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 assess 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 Ambulance Trust:

2.1. The Committee has been advised of the steps taken by Hampshire Ambulance to ensure that patients experiencing falls are dealt with appropriately.

2.2. This information has been shared with colleagues in social services.

3. Mid and South West Hants Cluster: surgical services reconfiguration

3.1. The Committee has been apprised of the intention of the review the options for a reconfiguring surgical services across SUHT, WEHT, Lymington Hospital and Andover Hospital.

3.2. The lead individual for this work will be Mark Hackett, Chief Executive of SUHT

3.3. The case of need, and the options for providing surgical services to this population needs to be established to allow members to determine if the changes are substantial.

3.4. A presentation will be made to members on early thinking about the way in which this work will roll forward. A briefing note on the emerging service strategy for SUHT is attached at Appendix One.

3.5. The framework for assessment attached at Item 8 of this agenda will inform this process

3.6. It is anticipated that other OSCs will be affected by any proposals to vary or develop these services- confirmation of patient flows is therefore necessary.

4. Winchester and Eastleigh Health Care Trust: temporary closure of Endoscopy Services at Andover Hospital

4.1. WEHT has apprised the Committee of urgent action in response to identification of a contaminant in the endoscopy suite at Andover Hospital.

4.2. The events that led to this discussion are attached at Appendix Two.

4.3. It is anticipated that the action required to address the problem will be available in February

4.4. Action is being taken to provide an alternative service and ensure that GPs, patients and staff are aware of the alternative plans.

Items Requiring Action

5. Blackwater Valley and Hart PCT: Modernising Health Services at Fleet Hospital

5.1. Following consultation with local people in early 2004 Blackwater Valley and Hart PCT has been working with local stakeholders to identify affordable options for developing Fleet Hospital.

5.2. The resultant options are now out to public consultation. This will commence on 1 December and conclude on the 25 February

5.3. The proposal is attached at Appendix Three

6. Maternity Services in South East Hampshire

6.1. Portsmouth City Council Health Overview and Scrutiny Committee is taking the lead in co-ordinating the joint committee to consider the proposal. The date for the commencement of formal consultation is still to be confirmed.

7. Planning Future health Services in Fareham and Gosport

7.1. Arrangements by Fareham and Gosport PCT for conducting the formal consultation on the future pattern of health services in Fareham and Gosport have been previously shared with the Committee.

7.2. The response of the PCT to the request for further information is attached at Appendix Four

7.3. An extraordinary meeting of the Committee had to be deferred due to delays in publishing information on the financial appraisal of the options under consideration by the PCT.

7.4. The meeting has been rearranged for 26 November.

7.5. The Committee will consider the outcome of the consultation process and the preferred option to be presented for consideration by the Trust Board.

7.6. Partner organisations from Fareham and Gosport will be invited to attend the meeting to share their views on the options presented.

7.7. The interests of the Committee when considering the proposal from Fareham and Gosport PCT 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

8. Department of Health: Future Arrangements for the support of Patient and Public Involvement in Health

8.1. On 5 November the Department of Health launched a consultation on the arrangements for the future of patient and public involvement in health. This will end on 30 January.

8.2. A short briefing note on the points to be considered is attached at Appendix Five

Recommendations

9. Mid and South West Hants Cluster: surgical services reconfiguration

9.1. The Hampshire and Isle of Wight joint Committee is advised of the OSCs whose populations will be affected by the proposed changes

9.2. The Committee is briefed on the joint arrangements established

9.3. The framework attached at item 8 informs the development of the proposals

10. Winchester and Eastleigh Health Care NHS Trust: temporary closure of Endoscopy Services at Andover Hospital

10.1. The Committee is apprised of the any decisions taken with regard to the Endoscopy service at Andover Hospital at its meeting in March 2005.

11. Blackwater Valley and Hart PCT: Modernising Health Services at Fleet Hospital

11.1. Any comments members wish to make to the PCT on the proposal are sent to the Chairman by the 7 February 2005.

12. Maternity Services in South East Hampshire

12.1. The Committee seeks clarification on the date for commencing formal consultation

13. Planning Future Health Services in Fareham and Gosport

13.1. Preparatory work for the meeting on the 26 November 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

_ An independent view on the financial analysis produced by the PCT is obtained

_ Invitations to key partner organisations share their views on the proposals developed by the PCT.

