Appendix Six

Hampshire County Council

Health Review Committee: Extraordinary Meeting 26 November 2004

Future of Health Services in Fareham and Gosport: Recommendations for Action

Purpose and Next Steps

1. This report summarises the outcome of the meeting held on 26 November 2004 to consider the consultation by Fareham and Gosport Primary Care Trust (PCT) regarding arrangements for providing NHS services to people living in Fareham and Gosport.

2. The interest of the Committee in responding to the proposal is two -fold:

· Is the Committee satisfied with the content of the consultation and that sufficient time has been allowed.

· Is the preferred way forward in the interests of the health service in the area affected.

3. A select committee approach was adopted to consider this matter. This provided an opportunity for the PCT to set out the case for change and for key stakeholders in Fareham and Gosport to share their views on the proposal and consultation process.

4. Key stakeholders attending the meeting on 26 November included:

· Portsmouth Hospitals NHS Trust

· Hampshire and Isle of Wight Strategic health Authority

· Ministry of Defence

· Member of Parliament for Fareham

· Hampshire Social Services

· Fareham Borough Council

· Fareham Community Action

· Gosport Voluntary Action

· Save Haslar Task Force

· Gosport Borough Council

· Member of Parliament for Gosport

5. The Fareham and Gosport Patient and Public Involvement Forum were invited to attend the meeting to give independent feedback on the views of people living in Fareham and Gosport. A letter was received declining the invitation of the Committee to attend the meeting on 25 November 2004.

6. The Board of Fareham and Gosport PCT will take the final decision on the way forward on 15 December 2004. The Committee will expect that the relevant recommendations set out in this report will be responded to at that time.

7. If the Committee is not satisfied with the response of the PCT, the option remains for the decision of the Board to be `called in' for formal scrutiny. If any outstanding issues cannot be resolved locally the matter may be referred by the Committee to the Secretary of State for Health. The grounds on which this action can be taken are prescribed and would need to demonstrate the basis on which the Committee was contesting the decision of the PCT.

Findings of the Committee

Content and Timing of the Consultation process

8. The Committee noted the detail report produced by the PCT outlining the consultation process followed and the way in which this had shaped the current proposal.

9. In terms of the consultation process the Committee is clear that this has been satisfactory and robust.

Is the preferred option in the interest of health services in the area.

10. Members were mindful that the configuration of health services in south east Hampshire was a complex issue and included non-NHS interests such as the MoD. The action points set out below therefore relate to:

· Specific recommendations for consideration by the PCT Board.

· Areas where the Committee will be seeking further information and comment not previously covered in evidence to Members.

11. The Committee was clear that the current status quo in terms of health provision in Fareham and Gosport is not sustainable. This was influenced by the decision taken in 2000 with regard to the redevelopment of the Queen Alexandra Hospital in Cosham. The Committee did not revisit that decision. Many present did however voice reservations about the proposed capacity of the new acute hospital to meet the increasing health demands of local people.

12. The Committee took the view that well developed and robust community services will be essential if the new development at Queen Alexandra Hospital is to work effectively and act as the `hub' of an integrated health service across south east Hampshire. The services to be provided to the people of Fareham and Gosport do not exist in isolation and will be interdependent with other health services in the area. The uncertainties expressed by key stakeholders during the course of the meeting highlighted that people who were not part of the NHS still needed to be convinced that this strategic thinking is taking place. This point needed to be addressed as a matter of urgency by the NHS.

13. The Committee recommended that the additional health needs information referred to by the PCT, is made available to the Committee. This should include the way in which primary care and community services across Fareham and Gosport will be developed to complement the services provided at Queen Alexandra Hospital and take account of the need to keep as many services as local as possible. In particular people living in Gosport need to have a better understanding of how the commitments made to them in 2000 will be delivered, with as many services as possible being provided in the community.

14. The Committee noted the emphasis quite properly given to the strength of the views of local people about the way forward. These had to be given due weight by the PCT. However there are other factors, including financial considerations which will shape the extent to which the PCT can accommodate the preferences expressed and these could not be ignored.

