Hampshire County Council

Health Overview and Scrutiny Committee

Report on Progress Spring 2004 to Spring 2005

Introduction from the Chairman

This report provides our second up-date on the work of the Health Review Committee (the Committee) over the last 12 months. It sets out progress with the agreed work programme and describes additional action taken to ensure that the Committee meets its statutory responsibilities with regard to the overview and scrutiny of health services in Hampshire.

Members have continued to take the lead across a number of areas of work, both planned and unplanned. By adopting a flexible approach to health scrutiny, and carefully targeting resources to secure improvements in service delivery, we have been able to deliver our work programme and undertake a number of additional initiatives.

Particular pressures over the last 12 months have come from the NHS, which is required to consult the Committee when proposals to substantially change or vary services are under consideration. In addition to national drivers for modernisation, and major policy initiatives such as the new GP contract, local NHS services have to manage significant financial challenges to ensure that health services in the area are affordable and sustainable. This year has seen a further deterioration in the budgetary position of the local NHS and the Committee anticipates that 2005/06 will bring significant change as NHS organisations in Hampshire and the Isle of Wight strive to achieve financial balance.

The importance of effective communications and constructive working relationships has been highlighted in our discussions with partner organisations over the last year.

We are committed to building on the progress achieved to further strengthen our networks across health, local government and the voluntary sector. This requires that the Committee has links with more than 40 different organisations in Hampshire's boundaries alone and the complexity of these arrangements remain a source of concern.

The report sets out:

· The approach of the Committee to health overview and scrutiny (Section 1)

· The achievements of the Committee over the last twelve months, including joint scrutiny arrangements (Section 2)

· The outline work programme for 2005/06 (Section 3)

More detailed information on the work of the Committee, can be found on our web-site at www.hants.go.uk/healthscrutiny

Cllr Dr Raymond Ellis, C.Chem FRCS, Chairman, Health Overview and Scrutiny Committee

Section 1: Local Progress with Health Overview and Scrutiny.

Health Overview and Scrutiny is a relatively new statutory responsibility for local government. The legislative framework within which the Committee functions allows Members to consider any aspect of health that affects the population of Hampshire. It also places very specific duties on the NHS with regard to consultation, information and responses to any recommendations made by the Committee. The Committee is a statutory consultee on any substantial change being considered by the NHS and has the power to refer contested decisions about health services to the Secretary of State for Health. A summary of the main powers of the Committee, and the duties placed on the NHS, is attached at Appendix One. Arrangements are in place to allow these powers to be delegated for specific proposals affecting the health of local people to be considered by a joint committee or, in exceptional circumstances, by another scrutiny committee set up by local government.

As its role has developed the Committee has been mindful that it is not the only, or even the main form of engagement between the NHS and local government. Services are increasingly commissioned in partnership across health and social care, and local strategies are key initiatives in promoting seamless service across different communities. Patient and Public Involvement Forums (P&PIFs) and District Councils each have a role to play in shaping the Committee's understanding of local issues, providing a rich source of intelligence about issues relating to health and health services. Similarly the Committee needs to have a

constructive working relationship with internal service providers, the Cabinet and other authorities and public agencies with a scrutiny function.

Health and health services in Hampshire are complex, with different priorities in different communities. The network of working arrangements that has emerged in the last year demonstrates the commitment to ensure that, to the fullest extent possible, it is the local community that has the greatest influence on the development of health services in a particular area. This local influence has been a recurrent theme as the work programme has rolled forward and will remain a central feature of the work of the Committee.

No additional resource has been made available by central government to fund the work of the Committee and this inevitably constrains the range and scope of scrutiny that can be undertaken. Effective targeting has therefore been necessary to enable the scrutiny process to be both credible and influential The approach adopted by the Committee places emphasis on ways of working that are:

· Challenging but not confrontational

· Evidence based

· Able to improve service delivery

The role of the Committee as a `critical friend' has been established and the last year has seen a maturing of relationships with partner organisations, particularly the local NHS. The financial challenges facing local health services, and the potential impact on local people make it vital that the Committee maintains a constructive dialogue with all concerned.

