Contact : Denise Holden, Health Review Manager, Ext 7338
e-mail address: [email protected]

1. Introduction

1.1 This paper sets out the regulatory framework and the key points to be considered by the Health Review Committee in the when scrutinising the proposal from Winchester and Eastleigh Healthcare NHS Trust (WEHT) to close the in-patient beds at the Mount Hospital with effect from the end of August 2004.

1.2 It is important for the Committee to understand the reasons for this decision by the Trust. It is also essential that local people, patients and their families are clear about the grounds on which this proposal is based as the future of these services has been the subject of very recent formal consultation initiated by the commissioning Primary Care Trusts (PCTs), Eastleigh and Test Valley South PCT (ETVSPCT) and Mid-Hampshire PCT (MHPCT).

1.3 The result of the listening exercise, undertaken by the PCTs and WEHT prior to formal consultation and published by the PCTs on 18 May highlighted specific local concerns about

· The need for local services, not located in Winchester

· The need for services that are accessible by private and public transport

· Support to carers through the provision of respite care

1.4 Related recurrent themes raised through the formal consultation process included

· the special needs of patients with dementia

· praise for the quality of care provided by staff at the Mount Hospital, despite difficult circumstances

· community service support after discharge and the value of the `Preventing Dependency' Team

· the evidence base supporting the provision of care for older people requiring rehabilitation at home rather than in an acute setting

· significant concerns that the savings identified would have a negative impact on the local provision of these services.

1.5 Other issues were raised about the disposal of the site and the use of the funding however these fell outside the remit of the Committee

2. Regulatory Context

2.1 NHS bodies have a duty to consult local Overview and Scrutiny Committees (OSCs) on any proposals under consideration to substantially vary or develop NHS services.

2.2 This consultation does not need to take place if a decision has to be taken immediately because of a risk to the safety or welfare of patients or staff. These circumstances should be exceptional in as much as allowing time for consultation could place patients or staff at risk. In these circumstances the NHS body should notify the Committee immediately of the decision taken and the reason why no consultation has taken place.

2.3 If the OSC determines that the reasons for not carrying out consultation are inadequate it may refer the matter to the Secretary of State setting out the reasons for this conclusion. It should be noted that this power relates only to consultation with the OSC and not consultation with other stakeholders.

2.4 In addition OSCs have a responsibility to consider whether a proposal for substantial change is in the interests of local health services. The criteria for assessing proposal from the NHS to vary services, published by the Committee include issues such as the acceptability of the proposed change to service users or the impact that proposals may have on other health services.

2.5 The power to refer matters to the Secretary of State should not be used lightly and contested decisions must be clear that all options for local action have been exhausted.

3. Background Information

3.1 At its last meeting the Committee received and endorsed the response the formal consultation on the future of rehabilitation services for older people provided at the Mount Hospital. This was underpinned by comments on the initial `listening document' produced by the PCTs and a visit to the Mount Hospital by the working group considering this matter. The Committee was clear that its interests in responding to the consultation were directed to the following questions

(i) Has there been adequate involvement of local people in shaping the document and responding to consultation

(ii) Is the proposed way forward in the interests of the local health service

3.2 The response of the Committee therefore focused on the provision of rehabilitation services provided by the PCTs rather than the issues associated with the disposal of the site.

3.3 In its deliberations the working group appointed by the Committee took particular account of the steps being taken to enhance and extended community services to enable people to remain at home and independent for as long as possible as well as the assurance that services would continue at the Mount until alternative provision has been secured. This latter point was reinforced by the PCTs on pages 8 and 30 of the Consultation document.

3.4 Pressures on staff caused by long standing uncertainty regarding the future of the Mount Hospital, and the environment in which they worked were recognised as one of the drivers for change throughout the consultation process. Action by the PCTs, in collaboration with WEHT, to provide joint solutions to these pressures were clearly described in the `Outline Business Case' (OBC) also published on the 18 May (see Para 2.4 `the Heads of Agreement' and section 10 `Contingency Arrangements'). The identification of innovative new ways of working as part of the reprovision of these services were set out by the PCTs in the Consultation document and the Committee took the view that this, together with the clarity about the future of these services provided sufficient stability and flexibility to enable services to continue to be provided at the Mount Hospital until summer 2005, unless there was an irretrievable deterioration in the current staffing position.

