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 reporting are 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

_ The Committee notes the response from PHT

_ The Joint Committee continues to monitor progress with the review of maternity service planned by the PCTs

_ The relevant Maternity Services Liaison Committee, P&PIFs and District Councils are able to contribute to the review process

2.2. Cleanliness in Hospital

_ Members receive an update on local progress against targets in January.

2.3. Compliance with NICE Guidance

_ PCTs and the SHA are asked to review the priority accorded IVF, taking account of the requirement for section 11 involvement and the need for consistency in the exception criteria to ensure equity of access.

2.4. Ambulance Service Estates Strategy

_ The Committee is advised of the consultation document when it is published

2.5. Return of Neurology Referrals

_ The correspondence to date is noted

_ Members receive confirmation that patients are being seen within target waiting times and the delays imposed by the quota system addressed.

2.6. Healthcare Commission: contribution to self assessment

_ The Chairman and Chief Executive respond to individual requests from Trusts for comment using the following criteria:

· Individual issues raised with the Trust on behalf of the Committee

· Progress with P&PI

· Evidence of partnership working arrangements

_ Supporting comments will not be provided to Trusts approaching the Committee after 30 September

_ The Healthcare Commission is advised of the Committees concerns about the way in which the assessment process, and the HOSC contribution to this, has been managed

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.

Appendix One

Dear Cllr Dr Ellis

Thank you for your letter received by Ursula Ward, Chief Executive of Portsmouth Hospitals NHS Trust, on 13 July 2005, outlining your concerns around the temporary closure of the Grange Birth Centre at Petersfield.

As Ursula is now away on holiday I am replying on her behalf and in my role as Deputy Chief Executive. I appreciate you taking the time to write to me and would like to reassure you the Portsmouth Hospitals NHS Trust believe that every possible avenue was explored before making the difficult decision to opt for temporary closure of two of our Birth Centres, Grange at Petersfield and Blackbrook at Fareham. I can confirm that the closure is temporary caused by staffing difficulties and the Trust is well aware of its responsibility to consult the committee on any permanent service change. It is not the Trusts intention that this is seen as a permanent change to the service but as a reaction to unprecedented levels of maternity leave amongst clinical midwives coupled with unusually high levels of sickness.

As you are aware, a very significant number of our midwifery staff are either pregnant or are on sick leave. Those who are on maternity leave have told us that they intend to take a minimum of six months maternity leave.

The Trust did explore and is continuing to explore a number of solutions to this difficulty. Regrettably the locally based midwifery agency was able t0 provide only a small number of temporary midwives and agency staff were not available when enquiries were make significantly further afield. The service did recently recruit student midwives who qualified in March 2005 with a further number completing their training in October. It is hoped that many of the students will become midwives within our service and we have contacted them both formally via their course tutors and informally on a one to one basis to encourage them to fill in application forms. However, they are not yet available to practice and will require a period of orientation.

A key aim of Maternity Services in Portsmouth Hospitals NHS Trust is to enable women to experience choice around their place of birth. When it became clear that the service would be unable to provide midwifery care to a safe standard based around a choice of six places of birth i.e. home, co-located unit and three stand alone units and the main unit, the difficult decision was made to temporarily close the two Birth Centres which had the lowest occupancy and to redeploy the staff to the remaining two Birth Centres and into the Community service.

It is of great importance to Maternity Services and to the Trust as a whole that all women have a range of options that enable them to feel comfortable, relaxed and in control both antenatally, during labour and postnatally. The provision of two birth centres we believe still allow this choice as well as the option of home birth with now, enhanced availability of midwives on the community to facilitate this choice. As a result of this we sincerely hope that those women who previously chose out of hospital birth would continue with this choice either at home or in an alternative Birth Centre. All women who previously chose birth centre birth is one of the two temporarily closed units are being offered the chance to talk to the senior midwife for the area and/or their community midwife to further discuss out of hospital birth.

In answer to your specific concerns asked I can confirm

1. To date- temporary contracts to cover maternity leave have been offered to midwives available for work. 3.8 full time midwives have accepted temporary contracts. A recent advertisement attracted 3 external full time midwives. 3 full time posts (permanent) were offered to the candidates. Regrettably at the last moment one midwife was unable to be appointed, (for personal reasons) but two external candidates are commencing employment with us as soon as they can. In addition all of our midwives have been offered excess hours and overtime to cover the shortfall. However I am sure you will appreciate that there comes a point when it is not advisable for staff to continue to work in excess of their contracted hours and the senior midwives for each area and the Head of Midwifery are, I know, monitoring these excess hours very carefully.


2. I can confirm that antenatal and postnatal community care are offered as normal and parent education classes are being offered as normal. We are unable to offer birth or inpatient postnatal stay in either Grange or Blackbrook. Home births have been offered and from recent discussions with Donna Ockenden I am not aware that any women has been either declined a home birth or declined either birth care or postnatal care in either of the two remaining units or the main unit. The Executive Team are being kept up to date on a regular basis on the situation in Maternity Services at this difficult time.


3. I can confirm that those women affected by the closure have been offered the opportunity to speak to their own community midwife or the senior midwife for the community area to discuss options available to them.


4. I can confirm that Donna Ockenden and Ian Golland (Divisional Clinical Director) have been asked to advise the Executive Management team when they feel that the birth centres can be safely reopened thus providing care in labour/ at birth across all 6 sites again (i.e. co-located unit - Mary Rose, 3 stand alone centres, home birth and main unit birth) When this can be achieved safely the Trust plans to reopen the birth centres.


