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 response to these referrals. It sets out the inquiries received, the source of this inquiry and any 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. Ambulance Service Estates Strategy

_ Members confirm if they consider the proposal to be a substantial change in service

_ Any further action identified by the Committee is shared with the Trust

2.2. Aldershot Health Centre

_ Members receive the presentation on 28 March

2.3. Return of Neurology Referrals

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

2.4. Transfer of Cancer Services

_ That the Committee requests that the October 2006 target date for transfer of the Upper GI Cancer Unit to RSCH be postponed until the review by Professor Mike Richards is completed, and its recommendations have been considered by the SWSH Cancer Network

_ That the October 2006 target date for transfer of the Upper GI Cancer Unit to RSCH be postponed until more substantial patient and public engagement has been undertaken with respect to the plans mapped out for OG cancer services within the SWSH region.

2.5. New Street Practice

_ The PCT confirms engagement with local people and other key stakeholders in support of Section 11 of the Health and Social Care Act

2.6. The future of Redclyffe House Gosport

_ Members receive confirmation of the proposals for this facility from the PCT and the report from the P&PIF at their next meeting

_ The views of adult services on the proposals are sought

2.7. Cleanliness in Hospitals

_ Members thank the Forum for a helpful report

2.8. The future of the Lawns Day Hospital

_ Members receive the response from Hampshire Partnership and the a copy of the review undertaken by the PCT at their next meeting

2.9. Feedback from area meetings

_ Feedback from the area meetings informs the topics for review in 2006/07

2.10. Closure of Midhurst Hospital

_ Members are apprised of the Hampshire patients that will be affected by the closure of this hospital, and the action being taken in response to this, at the May meeting

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

The Jarvis Centre

Stoughton Road

Guildford

Surrey

GU1 1LJ

Tel 01483 783117

Fax 01483 783179

Email [email protected]

10^th March 2006

Dear Dr Ellis

Proposed Transfer of the Upper GI Cancer Unit from Frimley Park to the Royal Surrey County Hospital

Thank you for your recent letter. I have set out in the attached briefing paper my response to the points you raised.

In recent months the Network has become aware of the concerns of the local population regarding this proposed transfer. The network has, therefore, invited Professor Mike Richards, National Cancer Director, to validate that the plans mapped out for OG services through the Network represent the most sensible solution to meeting the IOG guidelines in the light of the wider pattern of healthcare provision across local acute services. Professor Richards has also been asked to confirm that the Royal Surrey County Hospital will be ready to take these services on within the agreed timetable and that the planned changes will enable local services to comply with national guidance. His involvement will be timed to coincide with other planning work on local acute hospital services that is currently underway.

It is recognised that the existing timetable for the transfer of services from Frimley Park Hospital may need to be revised in the light of this additional work. Whilst recognizing that this will have some operational implications, it is considered that we have a responsibility to seek expert advice on the existing plans to provide us with reassurance on the future direction for these very important services.

I trust this is clear, however, if you have any other questions please do not hesitate to contact me.

W B C Thomas

Network Director

CC Sir Ian Carruthers

Cllr C Leversha

Ms C Morris

Cllr Bob Lacy

Cllr John Ades

Cllr Robin Brown

Andrew Morris

Nick Moberley

Nick Yeo

Julia Russell

Briefing Paper for the Hampshire County Council Overview and Scrutiny Committee

1 Background & reasons for the proposed transfer

Over the past few years the National Institute for Clinical Excellence (NICE) has produced a series of Improving Outcomes Guidance manuals setting out how and where services for patients with cancer should be provided. Improving Outcomes in Upper Gastro-intestinal Cancers was published in 2001. The general direction proposed by NICE is that there should be fewer, more specialist centres for rarer cancers, where all patients can benefit through access to specialist clinical teams. All 34 cancer networks in England have, therefore, been working to put together plans which will meet the requirements of the clinical guidelines, covering a range of tumour sites.

