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 these referrals. It 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. Patient and Public Involvement:

_ Members note feedback from the area meetings includes participants views on key challenges facing the health economy, the main areas for health scrutiny, identification of the working relationships needed to support health scrutiny attached at Appendix A

_ This informs the work programme for 2005/06

2.2. Beyond Healthfit: The Committee:

· Notes the report attached at Appendix B

· Takes action to secure the Local Delivery Agreement (LDA) for south east Hampshire

· Confirms its expectation that all proposals that have the potential to be substantial are discussed with the Committee at the earliest opportunity. Information provided to members to inform this discussion will include the following as appropriate

1. Case of need (as set out in the assessment framework)

2. Contribution to clinical transformation

3. Contribution to financial recovery

4. Contribution to service improvement

5. Substantial service change

6. Section 11 engagement

7. Section 7 engagement

8. Cross boundary implications

9. Clear delivery timeframe/milestones

10. Risks

· That the Committee continues to monitor the delivery of the LDAs across the health economy

2.3. Out of Hours Services

2.4.

That the Committee notes the response of the SHA attached at Appendix C

· That members determine if Out of Hours service provision in Hampshire should be subject to review by the Committee

2.5. Progress with Work Programme: Members note progress with the Health review Committee Work Programme (attached at Appendix D)

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: 30 November 2004

Inquiries Received and Action Taken

Health Review Committee Appendix A

30 November 2004

Feedback from Area Meetings

Synopsis of Key Points

Introduction

In September and October 2004 Hampshire County Council Health Review Committee arranged for three local are meetings across Hampshire. These broadly focused on north Hampshire, Mid and South West Hampshire and Southeast Hampshire. The purpose of these meetings was to bring together the partner organisations to discuss the main challenges facing the local health system and improve understanding of the different roles each organisation has in the new arrangements for patient and public involvement in health.

The participants were drawn from the local NHS organisations, district and borough councils, Patient and Public Involvement Forums (P&PIFs) and neighbouring health overview and scrutiny committees (OSCs).

The meetings provided an opportunity for participants to discuss how local arrangements were working and also invited feedback on three issues

1. Looking ahead: What do you consider to be the main challenges for health services in your area?

2. Making a difference: What do you consider to be the top three issues for health overview and scrutiny in the coming year?

3. Working Relationships: What are the key working relationships that need to be in place to enable your organisation to engage with the new arrangements for health scrutiny. Do you feel that these are developing, if not what action needs to be taken to address this?

The responses received are outlined below. These will included with other comments identified at the informal meetings currently taking place with district authorities and NHS Trusts to shape the work programme in the coming year.

Main Challenges

A major challenge for the NHS related to the implementation of `Beyond HealthFit'. The financial pressures underpinning service reconfiguration, matching demand with resources and continuing to meet targets were specific areas highlighted by the NHS. The need to build `real' partnerships with other NHS organisations as well as OSCs and P&PIFs was also identified.

Local Authorities mirrored a number of these issues although from the perspective of the timeframes for scrutinising proposals. Particular concerns were raised about `Beyond HealthFit' being driven by financial pressures rather than the needs of local people.

P&PIFs identified the need for `genuine ` consultation with patients and the public and the need for joint working across the statutory sector and voluntary organisation.

Other common themes highlighted as challenges included

_ Out of hours and emergency care

_ Dental services

_ Partnership working

_ Managed care

Making a Difference- the top three issues for health scrutiny in the coming year

NHS respondents focused particularly on the need for OSCs to understand the need for change and respond appropriately to `Beyond HealthFit' and associated consultation. Equal importance was placed on the need for the implementation of `Beyond HealthFit' and delivery of financial balance to be addressed by OSCs

Broad themes from Local Authority respondents emphasised cross cutting work supporting the scrutiny function, including transport, public health and between health and other service providers. Recruitment and retention of staff was also raised.

P&PIFs wanted OSCs to work with them more closely.

Common areas for scrutiny in the coming year highlighted included

_ Effective delivery of the public health agenda, including work with vulnerable groups

_ Out of Hours, walk in centres and emergency care

_ Partnership working/delivery of the duty of partnership across health and social care

_ Integrated services for older people, including hospital admission and delayed transfers of care

_ Transport. Including patient transport and public transport

Key working relationships: development and action

Generally the message was that progress was beginning to be made but all commentators acknowledged that this was an evolving process. More work needed to be done to build trust and understanding of the roles the different contributors to the new system.