The forward work programme of the Committee set out in Section Three of this report has been developed in discussion with P&PIFs, District Councils and NHS organisations in Hampshire. It takes account of the work that the Committee must do, specifically:

· Respond to proposals to substantially vary NHS services in the area of the Committee

· Manage referrals from P&PIFs (and other partner organisations)

In addition it identifies issues that may benefit from a more in-depth thematic review. To make the best use of the resources available to the Committee the following four criteria have been developed to guide members when selecting topics for review:

· Capacity to influence and improve the service under consideration

· Timeliness and relevance to local health services

· Issues not under consideration elsewhere

· Issues not subject to other scrutiny or performance monitoring activities

Section Two: Progress with the work programme 2004/05

A report on the progress of the Committee in 2003/04, and a work programme for 2004/05 was published in May 2004. This described the approach to health scrutiny adopted by the Committee and underpinning the work strands. These were:

· Relationships and Communications-

· Reviews of Health Services-.

· Health Inquiries

· Substantial Variation or development of NHS services

An up-date on progress with the work of the Committee was produced in November 2004. More detailed information about the work undertaken by the Committee against each work strand in 2004/05 is set out below.

Relationships and Communication

The Committee has actively sought to consolidate the working relationships that exist with its partner organisations. Members hosted and contributed to a number of local and national events associated with health scrutiny. These were aimed at raising awareness and understanding of the role of the Committee and its links with arrangements for patient and public involvement in health. This has included:

a) An event for NHS Chairmen and Chairmen and lead officers from Health Overview and Scrutiny Committees in Hampshire and the Isle of Wight

b) Three local area meetings for P&PIF Chairmen, lead members and officers from district authorities, NHS Chairmen and Chief Executives. These meetings were held in mid & south west Hampshire, north Hampshire, south east Hampshire. The events were structured to be as participative as possible and invited feedback on

i) The main challenges facing health services in the area

ii) Issues to be considered by the Committee for review in the coming year

iii) The working relationships necessary to support the effective delivery of health scrutiny.

This information has been collated to inform the work programme for 2005/06.

Over the late autumn and winter the Chairman and lead officer made a series of informal visits to District Councils and NHS organisations in Hampshire. Additional comment was invited on the approach adopted by the Committee, and key issues for scrutiny in the coming year. These comments were incorporated into the feedback from the area meetings.

In May 2004 a dedicated web site for health scrutiny was launched (www.hants.gov.uk/healthscrutiny) to make information about the role of the Committee more accessible to local people. The site includes general information about health scrutiny, details of locally specific work undertaken by the Committee and links with other overview and scrutiny committees and health organisations operating in Hampshire and the Isle of Wight. This site will continue to be developed and expanded subject to funding availability.

Committee meetings include briefings by NHS partners and others to up date members on key issues. Topics covered in the last year have included:

o `Beyond HealthFit'

o Developments in NHS dentistry

o Orthopaedic Choice

o Out of Hours Services

The Chairman of the Committee has maintained a regular presence at the Strategic Health Authority Board meetings and Portsmouth City Council Health Scrutiny Committee meetings.

Reviews of Health Services

The review programme for 2004/05 included:

· Access to therapy in services for children in school and pre-school (lead member Cllr Mrs McNair Scott)

· Access to foot care for people with diabetes (lead member Cllr A Dowden)

· Administration of medication in schools (lead member Cllr R Ellis)

Work on the first two reviews was completed in late 2004 and final reports agreed in March 2005. Progress with implementing the recommendations set out in the reports will be evaluated in 2005/06.

Initial investigations into the administration of medicines in schools indicated that sound systems were in place for managing these arrangements and there was therefore little scope for the Committee to further influence this.

The Committee has also asked for progress reports on the implementation of recommendations from previous reviews of services. The effectiveness of this as a mechanism for ensuring that appropriate action has been taken will be reviewed in 2005/06.

Health Inquiries and Referrals from Partners

P&PIFs have the right to refer issues of concern to the Committee for further investigation. Provision has been made for such referrals to be explored and acted on without resort to a formal review. Where issues raised are already subject to monitoring or other performance management activities, inquiries can be resolved through appropriate sign-positing and reporting back to the Committee. This ensures that the work does not duplicate other scrutiny activities. Where a query cannot be satisfactorily resolved then scope for further action can be considered.

Issues of this nature considered by the Committee, and the action taken, are fully reported in the agenda papers and have included the following topics over the last year:

· Diagnostic &Treatment Centres

· Arrangements for patient and public involvement in health

· Redevelopment of Queen Alexandra Hospital and services in south east Hampshire

· Out of Hours Provision

· Foundation Hospitals

· `HealthFit' and `Beyond HealthFit'

Where appropriate briefing papers and any associated correspondence is included in the agenda papers (these are available on the web site).