Upper GI surgery covers both pancreatic and oesophago gastric (OG) cancers. NICE has recommended that the catchment populations for pancreas should be 2m and 1m for OG. For each cancer site there should be a specialist team & centre for referral and treatment. All patients are still seen initially at their local hospital.

Upper Gastro intestinal services within SWSH were the subject of a separate Peer Review between the 23^rd and 25^th February 2004. The date suggested by the Surrey West Sussex & Hampshire (SWSH) Cancer Network Upper GI Tumour Group for centralising and transferring services to the Royal Surrey County Hospital site was 2012. However, the review team found this unacceptable and strongly recommended that an agreed action plan should be signed off by June 2004.

The Upper GI Tumour Group comprising of surgeons, physicians, nursing, other clinical and managerial staff from the Network team and hospitals continued to meet to debate and discuss this issue.

Finally, in May 2004, and with the help of the then Chair of the SWSH Cancer Network, Mr Simon Robins, who was also the Chief Executive of the Surrey & Sussex Strategic Health Authority, 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. This decision was reached through a consensus of opinion with agreed transfer dates of April 2005 for pancreatic activity and October 2006 for OG activity.

The milestone dates were included in the Improving Outcomes Plan for Upper GI Cancers which was approved by members of the SWSH Cancer Network Policy Board in June 2004. The Policy Board includes representation from the eight PCTs, four acute trusts and the Network User Partnership Group The plan was also agreed with the Strategic Health Authority and the Cancer Action Team at the Department of Health.

2 Clinical Views & Involvement

Two consultants at Frimley Park Hospital were not in favour of the move and expressed a number of concerns. The CEO at Frimley Park also questioned the transfer of the service suggesting that the shift needed to demonstrate "better value for money" or "improved outcomes".

As a result, two implementation working groups were set up, the first covering pancreatic activity and the second OG. The purpose of the groups was to work through and agree the changes in working practices together with the investment required in infrastructure. Both groups were initially chaired by the consultant surgeons from Frimley Park Hospital. The surgeon chairing the pancreatic group, Mr Iain Patterson, decided to step down, and was replaced by a surgeon from the Surrey and Sussex Trust in Redhill, Mr Robin Lightwood (who is also the chair of the Upper GI Tumour group).

Other members and participants in the groups included consultant surgeons, physicians, oncologists, radiologists and anaesthetists. Specialist nursing staff and managerial staff from the Acute Trusts and network team were also included.

3 Pancreatic Cancer

The pancreatic group produced a plan for moving the service to the Royal Surrey County Hospital site which was approved by the Network Commissioners in December 2004, and by the Policy Board in March 2005.

As part of the start up costs and to cover activity excluded from PBR and tariff, the eight network PCTs agreed to provide maximum funding of £268k in 2005/6 and 2006/7. This also covers the moves of gynaecology and urology. Future funding will have to be secured from activity.

Surgical activity for patients with pancreatic surgery from Ashford St Peter's and Surrey & Sussex Healthcare transferred to the new Unit at the Royal Surrey County Hospital in April 2005. Frimley patients started to be referred in September 2005. The unit is also taking referrals from the Sussex Network and from other areas

4 Oesophago gastric Cancer

Discussions on the transfer of surgical services for patients with oesophago gastric cancers have been ongoing for over a year. As with the pancreatic move, a small working group was establshed comprising of consultants, other clinical, nursing and managerial staff to work through the logistics and to ensure that the right investments and infrastructure were put in place to facilitate the move.

The group has been chaired by Mr Sukhpal Singh, a consultant surgeon at Frimley Park Hospital. He has been very rigorous with this process to ensure that the new service and team will provide the same quality service, and levels of patient care that have been provided at Frimley Park Hospital

On 30^th June 2005 the Network Commissioning Group received and considered the business case produced by the Working Group. The Commissioning Group then recommended to the SWSH Cancer Network Policy Board that the case should be approved and the Board endorsed this recommendation at its meeting on 4^th July, 2005.

