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.

2. Recommendations for Action:

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

_ Members note the response to Winchester and Eastleigh Patient and Public Involvement Forum attached at Appendix One

2.2. Cleanliness in Hospital

_ Members note the comments attached at Appendix Two

2.3. Access to Counselling services in North Hampshire

_ Members receive an up-date on progress with local resolution from the P&PIF

2.4. 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.

2.5. Community Hospital Services in South West Hampshire

_ The Committee deals with this matter as a substantial variation to NHS services

_ The District Councils affected by proposals from the South West Alliance are invited to contribute to the consideration of this matter by the Committee

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 Overview and Scrutiny Committee: 31 May 2005

Table One: Inquiries Received and Action Taken

Hampshire County Council Appendix One

Health Overview and Scrutiny Committee: 31 May 2005

Inquiries received: Car parking at Royal Hampshire County Hospital, Response from Hampshire County Council/ Winchester City Council

Both the City and County Councils considered that the proposed bus service should be primarily funded by the Romsey Road employers. However the employers including the hospital have declined to give any financial assistance to this service, and the two Councils are jointly funding the experimental service. The service is only likely to be successful if there are complementary parking policies introduced by the various employers. In particular we consider that the parking charges for staff parking at the hospital need to be increased substantially, and these increased charges could then be used to cross-subsidise a permanent Park and Ride bus service.

You have made an incorrect assumption that the experiment could be halted after 3 months. The experiment is for a minimum of 6 months, but after 3 months operation it will be reviewed. It will take about one month for surveys to be carried out and a report to be prepared and then considered by our Cabinet to decide whether or not to continue the service. If it is decided to discontinue the service, two months notice then has to be given to the Traffic Commissioners before a bus service can be withdrawn. You will therefore appreciate why the experiment has to be reviewed after 3 months in order to have the option of ending the experiment after 6 months.

The answers to your 6 specific questions are as follows:

1. The times have been agreed with hospital representatives. They would have preferred longer hours of operation but they were not prepared to fund the additional costs.

2. The bus service is targeted at staff working between 07.30 and 17.30. If these staff were all required to use Park and Ride, there would then be more parking spaces available for employees working early, late and night shifts, and for visitors.

3. The Chilbolton Avenue roundabout could be used as a u-turn facility by low floor buses. Low floor buses have not been specified due to the higher costs of a contract requiring these vehicles.

4. The transfer time from Park and Ride to the hospital needs to be kept to a minimum if it is to be attractive to users.

5. There is already a high standard Service 5 bus operated commercially by Stagecoach between the Broadway and the Hospital from 06.30 to 23.30. The Council would not provide an alternative option subsidised by Council Tax payers that would reduce the number of passengers using Service 5.

6. The reason for not specifying a low floor bus is primarily the extra funding that would be required. However since this bus service is targeted solely at existing employees who are car drivers, we would expect all employers to provide priority parking on their sites for staff who are disabled badge holders.

The other aspect that may be useful to explain is why the option has not been taken solely to extend the existing route. This is due to the existing buses being fully laden with seated and standing passengers at the busiest morning and evening periods. It was therefore considered essential that any enhancement of the service should provide additional capacity if it was likely to attract additional Park and Ride users.

I hope that the above information is useful, and that you will appreciate that many of the issues you raise are related to funding. Both the City and County Councils will work with the hospital to try and ensure that this experiment is a success, but this is unlikely to be achieved unless the hospital is committed to resolving the parking problems on its site. If you need any further details on the new service which will commence on 7 March, do contact Alan Jowsey, the City Council's Head of Traffic and Transport, tel. 01962 848583.

Hampshire County Council Appendix Two

Health Overview and Scrutiny Committee: 31 May 2005

Inquiries received: PHT response on cleanliness in hospital

Key points

You raise a couple of issues, namely:

1 Information around the monitoring arrangements in place to ensure that cleaning and Infection Control procedures are followed in ward areas.

2 Clarity around processes to follow up reports of poor standards or practice from patients and the public through complaints or the PALS.

To answer the first point you make, I refer initially to our cleaning procedures. Our Hotel Services Manager has clarified the arrangements for monitoring these as follows:

· Day to day cleaning is monitored by Domestic Supervisors.

· Monthly audits of cleanliness are carried out by the Ward Sister and/or the Modern Matron with the Domestic teams.