3.5 The OBC, which effectively initiated the process of replacing the current service model included a full option appraisal that specifically rejected the case for reproviding services at the Royal Hants County Hospital (RHCH) on the grounds that it:

· Did not comply with the `Head of Agreement'

· Would result in a reduction in local services for Eastleigh residents

· Had potential for the loss of skills and experience should staff not transfer

· Would prohibit the development of community based alternatives and managed care in the community

· Would not be in line with patient and public views

· Would inhibit redesign of older people's services

· Will maintain the current level of avoidable admissions

· Will not reduce length of stay

· Would not support a reduction of delayed transfers of care

· Would not support the development of interagency working

3.6 The benefits were identified as

· Risk and responsibility remains with WEHT

· Ability to achieve some revenue savings and enable the site to be released for capital

3.7 The conclusion reached by the PCTs regarding this option stated `this option would fail to achieve the redesign objective, in particular this would result in a reduction in local services and would not achieve the clinical objectives...'

3.8 On 1 July the Health Review Manger was contacted by the Chief Executive and advised that, following a Board decision on the 30 June, The Mount Hospital inpatient service would close on the grounds of safety at the end of August. The documents associated with this decision were sent to the Committee on the 5 July; these are attached at Appendices 1-4.

3.9 The correspondence shared with the Committee included the responses of the Chair and Chief Executive of WEHT to the consultation undertaken by the PCTs. These clearly state the concerns of the Trust at the commitment to continue to provided services at the Mount Hospital and that `there would have to be a contingency plan in place to mitigate the risks of even more staff leaving'.

3.10 The Chair of WEHT highlights that `it may become necessary for patient and staff safety reasons to temporarily use facilities at RHCH in advance of the final reprovision'. This letter also confirms the need for a contingency plan that includes the joint approach to be taken if at any time it became necessary to move patients from the Mount in advance of them being fit for discharge.

4. Case for Formally Scrutinising the Decision to Close Inpatient Beds at the Mount Hospital

4.1 The Committee comprises of lay members from Hampshire County Council and includes representatives from District Councils. If clinical advice states that a service is unsafe, putting patients at risk, then the Committee must accept this advice accordingly. There is however a duty on the Committee to assure itself that the reasons for not going to public consultation are adequate and that the change proposed is in the interest of the health services in the area of the Committee.

4.2 The decision made by WEHT to close the inpatient beds at the Mount Hospital on the grounds of patient safety needs to be fully understood by the Committee and wider community, not least because of the high profile consultation that has only recently concluded, with full engagement of WEHT, prior to the publication of the OBC in mid May. The Committee identified the process of engagement that underpinned this consultation as an example of good practice.

4.3 The Committee is aware of the pressures on staffing levels at the Mount Hospital and the fact that some beds had been closed as a result. In the discussions that took place during the consultation this point was recognised, as was the need to modernise the environment in which care was provided. There was also consistent praise for the quality of care provided by staff working at the Mount Hospital. At no point was it indicated that staffing had reached the point where patient safety was compromised. The contingency plan referred to in the OBC identified a process for dealing with a further deterioration in staffing levels and ETVSPCT had acted to prevent this by creating a joint appointment to ease pressures. The Committee has therefore requested that WEHT provides additional information on:

· The contingency plan agreed with the PCTs

· The `trigger' that initiated this phase of the contingency plan

· The immediacy of the risk to patients

· The extent to which partner organisations, including PCTs and social services, were able to contribute to this decision

4.4 Equally it is important for the Committee to understand the decision to relocate the beds to the acute hospital site. The Committee and local people gave significant weight during the consultation process to the benefits of a wider range of community services closer to people's homes. This was reinforced by clinical views that an acute hospital was not an appropriate setting for older people requiring rehabilitation services for a variety of reasons. The Committee is also mindful that there are risks associated with moving these vulnerable patients should the beds at the Mount Hospital close. The Committee is therefore keen to learn if other options for providing rehabilitation services have been explored with PCTs and other partners such as social services.

