Contact: Denise Holden ex 7338

e-mail: [email protected]

1. Summary and Purpose

1.1. The purpose of this report is to alert Members to proposals from the NHS to vary or develop health services provided to people living in the area of the Committee.

1.2. Proposals that are considered to be substantial in nature will be subject to formal consultation. The nature and scope of this consultation should be discussed with the Committee at the earliest opportunity.

1.3. The response of the Committee will take account of the criteria adopted by the Committee on 29 July 2003 with particular emphasis on the duties placed on the NHS by Section 11 of the Health and Social Care Act 2001.

1.4. The Report is presented to the Committee in 2 parts:

_ Items for information: these alert the Committee to forthcoming proposals from the NHS to vary or change services. This provides the Committee with and opportunity to determine if the proposal would be considered substantial and access the need to establish a formal joint committee

_ Items for action: these set out the actions required by the Committee to respond to proposals from the NHS to substantially change or vary NHS services.

1.5. The report and recommendations support the delivery of Aim 5 (Improving Services) of the Corporate Strategy.

Items for Information

2. Hampshire Partnership Trust: Secure Adolescent Mental Health Services for the South of England

2.1. The Committee has been alerted to proposals for the development of secure adolescent mental health services across the region.

2.2. The initiative is at the very early stage of development and is not due to be completed until January 2007: it is therefore unlikely to be subject to formal consultation until 2005/06. A brief summary of the proposal is attached at Appendix A. Full details of the project initiation bid are available from Denise Holden.

2.3. The catchment population has yet to be determined, however the project manager is aware of the responsibilities of the Trust in relation to the duty to consult with all Health OSCs whose population may be affected.

2.4. Through the Hampshire, Isle of Wight, Portsmouth and Southampton Joint Committee the Trust has been asked to

_ Provide the Committee with an up-date on a regular basis

_ Provide information on the process for discharging section 11 responsibilities as the project rolls forward

_ Ensure that all partners (e.g. social services) are engaged

2.5. The Trust has been thanked for contacting the Committee at this early stage of developing a proposal

Items Requiring Action

3. Winchester and Eastleigh NHS Trust: Closure of the Mount Hospital on Safety Grounds

3.1. The recommendations of the Committee were communicated to Winchester and Eastleigh HealthCare Trust (WEHT) after the formal scrutiny meeting on 27 July. These are attached at Appendix B

3.2. Initial meetings between the hospital Trust and the PCTs were held on 29 July and continued in the period to the end of August. The response from the Trust to the recommendations made by the Committee are attached at Appendix C. Full details of all the Annexes provided to this letter, and the weekly up-dates that are being provided for interested parties are available from the Health Review Manager.

3.3. The Committee needs to determine if it accepts with the response from the WEHT.

4. Maternity Services in South East Hampshire

4.1. The Committee has been advised the consultation on the provision of maternity services in south east Hampshire is likely to commence in October. Portsmouth City Council Health Overview and Scrutiny Committee is taking the lead in co-ordinating the joint committee to consider the proposal.

4.2. A letter outlining the expectations of both Committees and requesting further information from the lead PCT is attached at Appendix D.

4.3. The Committee has previously agreed that four members from Hampshire will be appointed to the joint committee that will consider this proposal. Cllrs Ellis, MacNair Scott and Dickens have agreed to undertake this work.

4.4. The fourth member from the Committee was drawn from the district local authority appointments made by HIOWLA. Changes in the membership of the Committee require that another individual be identified to serve on the joint committee and to ensure that there is effective communication between the local authorities whose populations will be affected by the proposal.

5. Planning Future health Services in Fareham and Gosport

5.1. Arrangements by Fareham and Gosport PCT for conducting the formal consultation on the future pattern of health services in Fareham and Gosport were shared with the Committee at the last meeting.

5.2. An interim response from the Committee requesting further information from the PCT is attached at Appendix E

5.3. An extraordinary meeting of the Committee has been convened for the 21 October to consider the outcome of the consultation process and the preferred option to be presented for consideration by the Trust Board on 3 November 2004. Partner organisations from Fareham and Gosport will be invited to attend the meeting to share their views on the options presented.

5.4. The interests of the Committee when considering the proposal from Fareham and Gosport PCT on 21 October will exist at two levels.