· Quarterly there are PEAT (Patient Environment Action Team) audits, which also look at cleanliness in the clinical areas. There are also PEAT audits carried out at least yearly by the Department of Health and we are required to achieve certain standards (which we have to date).

In many cases the cleaning is shared by the domestic and ward staff (health care assistant and registered nurses), eg beds and furniture. You may be aware through the local press of an initiative to steam clean beds and furniture floor by floor at Queen Alexandra Hospital. This has been completed on a number of floors already and the effects are tangible. There are issues around old beds and furniture which are beginning to rust and therefore do not aesthetically look very smart, however there are plans in progress to replace all beds, on a rolling programme within the next five years.

To answer the second part of the first point around monitoring Infection Control procedures, our Nurse Specialist in Infection Control has detailed their compliance measurements:

· Most clinical areas have a 'Link' nurse for Infection Control who carries out three-monthly audits of their area, which specifically look at hand hygiene and environmental issues. These audits are sent to the Infection Control team and Ward Manager. Areas that have scored poorly or who are known to have high levels of healthcare associated infection are then visited by the Infection Control team, who reaudit and give advice on methods to improve compliance.

· All newly identified MRSA patients receive a visit from the Infection Control team. The ward is assessed for contributing factors and staff given advice on management, containment and eradication of the bacteria.

· The three hospitals are participating in the National Patient Safety Association `cleanyourhands -campaign'. The Senior Nurse for Infection Control and Divisional Senior Nurse have now instigated fortnightly compliance visits to ensure that all hospital staff are washing their hands and using alcohol gels.

· There are long established procedures in place to measure the rate and incidence of infections, particularly wound infections and MRSA.

The second of your queries relates to how we follow through concerns raised by the patients and he public. Our PALS Manager has provided the following response:

· Any issues raised by the PEC (Patient Experience Council) are minuted and allocated actions to the appropriate person for follow up.

· The minutes are shared with the Trust Governance Committee, which is chaired by the Chair of PEC.

· The minutes are also distributed to the Divisional representatives of the PPI steering Group, who feed into the Divisional Governance Teams.

· The minutes are also sent to the Forum Support Organisation (FSO) to distribute to the PPIFs. We also sent the MRSA action plan to the FSO.

· Presentations have been given to the PEC and the Portsmouth City PCT regarding MRSA.

· The Trust has included a patient representative on the Health Care Acquired Infection co-ordinating group. She is also a ward representative on Gynae. One of the roles of a ward rep is to look at issues such as cleanliness. These issues if not dealt with locally will be escalated.

· The PEAT (Patient Environment Action Team) is often used and through this group additions have been made to the painting programme.

· An issue regarding the cleaning of high level areas (such as curtain rails) was raised at PEC, via award rep and subsequently the Service Level Agreement for cleaning the Trust has been shared with the PEC.

· PALS have a database to record concerns and it has a specific category for cleanliness.

· PALS work closely with Complaints and belong to the Trust CLIP (Complaints, Litigation Incidents and Risks). In the future the quarterly reports to the board will identify areas of concerns and trends.

I hope that this answers your specific queries, however there are a number of further points that should be made. I think it is important to note that whilst there is every goodwill and commitment on the part of our clinical and domestic staff, Queen Alexandra Hospital has provided some very real and difficult challenges, particularly in recent months. We have had a prolonged period where the winter vomiting bug has been in the hospital putting enormous strain on the domestic teams, as they have been continually diverted to do deep cleaning and 'scrubs' in infected areas, meaning that some of the day-to-day cleaning has had to be rationalised. The vacancy rate and turnover is high in this group of staff, a picture that is not peculiar to Portsmouth.

The day-to-day reality of the Queen Alexandra Hospital site is one of a very acute site where occupancy rates in recent months have been in the ninety percents. It is well documented that once occupancy rates exceed 85% incidence of infection rise considerably. The Government target for occupancy is around 80% but this is never achieved at Queen Alexandra Hospital. The PFI will bring us more beds and therefore we would expect to see a lowering of our occupancy rates and the benefits that follow.

As well as the measures described above we are just putting the finishing touches to a Trust-wide strategy for reducing healthcare associated infection. This strategy will have four key action plans that will provide a multisystem approach. The four plans will include:

(a) specific Infection Control issues;

(b) a Matron's Charter Action plan;

(c) a plan by the PEAT team which will concentrate on environmental issues; and

(d) a three-year plan by our IV Access nurse, which looks specifically at reducing blood borne infections.