4.5 The Committee has initiated immediate action to provide an opportunity for WEHT to set out the rationale behind the proposal to close the Mount Hospital at the end of August. This will take the form of an extended meeting on 27 July and will include opportunities for the Trust, and other stakeholders affected to share their views with the Committee.

4.6 In order to provide a clear framework for scrutiny it is proposed that the following issues are explored in more detail

(i) Are the reasons for not going out to consultation adequate (If the Committee considers that the case for not going to public consultation are not adequate then the following points, drawn from the Committee's criteria for assessing substantial change to health services need to be considered)

(ii) Will there be changes in the accessibility of services for the people using the service

(iii) Is the change based on clear evidence and best practice

(iv) What impact will the proposal have on the wider community and other service providers.

(v) Is the proposal to close the beds at the Mount Hospital in the interests of health services in the area of the Committee

4.7 Key discussion points underpinning each of these questions are set out below.

5. Key Points to be Scrutinised

5.1 Are the reasons for not going out to public consultation adequate, specifically are the risks to patients such that immediate action is required to close the beds at the Mount Hospital.

5.1.1 WEHT has been asked to provide details of the contingency plan and information on the actual cause of the `trigger' to close the Mount. Whilst the Committee is not seeking to challenge medical advice, the views of the PCTs regarding the alternatives for providing clinical services have been invited.

5.1.2 Para 3.7 of the Board Paper refers to the need to transfer the services to RHCH `should the staffing levels worsen' and 3.8 refers to `action to invoke contingency arrangements should safe staffing levels become unsustainable'. Para 4.1 refers to additional nursing staff recruited in April, including a joint appointment. Subsequent references are made to difficulties in recruiting a clinical medical officer and the anticipated absence of a senior nurse as well as continuing occupational therapy vacancies. No reference is made to services actually being unsafe or discussions with PCTs to identify a means of dealing with this matter and the Committee has WEHT to comment further on this point.

5.1.3 The note of the Board meeting at which the decision to close the Mount was made refers to `urgent action required to ensure patient safety and quality of service'. Subsequent reference is made to the risks of moving frail elderly patients and the clinical experience available to minimise these risks.

5.1.4 Additionally it is recorded that patients will not be moved from the Mount against their will. Whether this has the potential to split service provision is not clear.

5.1.5 Correspondence from the Trust dated 5 July states that the service is `not actually unsafe at the moment, (but) of such fragility that we need to take the action proposed' and refers to `potentially inadequate levels of staffing'.

5.1.6 These comments need to be further clarified to enable the Committee to come to a view regarding the reasons for not going to formal consultation regarding the proposal to close inpatient services at the Mount Hospital. Members will therefore wish to ascertain

· Are patients at risk

· The immediacy of that risk

· The `trigger' to invoking the contingency plan

· Options explored with partners for continuing to provide services from the Mount Hospital.

5.1.7 Additionally the following points have been raised with PCTs

(i) What is the scope for bringing the new service model forward from next summer

(ii) Are there other options for providing staff for these services

(iii) The business plan identifies a number of innovations in workforce development, what is the scope for these to be used to support the continued provision of services at the Mount.

5.2 What are the changes in the accessibility of services for the people using the service

5.2.1 The Committee will need to be assured that people using the services will be able to access them when they need to. Specific points here relate to

i. Public and private transport availability. The proposal from WEHT makes particular reference to the pressures on car parking and this is a recurring concern raised by local people

ii. The potential impact of pressures on beds from other services provided by the Trust, particularly over the winter months. The outcome of consultation document records specific issues relating to `red alerts' to GPs.

iii. The proposal to the Board (Para 5.3) makes particular reference to faster discharge, linked to a reduction of 7 beds- will this place greater pressure on carers and community services- if so how will this be managed to ensure that patients are fully supported on discharge.

