commissioning, the price that PCTs pay for services will be nationally determined, therefore disinvestment in services in a planned way should become easier as PCTs become able to withdraw finding as they see fit, using a more simplified arrangement than exist at present. As a result, PCTs will be well placed to put these important service model changes into place without unnecessary financial complications. It should be remembered that this new financial procedure will exist for both PCTs and non Foundation Trust hospitals. However, Foundation Trust Hospitals will be moving through a transition process towards the new funding regime at a slightly quicker pace their non Foundation Trust counterparts.

2. Patient's choice versus legally binding contracts:

Part of the assessment process that both the Strategic Health Authority and the Regulator will be testing is how sensitive the financial plans are to alterations in the planning assumptions. As part of this process, PCTs are being asked to sign up to activity assumptions. So far, this has resulted in prospective Foundation Trust being particularly prudent in determining how assumptions are calculated. The PbR mechanism asserts that Foundation Trusts will carry any financial risk as monies flow to relevant providers. There remains ample incentive for Foundation Trusts to deliver both high quality services and choice, thereby remaining an attractive first option for patients.

3. Mechanisms for dealing with major service reconfiguration:

This issue will be addressed in two main ways; First, Locality Plans are currently being developed as part of the `Beyond HealthFit' process. These will develop into Accountability Agreements through which localities will be held to account for the delivery of reconfiguration and of service change. These plans will not be signed off by the Strategic Health Authority unless they are coherent and address the interfaces between primary, intermediate and secondary care.

Locality Specialist Commissioning is hosted by Mid-Hampshire Primary Care Trust and needs to ensure that specialist services are dealt with effectively. Similarly, the Central South Coast Specialist Commissioning Group needs to coordinate specialist commissioning across commissioners and providers within the normal context.

Primary Care Trusts locally have begun to revisit commissioning strategies, partly stimulated by the introduction of Foundation Trusts. This Commissioning Strategy will explicitly set out the short and medium term vision. As part of the Foundation Trust assessment process, the SHA will seek to ensure that Foundation Trust Service Delivery Strategies reflect commissioning itineraries.

4. Patient flows and provider capacity:

In 2002/03 the Hampshire and Isle of Wight Strategic Health Authority coordinated work around developing a Capacity Plan. This plan sought to balance existing NHS capacity, known planned developments and demand (reflecting delivery of known NHS Plan targets). This set out a `capacity gap' between capacity and demand which informed a national programme to procure additional capacity through the expansion of NHS Treatment Centres and independent capacity.

Between now and October, the SHA is revisiting the Capacity Plan and considering some additional elements around diagnostics. This again will seek to examine local capacity against demand which will again inform the national context. Local PCTs and Trusts will be actively engaged in this process and the Hampshire and Isle of Wight Capacity Plan will represent the sum of its 10 PCTs. As a result, of `Beyond HealthFit', locality plans will need to be fully reflected in the final capacity plans.

5. Workforce Development:

The national procurement of Independent Treatment Centres has set out some recommendations which aim to prevent new suppliers employing staff already engaged in the National Health Service (NHS). In essence, independent providers must not recruit from the NHS where the provider is only offering additional patient activity. Only where the provider is assuming responsibility for capacity which currently rests with the NHS, can they agree with NHS employers the secondment or transfer of NHS employees.

Much is made of the freedom of Foundation Trusts to determine the pay, terms and conditions of their employees. In fact, their discretion is no greater than that of existing Trusts and PCTs who may determine pay locally. Within some existing Trusts and PCTs the majority of their employees are on local rather than national pay rates. Others have not exercised this discretion to any notable extent. All Trusts and PCTs are faced with the fundamental constraint that they can only determine local pay rates which they can afford. This constraint will apply equally to Foundation Trusts and it is not anticipated that pay rates here will be noticeably different from those offered elsewhere within the health community. However, we might envisage improved pay within those staff groups which are difficult to recruit in an attempt to gain advantage in the recruitment market. In overall terms this might be considered a sensible investment, especially where the recruitment and retention of staff is critical to the delivery of business.

At the moment the Strategic Health Authority has made a note that any Trust wishing to pay a recruitment premium to a consultant for example, should first seek SHA approval. We will soon be discussing similar controls on recruitment and retention premiums for other staff when a pay project called Agenda for Change is introduced later this year.