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 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. New issues raised with the Committee, and those that are subject to routine monitoring set out in Table One of this report.

1.6. 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. `Park and Ride Services to the Royal Hants County Hospital'

_ Members note the issues raised by Winchester and Eastleigh Patient and Public Involvement Forum

_ The Committee receives a copy of the response of the County Council to the Patient and Public Involvement Forum

2.2. Future Management of Patient and Public Involvement Forums

_ Members note the plans for supporting Patients Forums following the abolition of the Commission for patient and Public Involvement in health

2.3. Out of Hours Services

_ The issues raised by Salisbury District Council are taken into account when the work programme for 2005/06 is agreed.

2.4. Local Action on NHS Dentists

_ New Forest PCT provides an up-date on local action being taken to improve access to NHS Dental services in at the next meeting

2.5. Beyond Healthfit

_ The Committee notes the closure of the HealthFit/ beyond HealthFit programme.

2.6. Car Parking at Petersfield Hospital

_ The Committee receives a copy of the response of East Hants PCT to the concerns raised by East Hants District Council.

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.

Hampshire County Council: Health Review Committee: 29 March 2005

Table One: Inquiries Received and Action Taken

Hampshire County Council Appendix One

Health Review Committee: 29 March 2005

Car Parking at the Royal Hants County Hospital and Park and Ride

Key Points Raised by Winchester and Eastleigh Patient and Public Involvement Forum.

We were pleased to hear that the Park and Ride extension to the hospital had been agreed. However, it is very disappointing to learn of the 6 months trial that would obviously benefit some staff but be of no use whatsoever 'to patients or families wishing to visit patients.

As a Forum for "Patient and Public" Involvement we naturally lobby on behalf of the public whilst we acknowledge that reducing staff usage would free up some parking on site. However, enabling visitors to the hospital to use Park and Ride would have considerably reduced further the numbers bringing their cars through the City and on to the hospital site.

We understand that the 6 months trial will be reviewed after 3 months and If it Is not being used it will be halted^-. if this is so and the trial is halted after 3 months, it is not therefore a 6 months trial. Why, in fact, a review half way through? We fear it is designed to fall with the proposed time-tabling.

At our public meeting held on 3^d February we were asked to write on behalf of the public to express their disappointment that

· The proposed trial will not incorporate the needs of people wishing to use or visit the hospital.

· They also said it did not constitute a proper Park & Ride if provided at peak times only and does not stop 'In town.

· They argued that the philosophy of reducing car journeys through the City Centre is laudable but the success of Park & Ride schemes really lies in their reliability and frequency. HCC staff, for example, wishing to take advantage of Park & Ride can do so from St Catherine's or anywhere from City Centre and get off at The Castle a' any time and vice versa. However. this would seem not to be the case for hospital staff, a high number of whom have strange shift patterns, nor presumably other possible users such as staff and visitors to the Police HQ and HIM Community Prison or university collage Winchester. Nor, of course, would patients and visitors the hospital

· Staff and visitors will not, of course be able to park at St Catherine's and avail themselves of Park & Ride if there is no bus at the time they need to leave.

· The public are unable to understand why the service route could not have been extended up the Romsey Road and turned round at the Chilbolton Avenue roundabout if not at the Hospital. Many a juggernaut has been seen making such maneuvers there.

The public and my Members have asked me to pose the following questions:

1. Have these times been agreed with the Trust ?

2. Was it proposed to accommodate staff shifts? what of staff starting at 7pm for example?

3. If the roundabout is a real problem for the low floor buses, they asked whether any other routes had been suggested and costed that might, for example, enable entry from Chilbolton Avenue into Romsey Road?

4. What is the thinking behind not stopping at the usual Park & Ride stops except in Jewry Street? Was it because it will be an express route" for staff? it will of course prevent greater use of the bus by people wishing to get to the hospital, Prison- Police HQ and UCW.

5. On the other hand, if it is necessary to ensure the bus is used sufficiently well to justify its existence, why has this restriction been introduced? This would, of course, also apply to some patients with early appointments.

6. Also, what is the reason for not using a low floor bus for this trial? it discriminates against any disabled user.

Hampshire County Council Appendix Two

Health Review Committee; 29 March 2005

New Arrangements for Patient and Public Involvement Forums

Patient and Public Involvement Team

Richmond House

79 Whitehall

London

SW1A 2NS

15^th March 2005

Government response to the consultation exercise about the future support arrangements for patient and public involvement in health

Introduction

The consultation has provided considerable feedback which will inform the implementation of the main areas of development over the next year. These include:

· the role of the NHS Appointments Commission in appointing forum members

· the functions of the centre for excellence in patient and public involvement

· staffing support for forums

· effective relationships between forums and key stakeholders

This paper sets out the main themes that have emerged and the key decisions which ministers believe are fundamental for PPI forums to be effective.

