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 and action taken. 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 (P&PIFs) and other partner organisations (Hampshire district councils, NHS organisations, 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.

Table One: Inquiries Received and Action Taken

2. Recommendations for Action:

2.1. Closure of the Grange and Blackbrook Birthing Centres

_ Members are briefed at the next meeting regarding the response of PHT to the letter from the Chairman attached at Appendix One and consider the scope for further action

_ The PCTs are invited to clarify the alternative options for providing these services and reopening the birth centres

_ The views of the relevant Maternity Services Liaison Committee, P&PIFs and District Councils on the closures, and other options to be explored, are invited

2.2. Cleanliness in Hospital

_ Members note the reported performance of local NHS Trusts with regard to the incidence of MRSA attached at Appendix Two.

_ Members are provided with an up date on progress with the local target to cut MRSA rates by 50% at the January meeting.

2.3. Compliance with NICE Guidance

_ Members note the correspondence to the SHA sent on behalf of the Committee (Appendices Three and Five) and the initial response received (see Appendix Four)

_ Members are advised of the further response of the SHA and consider the options for further action

2.4. Ambulance Service Estates Strategy

_ The Committee is briefed on the outcome of the meeting with the Joint HOSCs and Hampshire Ambulance NHS Trust on the 9 August 2005.

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 Appendix One

Health Overview and Scrutiny Committee: 26 July 2005

Closure of the Grange and Blackbrook Birth Centres; Letter to PHT

Dear Ursula

Temporary Closure of the Grange and Blackbrook Birth Centres

I am writing to express the deep concern of the Committee about the action taken by the Trust to close the Grange and Blackbrook Birth Centres at such short notice. This has, as I am sure you are aware, caused deep consternation within the communities affected and raised real anxieties that the closures may be permanent. I am sure that I do not need to draw to your attention the need for any such decisions to be discussed with the Committee and would wish to confirm that we would view any suggestion of permanent closure as a substantial service change.

When visiting the Grange recently our members were struck by the excellent services that were provided to local women and their families, and noted that this was increasingly the choice of birth place for women. It would be deeply regrettable if the action taken by the Trust erodes the progress to date in promoting mid-wife led birth centres across south east Hampshire.

In order that I can fully brief our Members on the reasons for this action by the Trust I would be grateful if you could provide the Committee with the following information. This will enable us to consider further action, if any, that we need to take:

· Action taken by the Trust to identify cover for the midwives taking maternity leave, including approaches to agencies

· Confirmation of any other services to local women that have been affected by the decision to close. We are particularly keen to ensure that the full range of ante and post natal support and advice is easily accessible within the communities affected. This includes the provision of support such as parenting classes.

· Confirmation that all the women affected by the decision have been contacted to discuss the options open to them.

· Details of the mechanisms in place to reopen the Birth Centres.

· Confirmation that all funded post are currently filled

· The reasons why the birthing pool and other equipment has been removed from the Grange

· The contingency arrangements in place should there be any further long term staff sickness or maternity leave

We would also find it helpful to understand the reasons why there was such short notification of the need to close these units, particularly when women and their families had been booked into both Blackbrook and the Grange.

I know we will be meeting to discuss this on the 9 August, however it would be helpful to have your response prior to this meeting.

Yours sincerely

Cllr Dr Raymond J Ellis C.Chem FRSC

Chairman, Health Overview and Scrutiny Committee

CC Health Overview and Scrutiny Committee Members

Portsmouth City Council Health Overview and Scrutiny Committee

Cllr Jennifer Gray, East Hampshire District Council

East Hampshire Patient and Public Involvement Forum

Portsmouth Hospitals Patient and Public Involvement Forum

Mark Hoban MP

Hampshire County Council Appendix Two

Health Overview and Scrutiny Committee: 26 July 2005

MRSA Rates in Local Hospitals

Department of Health Mandatory MRSA Bacteraemia Surveillance Scheme - MRSA bacteraemia by NHS Trust

Hampshire County Council Appendix Three

Health Overview and Scrutiny Committee: 26 July 2005

Nice Guidance: Letter from Hampshire HOSC

Dear Jonathan

Local compliance with NICE Guidance

Thank you for taking the time to meet with me last week. It was very helpful to be able to have such an open discussion about the issues facing the health economy in Hampshire.

You may recall that I briefly mentioned anecdotal comments we had received about different responses by Hampshire PCTs to the implementation of NICE Guidance; in particular treatment for people with fertility problems and access to screening for Downs syndrome.

I have now received the attached correspondence from a local MP and Fareham and Gosport PCT. This confirms that fertility services will not be provided, except in `exceptional circumstances'. Whilst I understand the financial case put forward by the PCT I am concerned that this decision was taken without reference to the national evidence base that underpinned the NICE guidance and the subsequent commitment by the Secretary of State for Health, nor has there been any engagement with the people who might benefit from treatment. Access to services needs to be fair and equitable across the Health Authority area and I am not clear that this is the case for these services.