_ Has there been adequate consultation with local people regarding the options

_ Is the preferred option identified in the interests of the health service in the area

6. Amendment to the Criteria for assessing proposals fro the NHS to vary or develop services

6.1. The Committee has previously identified criteria for assessing proposal fro the NHS to vary or changes services. These seek to ensure that that Committee considers the proposal from the perspective of the population affected.

6.2. The criteria have been circulated to all partner organisations and are available on the web-site www.hants.gov.uk/healthscrutiny

6.3. The Race (Amendment) Act 2000 places a duty on all public bodies to promote race equality. A key element of this duty is the need to assess the impact of new policies or service changes on different racial groups and consult on these. It is likely that this requirement will be extended to include gender and disability over the next two years.

6.4. Any proposal presented to the Committee should now include an appropriate impact assessment.

Recommendations

7. Winchester and Eastleigh NHS Trust: Closure of the Mount Hospital on Safety Grounds

7.1. The Committee confirms whether the response from WEHT to the recommendations are acceptable

7.2. The Committee reaffirms that WEHT immediately advise the Committee of any further change to the services provide at the Mount Hospital.

7.3. Eastleigh & Test Valley South PCT provide the Committee with an up-date on progress with the implementation of the new service model at its next meeting

8. Maternity Services in South East Hampshire

8.1. The Committee agrees the fourth member to be appointed to the formal joint committee to consider this proposal. This member will be drawn from the local authority appointments to the Committee made by HIOWLA and will have ensure that the district authorities affected by the proposal receive information about the changes and have the opportunity to respond to the consultation.

8.2. The Committee reaffirms its expectation that this Joint Committee will take account of the criteria for responding to consultation agreed by the Committee.

8.3. That the Joint Committee will consider the proposal from the NHS taking account of the population affected.

9. Planning Future Health Services in Fareham and Gosport

9.1. Preparatory work for the meeting on the 21 October includes

_ A briefing paper for members including the additional information requested by the Committee, the purpose of the meeting, the role of the Committee in considering the options presented and appropriate background information

_ Key partner organisations are invited to attend the meeting to share their views on the proposals developed by the PCT.

10. Amendment to the Criteria for assessing proposals fro the NHS to vary or develop services

10.1. That the Committee amends the criteria for assessing proposals from the NHS reflect the requirements of the Race (Amendment) Act 2000.

10.2. That this information is communicated to all partner organisations

Appendix A

SECURE ADOLESCENT MENTAL HEALTH FACILITY FOR THE SOUTH OF ENGLAND

PROJECT INITIATION DOCUMENT

1. INTRODUCTION AND PURPOSE

The purpose of this document is to describe the key objectives for the development of a secure in-patient adolescent mental health service to serve the population of the South of England who meet the criteria as outlined below in the Project Brief.

The document describes the approach and methodology being taken to effectively plan and implement the project objectives. Formal approval of the Project Initiation Document by the Project Board, will give confirmation of the approach to achieving the project goals and the facilitation of the service development proposals.

2. PROJECT BRIEF

The project brief is described in the Strategic Outline Case (SOC) dated October 2003.

An extract from the Executive Summary is included as follows:

2.1 Outline of Proposed Service

The proposed service is to offer secure in-patient forensic facilities for adolescents who meet the criteria agreed by NSCAG as outlined below:

· detainable under parts 2 or 3 of the Mental Health Act 1983

· aged between 12-18 (this means 17 for referral purposes really)

· require care and treatment for a period of between 1-12 months in a secure environment by reason of the risk they pose (2.5 months median)

· all other more local facilities have been exhausted (not on availability

of beds but on ability to treat/contain)

· not Learning Disabled, Aspergers or brain injury

· normally, not personality/conduct disorders unless with mental illness

· usually with a worrying forensic history/index offence (although not necessarily with a conviction).