5.3 Is the change based on clear evidence and best practice

5.3.1 The clinical case for re-providing rehabilitation services closer to people's homes was given particular weight in the formal consultation process carried out by the PCTs. Much of the evidence cited related to the fact that the inpatient population affected was vulnerable and should not be in an acute setting for a variety of reasons including the ability to remobilise people back to independence and the threat of MRSA and other hospital acquired infections.

5.3.2 The Committee needs to be clear that this major move is the only option open to the NHS in order to minimise any risk to current to potential patients and is particularly keen to establish

1. That all options for providing these services were explored with partner organisations prior to this decision being reached. This will include discussions regarding new ways of working that may be possible to maintain services as close to peoples homes as possible and consideration of the scope for moving the timetable for the reprovision of these services forward.

2. That any decision relating to moving these patients is clinically necessary and that patients will only be moved as and when it is safe to do so (this could cause complications in the form of a split site service)

3. That the impact the closure of the inpatient beds will have on the day hospital or other services currently provided at the Mount has been fully evaluated

5.4 What impact will the proposal have on the wider community and other service providers

5.4.1 The Committee will invite feedback and comment on the proposal from as wide a range of interested parties as possible, recognising that the time constraints that we need to operate within are limited. As a minimum the Committee will invite written feedback from all the respondees identified in the `Outcome of Consultation' document.

5.5 Whether the proposal is in the interests of health services in the area of the Committee

5.5.1 In part the scrutiny points outlined above will inform this question as this will give the Committee a view of the proposal from across the health community affected. Subordinate to the questions relating to the safety of patients and the reasons for not going to public consultation the Committee will need to consider the severe financial pressures facing local NHS services and the consequences to other service providers should the move take place.

5.5.2 The extent of partnership engagement in proposing this option will also be a factor. It must also be recognised that significant concerns were expressed by local people in the formal consultation regarding the intention to save some £425,000 as a consequence of the proposed reconfiguration. Although the papers prepared by the Trust are clear that financial issues are secondary to patient safety in putting this proposal forward the Committee is aware of concerns that a further £325,000 may be lost from these services.

5.5.3 Continuing briefly with the financial themes the Committee may wish to explore further

· what will be the costs of effecting the movement of patients?

· what will be the costs of travel plans, car parking etc at the new location?

· how are the staff savings achieved? Are they net of any need to attribute remaining costs at The Mount across a narrower range of services?

· what is the relevance of releasing 'up to £325,000 in a full year', given that the temporary arrangements will last for only Oct-July, say 9 months? Isn't £245,000 the maximum gross saving achievable?

5.5.4 These key scrutiny points focus very specifically on the statutory role of the Committee and may not reflect the wider concerns that members may have. It is however important that approach of the Committee is clear and that the Committee is objective when coming to a view.

6. Decisions by the Committee

6.1 Once the Committee has heard the views of all contributors, members will need to consider the following through a formal vote:

· Does the committee support the proposal to close the inpatient beds at the Mount with effect from end of August 2004

6.2 If the vote supports the proposal then no further action is required

· If the Committee does not support the proposal then the decision needs to be made about whether the proposal is substantial

6.3 If members do not consider the proposal to be substantial then no further action is required

6.4 If the Committee does is of the view that the proposal is substantial then this decision and any recommendations for action will need to be set out. WEHT will have 28 days to respond to the Committee. If the Committee is not satisfied with the response then the matter can then be referred to the Secretary of State.

7. Conduct of the Scrutiny Meeting: 27 July 2004

7.1 The meeting will commence at 11 am, with a series of presentations from key partners including social services, ETVSPCT, Mid- Hants PCT, Eastleigh Borough Council, Test Valley Borough Council, and Strategic Health Authority. These will run to a maximum of 15 minutes and will address three questions:

· Were they involved in the decision to close the Mount Hospital and relocate the beds to WEHT

· Do they support the proposal as it currently stands

· What other options exist for rehabilitation services to these patients

7.2 Contributions may also be made in writing to the Committee before the meeting and have been invited from main voluntary sector organisations, Parish Councils and Unions.