Recurring comments referred to the need for consistency in communications, as early as possible and awareness that different issues will need different solutions.

Opportunities to develop common protocols or priorities for action were identified by the NHS.

Local Authorities noted that there were tensions between different NHS organisations and the NHS and other service providers.

Hampshire County Council Appendix B

Health Review Committee

Informal Briefing Note: `Beyond HealthFit: Local Delivery Agreements

Introduction and Background

The Health Review Committee has been pressing the Strategic Health Authority for details of the Locality Delivery Agreements (LDAs) that will underpin the delivery of `Beyond HealthFit' since the summer of 2004. Previously to this information was requested on the engagement of local people and communities in response to the `HealthFit'.

The Committee has recognised the significant challenges facing the NHS in Hampshire and the Isle of Wight; these have been exacerbated by the continuing deterioration in the financial position. The Committee has been clear in its expectation that any proposals for changing services in the Hampshire should be discussed the relevant overview and scrutiny committees (OSCs) at an early stage to

determine:

1. If the change constitutes a substantial variation or development

2. The timing and content of the consultation process.

Where it is agreed that the proposal does constitute a substantial change the response of the OSC(s) to the subsequent consultation process will be shaped by the following considerations:

1. Has the consultation process been appropriate in terms of timing and content, including the delivery of Section 11 requirements

2. Is the change proposed in the interests of the health service in the area: this requires that the OSCs affected have an understanding of the case of need and rationale behind the proposal, and the options considered

In order to facilitate the delivery of `Beyond HealthFit' the SHA has arranged a briefing session for OSCs and Patient and Public Involvement Forums on the 10 November. The Local Delivery Agreements to be shared with members to date focus on work in

_ Mid and South West Hants cluster (received 26 October)

_ North Hants cluster (received 3 November)

_ South East Hants cluster (not received)

In response to a request from the Committee to give a context to the information from the clusters the SHA prepared a short briefing note. This is attached at Annexe One to this note.

The LDAs and up-dates on progress shared with the Committee consist of a considerable amount of detail, some elements of which remain unfinished. They are available for viewing on request or can be sent electronically.

This note summarises the LDAs received to date and highlight issues that those members attending the event on 10 November may wish to explore in more detail.

Key issues

There are a number of issues that need to be considered in the LDAs that will provide members with the information they need to determine if:

1. The proposal is substantial and therefore subject to formal consultation with the OSC.

2. If the proposal is in the interest of the health service in the area

This information will be drawn from

_ Understanding the rationale behind proposals and the contribution they make to `Beyond Health Fit' in terms of

o Clinical transformation

o Financial recovery and affordable services

o Service Improvement

o Delivery of national targets

_ Clarity about whether the change is substantial in nature and the consultation process to be followed

_ Evidence that section 11 engagement is in hand or planned

_ Identification of any risks associated with the projects

_ Clarity about the timeframes for delivery

It is not possible to determine if there is a strategic rationale to the project areas identified from the information provided. `HealthFit' set a clear direction of travel for service reconfiguration and it is important for the Committee to be able to understand the local factors that shape proposals. Equally it is clear that some issues, such as neonatal services, need to be dealt with at a more strategic level and it is not clear how this work will be supported across clusters.

Mid &South West Cluster

The 21 projects included in this plan relate to a range of clinical services and the management of support functions based on five programme areas

1. Children and families (lead Rod Halls)

2. Surgical services (lead Mark Hackett)

3. Unscheduled care (lead Brian Skinner)

4. Long term conditions/chronic disease management (lead John Richards)

5. Prescribing/medicines management. (Lead Chris Evernett)

No financial savings are identified for 2004/05 and just £2 million have been identified for 2005/06. A number of projects will require some additional capital/revenue investment.

The plan- originally developed in July 2004 includes a number of timescales for delivery that have already slipped. General comments at the informal meetings suggest that two major areas of development will be deferred (neonatal services and maternity services). A major area of reconfiguration will be surgical services and it is anticipated that the case of need supporting any proposals for changing these services will be developed over the next few months. Where they exist the references to patient and public involvement are not sufficient to allow for and informed view of compliance with either section 11 or section 7 duties.