Background

In July 2004, Ministers announced the results of its review of Arm's Length Bodies. As part of that review we announced that:

· the Commission for Patient and Public Involvement in Health (CPPIH) will be abolished

· the NHS Appointments Commission (NHS AC) will appoint forum members in the future

· new arrangements will be put in place to ensure continued support for PPI forums

· we would develop proposals for a new "centre for excellence" in patient and public involvement in health

· the formal structures and levers for patient and public involvement will remain the same. These include:

o Patient Advice and Liaison Services (PALS)

o Independent Complaints Advocacy Service (ICAS)

o Overview and Scrutiny Committees (OSCs)

o Duty on the NHS to involve and consult patients and the public

PPI forums will remain independent of the NHS and be responsible for their own work plans and priorities.

In November 2004 we launched a consultation on the future support arrangements for PPI forums. The responses were published on 28 February 2005.

Altogether, there were 4211 responses to the consultation exercise. We also received over 100 discussion papers together with the results of nine regional workshops with members of forums, workshops with Forum Support Organisations (FSOs) and with CPPIH staff and commissioners. In addition, we received information from many separate events and workshops which took place across the country.

We are pleased to have received such a huge volume of feedback. Thank you to everyone who took the time to participate in this important exercise.

Consultation conclusions

The consultation has shown us that there is a tremendous appetite for effective and efficient arrangements to enable patients and the public to get involved in influencing changes in the health service. It has also told us that we need to address some key issues.

We have heard that to be effective and credible organisations, forums need greater clarity about their role and how they can best relate to other organisations. Forums and their partners need to understand how they can influence the performance of the NHS and the government's objectives for the NHS. The consultation has also given us a much clearer understanding of the skills and support that forums need to be able to carry out their functions.

PPI forum appointments

The recruitment and retention of forum members was the primary concern of forum members, CPPIH staff and commissioners and Forum Support Organisations. The forum appointments process was the first experience of patient and public involvement for many forum members

and in many cases there was inconsistent information, seemingly unnecessary bureaucracy and the process felt very slow and cumbersome. At the north west workshop for forum members a forum member summed up the strength of feeling about this issue:

I know many people who have wanted to join forums and they have waited absolutely months. And some of them got fed up.

There are concerns about the NHS AC carrying out forum member appointments in the future. There are concerns that the NHS AC is not sufficiently independent of the NHS, and that the NHS AC does not have experience of recruiting or appointing volunteers. An example of this view was expressed by a forum member at the Yorkshire and Humberside workshop for forums:

My main objection about the Appointments Commission is that they don't have the experience of dealing with the volunteers, it's a totally different cohort and there isn't the expertise there. That's my main concern.

The NHS AC has considerable expertise and experience in making appointments and will further develop this by working with the CPPIH, PPI forums and voluntary sector organisations to ensure effective recruitment of volunteers that reflect local communities. The NHS AC is an independent organisation - it was set up to provide distance between Ministers and appointments to NHS trusts and PCTs.

Most workshop participants agreed that a chair is needed to provide a focal point for the forum, to facilitate meetings and provide overall leadership for the forum. However, some forums believe that their chair had adopted an autocratic working style and is forcing through their own agenda, others felt that the chair had become overloaded with the demands placed on them.

After weighing up the options, we have decided that in the future all forums will be required to have chairs who will be appointed by the NHS AC. This approach will provide consistency between forums in how they operate and address a common criticism that the standards and behaviour of forums vary greatly across the country. The appointment of chairs would go a long way to making this achievable, providing local leadership and a focal point for communications.

Forum members will be involved in the process of appointing chairs.

The NHS AC will use the information from the consultation and work with forums to confirm the skills people need to be able to demonstrate to

become forum members and chairs and provide the opportunities that people need to develop these skills. This will include providing specific training about chairing skills. The main qualities needed to be an effective member are perceived to be:

· to want to improve the local health service (65%)

· to have good communication skills, both listening and speaking (63%)

· to be able to build and manage relationships with other people and organisations such as the NHS and local community groups (54%)

· to be able to work as part of a team (49%).

Support arrangements for PPI forums

Forums that feel they have made the most impact so far tend to be forums that are also happy with the FSO support they have received. Forum members who took part in the workshops agreed that access to good quality local support is essential to the success of the forum.

The consultation also confirmed that forum members need effective staff support and want more influence over the organisations that provide support to them. A forum member at the south west forum workshop described what is required:

Professional support for the minute taking and writing of notes, writing letters to asking questions of the trust that you want, organisation of meetings that you want to meet, to whom, when and the appropriate dates, so that we're not duplicating ourselves in all sorts of other things.