This would usually mean that the young person presented a risk to others that required their detention in conditions of security. This risk would normally include risk of the following:

· Direct violence to others, including homicide

· Seriously sexually aggressive behaviour

· Destructive and life threatening fire setting

The service will include:

· Case management

· Assessment and treatment by a full multi-disciplinary team

· Access to appropriate education

· Occupational and life skill activities

· Psychological testing and treatment

· Individual and Family therapy

· Medication

2.2 Health Service Need

The service development proposals described in the SOC/OBC respond to identified health service need as they provide:

· Better Access to Services

· Improved Clinical Quality

· For Improved Environmental Quality

· For Development of Existing Services and Provision of New Services

· For Improved Strategic Fit of Services

· To Meet National and Local Policy Imperatives

· To Make More Effective Use of Resources

· To Meet Training, Teaching and Research Needs

The consequences of not prioritising the proposal are:

o Unmet targets

o Failure to meet requirements of Safety, Privacy and Dignity in Mental Health Units

o Inappropriate placement of patients

o Inappropriate models of care

o Investment blight - does not enable repatriation to services closer to home

o Service quality and human rights issues, inappropriate detention

2.3 Needs Assessment

Although there have been a number of studies that have looked at the need for Secure Adolescent facilities, there has been no definitive national study that has been accepted by all.

The most comprehensive in scope of these studies was that undertaken by Philip Vaughan for the Wessex consortium in June 2001 and this has been the basis of this assessment of need. This study was a very thorough survey of need within Hampshire and the Isle of Wight identifying all those who on 1^st January 2001 who:

· "were detained in conditions of security or who need to be detained because of the risk they posed to themselves or others, or who are likely to abscond from an open facility, and;

· "whose mental disorder is of a nature or degree that warrants in-patient treatment and care in a setting appropriate to their age and clinical need."

The study identified 23 young people who met his criteria of whom 14 were boys and 9 girls. The 23 were then matched against the NSCAG criteria outlined above. This identified 5 young people who met the criteria of whom:

· one was in a Young Offenders Institution

· two were in Local Authority secure accommodation

· only two were appropriately placed in specialised adolescent secure psychiatric units, one in the NHS and the other in the private sector.

So for a population of approximately 2 million people the report identified a group of 5 young people who required secure inpatient psychiatric adolescent services and met the current draft criteria as outlined by NSCAG.

The South of England covers a population of approximately 14 million and so if this study were projected upward we would see a need of 35 places.

In preparing this report commissioners across the area were asked to identify the number of young people in secure adolescent mental health facilities in January and February 2003. This stock take identified current usage as 24 beds as outlined below:

Area	No. of Adolescents in secure accommodation 28th Feb 2003
Kent, Surrey and Sussex	9
Berkshire	2
SW Region	7
Wessex	3
Oxfordshire/ Buckinghamshire	4
Total	25

The former South West Region undertook a detailed stock take of the current use of secure adolescent facilities in January 2003. This showed 7 youngsters currently in NHS medium secure provision (St Andrews and Huntercombe) of which 2 patients would not have met the NSCAG criteria as they had both had drug and alcohol addition. In respect of the other 5 there was insufficient information to be able to determine.

Considering these factors it is believed that the initial need within the South of England would be met by the provision of 20 beds especially taking into account the other increases in such beds with the new developments in London and Birmingham.

During the preparation of the report clinical and commissioning colleagues have also expressed a need for secure services for a group of young people with problems of mild learning disability or Asperger's Syndrome and who require a secure mental health facility but who do not meet the current NSCAG criteria. This need has not been fully researched and is not directly dealt with in this proposal however an element of flexibility is called for in the design that would allow some consideration to be given to these groups of young people in the future.

2.4. Strategic Context/ National Initiatives

The underpinning national policies relevant to these interim developments are:

· The promotion of effective assessment and treatment of young people who require admission under the Mental Health Act (1983) and whose behaviour represents a direct and serious risk to others and who require treatment within conditions of security;

· The promotion of social inclusion and prevention of exclusion;

· Equity of access to mental health services closer to home;

· Improving the care of children and young people with mental health problems.

2.5. Service Benefit/Option Appraisal

A number of options were considered but those outlined below were considered to be feasible and reasonable to be formally appraised

The options identified are as outlined in the table below:

As can be seen there were five agreed options with sub options that related to the location of the proposed unit(s). These options were considered and appraised according to agreed criteria at a meeting of stakeholders held on 8^th April 2003.

At a meeting on 11^th July 2003 with representatives of NSCAG there was an informal agreement from them to revenue fund 20 places in the South of England at a cost of approximately £250K per place per annum plus set up/project costs. This has now been confirmed.