15. The role of the PCT was to identify and meet the health needs of local people living in both Fareham and Gosport. Planning to date seemed to have been reliant on broad demographic trends. The Committee was of the view that further work needs to be done to refine this information to give more clarity about the health services that people living in the different communities need, taking account of the key policy documents such as `Keeping the NHS Local' and the approach to health needs commissioning outlined in the briefing note for the meeting.

16. The Committee recommended that the PCT re-examine the population projections provided to take account of the planning assumptions discussed during the day and the policy of the Office of the Deputy Prime Minister with regard to new housing. Members expressed deep concern at the figures presented regarding projected population growth as well as the lack of information about progress with planning applications to support the schemes discussed. The Committee was of the view that both these points represent a major risk to future provision.

17. The Committee strongly supported the emphasis placed by the PCT on `Keeping the NHS Local' and considered that a more detailed health needs assessment would create a better understanding of the role of community hospitals will have as the heart of the communities in Fareham and Gosport. In particular the Committee would be keen to see additional information on extended roles for health professionals, the provision of ambulatory care, integrated unscheduled care (including minor injury units, GP out of hours and other emergency services) and the role of telemedicine as part of this work.

18. Members were also unclear about how the different needs of the people living in Fareham and Gosport would be assessed and met. The Committee heard comparisons of health services across these populations, particularly with regard to the provision planned at Coldeast Community Hospital. No information was available to indicate if these comparisons were appropriate. An example shared with the Committee was the case for there to be an Accident Treatment Centre based at Coldeast Community Hospital, providing services for people living in the surrounding communities rather than confined to those living in the PCT boundaries

19. The Committee heard that the different populations of Fareham and Gosport were concerned that they could be disadvantaged by the decision to site a specific service in another part of the patch. This is both divisive and unhelpful. The Committee had previously requested that was clarity about the way that the health needs of the different communities of Fareham and Gosport would be met. This information had not been forthcoming. In particular the Committee wanted to see further detail about the health needs of vulnerable groups living in the area and the way in which front line services, such as out of hours and unscheduled care will be managed given the realities of access to services and transport issues to and from the Gosport peninsula.

20. The Committee recommended that additional information be provided to Members on the health needs of local people, differentiating between the communities of Fareham and Gosport. The Committee also required further information about the way in which the health needs of those identified as being vulnerable or disadvantaged would be met.

21. Access was a major issue and conflicting views on the validity of the traffic impact assessment were shared at the meeting.

22. The Committee is therefore recommending that agreement be reached between the PCT and Gosport Borough Council on an appropriate methodology for assessing the impact of the changes proposed on traffic and transport considerations. It may be possible to integrate this with the next stage of assessment outlined by the PCT.

23. The Committee was of the view that, whatever option for moving forward was decided by the PCT at its meeting on 15 December, the Board must have absolute confidence that the option is sustainable and in line with the current and future health needs of the population. The Committee noted that the PCT was already struggling with an underlying deficit that was projected to rise to £10.8 million at the end of the financial year. This was significant and did not sit easily with the statutory duty to remain in financial balance. The costs of the servicing the Queen Alexandra Hospital PFI project have risen considerably and the contract had still not been signed. Additional financial pressures from the new General Medical Services contract, agenda for change and payment by results were also starting to emerge in the health economy.

24. The Committee was of the view that these factors represent a considerable risk to plans to develop and enhance community services in Fareham and Gosport.

25. The Committee recommended that the PCT Board provide clear and unequivocal evidence that these risks are being managed to ensure that the acute and community health services planned are affordable and sustainable. Additionally the Committee will write to Portsmouth Hospitals NHS Trust to ask for details of the final cost of the PFI contract. Should this exceed the estimated cost of £200 million stated at the meeting the Committee may wish to investigate this further.