In addition a forum member at the London workshop commented:

I like having our FSO there because our FSO has all the community databases, all the demographic details of the borough. It's got a big resource there that we can tap into.

We were keen to understand the extent to which forums wanted to control their staff support. There was little support for forums to be responsible for directly employing or managing that support - only 1in 6 respondents supported this option. As one forum member at a forum workshop put it:

I am quite happy to say what the needs are, and as a forum I think we should say what our needs are, put those across very clearly and hand them over to whoever's responsible for appointments at the end of the day and to respect those needs and get on and hire and recruit staff and do everything that connected with, you know, having contracts etc. I don't want to be an HR department in our own right as a patients' forum.

Page 4 of 10 Gateway reference 4629

Forums said that they want to be able to determine how budgets are spent but they do not want the responsibility of managing those budgets. A forum member at the south west workshop for forums commented:

I'm not a financial wizard, but I want to know how the money is spent, and I would like to be involved in spending it, to achieve what we as members want to achieve.

Over half (55%) of respondents felt the support for forums should be provided by organisations that were both independent of the NHS and familiar with it.

Whilst the current FSO arrangements have led to a range of satisfaction with their performance, we think that the best means of supporting forums is through the independent sector. We would like to capitalise on the FSO experiences, whilst at the same time making some important changes. We know from the experience of the CPPIH that managing a large number of individual contracts takes a lot of time and effort. We are keen to minimise disruption for forums by sticking to boundaries that are familiar to forums but also we are keen to make it easier for forums to work across boundaries that are relevant to them i.e. likely to be part of the patient pathway.

For these reasons, we have decided that the staff support for forums will be provided under contract between the Department of Health and independent sector organisations. We will tender for a limited number of contracts to provide staff support across the existing nine regions. We know that the new contract specifications need to be revised to reflect better the staffing needs of forums. We will therefore involve forums in determining the specification of the contracts and in the process of awarding them and in the ongoing contract management.

The CPPIH is currently in the process of extending FSO contracts where they are performing to a satisfactory standard and wish to continue. Where contracts are extended, they will continue until August 31^st 2006.

Centre for excellence in patient and public involvement

The consultation exercise asked for views on the proposed centre for excellence for patient and public involvement. A view to emerge strongly from the consultation was that what was envisaged was another `arm's length body' to replace the CPPIH which would duplicate expertise that was already available. A forum member at the north east workshop for forums said:

So what's the point in getting rid of the Commission if you're going to reinvent it?

We can confirm that the centre is likely to be part of an existing organisation(s). The centre will not be a new Commission.

There was broad agreement that advice and guidance for forums is necessary and that this should be provided centrally. Forum members, in particular, thought it was important that the new centre should be able to commission or carry out research, and analyse and share best practice. Over half (56%) of respondents believed the centre should co-ordinate the provision of PPI training for forum members and the NHS and in particular there was a call for diversity training to be available. It will have a key role in identifying the best and most appropriate available training in patient and public involvement for both forums and the NHS.

The centre should also avoid duplicating existing materials so it will have an important role in directing people to existing advice and information. It will also develop the CPPIH's Knowledge Management System, along with other methods to promote best practice in patient and public involvement. Importantly the centre will also be a resource for the NHS. In a written submission a forum member wrote:

The FSO should be adequately provided with national, regional and local

information to meet our needs. Development of members' abilities to reach out to the public will be necessary and a robust procedure for effective use and application of views obtained will need to be developed.

The development of a centre to provide advice on PPI for both the NHS and patients' forums would be something we would probably find valuable in our need to develop our own PPI needs as indicated above.

The centre will be a resource centre - which is a more accurate description of what respondents would like to see provided.

Additional information from the consultation

The consultation and the additional responses received also enabled us to draw some conclusions in additional areas.

Working in partnership with others

A key theme from the consultation exercise was the need for further clarification about the respective roles of forums and Overview and Scrutiny Committees (OSCs). FSOs in particular believed this lack of clarity and understanding has been a barrier to forums developing effective relationships. Many forum members would like greater clarity about their role and responsibilities as well as those of key partner organisations - this was particularly evident where forums had experienced difficulties forging relationships with the local NHS trust or OSC. There is agreement that greater clarity would reduce duplication and any unnecessary waste of public funds or time. Many forum members felt that it was difficult to force a trust or OSC to work with a forum if it does not want to and that clarification and guidance is the best way to iron out any current tensions and difficulties.

A forum member who attended the workshop in the north west commented:

At the end of the day we really do understand and need to understand what other people are already doing so that we actually don't double up on that work and reinvent the wheel.

The Centre for Public Scrutiny will be preparing advice for forums and OSCs on this. The guidance will emphasise the importance of forums developing relationships with OSCs and establishing close and effective working arrangements.

