Archived decisions

Hampshire County Council

Health Overview and Scrutiny Committee Item 6

31 January 2006

Inquiries Received and Action Taken

Report of the Chief Executive

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

Topic/inquiry

Source

Action Taken

Comment

Temporary Closure of the Grange and Blackbrook Birth Centres

East Hants District Council, County Councillors,

Local People

Refer to Item 5, section 9

Continue to monitor.

This has been a highly controversial action that cuts across accepted good practice.

Compliance with NICE Guidance

Local MP

The presentation to the joint Committee on 5 December confirmed that:

    · A consistent approach will be fully implemented across H&IOW from 1 April

    · Eligible families will be able to receive some services from 1 January

    · PCTs were seeking the views of stakeholders about the criteria

    · The joint HOSC has asked that there be a single appeal process across Hampshire to ensure consistency in decision making

Ambulance Service Estates Strategy

New Forest DC, Ringwood TC, New Forest P&PIF

The consultation on the national programme and the PCT/SHA reconfiguration associated with `Commissioning a patient led NHS' was launched on the 14 December. It was expected that the estates strategy would be included in this, however this is not the case

Return of routine neurology referrals

Committee member

Confirmation that the back log has been resolved is awaited

Transfer of upper GI cancer surgery from Frimely Park to Royal Surrey County Hospital

County Cllr

Additional information has been sought on the background to the decision to move these services and the impact this may have on the quality of care. Initial comments and suggested next steps are attached at Appendix One

Progress with Aldershot Health Centre

Committee Member

Members will receive a presentation on progress with this work on the 28 March.

Closure of New Street practice

Committee members

Following the conviction of the GP at this practice the PCT has sought another provider through the agreed tendering process. This has not been successful and the PCT now has no choice but to close the practice. This action is supported by the LMC.

Having been appraised of the action of the PCT to secure an alternative provider the Chairman has indicated that this is not a substantial service change as all patients will be able to re-register with other local practices. Those affected by the changes, including local councillors, would need to be kept up-dated on the situation

Independent Sector Procurement: Diagnostics

Committee Member

The SHA has signalled its intention to purchase a range of diagnostic services from the private sector as part of a national programme. Further information is attached at Appendix Two.

Particular queries that the Committee may wish to raise with regard to this proposal include:

    · The volume of activity purchased and the `choice' initiative

    · Payments that exceed the agreed national tariffs

    · The quality of service

    · The need for appropriately trained and qualified staff

    · Impact on NHS providers in the area

2. Recommendations for Action:

2.1. Closure of the Grange and Blackbrook Birthing Centres

      _ Please see Item 5 section 9

2.2. Compliance with NICE Guidance

      _ Members are advised of the final criteria for accessing these services when these are available

2.3. Ambulance Service Estates Strategy

      _ The Trust provides confirmation about the way in which this proposal will be taken forward

2.4. Return of Neurology Referrals

      _ The Committee continues to pursue this matter until the Has confirms that the backlog has been cleared and the referrals from GPs are being dealt within the target waiting times

2.5. Transfer of Cancer Services

      _ Members note the questions identified in paragraph 5 of Appendix One.

      _ A special meeting is held, with Surry HOSC, to provide an opportunity for key stakeholders to respond to these questions and any other queries that members may wish to raise.

2.6. Aldershot Health Centre

      _ Members receive the presentation on 28 March

2.7. New Street Practice

      _ Members confirm the advice given by the Chairman

2.8. Independent Sector Procurement

      _ The Committee writes to the SHA requesting clarification on the points raised above and any other issues raised by members.

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

Transfer of Upper GI Cancer Unit from Frimley Park to Royal Surrey Hospital in Guildford issue

Background

    1. Newspapers report a potential issue concerning planned transfer of the Upper Gastro-intestinal Cancer Unit from Frimely Park Hospital to The Royal Surrey Hospital in Guildford. Frimely Park is on the border of the Hampshire District of Rushmoor and Surrey. Patients in the Blackwater Valley and Hart PCT/Districts of Hart and Rushmore are within the catchment area of Frimely Park Hospital, therefore this proposed change of service delivery is of interest to the Committee.

    2. Transfer of the Upper GI Cancer Unit is an initiative of the Surrey, West Sussex and Hampshire (SWSH) Cancer Network with the intention of following the recommendation of the NICE guidance to consolidate expertise in Cancer Centres. In May 2004 a decision was taken to move surgical services for patients with pancreatic and oesophago gastric cancers to the site of the Royal Surrey County Hospital in Guildford, adjacent to the St Luke's Cancer Centre. The agreed transfer date for OG activity is October 2006.

    3. Whilst there is a determination to move towards consolidating cancer expertise at the RSC Hospital in Guildford, there is nevertheless significant concern from some clinicians and members of the public based on a number of factors including:

    4. A peer review of RSC in 2002 apparently expressed concern about RSC hospitals cancer service, but a peer review published late December 2005 "wished to acknowledge that they considered this unit (i.e. the Upper GI Cancer Unit at FP) to be a Centre of Excellence" . The report also states "Given the current capacity issues and severe financial constraints on the health economy, the Review Team has reservations about the Network's ability to successfully implement the IOG plan." (i.e. the Improving Outcomes Guidance plan to move the unit from FP to RSCH at Guildford) There is therefore concern by some FP clinicians that it may not be in patients' best interests to be referred to a newly established service at Guildford when a centre of excellence with very good outcomes already exists at FP.