The specific projects included in the plan relate are listed below:

1. Obstetrics and Paediatrics

2. Midwifery led review

3. Neonatal intensive care

4. Neonatal Intensive care unit

5. Soton & Winchester treatment centre

6. Treatment Centre Commissioning

7. Overall plan for surgery

8. Single surgical service

9. Joint Urology service

10. Vascular Surgical service

11. Whole system orthopaedics

12. Unscheduled care

13. Refocusing points of access to A&E

14. Prescribing/medicines management

15. Pathology Rationalisation

16. Pharmacy Rationalisation

17. Decontamination Rationalisation

18. Rationalisation of non clinical support services

19. Estate Rationalisation

20. Informatics

21. Financial recovery Plan

North Hampshire

The 10 projects included in this plan relate to a range of clinical services and support functions. Each project identifies the contribution that will be made to financial recovery and the risks associate with these, including those projects that require additional funding to deliver the anticipated benefits.

The LDA-, which combines the north and north east Hampshire plans-includes a number of timescales for delivery that have already slipped. Where they exist the references to patient and public involvement are not sufficient to allow for and informed view of compliance with either section 11 or section 7 duties.

The specific projects included in the plan relate are listed below:

1. Managing demand-scheduled care

2. Managing demand-unscheduled care

3. GP commissioning-scheduled care

4. Review of Tertiary Services

5. Medicines Management

6. Workforce Review

7. Radiology/Pathology procurement

8. Management Integration

9. Commissioning savings-Continuing care, special placements, high cost treatments

10. Maternity Services

Appendix B Annexe One

Briefing Note

Health in Hampshire and the Isle of Wight

1. Introduction

1.1 This briefing note explains the background to the HealthFit and Beyond HealthFit programmes and the recently-produced Locality Delivery Agreements that will be the focus of the Health and Scrutiny Event to be held in Winchester Guildhall on Wednesday 10^th November.

2. HealthFit

2.1 The Franchise Plan of 2002 identified a need to:-

· plan and secure capacity

· recruit, retain and develop the workforce

· achieve financial balance

· address service configuration

2.2 The HealthFit project came about from the need to address service configuration. Launched in December 2002 its aim was to achieve "An agreed strategic framework for the development of sustainable, affordable and efficient health services in Hampshire and the Isle of Wight, which meet the health care needs of the population and deliver the NHS Plan". HealthFit concentrated on five key areas (see 2.4) which were chosen as those most likely to contribute to this aim.

2.3 Factors driving change included:-

· Workforce issues e.g. European Working Time Directive and recruitment, training and retention of staff

· Pressures towards centralisation e.g. increasing medical specialisation

· Pressures towards localisation e.g. development of primary care

· Changing attitudes to health

· Information management and technology

· Escalating costs of health services

· Addressing health inequalities

2.4 The HealthFit Strategic Framework document was published in January 2004 and focussed on five clinical areas:-

· Maternity services

· Paediatric services

· Services for older people

· Emergency care services

· Cancer services

3. The Wider Context

3.1 HealthFit and its successor, Beyond HealthFit, are one (important) part of planning for health services in Hampshire and the Isle of Wight. The development and subsequent delivery of plans needs to take place alongside:-

· Delivery of the NHS Plan and NHS Improvement Plan targets, including:

¬ Elective access

¬ A&E

¬ Booking

¬ Ambulance

¬ Financial balance

· National Service Frameworks implementation

· System reform agenda:

¬ Choice

¬ National Programme for IT

¬ Foundation Trusts

¬ Payment by results

· Pay reform agenda

4. Beyond HealthFit

4.1 By spring 2004 real success had been achieved

· Sustained performance against national targets

· Improved star ratings

· Good examples of modernisation

4.2 Nonetheless there remained a number of unresolved critical challenges:-

· Sustainability of clinical services = need for radical transformation

· Unaffordable health system, resulting in increasingly demanding (and undelivered) savings targets = deteriorating position

4.3 The Beyond HealthFit programme was the health community's response to this and focuses on 4 areas:-

· Clinical transformation (previously HealthFit)

· Financial recovery

· Process modernisation

· Refocusing leadership

4.4 The work streams and projects encompassed in Beyond HealthFit are described either within the SHA Work Programme (for projects that are either clearly the responsibility of the SHA or would benefit from a pan-HIOW approach) or within Locality Delivery Agreements.

5. Locality Delivery Agreements (LDAs)

5.1 LDAs are the focus of the event on 10^th November. The NHS, working in localities, will share outline thoughts and ideas with Overview and Scrutiny and Patient and Public Involvement Forum colleagues and explore how we should engage people in the ongoing development of LDAs.