Despite being involved in preparing the business plan Mr Singh has continued to voice his opposition against the move. The consultants at the Royal Surrey County Hospital and the Chair of the Tumour have endeavoured to persuade him to change his mind but to no avail.

The Working Group will now work through the details of the move which is scheduled to be completed by October 2006.

5 Public Consultation

During the preparation of the plans and on going discussions the Network Director and CEO of the Royal Surrey County Hospital met with representatives from the Surrey Overview and Scrutiny Committee in March 2005 to talk through the implications of all the plans (upper GI, gynaecological and urological cancers) and to explain the changes. The members of the committee felt that on balance the changes were not significant to warrant a formal consultation process. The number of OG operative procedures transferring to the RSCH is approximately 35 to 40 per annum.

It should be remembered that all patients will begin their journey with a referral by their GP to a local cancer unit. They, the minority, will only be referred to the Centre, (RSCH) when they need an operative procedure.

The Network Director and CEO of Royal Surrey also held an informal meeting with the Convenor and colleagues of the OG support group at Frimley Park and the SWSH Network Director also presented information to the SWSH User partnership Group during 2004 and 2005.

6 The Network Approach & Clinical Networks

It is certainly not the intention that the team at Frimley Park Hospital is broken up. We are proposing subject to their agreement to relocate some of the members of the team to the Royal Surrey County Hospital where they will be joined by existing and new staff from other units.

This will allow the Network to be compliant with the Improving Outcomes Guidance produced by NICE, and to develop a specialist team and centre to serve the needs of all patients throughout the SWSH area.

The whole ethos behind managed clinical networks is to utilise the skilled and scarce medical, nursing and other clinical resources by bringing them together to provide care for patients across pathways which transcend individual organisations, and most importantly improve the outcomes for all patients and not just a few.

Throughout this process it has always been very clear that no moves will take place unless the Policy Board is reassured that the new services are equivalent too and preferably better than the existing services. The Chair of the Policy Board restated this to the Executive Directors from the RSCH at the Board meetings in October and December 2005, and asked the CEO of the RSCH for regular updates.

7 The Royal Surrey County Hospital - Progress

The RSCH to date has delivered on its promises in terms of refurbishing and extending the number of ICU beds, level 1 beds have been opened and a cancer surgical ward is being developed. Additional intensivists have been appointed, together with a second consultant gastroenterologist, an additional radiologist with an interest in interventional techniques and nurses. Consultant staff from other units are also being offered sessions where this is appropriate.

The success of the HPB unit with consultants visiting from both Surrey & Sussex and Ashford St Peter's trusts demonstrates that it is possible to operate as a clinical network without threatening individual units.

8 Peer Review

The SWSH Cancer Network did not assess the unit at Frimley Park. The Peer Review was conducted by an external team. (patient representatives, clinical, and managerial staff from other networks). The Peer Review report also contained a lot of opinion rather than fact which we found surprising. The use of the wording "centre of excellence" was not helpful, particularly as all hospitals are providing good services.

The required populations to achieve IOG compliance are 2 million for Pancreatic cancer and 1 million for Oesophago gastric cancer. Neither the RSCH nor Frimley Park is currently a compliant specialist centre as they do not serve the appropriate population. The Pancreatic Centre will be fully compliant by 2007 when additional activity is transferred from a neighbouring network.

The Peer review looked at approximately 70 measures for a specialist centre using two sets of measures, level 1* and level 1 and 2.

For 1* measures Frimley achieved 79% compliance and the RSCH 69%. Whilst this looks significant we are talking about a difference of a 6/7 measures, and having looked at these again, compliance for 3 measures at Frimley is questionable.

For 1/2 measures Frimley achieved 67% compliance against 68% at RSCH.

I trust this briefing paper is clear, however, if there are any other questions please contact the undersigned.

W B C Thomas

Network Director

10/3/06

Appendix Two

Dear Martin

Closure of the Lawns Day Hospital

At our meeting last week you will have noted that members raised some concerns about the closure of the above facility, on the grounds that it was not suitable for patients with dementia. This was only drawn to our attention last November, when plans for implementing changes had effectively been agreed.