26. With regard to Royal Naval Hospital Haslar, the Committee noted that the MoD has been clear throughout regarding the intention to close the Haslar site, based on the Defence Medical Services Review undertaken in 1998.

27. Members noted that there is a significant military presence in the Hampshire area and that a large proportion of this population could be affected by decisions of the MoD regarding health service configuration. The decision taken by the MoD some seven years ago could not have foreseen the current involvement of military personnel in so many different conflict arenas with the potential increase in medical care that these bring. The Committee will seek to understand how these fundamental changes have been taken into account.

28. It was the unanimous view of the Committee that the MoD be invited to comment on whether the findings of the Defence Medical Services Review now need to be reconsidered to take account of the many factors that have changed since 1998. In the summer of this year the BMA indicated that recruitment and retention of medical personnel issues still exist. Members were concerned that, should there be an escalation in the health needs of the armed forces, there was potential for civilian NHS provision to be seriously disrupted. The Committee did not believe that this would be in the interests of the public or the armed forces.

29. Taking into account the considerable investment of public funding in Haslar Hospital the Committee was keen to establish the feasibility of reducing or waiving the transfer of assets if this is considered to be in the public interest. Conflicting information on this point was received at the meeting. The MoD was clear that Government Accounting rules preclude this option. Gosport Borough Council cited an example of these rules being waived. The Committee requested that this point be explored further as a matter of urgency. The Committee will also seek an assurance from the MoD that, should a decision be made to proceed with closure of the Haslar site, this will be able to demonstrate that this is the only viable option that represents value for taxpayer's money.

30. The MoD was clear with regard to its duty to maximise return on surplus land. The Committee was of the view that this should be secondary to changing circumstances and the public interest.

31. The Committee will write to the Secretaries of State for Health and Defence, copied to the Defence Select Committee requesting additional information with regard to the Defence Medical Services Review and the impact these decisions will have on local NHS provision, taking account of commitments made in 2001. The Committee will also seek an assurance that the Defence Medical Service Review has been evaluated to ensure that it is able to meet the existing and new challenges facing our armed forces in Hampshire.

32. The Committee was clear that the NHS, on its own, could not afford the capital and revenue costs quoted for the retention of part of the Haslar site without a disproportionate impact on direct service provision to the community that is served by the PCT. This would not be in the interest of the health service in the area. Nevertheless it is also true that, if the costs associated with the use of the site were comparable with other options, the Royal Hospital Haslar would be the site of choice for many people living in south east Hampshire. The strength of public feeling support for this way forward makes further evaluation of other options imperative. One way of achieving this would be for there to be a sharing of the costs of using the site, working across different public sector organisations and commercial interests.

33. The Committee was of the view that this option has not been fully explored and will ask that the MoD now takes stock of the options for getting maximum benefits from the site by working with both Gosport Borough Council and the PCT to fully explore the options for achieving this objective. An agreed basis for valuing the Haslar site would be one way forward.

34. Although the LIFT programme may not be a feasible route for bringing potential partners together there are examples of other projects such as the `Health Park' model in south Bristol, that provides a `one stop' centre for people with health, social and economic needs. This and other innovative solutions to the current impasse need to be tested rigorously.

35. The Committee welcomed the confidence of the MoD and Portsmouth Hospitals that Haslar Hospital would not close until at least the summer of 2008. This decision is currently with the Minister responsible.

36. The Committee was unanimous in its view that it would not be in the interests of the health service in the area for Haslar Hospital to close before the redevelopment of Queen Alexandra Hospital was complete. The MoD has given a clear commitment that Haslar would close `only when suitable alternatives are in place to ensure the continued health care of the area'. To impose a deadline for closing a hospital that could compromise this position, without consultation and due regard to the impact on local people would not be acceptable to the Health Review Committee.

37. The Committee will write to the Secretary of State for Defence setting out this view as a matter of urgency. Should the a decision be made that Haslar should not remain open at least until the redevelopment of Queen Alexandra Hospital is complete the Committee will wish to consider further action in the interests of the health service in the area.