14. Department of Health: Future Arrangements for the support of Patient and Public Involvement in Health

14.1. Members advise the Chairman of their views on the proposals by 10 January 2005.

14.2. The Chairman, in consultation with the Chief Executive drafts a response to the consultation on behalf of the Committee

14.3. Members agree the response on 25 January.

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

Appendix One

Southampton University Hospitals Trust

Report to the Board: November 2004

Emerging Service Strategy

Introduction and Background

1.1 In June 2004 the Trust Board considered and approved the five-year service development strategy prepared specifically for the Foundation Trust Application.

1.2 Since this time the service strategy has been refined to reflect:

_ The current thinking on the Beyond Healthfit Programmes of work

_ The current financial position

_ The latest thinking on Payment by Results

_ Becoming a Foundation Trust at some point in the future

1.3 The key themes of the emerging service strategy are set out in this paper for discussion. The Trust is committed to involving staff, patients and the public in the development of the strategy and wishes to work with the OSCs as the themes are developed into a more comprehensive service and financial framework. The Trust Board are asked to support the emerging service strategy for the period 2004/5-2008/9.

2 Our Vision

2.1 Our vision must be focused on:

_ improving the patient experience of our services

_ improving the staff experience at work

_ improving the wider citizens experience of the hospital across the wider economy

2.2 To become a Hospital of Choice we must continue to change and improve our services to meet the growing expectations of patients and their carers. We must develop a sharper focus on improving the working lives of our staff - research suggests that the clinical service offered to patients improves when we do this. Similarly the Trust does not exist in isolation. It works across a complex network of external relationships with the public, elected bodies, councils, universities and citizens. We must listen and respond to what they say to us.

2.3 A series of draft strategies for these areas will be developed during 2005 to set an organisational direction aligned to the service plan outlined within this paper.

2. The Service Strategy

2.1 There is a wealth of local and national research that tells us what patients and the public want from their NHS:

_ Shorter waiting times

_ treatment as close to home as possible

_ modern buildings and equipment

_ responsive and flexible services

_ good quality clinical care

_ clean hospitals they can get to easily

_ more opportunities for involvement and influence

2.2 At the same time, the current model of healthcare in this area is not sustainable in clinical governance, workforce and financial terms. The result of these factors is that the local health community has a substantial underlying financial deficit. Increasing standards for clinical governance and clinical practice, coupled with workforce issues such as Agenda for Change, the Working Time Directive and the Consultant Contract have become primary drivers for change.

2.3 Southampton University Hospitals needs to change what it does, and how it does it, to meet the needs of patients in a model of care which is modern, sustainable and affordable.

2.4 This means that we will:

2.5 Transfer to community settings services which don't need to be provided in hospital. We will see elderly rehabilitation move from Southampton General Hospital to community hospitals across the locality. With our partners we are developing new ways to provide care to patients with chronic and long term conditions such as diabetes, heart disease and respiratory problems. Together these initiatives mean that patients receive care closer to their homes, and often in their homes, and hospital capacity is reduced as it is no longer needed.

2.6 Remove the bottlenecks which mean that patients stay in hospital longer than they should. Many patients' experience in hospital is one of waiting. We are investing in diagnostic tests such as MRI, CT and endoscopy to speed up the care that our patients need. Day surgery - rather than inpatient surgery - is increasingly seen as the norm for planned operations. We are streamlining booking and the scheduling of care to reduce the number of times we cancel planned patient care, to give patients certainty that they will receive their care when they need it. With our partners we are working to eliminate delays in discharge, so that patients can be cared for in the most appropriate environment for their needs at every stage of their journey through the healthcare system. These changes will enable the Trust to remove capacity it does not need and invest in the capacity it does.

2.7 Reconfigure Surgical Services. We are working with the other hospitals in the area to review the provision of cancer surgery, emergency surgery and elective surgical services to devise a new single surgical delivery system. With our partners we are working to ensure the most appropriate configuration of surgical services at Southampton General Hospital, Princess Anne Hospital, the Royal South Hants Hospital, the Royal Hampshire County Hospital Winchester, and at Lymington Hospital. This will mean investment in some services and infrastructure particularly critical care beds but some disinvestment where services are duplicated or no longer needed.