The agreed Preferred Option was:

· To build one unit of 20 beds located in a suitable location in the south of England.

This option was agreed because:

1. This gave good accessibility across the South of England;

2. The south coast proposal was far enough from the London proposals to improve the national spread of these units;

2.6 Design and Flexibility

The design of the establishment will need to take full account of

· the needs of this client group

· the need for appropriate privacy and gender separation

· flexibility for future growth, change of use and changing service requirements

The unit will be dealing with young people with a range of needs and it is essential that the unit is designed to offer flexibility to support the clinical team in dealing with these divergent demands. It is believed that a `pod' system would most likely offer the flexibility required although alternative designs will be considered.

2.7 Design Champion

The trust has appointed a non executive director as the design champion whose role will include a responsibility to ensure that:

· The building promotes civic pride

· Consumerism is taken into account

· Patients and staff are consulted and their views addressed

· The building fits into the local surroundings and settings

· The building is fit for purpose

· The building takes on board modern technology

The design champion will ensure that:

· All procedures encourage the achievement of high design quality

· An assessment is made of the current environment for patients, staff and visitors

· The `Achieving Excellence Design Evaluation Toolkit' (AEDET) is used where appropriate

· A trust design action plan is produced and delivered

· The evaluation of tenders when necessary is based on best value and not lowest cost

· Budgets and timetables are realistic

· The trust has the right skill mix to deliver the design agenda

· A design vision is established in order for the trust to produce a clear brief

· The scheme includes the full involvement of the local community and the support of clinical and other staff

2.8 Procurement Process

Following debate at the Catchment Group, LSCGs in the 2 areas listed were approached to invite local providers to respond with initial interests. Hampshire Partnership NHS Trust was selected as preferred provider for the delivery of the service by 05/06.

The process to select the partner to support the Trust in the development of this facility will be selected via LIFT or P21. The Trust will use consistent principles and criteria by which an NHS Trust may select a NHS ProCure21 Principal Supply Chain Partner (PSCP). The selection will be made by taking into account relevant experience, the team actually proposed, the planned approach and the availability of resources.

The main objective of the process is to select the PSCP judged by the Trust as most likely to effectively deliver the scheme identified by the Trust whilst minimising the resource input required by both parties.

3. OBJECTIVES

The main goals for the project are to:

· Deliver an operational 20 bed secure adolescent unit by early 2007

· Deliver within affordability envelope

· Be a centre of excellence for secure adolescent unit

· Ensure participation and ownership of public, patient, staff and key stakeholders, throughout the project

Hampshire County Council Appendix B

Health Review Committee: 21 September 2004

The Mount Closure: Scrutiny Meeting Recommendations, 27 July 2004

Health Scrutiny meeting: Conclusions and recommendations

I writing to confirm the findings of the Health Review Committee following today's scrutiny meeting. You will have identified that concerns of members regarding the proposal from Winchester and Eastleigh HealthCare NHS Trust to close inpatient beds at the Mount Hospital. These remain at a number of levels, nevertheless, in view of the strength of the clinical advice regarding the safety and well being of patients the Committee resolved the following:

`The reasons for not going out to consultation are adequate in as much as there is a significant risk that these services will need to close at the end of August due to staff vacancies. The Committee accepts that there needs to be proper planning for this eventuality. The inpatient services at the Mount Hospital are fragile and it is to the credit of staff that they have been sustained.

Having said this it is deeply disappointing that, some 4 weeks after the Trust deciding to invoke the contingency plan, so little progress has been made in terms of discussions with partner organisations to identify the options for continuing to provide these services locally. The Committee would wish to see further evidence that this engagement has taken place. It is insupportable that the local NHS is not fully communicating in this respect.

Should the Trust proceed with the planned closure, the Committee would expect there to be clear and unequivocal clinical advice that all other options had been exhausted. Subject to the point above the Committee would also recommend:

· The WEHT Board defers the proposed closure until the 30 September to enable all options to be fully explored with partner organisations

· That ESTVSPCT and Mid-Hants PCT initiate immediate action to explore the scope for bringing forward their planning of the new service model

· That there is a jointly agreed contingency plan put in place setting out clearly the triggers for further action and who would be responsible for initiating this. This will be headed by a consultant with the pre-requisite professional knowledge of rehabilitation services

· That, should the point be reached where there is no other option but to transfer patients, all risks to patients are fully assessed with the involvement of carers, families and the responsible clinician

· The impact on the other services should the inpatient beds close are defined and communicated to the Committee'.