5. I can confirm that all funded posts have been filled. The exception to this is the vacancy referred to in point one where we are waiting for an external candidate to start. We are in the process of offering staff on temporary contracts, a permanent contract to cover the one remaining vacancy. We also have a post that will become vacant with effect from 1 August and this will be offered to staff on temporary contracts.


6. The birthing pool and labour ward bed remain in the Grange. We were given permission by the WRVS to move the bed to another area where it can be utilised during the temporary closure and we will be doing this.


7. Temporary contracts will be offered to cover the maternity leave once students qualify in October. The safety and integrity of the service, is being monitored on a daily basis by Donna Ockenden, Head of Midwifery and her senior team. They are reporting to the Executive Team as described on an ongoing basis. We believe that the key issue of safety for mothers and babies cannot be understated therefore there will be no plans to reopen the temporarily closed birth centres until we are able to staff them and the community safely. We would be happy, of course, to keep you up to date with progress on this issue.

I hope that my letter to you deals with your queries and concerns in a satisfactory way (I understand you are meeting with Ursula Ward on her return from holiday). However if you require further information in advance of the meeting please do contact me again.

Appendix Two

Hampshire Ambulance Estates Strategy

Following our recent telephone discussion yesterday, I put the question of public engagement

/ consultation by the Trust under Section 11 to the PPI Forum in order to obtain a formal view.

There was, as I expected, some marked differences of view. However, the Forum was clearly united on the following issues:

1. There had not been sufficient public consultation during the development stage of the

Strategy, leading to what some Forum members regarded as fait accompli being

presented by the Trust Board for the engagement process.

2. There was recognition that the Forum had won a significant concession from the Trust

in that the originally planned engagement meetings during August had been opened

out to a programme of public meetings in ambulance stations and elsewhere during

September and October. However, in spite of repeated requests to the Trust, there

was still no published programme of meetings for Forum members to act on, which

was creating uncertainty.

Some members considered the proposed strategy does amount to a substantial change of service - closure of Ambulance stations, lack of information on proposed shift patterns etc. -

others that the service would remain the same; it was the method of delivery that would

change.

Forum members also had in front of them the knowledge that the Southampton City and New

Forest PCT PPI Forums had both formally called for full consultation, and it was reported that

East Hampshire had also done the same. I reported that I understood the OSC was still

awaiting from the Trust an explanation of why the Estate Strategy did not amount to a

substantial change in service requiring full consultation.

It was put to a vote and by a majority the PPI Forum decided that with the continued lack of

sufficient information from the Trust on either the programme of engagement, or the

reassurance that a substantial change of service was not involved, we would formally ask the

OSC to require full public consultation.

Appendix Three



Dear Ursula

Return of Routine Referrals

I am to express my alarm at the attached letter, which appears to be returning routine referrals to the referring GP.

The decision to refer is clinical and for all referrals to be returned on what would seem to be administrative grounds, without clinical opinion being sought, is not a practice that we would consider to be acceptable. I am therefore keen to understand the grounds on which this action has been sanctioned by the Trust and any other specialties that have been similarly affected. If this is an issue relating to finance then it is up to the organisations affected to resolve this. For individual patients and the clinical judgement of GPs to be dealt with in this arbitrary manner has a number of ethical and professional considerations that we will wish to explore further.

I would be grateful if you would give this matter your urgent attention and provide us with a full explanation of this action, including the number of patients that have been affected.

Attachment

Text of letter from Portsmouth Hospitals Trust, Operational Manager-Neurology

28 June 2005

Return of Routine referrals

PHT has been asked to return all routine Neurology referrals to the referring GP, for all referrals over and above our present outpatient capacity. Accordingly I am returning your referral along with this letter. Fareham and Gosport PCT, who are the lead commissioner for neurology in the district, will shortly be distributing a letter fully explaining the circumstances of this development.

Appendix Four

Return of Routine Referrals

i am writing in response to your letter of 2nd August expressing your concerns about the return of routine Neurology referrals.

The Neurology service in Portsmouth is run by the Wessex Neurology Centre, which is part of Southampton University Hospitals Trust (SUHT). Portsmouth Hospitals NHS Trust (PHT) acts as host for the service on SUHT's behalf. The decision to introduce a quota system for routine referrals was taken by SUHT in agreement with Fareham and Gosport PCT, the lead commissioner for Neurology in the Portsmouth district.

Your letter states that referrals are being returned "Without clinical opinion being sought". f can assure you that all referrals to the Neurology service are graded for urgency by a consultant neurologist and all those graded urgent or priority are being accommodated. However, there is only enough capacity to see a total of 36 routine referrals a month. This is the nature of the quota system mentioned above.

It is for SUHT and the PCTs to explain the decision they have made to introduce a quota system, however f can provide some further information as requested. To date, 391 routine referrals have been returned since the quota system was introduced at the beginning of June, impacting on referrals received since fate May. Since that foe, the PCTs have written to all GP practices identifying alternative providers for the GP to refer to. To

put these numbers into context, it should also be born in mind that prior to this system, not all referrals necessarily resulted in an outpatient appointment being made.

It is agreed across the health community that action needs to be taken urgently to resolve the gap between demand and capacity, so that the quota system can be discontinued at the earliest opportunity. The local PCTs are working with SUHT and with PHT to produce a solution on this issue.