7.3 This will take us through to 12.30 when a working lunch will be provided

7.4 At 1.00 WEHT will be invited to set out the rationale underpinning its decision, including the options considered. This session will run for 45 minutes

7.5 This will be followed by questions from members of the Committee (and others?) running to 45 minutes (or 60).

7.6 Members of the Committee will then be invited to vote on whether they support the proposal. If not the recommendations for further action to be presented by the Chairman for agreement by the Committee. I would anticipate that the meeting would close at approximately 3.30.

8. Other factors to be considered

8.1 A press release will need to be prepared to go out, probably in the week commencing 19 July alerting people to the action of the Committee. This could include an invite for local people to share their comments with the Committee. The meeting will attract public and other interest.

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:

Published works

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

File Location

None

Appendix One

Future of inpatient services - The Mount Hospital

Following our brief telephone conversation last week I am attaching a copy of the paper which went to our public Board meeting last Wednesday. This argues that, in view of the difficulties in maintaining safe standards of care, due to potentially inadequate levels of staffing, arrangements should be put in hand to transfer the inpatient services to the Royal Hampshire County Hospital on a temporary basis.

You will see that the Board approved such a move subject to satisfactory further discussions with the PCTs and the Overview and Scrutiny Committee. They were also at pains to ensure that every effort be made to minimise disruption to patient care and that the changes should be undertaken with the full involvement of patients and their relatives. These points are reflected in the minute recording the discussion and decision on this item, as agreed by the Chairman.

As you know the future of services at The Mount has been under discussion for several years and certainly over recent months the Trust Board has kept staffing issues under close scrutiny advised by the Director of Nursing.

We now believe that the staffing situation, although not actually unsafe at the moment, is of such fragility that we need to take the action proposed. When we responded to the consultation on the future of The Mount led by Eastleigh & Test Valley South PCT, we made it extremely clear that such action may become necessary before their revised model of care is actually in place; and so it has turned out. A copy of my Chairman's letter to the Chair of the PCT, which sets the issue out unequivocally, is also enclosed. Such a possibility was also reflected openly in the public meetings and indeed also features in the final response to the consultation itself.

We remain committed to the final model of care as proposed by the PCT and the changes now are definitely only temporary in nature and are necessary now only because of the clinical concerns as explained.

As I explained when we spoke, we would be happy to arrange for you and your colleagues to visit the new wards at the Royal Hampshire County Hospital which undoubtedly provide far superior physical accommodation. We would also be grateful for the opportunity to attend your meeting on 27^th July and I know both the Director of Nursing, Kay Riley, and the senior medical staff most concerned with this service would be pleased to explain the matter and answer any questions Members may raise.

In the meantime if you would like any further information please contact me.

Appendix Two

WINCHESTER AND EASTLEIGH HEALTHCARE NHS TRUST

PAPER TO TRUST AND MANAGEMENT BOARD MEETINGS - JUNE 2004

TOPIC: Proposal regarding the transfer of Inpatient Services at the Mount Hospital to the RHCH site

AUTHOR: Pat Petrie, Divisional General Manager, Medicine & Elderly Care

SPONSOR: Jo Paul, Director of Operations and Performance

1. EXECUTIVE SUMMARY

1.1 Currently there are 26 inpatient beds providing a rehabilitation service at the Mount Hospital, Bishopstoke. Consultation regarding the future reprovision of physical rehabilitation services has taken place and plans are being progressed with Eastleigh and Test Valley South PCT (ETVSPCT) and Mid Hants PCT (MHPCT). In responding to the consultation Winchester and Eastleigh Healthcare NHS Trust (WEHT) raised concerns regarding the staffing at the Mount and that interim contingency plans may need to be considered with services temporarily reprovided at the Royal Hampshire County Hospital (RHCH) if the situation worsened. Maintaining safe levels of trained nurse staffing has been an ongoing concern (with the result that 12 beds have been closed at the Mount in the last year).