2.8 Expand Specialist, Tertiary Services at Southampton General Hospital. We will develop our services for patients with the most complex and acute needs. We are already building a major extension to our cardiac unit, and have plans to grow our oncology and neurosciences services to meet patient demand.

2.9 All of this means that SUHT will be an organisation focussed on the care of the most acutely ill patients. We will invest in critical care services, expanding our Neonatal intensive care unit, and creating an integrated critical care unit at Southampton General Hospital to ensure that our sickest patients receive the care they need.

2.10 This reconfiguration of services will have an impact on our hospitals too.

2.11 We will develop the Southampton General Hospital as the base for our emergency and more serious acute elective and specialist services. We are developing a centre for emergency admissions linked to our Emergency Department. By 2008/9 we will have completed the expansion of cardiac services at SGH and using capacity released through service reconfiguration we will have increased capacity in the Southampton Oncology Centre. We will develop new critical care capacity at SGH and will provide the infrastructure needed to support higher levels of cancer and emergency surgery. We will address the chronic car parking difficulties we face through partnerships with local private companies, the City Council, the University, and other local organisations.

2.12 We hope to connect together Southampton General Hospital and Princess Anne Hospital with a bridge to improve access between the two facilities. We will expand Neonatal Intensive Care and will explore the opportunity to develop Princess Anne Hospital as a Womens and Childrens Hospital.

2.13 The Treatment Centre at the Royal South Hants Hospital will provide the additional capacity we need to bring waiting times for patients down so that by 2008 no patients wait more than 18 weeks from referral to treatment. We are working with our partners to develop the RSH as a show piece mixed care campus that would be the core of the regeneration of its inner city area. As a community hospital for the City of Southampton the RSH will be a base for outpatient and diagnostic services, as well as providing primary care, intermediate care and mental health services for local people. In the medium term we will review the role of the RSH hospital as a provider of surgical services and whether SUHT needs to be the primary owner of this site.

3 Conclusions

3.1 The emerging service strategy sets out what needs to be done over the next five years and some of the ways we are planning to approach this. The strategy will change what we do as a Trust, the way staff work within the organisation, and the way we use our assets. Success will be dependent on changing the way we work with our partners, overcoming the boundaries that exist between organisations.

3.2 We wish to engage with staff, patients and the public, and the OSCs, to discuss and debate this strategy as it is developed into a more detailed service and financial framework.

3.3 The Trust Board are asked to support the emerging service strategy for the period 2004/5-2008/9.

Paul Gray

Acting Director of Planning

Appendix Two

WINCHESTER AND EASTLEIGH HEALTHCARE TRUST

BRIEFING NOTE

ANDOVER ENDOSCOPY SERVICES - URGENT ACTION

In late August 2004 it was discovered through routine sampling that there was a contaminant - Pseudomonas within the Endoscopy washer at Andover War Memorial Hospital. Services were therefore stopped and there have been multiple attempts to decontaminate the system (see chronology of events below).

However, it has not been a simple process to rid the system of the contaminant. The manufacturers, sub contractors, estates and infection control department have been heavily involved in the process. Throughout this there has been no known cases of patient infection.

To manage the patients referred for Endoscopy / Cystoscopy, the Trust has run additional clinics for Endoscopy at Romsey and the Royal Hampshire County Hospital and has also treated cystoscopy patients within the Day Surgery Unit at the Royal Hampshire County Hospital. The Trust has sent out letters to patients who had been referred and to their GP's.

It was anticipated, that following thorough decontamination of the system, the Trust would be able to install new equipment and resume Endoscopy patient services at Andover the week commencing the 25^th October 2004.

Although the above action was completed, unfortunately following the installation of this new equipment, further cultures of pseudomonas have developed within this new system. The service has therefore been suspended until February 2005 pending a full business case to establish what is required to provide a safe service. The Trust is working with the PCT to issue joint communications to GPs and patients and arranging meetings with staff. Alternative arrangements for the treatment of patients are in progress at RHCH and Romsey.