Our expectation is that the Trust will respond to the relevant recommendations within 28 days, although given the pressures on the staffing position it may be appropriate to respond earlier than this. We will then be able to assess what further action, if any, would be appropriate.

I must stress that Members will wish to see clear action taken to work with partners to find a joint solution and the Committee will continue to take a keen interest in how this is taken forward.

I hope that our position is clear. Please do not hesitate to contact me or our lead officer if you have any queries.

Hampshire County Council Appendix C

Health Review Committee: 21 September 2004

The Mount Closure: Winchester and Eastleigh NHS Trust Response

Re: Health Scrutiny Meeting - Conclusions and Recommendations

I am writing in response to your letter dated 27^th July 2004 on behalf of Rod Halls, Chief Executive.

First of all, I would like to thank you for the positive way in which you and your colleagues have approached the issue of the closure of inpatient beds at The Mount Hospital. The Trust thoroughly understands the need for better communication with the Health Review Committee and recognises the learning curve which we all need to progress along to ensure full and transparent debate on future health management issues.

The Trust welcomes the Health Review Committee's acknowledgement of the strength of the clinical advice regarding the safety and wellbeing of patients at The Mount and consequently the real concerns that clinicians at the Trust have. Such understanding is important in the context of decisions taken by the Trust and PCTs. I also welcome your acknowledgement of the hard work of staff at The Mount in trying to sustain a safe service there.

The Trust accepts the criticism which was levied at it with regard to insufficient discussions with partner organisations relating to the options for continuing to provide services at The Mount. I believe that the Trust has worked to rectify that situation and can demonstrate that all options for strengthening and improving staffing at The Mount Hospital were considered by the Trust, working hand in hand with PCTs over the last few weeks. Rest assured lessons have been learnt from this situation.

The Trust and PCTs compiled an action plan to ensure the points raised by the Health Review Committee were met. I attach a summary of the outcomes against that action plan which were discussed at a meeting on 13^th August by managers and clinicians from the Trust and PCTs. Cllr Holden-Brown and yourself attended that meeting as observers on behalf of the Health Review Committee and I would like to thank you for your positive contribution at that meeting. The minutes of that meeting agreed by the Trust and PCTs are also attached.

I would like to respond specifically to the action bullet points laid out in your letter dated 27^th July.

1. The WEHT Board defers the proposed closure until 30^th September to enable all options to be fully explored with partner organisations

The Trust and PCTs have explored all options relating to safe staffing at The Mount Hospital. The conclusion from the meeting of 13^th August was that this would not be possible as the Trust and PCTs had been unable to recruit additional nursing and medical staff. Indeed the staffing situation has deteriorated due to a member of the nursing team having suffered a broken arm. The Trust and PCTs believe that all staffing options have been fully explored. The decision was made to stop the transfer of patients from the RHCH to The Mount with a date of 15^th September for the closure of inpatient wards at The Mount.

2. That ETVS PCT and Mid-Hants PCT initiate immediate action to explore the scope for bringing forward their planning of the new service model

Both PCTs and the Trust are working to bring forward the planning of the new service model including the possibility of implementing new locality based services on a temporary basis in advance of the full service provision which is subject to NHS Business Case approval. This will be overseen by a Mount Partners Meeting at which PCTs and Social Services are represented.

3. That there is a jointly agreed contingency plan put in place setting out clearly the triggers for further action and who would be responsible for initiating this. This will be headed by a consultant with the pre-requisite professional knowledge of rehabilitation services

I have attached the agreed Contingency Plan which set out the triggers for further action indicating who was responsible for initiating this. The plan was headed by Chris Gordon, a consultant specialising in rehabilitation of the elderly.

4. That, should the point be reached where there is no other option but to transfer patients, all risks to patients are fully assessed with the involvement of carers, families and the responsible clinician

I attach the Trust's process for overseeing the temporary transfer of the inpatient services at The Mount to RHCH which has been agreed by managers, clinicians and our partners. I give the assurance that the care and safety of patients is paramount during the transfer period and that carers and families will be totally involved in that process.