1.2 In the last month vacancies in occupational therapy and medical staffing have renewed concerns as to the ongoing vulnerability of inpatient services at the Mount thereby prompting this report.

1.3 In addition in the current financial climate there are significant savings, £325,000 that could be made by bringing the service onto the RHCH site.

2. DECISION REQUIRED

2.1 The Trust and Management Boards are asked to support a proposal that the inpatient service currently provided at the Mount Hospital be reprovided in the new temporary ward on RHCH site.

2.2 Patients requiring this service, following their treatment at the Royal Hampshire County Hospital, will be admitted to the new ward. No patients in the Mount will be transferred to the facilities at RHCH unless they choose to do so or it is in their best interests clinically.

2.3 This would be a temporary move of service until the new model being developed by the PCTs, is operational. It is estimated that this will be fully operational from the Summer of 2005.

3. BACKGROUND

3.1 The Mount Hospital in Bishopstoke is owned and managed by WEHT and provides a range of rehabilitation services mainly for the elderly. These include inpatient, day hospital, physiotherapy and occupational therapy services.

3.2 Annual admissions to the Mount Hospital between 2001 and 2004 ranged between 230 and 270 patients. The services are commissioned by ETVSPCT and MHPCT on approximately a 70/30 split.

3.3 The difficulty in recruiting sufficient trained nurses at the Mount Hospital to provide a safe level of cover has been a matter of concern for the past 15 months and Trust Board Members have been regularly appraised of the difficulties.

3.4 In March 2003 beds were reduced from 38 to 28 due to inadequate trained nurse staffing levels; and in August 2003 it was agreed that the number would reduce by a further 2 to 26 beds bringing the total to19 rehabilitation beds and 7 low dependency beds.

3.5 In April 2004 ETVS PCT published proposals for the reprovision of physical rehabilitation services currently located at the Mount Hospital and consulted on these between 15^th April and 13^th May 2004.

In summary the proposals were to provide:-

· 26 - 30 beds in one or more units to support patients being discharged from the Royal Hampshire County Hospital

· a new rehabilitation centre for patients with intensive rehabilitation needs

· the further development of the community rehabilitation team for ETVS patients and a new Preventing Dependency Team for Mid Hants patients in the Bishops Waltham area,

· respite care

· night support services

· outpatient physiotherapy clinics

· transport services to support the above

3.6 In its response to this consultation (letters dated 7^th May from Barbara North, Chair WEHT to Lynne Lockyer, Chair ETVS and 13^th May - from Rod Halls, CEO WEHT to the Consultation Office 2004) WEHT made it clear that, whilst supportive of the service model proposed, it still had concerns regarding staffing.

3.7 In particular it made it clear that should staffing levels worsen a temporary measure of transferring services to the RHCH may have to be implemented until the new service was in place.

3.8 In May 2004, the Winchester and Eastleigh Healthcare NHS Trust Board agreed Chair and Chief Executive action to invoke the contingency arrangements should safe staffing levels become unsustainable.

4. CURRENT SITUATION

4.1 In April 2004 the resignation of a senior nurse on night duty again caused concern as to whether safe staffing levels could be sustained. Since then the Trust has recruited 2 experienced part-time nurses via an agency and the PCT has employed an experienced nurse who will work at the Mount Hospital until the new model of intermediate care services is operational.

4.2 The bank occupational therapist (OT) providing cover to the Mount inpatient wards, leaves at the end of June and, despite advertising the vacancy, no replacement has been found. The options are either to engage a locum OT from an agency which is very expensive, or try to provide a very limited service from the already stretched OT service at RHCH. The lack of OT input will delay patients' rehabilitation, increase their length of stay and potentially increase the number of delayed transfers of care.

4.3 The Clinical Medical Officer at the Mount Hospital left in mid June and the Trust has been successful in appointing a locum for the next 2 weeks and is trying to appoint further locums until a substantive appointment can be made. This is by no means certain and these are unsatisfactory arrangements beyond the short term.