CHRONOLOGICAL ORDER OF EVENTS

Joanna Paul

Director of Operations & Performance

JP/lam

16^th November, 2004

Appendix Three

DRAFT - V1.0 (1/11/04)

DRAFT - V1.1 (12/11/04)

Modernising Health Services Provided at Fleet Hospital

Public Consultation on proposal starts on 1^st December 2004 and ends on 25^th February 2005

Background

Between November 2003 and February 2004 Blackwater Valley & Hart Primary Care Trust consulted with the public on proposals relating to the provision of rehabilitation services for older people at Fleet Hospital.

Following this public consultation period there was a lot of support for the concept of Fleet Hospital as a Centre of Excellence and the development of the Intermediate Care services. However some key stakeholder groups and sections of the public remained concerned about some aspects of the proposals. These were specifically:

· Removal of 12 EMI beds from Cox Ward

· Proposed use of Cox Ward for office space for the intermediate care team rather than clinical activity

· Viability of the remaining 18 beds

In April 2004 the outcome of the consultation process was reported to the Primary Care Trust Board and at this meeting it was agreed to work with local stakeholders to develop affordable options, within agreed parameters, that build on aspects of the original Primary Care Trust's proposals that were supported and address the other aspects. This consultation document will seek the opinion of the public on two options.

· Option 1 - 6 beds returning to Cox Ward

· Option 2 - The introduction of a new model of care for the existing 18 beds at Fleet Hospital and Cox Ward being used for additional clinical activity and to support the development of a Day Assessment Unit

The public are asked to provide the PCT with their views on the proposals.

Setting the Scene

This is a time of great change in the NHS. New contracts for GPs, dentists and pharmacists, more patient choice, a major change to the way in which health services are paid for, modernising the way that services are delivered to improve the patient's overall experience and reducing waiting times for and during treatment.

Primary Care Trusts have three core functions, to:

· Improve the health of the population

· Ensure we provide primary care community care and work to integrate those services

· Commission health care from other Trusts

The PCTs aim is to provide services, based on need, which are safe, sustainable and affordable for its population of 180,000. To achieve this we constantly review the way local healthcare is provided in order to meet modern needs.

Currently, unscheduled, or unplanned, care creates a significant burden on the health service both in terms of finance and organisation of services. A recent publication by the Department of Health estimates that 80% of bed days in hospital are currently used by emergency admissions (DH 2004 Chronic Disease Management: a compendium of information).

In recent years, a number of models of care have been piloted across the UK to test whether elements of the care for this group of patients - particularly those with chronic disease - can be managed more effectively to avoid unscheduled admissions to hospitals. The Primary Care Trust plans to put into place a generic model of `managed care' for the elderly and people with chronic disease to help them effectively manage their conditions at home and in the community thus preventing unnecessary admissions to hospital or if an admission is necessary it can be a community hospital admission rather than an acute hospital admission.

The local model of care is to ensure that any person in ill health will have their needs met through local services that prevent wherever possible the need for admission to hospital.

Patients will receive appropriate hospital care when it is needed. The service goal is to return them to their own home as soon as possible with the necessary support.

With these developments in mind the Primary Care Trust proposes to use the existing 18 inpatient beds at Fleet Hospital more effectively and appropriately for the needs of the local population and to introduce additional services to Fleet Hospital to support the managed care agenda.

Option 1

6 beds returning to Cox Ward

Fleet Hospital is a community hospital providing a mixture of inpatient, outpatient and diagnostic services.

Prior to 1998 Fleet Hospital had 30 inpatient beds. Following "The Right Balance" document (1998) the beds were reconfigured to provide Elderly Mental Ill (EMI) beds, consultant led beds and beds for use by local GPs The EMI beds were housed in Cox Ward and the consultant and GP led beds in Calthorpe Ward.

In 2003 the 12 EMI beds in Cox Ward transferred to Farnham Hospital. Farnham Hospital offers specialist facilities for EMI patients and the surroundings are more appropriate for them to be nursed effectively within. The original intention was to bring back 6 beds for rehabilitation purposes to Cox Ward.

As time has moved on these beds have been re-provided in the community at Place Court (social care and rehabilitation beds) and Thurlston House and the Primary Care Trust has commissioned 12 specialist rehabilitation beds at Farnham Local Care Centre (FLCC).