5. The impact on the other services should the inpatient beds close are defined and communicated to the Committee

In relation to other services at The Mount the impact on other services is limited but as follows:

· Receiving calls to the Mount site (all hours) - of all the services, currently social services do not have access to a direct dial line for receiving calls, and arrangements to address this are being discussed.

· WRVS and Chaplaincy services that attend the inpatients - arrangements for these services under discussion currently but inpatients will be able to access these services at RHCH.

· Hairdressing services - will transfer up with the inpatient service.

· The provision of Catering services will be reduced but will continue to be provided for Day Hospital attenders and be available for staff if they choose.

· Library services at The Mount for staff only - staff transferring will access the library services at RHCH and the continued provision of this service at The Mount is under discussion.

· Portering services will be managed by housekeeping services as the requirements will be minimal. One porter transferring from The Mount will be dedicated to providing support to The Mount beds once on the RHCH site.

I believe that the Trust has worked with PCTs and other partners to address the conclusions and recommendations which the Committee have made. At the meeting on 13^th August, I took the decision, as acting Chief Executive, that the inpatient service at The Mount Hospital had to close on the advice given to me by senior nursing and medical staff. This decision was fully supported by both PCTs. Subsequently, on 23^rd August 2004, an Extraordinary Trust Board Meeting took place where the Board ratified the management action to close inpatient wards at The Mount Hospital and their consequent transfer of services from The Mount to the Royal Hampshire County Hospital pending the implementation of locally based rehabilitation services by PCTs. At that meeting, and speaking on behalf of both PCTs, ETVS PCT fully supported this action and all partners have confirmed their full commitment to implementing the PCTs plans for the reprovision of inpatient services locally.

Once again, I would like to thank you for your help and assistance with this matter and assure you that the Trust and PCTs will make every effort in the future to ensure that appropriate communication is made within the NHS and with the Health Review Committee over any other potentially contentious health service issues which arise. If the Committee needs any further information or wishes to clarify any matters raised in this letter, please do not hesitate to contact me.

Ross Dunworth

Director of Finance

Hampshire County Council Appendix D

Health Review Committee: 21 September 2004

Maternity Services in South East Hants: Request for additional information

DEMOCRATIC SERVICES UNIT, CORPORATE SERVICES

Civic Offices, Guildhall Square, Portsmouth, PO1 2AL

Telephone: (023) 9268 8360 DX Portsmouth 2244

Fax: (023) 9283 4076

Email: [email protected]

Our Ref: 2508/SK/HOSC

Your Ref: 25 August 2004

Mrs Sheila Clark

Chief Executive

Portsmouth City Primary Care Trust

St. James Hospital

Locksway Road

Milton

Portsmouth

PO4 8LD

Dear Mrs Clark

PORTSMOUTH AND SE HAMPSHIRE MATERNITY STRATEGY

Thank-you for your email message dated 3 August 2004 attaching a copy of the Portsmouth and SE Hampshire Maternity Strategy.

As I intimated in my response to your email there are a number of points about which both myself and colleagues at Hampshire County Council would welcome clarification before the formal consultation period commences. I will list these points using numbered paragraphs for ease of reference.

1. It had been previously agreed with representatives of the Portsmouth Hospitals NHS Trust that any proposals for the future provision of maternity services would be deemed to be a substantial variation and as such should be subject to formal public consultation. This will allow all parties who contributed views to the formulation of the proposals, as well as local people, to comment on the final Strategy. Additional information on this process is set out in Section 6 of the DoH's Practice and Guidance on `Strengthening Accountability- Involving Patients and the Public'. Whilst we would welcome the engagement that has taken place with patients and other stakeholders in shaping the Strategy, it is important that an opportunity is provided for all those affected, or likely to be affected by the proposal to be able to contribute to the options for change that now need to be considered.

2. Guidance on Overview and Scrutiny of Health published by the DoH in July 2003 indicates that the NHS must make it clear when the consultation period for a proposal to vary services will end. In light of the additional information that we are requesting we consider that this formal consultation period has not yet started. Our expectation would be, however, that this will meet the minimum 12 weeks as recommended by the Government.