4.4 To compound the difficulties a senior trained nurse who provides night cover will be off for 6 weeks at the end of June. Nursing staff have helped to cover the shortfall in trained staffing by delaying taking leave etc, but they cannot continue to do so.

4.5 In summary, WEHT is continuously struggling to appoint sufficient qualified staff in a number of professional groups, to guarantee the continuity of a safe and acceptable level of staffing. The prolonged repeated use of temporary staff is not good for continuity of care for a fragile and vulnerable patient group.

4.6 In addition, despite every effort to keep the environment satisfactory at the Mount Hospital, the fabric of the building and the layout of the wards, is entirely ill-suited to the provision of modern dignified care in the 21^st century.

5. PROPOSAL

5.1 RHCH has provided 2 temporary, purpose built 28 bedded wards on site adjacent to the main body of bedded accommodation within the Trust. The wards provide 4 single rooms and 6, 4 bedded bays, with a day / dining room, both assisted and normal bathroom, shower and toilet facilities. These all ensure patients' needs for privacy and dignity are maintained with ample space around the beds for providing care. The physiotherapy and occupational therapy services are located within minutes of the ward in the same wing of the Trust.

5.2 The transfer of the inpatient service currently provided at the Mount Hospital would allow for the cross cover of medical, nursing and therapy support to be provided from the other acute bedded services.

5.3 The temporary facility provides an additional 2 rehabilitation beds. However other ward moves on the RHCH site will result in a net loss of 7 beds. Clinical staff support the view that with a more active rehabilitation process and more accessible diagnostics, the length of stay will be reduced to enable this reduction in beds to be achieved.

5.4 In terms of access to the RHCH, families and visitors would use existing parking facilities. It is recognised that parking is a problem but the Trust will shortly be announcing a range of measures to alleviate difficulties.

5.5 Staff have already had meetings to develop individual travel plans and would use a combination of public transport and car sharing. It is estimated an additional 2 parking spaces on an early, 1 on a late and 1 on nights will be used.

5.6 It is important to acknowledge that there is a financial saving resulting from moving the inpatient services to RHCH which is important to the Trust's financial recovery programme. The current costs of providing the inpatient service at the Mount is £1,138,000. Transferring the beds to the Royal Hampshire Hospital will cost £813,000 releasing up to £325,000 in a full year.

5.7 In summary, it is felt that the advantages of moving significantly outweigh the disadvantages and it is proposed that the move takes place from the August 2004.

6. PUBLIC AND PATIENT INVOLVEMENT

6.1 The issues surrounding the future of services at the Mount hospital have been discussed publicly and with staff over a number of years.

6.2 In its response to the public consultation by ETVSPCT, WEHT made it absolutely clear that a temporary move of services to RHCH may become necessary on the grounds of maintaining good patient care.

6.3 It is acknowledged that moving such a service is not to be undertaken lightly and that due regard must be paid to the views of public, patients and staff. Nonetheless, it believes the action recommended in this paper is the right course of action because:

· It is a temporary move into temporary accommodation whilst alternative, agreed plans are implemented;

· the superodinate priority is to maintain good patient care and the proposal clearly does that;

· satisfactory arrangements can be made to eliminate risk for patients and minimise disruption for staff.

7. PRACTICAL ARRANGEMENTS

7.1 The Trust recognises just how important it is to effect this move in a way which above all safeguards patient care. The Trust is committed to taking full account of the wishes of patients, their carers and relatives in that process.

7.2 The Trust will stop transfers from RHCH to the Mount from 26.7.04 when the new temporary ward becomes available and will start to place patients who would currently use the Mount into the new beds at RHCH.

7.3 The Trust recognises the vulnerability of those patients who at that time may still be waiting for an ongoing placement and will ensure that it works closely with patients, their carers and the PCTs to secure appropriate placements in the community. No patients in the Mount will be transferred to the facilities at RHCH unless they choose to do so or it is in their best interests clinically.