    5. (It should be noted, however, that the SWSH Network Director, when asked to comment, said it should be remembered that on the basis of the Peer Review `Quality Measures' and summarised in the report, the outcomes between the Upper GI Cancer units at FP and RSCH are not very different. In addition, he pointed out, RSCH has improved its infrastructure and resources since the peer review visit.). The Committee will wish to determine:

    · The actions taken by the Royal Surrey to address the issues identified in the peer review reports.

    · The way in which the views of patients and the public have informed the decision to move the unit, in accordance with section 11 of the Health & Social Care Act

    · The means by which the quality of care and service provided at the Royal Surrey will be assessed to ensure that it is equal to, or better than, that currently provided at Frimely Park.

Recommendation

It is recommended that a special meeting is held, with Surry HOSC, to provide an opportunity for key stakeholders to respond to these questions and any other queries that members may wish to raise.

Appendix Two

HAMPSHIRE AND ISLE OF WIGHT STRATEGIC HEALTH AUTHORITY

Information Briefing for the Overview and Scrutiny Committee

Phase Two Independent Sector Diagnostic Procurement

introduction

This briefing is to provide background information to the Overview and Scrutiny Committee on the Phase Two Independent Sector diagnostic procurement programme.

national context

In February 2005, John Reid, Health Secretary announced that NHS patients would get speedier access to high quality diagnostic tests in future thanks to a £1 billion procurement. The scheme would dramatically boost NHS capacity to provide diagnostic services and means patients would benefit from much quicker access to services such as magnetic resonance imaging (MRI), computerised tomography (CT) and ultrasound scans.

He said "By the end of 2008, we are determined no one will wait longer than 18 weeks for hospital treatment from the time they see their GP right through to the time of the treatment. To achieve this we must expand our diagnostic service capacity rapidly". He added "We are also going to end hidden waits. The time patients wait for diagnostics has not traditionally been counted as part of the waiting time measurement. We are going to change that".

Services would be provided more conveniently for patients and the Independent Sector providers would be asked to think creatively about how services could be best delivered and where they could be located. This would be done in conjunction with local Primary Care Trusts who commission patient services. He said "In buying extra capacity from the independent sector, we will significantly increase the NHS funded diagnostic provision and increase the numbers of expert staff, such as radiologists, to provide these services for NHS patients, with equal access free at the point of delivery."

local context

The national waiting time target of a maximum of 18 weeks from referral to treatment is to be achieved by 2008. An integral part of achieving this target and to improve waiting times further for Hampshire and Isle of Wight patients is to procure independent sector diagnostic activity via the national programme. The total value of this activity for Hampshire and Isle of Wight is approximately £6.4 million, which equates to approximately 47,300 scans per year. The contract length will be five years (with an option to extend for a further two) and is expected to begin in late autumn 2006. The types of diagnostic testing to be procured are:

    _ computerised tomography scans;

    _ computerised tomography scans;

    _ magnetic resonance imaging (MRI);

    _ ultrasounds;

    _ x-rays;

    _ physiological measurement (neurophysiology);

    _ audiology;

    _ endoscopy;

    _ dexa scans.

Through a separate procurement positron emission tomography computerised tomography (PET CT) scans will also be procured, but the value of that procurement is in addition to the values detailed in this paper.

The intention is for the independent sector to provide a number of Community Diagnostic Centres across the north, mid and south-west of Hampshire and to provide a service on the Isle of Wight. The provider will be expected to develop Community Diagnostic Centres in strategic areas that will provide diagnostic services convenient to patients. Patients should be able to access the service provider within 30 miles of their home, or less than one hour travelling time based on using public transport. For patients this will mean a shorter journey time to access services. A consistent and regular service will be provided; this could include some provision from a mobile facility or by using mobile equipment.

The provider will be expected to provide clinically effective, efficient, integrated, patient-centred pathways. The service must be comprehensive and based on agreed pathways of care and referral guidelines, including:

    _ investigation within two weeks from referral (via electronic booking from referral);

    _ diagnosis reporting within 48 hours following the investigation.

Patients will be given increased choice with the addition of the independent sector provision. Referrals will be made by a general practitioner or a clinician with special interest working in an interface service (primary care led service to assess a patient to determine whether admission to an acute hospital is required e.g. an orthopaedic interface service). There will also be the opportunity for patients waiting for a diagnostic test with an NHS provided to be offered choice with the independent sector provider.

Due to the relatively small volumes of independent sector activity to be procured, this will not substitute exiting NHS provision but will provide additional capacity to facilitate in reducing overall waiting times for diagnostic services across Hampshire and the Isle of Wight.

conclusion

The national waiting time target of a maximum of 18 weeks referral to treatment is to be achieved by 2008. To ensure delivery of this target diagnostic capacity needs to be expanded. The £1 billion diagnostic procurement will make this possible.

The Hampshire and Isle of Wight Strategic Health Community is committed to achieving this target and enhancing the health services that are provided to our patients. The service model proposed within Hampshire and the Isle of Wight will provide choice of provider, lower waiting times and a service that is geographically convenient to our patients.