As described above it is no longer appropriate for the EMI beds to return to Fleet Hospital. However, if local opinion is that 6 beds should return to Fleet they could only return as rehabilitation beds. The cost of this to the Primary Care Trust would be approximately £180,000 per annum. There will also be an estimated capital cost of £200,000 attached to this that will need to be spent to bring the ward up to the health and safety standards expected of a NHS inpatient facility.

The money attached to the original beds has been used to provide additional beds in the overall system as described above and has been invested in the provision of community services. There is no additional money available to support more beds at Fleet Hospital. As a comparison to bed costs the following community resources and combinations of these community resources can be purchased for £180,000:

? x District Nurses

? x Health Visitors

? x Physiotherapists

? x Occupational Therapists

Option 2

The introduction of a new model of care for the existing 18 beds at Fleet Hospital and Cox Ward being used for additional clinical activity and to support the development of a Day Assessment Unit

The existing 18 beds that constitute Calthorpe Ward at Fleet Hospital could now be used as follows to use them more effectively and appropriately to support the current needs and future needs of the local people and to support the Trust's vision of supporting people in the community wherever possible.

The beds would be grouped in the following way:

· 16 intermediate care beds

· 2 "Flexible beds" - for intermediate care or for use by GPs

A percentage of these beds will be used for patients who require a six to eight week stay for rehabilitation purposes. A further percentage will be for patients who have been admitted by a GP for a short stay and a final percentage will be used for booked medical respite care and for terminally ill patients. These will be primarily nurse and therapy led beds with medical cover being provided by local GPs. Out of Hours the medical cover will be provided by Frimley Park Primary Care Services.

Use of the inpatient beds at Fleet Hospital

Since the end of the previous public consultation the clinical support for Calthorpo Ward had changed with the introduction of the Modern Matron role and the change in the Ward Sister role. This change has had an impact in the way that Calthorpe Ward now runs. An analysis of the bed usage confirms that 18 beds is the number of beds required to support the proposed new model of care. The analysis shows an average bed occupancy of 82%.

Intermediate care services

In addition to these beds the Primary Care Trust has a very effective community based intermediate care team that supports patients and provides patient care in their own home (including residential homes) and consists of:

· Intensive therapeutic rehabilitation

· Nursing intervention, as required

· Physiotherapy and occupation therapy intervention, as required

· Regular assessment or reassessment of needs

Each patient that is referred to this scheme receives a comprehensive assessment. This results in a structured individual care plan involving active therapy and treatment with the aim of maximising independence. An episode normally last no longer than six weeks, although many patients require intervention for shorter periods of time. This services operates 7 days a week and will link closely with the model of care proposed for the beds at Fleet Hospital, with Social Services and with the managed care agenda.

Delayed transfers of care

Greater levels of social care, including more beds, are now allowing increasing numbers of people to be looked after in their own homes or in community settings for longer. This avoids a hospital admission altogether, or reduces the time that patients need to be in hospital. Delayed discharges from hospital have reduced considerably over the past two years. This means that beds do not become `blocked' at Fleet and puts additional bed capacity back into the system and provides patients with the most appropriate care at the most appropriate time and by the most appropriate healthcare professional.

Spot Purchasing

If it becomes apparent that additional bed capacity is required for a short time then the Primary Care Trust has the ability to `spot purchase' beds. This means that we can buy beds with a degree of flexibility as the needs arise.

A Day Assessment Unit for Fleet Hospital

An additional service that is proposed for Fleet hospital is the development of a Day Assessment Unit.

The aim of the service is to provide the older patients in the area with a facility for both medical and therapy assessment and treatment. A multi-disciplinary team will identify the patient's needs during a session and any further investigations, treatments or assessments will be planned. These may include home visits by any member of the team as appropriate in order to offer a comprehensive and holistic approach.

The advantages of the Day Assessment Unit will be that the patient is able to be seen by all relevant practitioners in one session and be brought back for review or further assessment at a later date and be seen by the same team members. Any minor adaptations will also be dealt with and therefore the patient will not normally be included on any further waiting list unless more extensive adaptations are required. Physiotherapy can also be extended to treatment in Fleet Hospital or undertaken at home. Patients can also be directly admitted to the beds on Calthope Ward it necessary therefore preventing an unnecessary acute hospital admission.