We are already working with forums and the Healthcare Commission to identify ways for their work to be more closely connected. Forums are a valuable resource for the Healthcare Commission and the information they gather can inform reviews carried out by the Healthcare Commission. In working more closely together, it will be important not to create additional burdens for forums.

Organisation of forums

We received a great deal of feedback on the need for forums to work closely together and for them to focus on the patient's experience that could involve several different parts of the NHS. Many workshop participants believe it would be logical to remove the distinction between PCT and NHS trust forums. Participants believed this would enable forums to look more effectively at the whole patients' journey.

After considering a number of ways we could reconfigure forums, we believe that this can best be achieved through combining forums within each Primary Care Trust (PCT) area. These forums would retain a specific focus on every NHS trust and NHS foundation trust in that PCT area. This would provide a coherent structure focused on the PCT which has responsibilities relating to both provision and commissioning of services. This approach will involve the minimum amount of disruption for forums, will provide continuity for NHS

organisations and enable forums to track the patients' journey more closely.

It will take primary legislation to change the number of forums. It may not be possible to make the change until summer 2006. In making this change it will be absolutely vital to retain at least the current number of forum members overall and the ability of forums to focus on concerns in every NHS trust. Meanwhile forums will continue to work together across NHS boundaries to carry out their functions.

In the meantime, we shall be working through how PCT forums will be best able to carry out their functions to ensure that their broadened remit delivers real local improvements. We shall be involving a wide range of stakeholders in this work, and in particular will wish to learn from forums themselves.

The consultation also told us that it was important for forums to be able to work together locally, regionally and nationally. Many workshop participants thought that regional networks were important to:

· share best practice

· ensure a more effective voice.

A forum member who attended the East Midlands workshop remarked:

I think we need to have more interaction with other forums. That people from each forum get together every now and again to just talk about what they're doing, how they're doing it, etc. so that we can learn from each other more than we can do at the moment.

We will explore what would best support forums to do this and develop options for regional and national networks of forums. In particular we will be learning from the experiences of the London forums which already work together on a regional basis.

Role of forums

Currently forums have a wide range of roles and a view expressed at the workshops was that the current role of the forum was too broad and that it needs to be tightened up to reduce the workload of forums and to make their role more achievable.

For the government the primary expectations of forums are to:

· monitor and review NHS delivery

· seek the views of the public about those services

· make recommendations to the NHS accordingly.

We encourage forums to focus on these three main elements and when we get the opportunity to review the legislation, we will refocus the forum role more closely on these three areas.

Accountability of forums

We need to make sure that the work undertaken by forums appropriately fulfils the role set out for them in legislation and that Ministers and Parliament are properly informed about achievements. It is important that forums, either individually or collectively, are able to demonstrate that patients and the community have received value from the money allocated to supporting and running them. We will therefore be developing a performance and accountability framework for forums to follow.

Timetable

It is not possible to be precise about the timing of the changes described in this paper because many of them require there to be a change in legislation. The timetable below is subject to there being a suitable government bill to make the changes in the next parliamentary session.

May 2005 Protocol for closer working between the Healthcare Commission and forums

June 2005 Guidance on working relationships between forums and OSCs

April- August Chairs to PCT forums appointed

2006

May 2006 New forum staff support arrangements in place

August 2006 NHS AC assumes full responsibility for making appointments to forums

August 2006 Extended FSO contracts expire

August 2006 Changes to forum structures organised around PCT forums.

August 2006 CPPIH abolished

Ongoing stakeholder involvement

The responses to the consultation exercise have been enormously valuable in informing these conclusions and will continue to inform our work in the future. We want to ensure that we have as many opportunities as possible to ensure people can input into the

developing arrangements. Forum reference groups for each of the main projects are being set up and the Department of Health, NHS AC and CPPIH will work closely with these groups throughout the development and implementation process.

We will keep you posted about developments through our newsletter and the CPPIH will continue to communicate with you about operational matters.

Summary of the way forward

· NHS AC will be fully responsible for forum appointments from the abolition of CPPIH in August 2006

· In the future all forums will be required to have chairs who will be appointed by the NHS AC - forum members will be involved in this process

· The proposed `centre for excellence' will become a resource centre for both forums and the NHS from December 2005

· Staff support will be provided under a limited number of contracts, focussed on the 9 existing regions

· Forums will be combined within PCT areas but retain a focus on every NHS trust in that PCT area

· The number of forum members across England will remain at least at the same level

· We will consider the development of regional and national networks for forums

· Forums will continue to be involved in the development of the work needed to make these recommendations happen.

Thank you

Thank you for responding to the questionnaire and for taking part in related workshops and events. The large response to the exercise is evidence of the commitment of everyone involved in patient and public involvement.

Patient and Public Involvement Team

Department of Health

March 2005