3. The Guidance also indicates that where a proposed change to services spans more than one PCT the PCTs affected will need to agree a process of joint consultation. The board of each PCT will also need to formally delegate responsibility for the consultation process to a joint PCT committee. It would therefore be helpful if you could confirm which of the local NHS bodies will be leading on the consultation process for the Strategy.

4. Prior to the commencement of the consultation period, the Joint Overview and Scrutiny Committee would find it helpful to have an further information on

· The options that were considered in developing the Strategy and the criteria against which these were assessed

· The options to be presented to local people and other stakeholders, including the preferred option of the PCTs

· Financial information on the anticipated costs of the options to be considered and any supporting business case

· Details of the projected need for maternity provision in South East Hampshire, including population trends

· An assessment of the impact of the preferred option on vulnerable or hard to reach groups

I look forward to receiving this information and details of the consultation process you intend to follow. In the meantime I can confirm that we are working closely with the other Overview and Scrutiny Committees affected by the proposals to establish a joint committee that will be able to respond to the proposal when it is received. This letter has been shared with representatives of Hampshire County Council.

If you would like to discuss any aspect of this letter further please let me know.

Hampshire County Council Appendix E

Health Review Committee: 21 September 2004

The Future of Services in Fareham & Gosport: Response from the Committee

The Future of local health services in Fareham and Gosport

I am writing on behalf of the Health Review Committee to ask for some additional information in relation to the consultation document issued by the PCT in late July.

The debate about the future of services in Fareham and Gosport has been of intense public interest for some considerable time. Many of the issues raised by local people have stemmed from concern that a highly regarded local health facility, the Royal Hospital Haslar, will be removed from public service in 2007. Although the decision to close the Hospital has been made by the Ministry of Defence, many people living on the Gosport peninsula have indicated their support for the continuance of NHS services on the site to make best use of the public monies that have been invested in the facilities. You are aware of the views of the Committee on this matter and the comments we have made to the House of Commons Health Select Committee. We remain of the view that the decision of the Ministry of Defence to close the site is deeply flawed, driven by short term budgetary pressures rather than the interests of our armed forces and people living on the Gosport peninsula. The work the PCT has undertaken to assess the potential to continue to provide NHS services on the Haslar site is appreciated and we look forward to receiving details of the independent review of the financial implications of this option.

The Committee, in line with its statutory responsibilities, will be considering the consultation process and preferred way forward identified by the PCT at a special meeting on the 21 October, in the meantime there are a number of points on which we would request additional information prior to this meeting.

Further information of the health needs of the different communities living in Fareham and Gosport and how these have shaped the current proposals that are subject to consultation would be particularly helpful to the Committee at this juncture. The consultation document is clear about the preferences of local people in relation to the provision of health services in their area. These preferences will however need to be balanced against a clear understanding of the current and future health needs of the population served by the PCT.

Although it was useful to see a copy of the analysis of activity across NHS services used by people living in the Fareham and Gosport area this only gives an overarching picture of how the population will change and grow in the next few years (i.e. by 4.5% in Fareham and 7.9% in Gosport). It is not clear how this information has been used to build a clear understanding of the health needs of the different communities that comprise the population served by the PCT and shape the current proposals for services in Fareham and Gosport. As I recall this point was raised at a recent meeting that you had with Portsmouth City Council and the intention at that time was to commission a further assessment of the changing health needs of the population.

Considerations such as an aging population, birth rates and deprivation will all influence the pattern of health services that local people need. Other factors such as transport (which has specific relevance for people travelling to and from Gosport and living on the peninsula), advances in technology and changes in primary care services will in turn impact on what can be provided locally to meet these needs. Both Fareham and Gosport Borough Councils have consistently stated that changes in the local population, such as new housing developments, have not been fully considered in the pattern of health services that is being suggested across south east Hampshire. In the context of the current consultation this issue has now reached the point where different populations in the Fareham and Gosport area are concerned that they may be disadvantaged, or have access to services compromised, by a decision to site a particular service in another part of the patch. The current debate over the range of services to be provided at the Coldeast Community Hospital is a specific example of this point. We consider this to be divisive and unhelpful. It is essential that there is clarity regarding the health needs of people living in both Fareham and Gosport and how the options presented in the consultation document will be able to meet these needs.