The Day Assessment Unit will offer many advantages to patients who often have complex needs and who require the help of more than one professional at any one time for multiple related and unrelated medical and social problems. The value of the multi-disciplinary team is under pinned by good liason that is vital to the success of team working. Liaison not only involves the team itself but includes people who have meaning for the patient, with the patient's permission.

GPs ,members of the intermediate care team, therapists and district nurses will be able to refer to this unit.

Additional Clinical Services for Fleet Hospital

The Primary Care Trust is committed to continuing to develop Fleet Hospital as a local centre for primary and community care. Reflecting this commitment the Primary Care Trust is looking at additional services that could be introduced to the Hospital which will add benefit to the local population. These include the development of a vascular assessment service and working with Frimley Park Hospital and North Hampshire Hospitals Trust to extend the range of outpatient clinics.

It is envisaged that these clinical services will take place in Cox Ward vacated space. The intermediate care team will have some office space allocated to them in this area but the majority of the space will be converted to provide generic treatment rooms that can be used to carry out any clinical activity.

Involving Local People and Organisations in planning the future of Fleet Hospital

As well as consulting local people on these proposals and asking for your views on the development of additional services, the Blackwater Valley & Hart Primary Care Trust has established a Fleet Hospital Stakeholders Group to oversee the local development. This group is instrumental in decisions about changes to the hospital and includes representation from the local community, Hart Voluntary Action Group, the Patient and Public Involvement Forum, General Practitioners, Consultants, The Friends of Fleet, Social Services, Local Council, Frimley Park Hospital NHS Trust and Blackwater Valley and Hart PCT (including staff from Fleet Hospital).

Conclusion

Both options 1 and 2 have been examined for their implications and benefits for patients, the public, the Primary Care Trust and the local care community.

The following criteria were used:

· Assuring standards of care

· Extending access of services

· Ensuring equity of services and funding

· Developing services which promote independence

· Helping older people to stay healthy

· Developing more effective links between health and other services

The preferred option of the Blackwater Valley & Hart Primary Care Trust is Option 2:

The introduction of a new model of care for the existing 18 beds at Fleet Hospital and Cox Ward being used for additional clinical activity and to support the development of a Day Assessment Unit

Option 1 restricts the Primary Care Trust to providing services based on beds whereas Option 2 gives the Primary Care Trust the ability to provide the local population with the most desired, appropriate and effective health care for their needs both now and in the future.

Local patient care is no longer centred on hospital beds. The majority of patients wish to be rehabilitated in their own homes rather than in a hospital and with the increased investment in community services to support this it is now possible for the majority of patients. Some patients need to access to a hospital bed and they will receive appropriate hospital care when it is needed. The service goal ,however, is always to return the patient to their own home as soon as possible with the necessary support.

The Primary Care Trust believes that it is important to have the correct number of hospital beds and enough support services in the community to support its population appropriately and effectively.

As previously explained there is no additional money in the health system to facilitate the return of 6 beds to Fleet Hospital. Therefore, if beds do comeback to Fleet Hospital there will need to be a disinvestments in services that are provided to the community. As highlighted previously this will mean fewer District Nurses, Health Visitors, Physiotherapists and Occupational Therapists all of which play a vital role in caring and supporting for patients in their preferred environment, which is their own home.

The Consultation Process

This Public Consultation starts on 1^st December 2004 and ends on 25^th February 2005.

Copies of the Consultation Document are being sent to all key stakeholders and are being placed in public places; it can also be read on the PCT website www.bvhpct.nhs.uk

A number of informal meetings at local groups and locations are being arranged. If you would like a visit from a representative of the Primary Care Trust, or further copies of the Consultation Document, please contact 01256 312200.

Public Meetings will be held to discuss the proposal as follows:

Harlington Centre, Hart, 7pm

The Tythings, Yately, 2pm

Hook Community Centre 7pm

The outcome of the Consultation will be published and will be discussed at a meeting, in public, of the Board of Blackwater Valley & Hart PCT . The date, venue and timing for this meeting will be advertised.