5.2 LDAs are a collection of initiatives being worked on collectively by PCTs and Trusts in the four geographical localities across Hampshire and the Isle of Wight:-

· Isle of Wight

· Mid and South West Hampshire

· Northern Hampshire

· Portsmouth and South East Hampshire

5.3 They are the PCT and Trusts' response to the challenges and opportunities identified in HealthFit and Beyond HealthFit and are owned and driven by the local organisations and will therefore be different in each locality.

6. Other information

6.1 Further information on HealthFit can be obtained from the Strategic Health Authority's website www.hiow.nhs.uk/healthfit/html

6.2 The Strategic Framework and a range of other documents will be available at the event in the refreshment area.

Hampshire County Council Appendix C

Health Review Committee; 30 November 2004

Out of Hours Services: Response from Strategic Health Authority

The Committee contacted the Strategic Health Authority (SHA) on the 30 September 2004 requesting additional information on a range of issues associated with these services. The specific points raised are set out below- with the response of the SHA in italics

1) Given the experience of the Isle of Wight health economy as an exemplar in OOH provision, and the progress with providing a fully integrated model of unscheduled care, how is the learning from this being used to inform other clusters in Hampshire

You will remember that the Pan Hampshire Out of Hours Group is a forum which meets regularly and is one where lead officers discuss the provision of service in some detail and share good practice. At these meetings, the Isle of Wight team will have had an opportunity to present their experiences, principles and lessons learned to the other cluster lead officers for consideration. In addition, county wide events were held on 9 June and 25 October to further these aims.

2) Given the significant deficit facing the NHS in Hampshire and the Isle of Wight, what assessment has been made of the costs of providing these services and is this funding available

All cluster plans have included comprehensive costings, which will now be reflected within PCT Local Delivery Plans and monitored through that process, with PCTs reporting monthly to the SHA on their financial position. The quarterly review process looking specifically at Out of Hours services includes representatives from the SHA performance management and finance teams, public health and clinical governance, the emergency care team and the Department of Health. The SHA has developed robust performance and financial management procedures to ensure compliance with regulations.

3) Is there a lead identified for taking this work forward in Hampshire and the Isle of Wight or is this being taken forward within each cluster

Centrally, both our Strategic Health Authority (SHA) primary care lead and financial lead work closely together to take this work forward, otherwise, the delivery and development of services rests with PCTs. This work links to the Unscheduled Care Project within the Beyond HealthFit work stream.

4) What patient and public involvement will underpin the local development of OOH services. Who will lead this

Each PCT is responsible for developing strong and lasting links with their Patient and Public Involvement Forums (PPIF) on this issue. During the review of cluster plans earlier this year, the central PPIF function from within the SHA was represented on the Review Panel.

5) What account is taken of journey time if a patient is asked to attend a centre

Agreement is sought with the patient upon contact and decisions about journey time are reached at that time. If at the point of first contact the patient indicates that they are unable to get to a centre, this information will determine if a home visit should be arranged.

6) What happens if a patient does not have transport

Where a patient does not have their own transport a range of options are available, but these vary somewhat within individual clusters.

7) Is the appropriateness of referrals to 999 or A&E assessed? If so by whom

The appropriateness of referrals to both A&E and 999 are continually assessed with dialogue established between the PCTs and Acute and Ambulance Trusts. The SHA through its performance management function, monitors both volumes of attendance at A&E and 999 journeys. The Out of Hours service providers are encouraged to utilise their individual emergency care networks to determine any impacts.

8) What evidence is there that service providers are able to meet the quality standards for face to face consultations within the agreed timeframes

In addition to conforming to national Carson Standards, each cluster has its own additional set of quality standards which is monitored by PCTs.

9) What are the options for providing OOH forward within different clusters and how is this involving A&E departments, ambulance services, social services and other providers of unscheduled care

The SHA, in conjunction with the Ambulance Trusts and the Modernisation Agency, recently held a workshop on the development of Unscheduled Care Services generally. This workshop re-emphasised the need to develop unscheduled care to incorporate Out of Hours Services. Future models are still being developed with NHS Direct and the Ambulance Service in particular, studying these issues.

10) How has the demand for these services been established to ensure that there is sufficient capacity in OOH provision

Cluster Plans map the level of current service and contain comprehensive models of service delivery into the future. These are continually being re-assessed to ensure that capacity meets demand and to refine existing plans once clusters have gone live.

11) Is demand mapped to identify peaks and troughs

Yes, that is correct.