I do believe that this is an issue that can be resolved locally, without recourse to the House of Commons and would therefore appreciate your advice about how this can most effectively be tackled with PCTs.

On a slightly different topic, I am also keen to establish where we are with the PFI contract for Portsmouth Hospitals Trust. Now the deadline for signing of the contract has past I have noted further reports in the media referring to increases in the cost to the local health economy. We have previously expressed concern about the affordability of the PFI. Given the deterioration of the financial position in the south east I would find it helpful to have the Health Authority's confirmation that any additional costs associated with the contract can be managed within the financial resources of the PCTs, without compromising community services.

Hampshire County Council Appendix Four

Health Overview and Scrutiny Committee: 26 July 2005

NICE Guidance: Response from SHA

Re: Local Compliance with NICE Guidance.

It was nice to meet with you and discuss health issues. In particular, many thanks for bringing to my attention your concerns regarding provision of In-Vitro Fertilisation (lVF) by Fareham and Gosport Primary Care Trust (PCT) and the Portsmouth Hospitals Performance Framework Indicator.

lf I may just deal with the IVF issue. As you are aware the National Institute for Clinical Excellence (NICE) published in February2004, its Clinical Guidelines 11, "Fertility: assessment and treatment for people with fertility problems".

It is worth clarifying the different types of guidance that NICE issues, and the responsibilities the NHS has for funding these different types of guidance. Currently NICE produces guidance in three main areas of health:

o Technology appraisals - which focus on the use of new and existing medicines and

treatments within the NHS in England and Wales;

o Clinical guidelines - which are recommendations on the appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales, based on the best available evidence, to help healthcare professionals in their work, but that do not replace their knowledge and skills;

o lnterventional procedures - which consider whether procedures that are used for diagnosis or treatment are safe enough and work well enough for routine use. This programme has been recently extended to cover Scotland, as well as England and Wales.

The Secretary of State has directed that the NHS is required to provide funding and resources for medicines and treatments recommended by NICE through its technology appraisals work programme.

It normally has three months from the date of publication of each technology appraisal guidance to provide funding and resources.

Where it is not possible to acquire the technology or where, perhaps because insufficient trained staff are available, the intervention cannot be applied within the three month period, it can be extended. Extensions are granted by the Secretary of State, on advice from NICE. The three month funding direction has been waived or extended for about ten percent of the technology appraisals issued to date.

The clinical guidelines and interventional procedure work programmes are not subject to the Secretary of State's direction to make funding available.

Primary Care Trusts (PCTs) are responsible for promoting health and providing healthcare to their populations within the resources available to them. As such, they have to make difficult decisions as to what services they are able to provide within these constraints.

All the PCTs in Hampshire and lsle of Wight have considered provision of IVF against an agreed ethical framework in the context of other competing priorities. Out of this work a joint statement was agreed by PCT commissioners as follows:

"PCTs have reviewed In Vitro Fertilisation (lVF) for the treatment of people with fertility problems against an ethical framework and local prioritisation procedure and because of competing priorities recommends that IVF will be considered a low priority and will not normally be funded-except in exceptional circumstances."

It was agreed that this statement would be taken to each of the Hampshire and lsle of Wight PCT Boards for agreement and ratification, subject to review in February 2006.

Hampshire County Council Appendix Five

Health Overview and Scrutiny Committee: 26 July 2005

NICE Guidance: Letter from Hampshire HOSC

Dear Jonathan

Local Compliance with NICE Guidance

Thank you for your letter of the 1 July, reiterating the position with regard to NICE Guidance. It was disappointing to note that, despite the Secretary of State's announcement in February 2004, local PCTs have come to the view that these services would not be provided to local people, irrespective of the evidence base cited by NICE. This has introduced an element of `lottery' whereby some PCTs will fund IVF and others will not.

It would be wrong for us to take the view that all conditions can be given the same priority, however, if a debate is to take place regarding the availability of a particular treatment then this must take place with the involvement of the relevant patients groups and other stakeholders, including the voluntary sector. We are not aware of that this discussion has taken place. It would therefore be helpful if you could provide us with the following information:

· The ethical framework used to inform this decision

· The definition of `exceptional circumstances'

· The range of fertility services that are provided for local people

· The numbers of couples in Hampshire who would qualify for access to IVF, based on the NICE criteria

· Other procedures/treatments considered to be a `low priority' and therefore not accessible to local people

In my letter of the 7 June I also asked for further clarification on position with regard to access to screening for Downs syndrome. This point was not addressed in your letter.