Making your views known

Comments on the proposal in this Consultation Document can be made by:

· Sending the Response Sheet at the back of this document to the office of: Debbie Glenn, Chief Executive, Blackwater Valley & Hart Primary Care Trust, Winchfield Lodge, Old Potbridge Road, Winchfield, Hook, Hampshire, RG27 8BT. Please mark the envelope `Fleet Hospital Consultation Response'

· Telephoning 01256 312200 or Fax 01256 312299

· E-mail:

Please note that responses may be made public unless confidentiality is specifically asked for. We may also publish your responses in a Summary of Responses to the Consultation unless you specifically include a request to the contrary.

Response Form

You can use this form to let us know your views on the proposals for Calthorpe Ward and developing additional services for Fleet Hospital. Please continue overleaf or on a separate sheet if you wish. Your comments should be sent to Debbie Glenn, Chief Executive, Blackwater Valley & Hart Primary Care Trust, Winchfield Lodge, Old Potbridge Road, Winchfield, Hook, Hampshire, RG27 8BT. Please mark the envelope `Fleet Hospital Consultation Response'.

Your Name (optional)............................................................................

Your Address: (optional) ............................................................................................................

............................................................................................................

Do you agree with Option 1 - 6 beds returning to Cox Ward

Yes

No

Don't know

Comment

Do you agree with Option 2 - The introduction of a new model of care for the existing 18 beds at Fleet Hospital and Cox Ward being used for additional clinical activity and to support the development of a Day Assessment Unit

Yes

No

Don't know

Comment

Please tick this box of you would like to receive an acknowledgement ...........................

Hampshire County Council Appendix Four

Health Review Committee: 30 November 2004

The Future of health services in Fareham & Gosport: Reply to the Chairman

12 October 2004

Dear Councillor Ellis

I write with reference to your letter dated 7^th September 2004 to Ian Piper, which has been passed to me for a response.

With regard to the likely impact of the proposals on the populations of Fareham and Gosport I enclose the pack of health needs information that was presented to the public during the four consultation meetings on 27^th September and 4^th October. Kathryn Rowles, Director of Public Health will attend the meeting to talk to the documents.

Capacity modelling for both elective and emergency orthopaedic services has been undertaken in conjunction with Portsmouth Hospitals NHS Trust (PHT). Based on this modelling, the PCT and PHT have developed a capacity plan for the next three years which sets out the level of activity to be commissioned from PHT in order to ensure the delivery of the maximum waiting times targets. PHT will have the capacity to undertake this activity and the PCTs will also continue to commission services from a range of local providers to ensure patients have plurality of choice.

This will include new treatment centres at both Southampton and Winchester.

The PFI will ensure the delivery of elective and emergency activity on a single acute site, ensuring the most effective use of resources. The PCT supports the development of the PFI and the continued commissioning of elective orthopaedic services from PHT as its main local acute provider.

The PCT has included some spare capacity in both proposals in order to expand services in future. We can confirm that Fareham Community Hospital will learn the lessons from the new Lymington Hospital in terms of flexibility for the future. This is particularly important given the population growth forecasts for the western wards.

The demand profile for the Out of Hours Service and emergency care is being looked at to ensure that there is capacity and whether it is in the right place, before it can all be linked together.

The existing Out of Hours service is a replacement service structured around that previously provided by the GPs to ensure continuity and that the PCT fulfils its statutory obligations. Work is ongoing with all of our partner organisations such as the Hampshire Ambulance Service and NHS Direct to look at future service provision, skill mix and access to primary care.

Primary care actually takes place in the surgery and emergency/unscheduled care takes place outside of practice hours. Many of the developments within primary care have led to better use of resources thus making practices more efficient during their opening hours. There will be further developments over the next two years within primary care as we start to apply a skill mix of GPs, nurses and other healthcare professionals. These are the clinical and medical developments that need to take place but these should be done in conjunction with service redesign of social and voluntary services to ensure that we make best use of all our estates, facilities and IM&T infrastructures.

The PCT and PHT will be consulting on services at night with Fareham and Gosport residents early in the New Year.

With regard to your reference to the HealthFit document I enclose a copy of our Intermediate Care Strategy as requested.

On the subject of treatment and transfer protocols, and video consultation/links, we have discussed this with PHT and they will be responding separately.