12) What account is taken of patients with special needs living in the community? How are these defined

I can reassure you that the requirements of patients with specific and special needs are factored into plans and developments. Often, calls are made by a third party on behalf of the patient, it is that this point of contact that information regarding special requirements will be established and recorded, in order that the service can respond to the patient in the most appropriate manner. Some PCTs are working with contractors on notifying Out of Hours services regarding all clients with special needs living within the community, in order that details are recorded and later recognised.

13) What account is taken of people receiving specialist care living in the community (e.g. people with mental health illness, people with chronic conditions, people who are terminally ill)

Again, a key measure for change within the local NHS is how we improve services for patients with both chronic and long term conditions.

14) What account is taken of the needs of patients who work and need non-emergency access either in the evening or at week-ends

PCT work closely with General Practitioners to ensure that services are suitable for all patients, including those who work and those who need non-emergency access. The development of Walk In Centres and Primary Care Centres have been paramount in assisting us in this aim. The SHA closely monitors the impact of Out of Hours services against national standards.

Hampshire County Council Appendix D

Health Review Committee

Briefing for Members: 30 November 2004

Progress with 2004/05 Work Programme

Introduction

1. This paper sets out progress with the agreed 2004/05 work programme for the Health Review Committee at 31 October 2004.

2. The Committee has continued to build a constructive approach to health scrutiny across Hampshire County Council service providers and with partner organisations. Emphasis in the last 7 months has been on:

a. Consolidating working relationships with partners in the NHS, Local Authorities and Patient & Public Involvement Forums (P&PIFs)

b. Taking forward a programme of thematic reviews aimed at improving local service delivery

c. Managing referrals and inquires from partner organisations

d. Responding to proposals from the NHS to substantially change or vary health services

3. Action has also been taken to follow up progress with the implementation of recommendations made by the Committee, provide a framework against which the NHS can assess proposals to change services and raise the profile of the Committee with NHS and other partner organisations.

4. The next sections of this report describe this work in more detail.

Consolidating Working Relationships

5. The Committee has hosted and contributed to a number of local events. These have been aimed at raising awareness and understanding of the role of the Committee and its links with arrangements for patient and public involvement in health. This has included:

a. Hosting an event for NHS Chairmen and Chairmen and lead officers from Health Overview and Scrutiny Committees in Hampshire and the Isle of Wight (4 May)

b. Hosting three local area meetings for P&PIF Chairmen, lead members and officers from district authorities NHS Chairmen and Chief Executives. These meetings were held in mid & south west Hampshire (8 September), north Hampshire (29 September), south east Hampshire (11 October). The events were structured to be as participative as possible and invited feedback on

i. The main challenges facing health services in the area

ii. Issues to be considered by the Committee for review in the coming year

iii. The working relationships necessary to support the effective delivery of health scrutiny.

This information has been collated to inform the work programme for 2005/06 and is attached at Annexe One.

6. Over the next two months the Chairman and lead officer will undertake a series of informal visits to all district authorities and NHS organisations in Hampshire. Feedback will be invited on the way the Committee has discharged its responsibilities in the last year and key issues for scrutiny in the coming year.

7. In May 2004 a dedicated web site for health scrutiny was launched (www.hants.gov.uk/healthscrutiny) to make information about the role of the Committee more accessible to local people. The site includes general information about health scrutiny, details of locally specific work undertaken by the Committee and links with other overview and scrutiny committees and health organisations operating in Hampshire and the Isle of Wight. This site will continue to be developed and expanded subject to funding availability.

8. Committee meetings are preceded by briefings from NHS partners to up date members on key issues. Topics covered since April 2004 include

a. `Beyond HealthFit'

b. Developments in NHS dentistry

9. The Chairman of the Committee has maintained a regular presence at the Strategic Health Authority Board meetings and Portsmouth City Council Health Scrutiny Committee meetings.

Reviews of Health Services

10. The Committee has identified the following four key criteria to guide members when selecting topics for review:

a. Capacity to influence and improve the service under consideration

b. Timeliness and relevance to local health services

c. Issues not under consideration elsewhere

d. Issues not subject to other scrutiny or performance monitoring activities

11. The review programme for 2004/05 included:

a. Access to therapy in schools (lead member Cllr Mrs McNair Scott)

b. Access to foot care for people with diabetes (lead member Cllr A Dowden)

c. Administration of medication in schools (lead member Cllr R Ellis)

12. Work on the first two reviews is now well advanced and draft reports will be shared with the Committee in November with a view to finalising the reviews in January. Initial investigations into the administration of medicines in schools indicated that sound systems were in place for managing these arrangements and there was therefore little scope for the Committee to further influence this.

