Archived decisions

Item 3

Dear Jonathan,

As I indicated during the SHA Board Meeting, we have very many concerns about the cost cutting options outlined in the paper on the Capacity Map. This paper is essentially a breakdown of existing stock and costs and not what we would regard as a capacity map. We would make the following points:

1. It reneges on the PCT proposals on which consultation has only recently concluded. These detailed proposals for community hospitals at both Gosport and Fareham, with firm dates for the completion. Indeed we are pursuing discussions about PCT proposals for facilities at the Fareham hospital, which we consider should be similar to those proposed for Gosport, particularly as the population of Fareham, (without taking in the proximity to Eastleigh and the Winchester part of Whitley), is considerably larger. The Gosport War Memorial Hospital site is not easily reached from Fareham, especially at peak rush hour times, car parking is not easy and we do not regard it as a suitable base for a minor injuries A & E for the Fareham population. These Community Hospitals need to be established now, but the time frame for this to occur is reducing rapidly. It is naïve in the extreme, in my view, to be pursuing this line now and even more naive as the Capacity Map group paper says at paragraph 32 to believe that under option 3a" Public aspirations will be met". Equally the public simply will not believe that project timetables are simply an issue and priorities. It will be seen as promises broken.

2. Some proposals in this paper cut across the on current maternity strategy consultations for this area.

3. There is no real information on current or future population health needs or with regard to patient flows.

4. There is no proposal for engagement with the local population on these proposals. These proposed service changes are substantial and would require both Section7 and Section11 consultation. These are not theoretical exercises as the population "out there" do require efficient health services as soon as possible

5. We are concerned that with the implementation of the PFIs, the LIFT projects, and the Mercury Treatment Centre the NHS provision for this area will be effectively mortgaged to the private sector. We were alarmed by the statement in the paper with regard to the QA PFI assumptions " but did not include any financial assessment or details of the proposed bed numbers". The provision of local health facilities is absolutely essential to our population and there must be sufficient funding to provide it. We feel that an earlier estimate of the effects of the various developmental projects on the total health economy of the area should have been made.

6. The choice agenda to some extent implies that an excess of capacity will be required, if the agenda is to be meaningful. There is little evidence to show that this will be the case, indeed at the same SHA meeting a later paper indicated that the capacity for cancer patients would be about 5% less than required even after the modernisation of the Queen Alexander Hospital.

7. The plan assumes that the current NHS long stay provision will be eliminated. If this is to be so, in view of the demographic data, which points to an increasing older population, then very firm plans for the provision of continuing care provision must be made. This is complicated by the difficulty in recruitment of front line social workers, affordable housing and other factors.

8. Is the PbR deficit of £4.5M a one off or a recurring feature?

9. We would oppose any delay in the implementation of the "spokes". My comment in 1 above are apposite.

10. Our preferred option would be option one, which has been the subject of consultation and for which time is a real burden of public expectation . Also we would not favour any delay in implementation, as the need for these facilities has been well established over many years and the population needs action and not words. We are amazed that the paper refers to the need for "further work planned to complete the capacity map" we would have assumed that all of this work would have been completed prior to the PFI proposal and the Fareham & Gosport PCT consultation. It does reinforce our view that the health needs of S. E. Hampshire should be considered as a whole and not as isolated development. For instance the ISTC at St. Mary's Hospital was not factored into the first proposals from the PCT.

11. The decrease in beds "of some 120 less than planned in the full PFI business case" is we feel is not supported by any proper analysis of future needs of an increasingly ageing population but purely by assumptions relating to more home care.

12. In paragraph 17 it is stated that the options were assessed in terms of " .....access, quality of environment, public aspirations, recruitment and retention" For whom was the access assessed and whose public aspirations were considered?

13. We have serious doubts, based on experience with other PFI projects, that the QA Hospital will be completed by 2008 and within budget.

In summary, I am unclear of the status of this work and, indeed, when the Capacity Map report will be published although you seem to be expecting a recommendation to the next Board meeting. My own view is that the options will give serious cause for concern to the Health Review Committee and the Hampshire, Southampton, Portsmouth and Isle of Wight Health Scrutiny Joint Committee, I believe they will regard options 2 and 3 as matters of substantial change to health service provision and subject to the consultation processes as detailed in Sections 7 and 11 of the Act. I really believe that further informed discussion is required before the Board decision is taken.

I hope that you consider these comments to be helpful, and of assistance to the SHA Board when they next consider the paper or any development of it..

With Very Best Wishes