Referring to outpatient clinics, the PCT believes that there will be scope for increasing outpatient clinics beyond 30% in order to minimise travel for local people. The figure of 30% was calculated on the basis that plain film x-ray and ultrasound would be available at Community Hospitals and it will be. As technology progresses and other diagnostic facilities become more portable and affordable, there is potential for an increase from 30%. The PCT and PHT will work closely on developing these facilities in future.

The 80 continuing care beds at Coldeast are a joint development between health and social services. They are nursing home beds and will inevitably provide a level of care to people with some `NHS continuing care' needs as well as to others who have ongoing nursing needs.

The 27 beds at St Christopher's are being reprovided due to the unsuitability of the environment. This issue was flagged up as urgent following an unfavourable Patient Environment Action Team (PEAT) report. The PCT assessed the needs of the current patients and alternative services have been commissioned to meet those needs. This had led to patients being placed in local nursing homes. Patients requiring assessment and treatment will be treated in hospital, either acute or community depending on their needs. In addition, services are being developed that will increasingly treat people in their own homes if that is their preference. All of this work is being progressed in partnership with Social Services colleagues and other local stakeholders including patients and their carers.

Finally, discussions are ongoing between Portsmouth Hospitals Trust and the Ministry of Defence about the continued use of the Haslar site from 31^st March 2007 until the redevelopment of QAH is complete in Summer 2008. Portsmouth Hospitals Trust and the Primary Care Trust will work together to ensure that we continue to provide services to our patients during that period.

Appendix Five

Future Support for Patient and Public Involvement in Health

The Government has recently announced that there are to be changes in the system for patient and public involvement in health. Now we are carrying out a major consultation exercise, which we want to be as inclusive as possible.

We would be extremely grateful for your views - please read on for details of the on-line questionnaire.

Some decisions have already been made

The government has already decided that:

· the CPPIH will be abolished

· new arrangements will be put in place to ensure continued support for Patient and Public Involvement (PPI) Forums

· NHS Appointments Commission will appoint forum members in the future

· a new centre of excellence for patient and public involvement will be set up

· the present system of patient and public involvement will remain the same. This includes:

o Patient Advice and Liaison Services (PALS)

o Independent Complaints Advocacy Services (ICAS)

o Overview and Scrutiny Committee (OSCs)

· the new arrangements will not cost more than the budget currently available for the CPPIH

· PPI Forums will remain independent and responsible for their own work plans and priorities

Therefore we would like your views on:

· How PPI Forum members should be recruited now and in the future

· The support and guidance they need to maximize their effectiveness

· The processes, structures and relationships they need to achieve this

The Questionnaire

An independent market research organisation, Opinion Leader Research (OLR) is carrying out this part of the consultation for us.

The questionnaire itself is available on their website at http://www.frameworkmarketresearch.com/surveys/004503/

We have included some additional information

· A statement by the Department of Health on the role of PPI Forums (link)

· A statement by the Commission for Patient and Public Involvement in Health of principles for PPI (link)

We do hope that you will read these, and that they will help you when considering your answers to the questionnaire.

What will happen next?

The answers to the questions will help the Department of Health take forward the work to

· transfer responsibility for making forum appointments to the NHS Appointments Commission

· put in place future staff support arrangements for forums

· establish a centre of excellence for patient and public involvement

· help patients' forums continue to work in partnership with the NHS, OSCs and the Healthcare Commission.

Information about what you tell us and what will happen next will be available in the New Year on the CPPIH Knowledge Management System and the Department of Health website.

If you have any questions about the process

Please contact us at:-

CPPIH National Centre, Floor, 120 Edmund Street, Birmingham B3 2ES

Tel: 0845 120 7111 or [email protected]

We very much look forward to receiving your views.

Yours sincerely

Steve Lowden Meredith Vivian

CPPIH Department of Health

Director of Governance/ Chief Executive Head, Patient and Public Involvement

This consultation exercise is being carried out in accordance with the six criteria in the Cabinet Office Code of Practice on Consultation. This Code is available at

www.cabinetoffice.gov.uk/regulation/consultation/code.asp

Any complaints about this consultation process should be referred to:

Mr Steve Wells, Consultations Coordinator

Department of Health, Room 361C, Skipton House, 80 London Road

London SE1 6LH

7th