As you will be hosting these services from the first of April it seemed sensible to approach you in the first instance to ascertain if this particular facility was suitable for other older patients, who could benefit for the range of services that could be provided from the site. One of our members has visited this facility recently and noted in particular the good repair of the premises, central location and accessibility, including ample parting. There is also the added advantage of co-location with adult services.

The emphasis in the recently published `White Paper' on partnership working to providing care as close to people's homes as possible gives a clear direction of travel for both the NHS and Local Authorities. This will require that we make the best use of resources, including facilities such as the Lawns to provide effective, seamless services.

My purpose in writing to you at this juncture is to ask if you would consider reviewing the decision the close the Lawns, taking account of the focus on local services as set out in the `White Paper'. Members are aware of the constraints caused by the current financial climate, and do understand that this may limit the capacity of the Trust to respond to this request. Nevertheless, if this resource is used to maximum effect for this patient group there could be tangible benefits to sharing these premises with adult services.

Please do not hesitate to contact me should you require clarification of any of the points we have raised. If you were able to let me have your response by 10 March I could appraise members of your views at our next meeting.

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

Appendix Three

HOSC Area Meetings: 1/2, 6/2, 7/2

Feedback Summary

Introduction

During early January 2006, Hampshire Overview and Scrutiny Committee arranged meetings at venues in different parts of Hampshire. The meetings provided opportunity to engage with District Council, NHS and Patient and Public Involvement Forums. Presentations were given by the Chairman of the SHA concerning potential configurations for SHAs, PCTs and the Ambulance Service. Stakeholders discussed issues of concern and were invited to provide written feedback to the committee 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 will inform the work programme for the coming year. A number of issues were raised as being significant challenges for local health services and a priorities for consideration in the coming year.

Main Challenges identified

All NHS stakeholders were very conscious of the significant impact of recent reorganisations, and were very concerned about the potential for the even more profound changes anticipated by the consultation options. Also of great concern to NHS organisations are managing the financial pressures whilst managing public expectations.

Local authority stakeholders also identified reorganisation and consequent disruption as being a major concern, but a number of responses also linked reorganisation of PCTs to their concern that if there should be one PCT for Hampshire, then there must be effective and strong ways in which to ensure the PCT is responsive to local needs and influence.

PPI Forum stakeholders, in common with others, saw reorganisation as a major challenge for their respective NHS organisations

Other common themes identified as challenges included:

· Transport

· Partnership working, particularly at local level, particularly if one PCT

· Fear of loss or reduction of services

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

NHS respondents saw engagement with Patients and the Public as being critical at a time when reorganisation and financial pressures could have serious impact on funding and service delivery.

Local authority respondents saw preventative or public health as a key issue as did some of the NHS respondents. Another broad theme picked up on the issue of how `improvements' promised by reorganisation or initiatives such as PBR might be measured?

PPI Forum respondents echoed some of the issues identified other stakeholders, such as preventative health, and how the effectiveness of the new organisations might be assessed.

Other themes included:

· Health inequalities - ensuring patients are not disadvantaged by difficulty of access to services or public health initiatives

· Ensuring delivery of the `White Paper' agenda

Key Working Relationships: development and next steps

Some stakeholders took the opportunity to indicate their appreciation of these events as a contribution to developing good working relationships. Indeed a number of comments suggested good progress has been made.

Several respondents see the scrutiny role as a key element in the ongoing work of relationship building as an independent, objective partner to District Councils, NHS bodies and PPI Forums.

PPI Forum respondents tended to indicate a need for better inclusion within the health system in some cases such as through better support from their Forum Support Organisation, or more effective engagement with bodies such as the HOSC

Recommendations

The committee thanks respondents for their feedback following the HOSC area stakeholder meetings

The committee accepts that the main challenges and issues for health scrutiny be included within the work programme of the HOSC for 2006-2007