13. The Committee has also asked for progress reports on the implementation of recommendations for action arising from previous reviews of services. The responsible bodies will therefore be invited back to up-date the Committee on progress on 30 November and 29 March.

Health Inquiries and Referrals from Partners

14. P&PIFs have the right to raise issues of concern to the Committee for further investigation. This work strand has therefore been designed to provide a route through which referrals from the Patients Forums and other partner organisations can be explored and acted on by the Committee without resort to a formal review. Issues of this nature considered by the Committee, and the action taken, are fully reported in the agenda papers and have included the following topics since April 2004.

a. Diagnostic &Treatment Centres

b. NHS Direct (x2 visits in May 2004)

c. Arrangements for patient and public involvement in health

d. Progress with Lymington PFI bid

e. Differential Tariffs paid by PCTs

f. Redevelopment of Queen Alexandra Hospital and services in south east Hampshire

g. Out of Hours Provision

h. Changes to PCT management arrangements (`Refocusing Leadership)

i. Foundation Hospitals

15. Where appropriate briefing papers and any associated correspondence is included in the agenda papers (these are available on the web site).

Proposals to vary or develop health services

16. The NHS has a statutory duty to consult the Committee on any proposals to substantially vary or develop health services provide to local people. Any changes planned therefore need to be discussed with the Committee at an early stage in order to determine if the proposal is substantial any how any formal consultation required will be undertaken.

17. In determining if a proposal is substantial the Committee considers the impact of the change on those using, or who may use the service in question, including carers. The acceptability of the change to patients and any implications for other service providers are specific areas of interest to the Committee.

18. More detailed information of the way in which the Committee will determine if a proposal is substantial is included in the 2003/04 Annual Report. This will be reviewed in the second part of 2004/05 to endure that changes to legislation (such as the Race (Amendment) Act 2000) and public health requirements are included. This will form the basis of an additional piece of work with other Health Scrutiny Committees in Hampshire and the Isle of Wight and NHS partners to agree a framework for assessing if a proposal represents a substantial change in service provision.

19. All proposals for changing NHS care considered and responded to by the Committee, with any interim reports, are included in the agendas papers and are available on the website.

20. Responses to consultation in the since April 2004 have included:

a. Reprovision of rehabilitation services at `the Mount' Hospital, Bishop stoke

b. `HealthFit' Strategic Framework

c. Mental Health Service Provision in North East Hampshire and Surrey (Joint response with Surrey Health Scrutiny Committee)

d. Foundation Hospitals (x5 applications affecting the population of Hampshire)

21. In addition the Committee has formally scrutinised the decision of Winchester and Eastleigh NHS Trust to close inpatient services at the Mount Hospital on the grounds of patient safety.

Joint Committees

22. Regular Joint meetings are held with the Chairmen and lead officers for Portsmouth City Council, Isle of Wight Council and Southampton City Council. These provide the opportunity for sharing information and agreeing how to respond to joint issues of concern. The Chairman of this Committee is currently Cllr R Ellis.

23. Additionally the Chairmen and lead officers for all Health Overview and Scrutiny Committees in the southeast region meet on a regular basis. Links have also been established with Health Overview and Scrutiny Committees operating in north Thames. This provides the opportunity for collective action in relation to issues of concern.

Looking Ahead

24. The Committee has commented extensively on the key challenges facing the health economy in Hampshire. The financial deficit facing the local NHS and the effect of nationally determined policies each have to potential to have a significant impact on health service provision to local people. Specific areas of concern identified by the Committee include

a. Changes in out of hour's arrangements in primary care and integration with other unscheduled/emergency services. Further information has been requested about the way in which these services are being rolled out across Hampshire. It is hoped this will give a factual basis for understanding consistency in provision and service quality. It is not currently clear if full use has been made of existing services, such as those provided by Hampshire Ambulance. This is likely to be a key issue for local people in the coming months.

b. The configuration of health services in southeast Hampshire and the delays in agreeing financial close on the private finance initiative contract. Current projections suggest that this work will not be completed until summer 2008.

c. The implications of `Beyond HealthFit' and the consequences for local people as hospital services are reconfigured around different clinical specialties.

d. Implementation of the new public health `White paper'