Proposals to vary or develop health services

The NHS has a statutory duty to consult the Committee on any proposals to substantially vary or develop health services provided to local people. Any changes planned therefore need to be brought to the Committee at an early stage in order to determine if the proposal is substantial and how any formal consultation will be undertaken.

In determining if a proposal is substantial the Committee considers the impact of the change on those using, or who may use the service in question, including carers. The acceptability of the change to patients and any implications for other service providers are specific areas of interest.

As a result of feedback from NHS Chief Executives in autumn 2004 the Committee undertook to develop a framework for assessing if a proposal represents a substantial change in service provision. This takes account of changes to legislation (such as the Race (Amendment) Act 2000) and public health agenda. The framework, developed in conjunction with other Health Scrutiny Committees in Hampshire and the Isle of Wight, was subject to a 3 month consultation with the NHS. It can be viewed at Appendix Two.

All proposals for varying NHS services considered by the Committee, with any associated reports or comments, are included in agenda papers.

Responses to consultation in the since April 2004 have included:

· Reprovision of rehabilitation services at `the Mount' Hospital, Bishopstoke (May 04)

· `HealthFit' Strategic Framework (May 04)

· Foundation Hospitals (x5 applications affecting the population of Hampshire, May 04)

· The Future of Health Services in Fareham and Gosport (Sept 04)

· Future Arrangements for the support of Patient and Public Involvement Forums (Jan 05)

· Healthcare Commission: Performance Assessment Framework (Jan 05)

· Commission for Social Care Inspection: Draft Standards for Improving the Regulatory Process (Jan 05)

· Redevelopment of Fleet Hospital (March 05)

In addition the Committee has convened two special `select committee' style meetings to consider issues relating to local NHS services:

· The decision of Winchester and Eastleigh NHS Trust to close inpatient services at the Mount Hospital on the grounds of patient safety (July 04)

· Proposals from Fareham and Gosport PCT to reconfigure health services in south east Hampshire (November 04). Issues of concern to the Committee were raised with the Secretaries of State for Defence and Health in December 2004. In the absence of a satisfactory response this matter was subsequently formally referred to the Secretary of State for Health with a request that further investigation is carried out by the Independent Reconfiguration Panel (January 05)

Joint Committees

Regular Joint meetings are held with the Chairmen and lead officers for Portsmouth City Council, Isle of Wight Council and Southampton City Council. These provide the opportunity for sharing information and agreeing how to respond to joint issues of concern. The Chairman of this Committee is currently Cllr R Ellis.

Additionally the Chairmen and lead officers for all Health Overview and Scrutiny Committees in the southeast region meet on a regular basis. Links have been established with Health Overview and Scrutiny Committees operating in north Thames. This provides the opportunity for collective action in relation to issues of concern.

Joint Scrutiny Arrangements

If a proposal from the NHS to substantially vary or change service provision affects the population of more than one OSC area there is a requirement that a formal joint committee be formed to consider that proposal. Further information on the arrangements in place to allow the Committee to respond promptly to such proposals is available on the web-site.

The Committee has formed two formal joint committees in the last year

· With Surrey Health Scrutiny Committee to consider changes to mental health and learning disability services (reported March and May 2004)

· working in partnership with Portsmouth City Council to consider plans for configuring maternity services in south east Hampshire. It is expected that this Committee will report its findings in early summer 2005.

Section 3: Outline Work Programme for 2005/06

The last 12 months have provided an opportunity for the Committee to consolidate the partnership working arrangements that exist across Hampshire. This allows better use of the local knowledge of District Councils, NHS organisations and P&PIFs to identify key issues for scrutiny. Comment from the area meetings, and one to one discussions with partner organisations provided feedback on the approach adopted by the Committee and priorities for consideration in the coming year. These were reported to the Committee in November 2004 and January 2005 respectively.

The meetings provided an opportunity for participants to discuss how local arrangements were working and invited feedback on three issues

1. Looking ahead: What are the main challenges for health services in your area?

2. Making a difference: What are the top three issues for health overview and scrutiny in the coming year?

3. Working Relationships: What are the key working relationships that need to be in place to enable your organisation to engage with the new arrangements for health scrutiny?

The responses received are summarised below and have informed the work programme for the coming year. A number of issues were raised as being both a challenge for local health services and a priority for consideration in the coming year.