7.4 If at that time any patients were to choose to transfer to RHCH they would move to the new temporary wards on the RHCH site during August 2004.

8. CONCLUSION

8.1 The Trust and Management Boards are asked to support the recommendation that the inpatient service currently provided at the Mount Hospital be reprovided in the new temporary ward on RHCH site from August 2004. Existing patients will be found suitable placements in the Community or will be transferred on the basis of need, to the facilities at RHCH.

8.2 This arrangement will provide fit for purpose accommodation and release savings that can contribute to the Trust's Financial Recovery Plan.

8.3 Staffing the new 28 bed facility on the RHCH site will also be easier to sustain with regard to nursing, medical and therapy staff.

8.4 The move of the inpatient service is a temporary measure until the new model of long-term service provision being agreed by the PCTs, is implemented in the summer of 2005.

Pat Petrie

Divisional General Manager

Medicine & Elderly Care

June 2004

Appendix Three

[Extract from Trust Board minutes Wednesday 30th June 2004]

Approved as a correct record subject to any amendments duly minuted.

Signed: .........................................

Date: .............................................

Appendix Four

7 May 2004

Ashley Wing

Royal Hampshire County Hospital

Romsey Road

Winchester

Hampshire SO22 5DG

Tel: 01962 825265

Fax: 01962 825190

E:mail: [email protected]

Ref: BN/ww/

Ms L Lockyer

Chair

Eastleigh & Test Valley PCT

The Mount

Church Road

Bishopstoke

Eastleigh SO50 6ZB

Dear Lynne,

Consultation on the reprovision of services currently located at The Mount Hospital.

Thank you for sending the Trust a copy of the consultation document which we were able to discuss at the Trust Board meeting on 28^th April. We are also inviting clinicians in the Trust to comment and Maureen Larkin is currently collating all responses so that we may make a formal response to the proposals by 13^th May.

May I take this opportunity to thank and congratulate your team for the positive and professional way in which this difficult project has been undertaken. Many members of the team here have been very complimentary and I believe it has finally been a very good example of effective partnership working.

In the light of those comments it is therefore with regret that I have to formally express the Trust's concern that the document explicitly states on pages 8 and 30 that "services will continue to be delivered at the Mount Hospital until such time as new services are in place", after the statement that "it is anticipated that new services will be in place by Summer 2005". I believe these statements only appeared in the final version, having been absent in previous drafts - a point Rod has raised with John. As you know, and as members of my executive team confirm has been discussed at public meetings, Winchester & Eastleigh Healthcare Trust has made it very clear that there would have to be a contingency plan in place to mitigate the clinical risks of even more staff leaving once the proposals to "close the Mount" became the subject of formal consultation and then decision. We have previously expressed to you our concerns that it may become necessary for patient and staff safety reasons to temporarily use facilities at the RHCH in advance of the final reprovison you are seeking to achieve, and which we have been working with you to secure. I am therefore concerned that the document does not accurately reflect our clearly stated and I thought agreed position.

Whilst I would not want to endanger the timetable which we all wish to achieve, I must formally request your assurance that the consultation process will be documented to accurately reflect the statements made in public that no-one can guarantee that all services will remain on the Mount site until reprovision is achieved.

In the meantime the Trust Board has asked that a formal contingency plan be brought to the next meeting which demonstrates clearly any plans to (a) limit discharges to the Mount should that be necessary and (b) separately identifies the joint approach which we would take if at any time it became necessary to move any patients from the Mount in advance of them being fit for discharge. As you know the latter is a course of action which we would only undertake in circumstances where patient safety was a real risk. Any such plan would also have to have to be confirmed with the full involvement of the Patient Forums and would include processes to involve patients, carers and relatives.

I look forward to receiving your reply and once again, please pass on this Trust's thanks to your team.

Kind regards,

Yours sincerely

Barbara North

Chair

Cc Rod Halls Chief Executive

Bridget Phelps - Chair Mid Hampshire PCT