Additionally the Committee is mindful that the NHS has made very specific commitments to people living on the Gosport peninsula in terms of the health services that would be provided. People living outside this area must be confident that these commitments will not compromise the delivery of health services able to meet their needs in the future.

Following on from this point there are a number of more specific issues that we would appreciate your comments on:

· Page 13 of your analysis of activity provides a profile of deprivation in local authority wards within Fareham and Gosport. What assessment has been made of the impact of the options currently subject to consultation on these populations?

· Page 11 of your consultation document is clear that the Queen Alexandra Hospital will take on acute inpatient work once it is redeveloped. In the meantime the treatment centre at the Royal Hospital Haslar is actively contributing to reducing waiting times for elective orthopaedic patients. Our understanding is that demands for acute trauma services are continuing to build. Given this point, has any modelling been done to test the scope for the continuation of a separate elective orthopaedic treatment centre for people in south east Hampshire? This could further reduce waiting times and absorb elective capacity displaced by pressures on emergency trauma services at the new Queen Alexandra Hospital. In other areas of Hampshire the case for the separation of elective/routine care from emergency and specialist care is being actively explored and we would be interested to know if the options for a similar pattern of services in south east Hampshire have been considered

· We strongly support the development of community hospital services in both Fareham and Gosport. It would be helpful to have confirmation that, in its role as commissioner of services on behalf of local people, the PCT will ensure that there in sufficient capacity in the facilities provided to deliver an increasing amount of care either in the community hospital or primary care setting, in line with `Improving Local Services' and able to meet the growing needs of both populations. We would be particularly keen to see community hospital provision which has the level of flexibility that the new Lymington Hospital will include.

· The use of community hospitals and the contribution that they make to out-of-hours provision was highlighted in the recent House of Commons Health Select Committee Report. Noting the comments in your consultation document on the use of the accident treatment centre at Haslar Hospital we were not clear what work had taken place to explore the scope for linking this service with other out of hours and emergency services across the area. This would secure a new integrated service model able to provide 24 hour cover to people living in Fareham and Gosport and fully utilise these hospitals as facilities at the heart of each community. Two thirds of primary care is now provided out of hours and pressures on general practitioners and other staff require that new ways of working be explored. Minor injury units, walk-in centres and accident treatment centres are different in the level of service they provide and each has a contribution to make to the development of integrated `unscheduled care services' in both Fareham and Gosport. These would complement each other and support ambulance services and A&E. There is no indication in your document that the options associated with these developments have been explored.

· The HealthFit document consulted on by the Strategic Health Authority earlier this year suggests that intermediate care facilities will be developed in south east Hampshire `centred on community hospitals and primary care facilities'. It would be helpful to have further detail of exactly the form that this will take for people living in the Fareham area.

· Remaining with the theme of community hospitals and HealthFit, the SHA document refers to children's services and the establishment of `treatment and transfer protocols, and video consultation with minor injury units and `small' hospitals'. Could you confirm how you envisage these services being provided within the options included in the consultation document?

· We would be interested to learn if the PCT anticipates that there will be scope for further extending the number of out patient clinics in the area beyond 30% to minimise travel for local people

· With regard to the reference to continuing care beds the consultation document makes reference to 80 new nursing home beds for local people. This is different from continuing care and it would be helpful if you could confirm what provision is being made to the way in which the 27 in patient beds at St Christopher's will be re-provided to ensure that there is appropriate provision for older people requiring both continuing care and assessment now and in the future. An indication of how this work is being progressed in partnership with social services would also be appreciated.

A final, slightly broader point on which we would appreciate your comments relates to the arrangements that will be put in place to manage any delays in the completion of redevelopment of Queen Alexandra Hospital. This was originally intended to be signed off in January this year. I understand that the contract has yet to be finalised with the Hospital Company. If this results in a delay to the completion of the redevelopment there is a significant risk that the Ministry of Defence will close the Royal Hospital Haslar without the new provision being available for local people. This point has been raised repeatedly in meetings and other discussions about the future of services in the area and I think we have now reached the stage where we need an assurance that contingency plans will be put in place to ensure that local people have access to the health services that they need.

Cllr Dr Raymond J Ellis C.Chem FRSC

Chairman, Health Review Committee