Main Challenges identified

A major challenge for the NHS related to the implementation of `Beyond HealthFit', a programme developed by the Strategic Health Authority to support the delivery of affordable and sustainable health services in Hampshire and the Isle of Wight. The financial pressures underpinning this programme, matching demand with resources and continuing to meet targets were specific areas highlighted by the NHS. The need to build `real' partnerships with other NHS organisations as well as the Committee and P&PIFs was also identified.

Local Authorities mirrored a number of these issues although from the perspective of the timeframes for scrutinising proposals. Particular concerns were raised about `Beyond HealthFit' being driven by financial pressures rather than the needs of local people.

P&PIFs identified the need for `genuine ` consultation with patients and the public and the need for joint working across the statutory sector and voluntary organisations.

Other common themes highlighted as challenges included

_ Out of hours and emergency care

_ Dental services

_ Partnership working

_ Managed care

Making a Difference: the top three issues for health scrutiny in the coming year

NHS respondents focused particularly on the need for the Committee to understand the need for change and respond appropriately to `Beyond HealthFit' and associated consultation. Equal importance was placed on the need for the speedy implementation of `Beyond HealthFit' and delivery of financial balance.

Broad themes from Local Authority respondents emphasised cross cutting work supporting the scrutiny function, including transport, public health and other service providers. Recruitment and retention of staff was also raised.

P&PIFs wanted a closer working relationship with the Committee.

Common areas identified as being suitable for review by the Committee in the coming year included

_ Effective delivery of the public health agenda, including work with vulnerable groups

_ Out of Hours, walk in centres and emergency care

_ Partnership working across health and social care

_ Integrated services for older people, including hospital admission and delayed transfers of care

_ Transport for patients and the public

Key working relationships: development and next steps

Generally the message was that progress was being made but all commentators acknowledged that this was an evolving process. More work needed to be done by all partners to build trust and understanding of the roles the different contributors to the new system.

Recurring comments referred to the need for timeliness and consistency in communications, and awareness that different issues will need different solutions.

Opportunities to develop common protocols or priorities for action were identified by the NHS.

Local Authorities noted that there were tensions between different NHS organisations and the NHS and other service providers.

Work Programme 2005/06

The Committee's work programme for 2005/06 will build on and consolidate the work of the last two years. Issues raised by Members and partners will inform the programme of reviews which have been prioritised according to criteria developed by the Committee.

Account has been taken of work that will require action, particularly with regard to proposals from the NHS to substantially vary or develop health care provision. The work programme of the Committee for 2005/06 with therefore comprise:

Relationships and Communications

· The Committee continues to actively engage with partner organisations through the area meeting structure and one to one meetings as appropriate

· Member briefings are arranged on the following topics:

o Access to NHS continuing care

o Mental health services in Hampshire, including services for children and young people

o Access to NHS dentists

o Water Fluoridation

o Developments in General Surgery

o Financing the NHS

· The web site is up-dated and extended to provide more accessible information about the work of the Committee and the issues raised

· Particular emphasis will be given to developing a closer working relationship with P&PIFs operating in the area of the Committee

Proposals to vary or develop NHS services

· The Committee continues to work closely with NHS organisations in Hampshire to ensure that proposals for substantially varying health services take account of the agreed framework

.

· Appropriate arrangements are put in place to enable the Committee to contribute effectively to the following consultations, within agreed timescales:

· Maternity Service Reconfiguration in South East Hampshire

· Surgical Service Reconfiguration in South West Hampshire

· Reconfiguration of Rehabilitation services in Winchester and mid-Hampshire

· South West Alliance Community Strategy

· The Committee will continue to be alerted to proposals from the NHS that vary or change services and responds appropriately within agreed timescales.

Reviews of Health Services

· The role of Hampshire County Council in promoting the public health agenda is considered by the Committee, working with other County scrutiny committees as appropriate

· The issue of Out of Hours and Unscheduled Care is further explored by the Committee as a priority

· The Committee reviews the effectiveness of is arrangements for assessing progress with the implementation of recommendations made to responsible bodies

· The Committee considers the scope for referring other issues raised by partner organisations, such as partnership working and transport to other scrutiny committees operating in the area

· Training is given to members and P&PIFs on impact assessment and equality issues

Health Inquiries

· The Committee continues to receive regular information on the issues raised by members and partner and action taken

· Particular issues for consideration for further action by the Committee in the coming year will include:

o The review of the south east Hampshire capacity plan

o Local action on NHS dentists

o progress with NHS financial recovery programmes

o closure of in-patient beds at the Fenwick Hospital