Archived decisions

Contact: Denise Holden ex 7338

e-mail: [email protected]

1. Summary and Purpose

1.1. The purpose of this report is to alert Members to proposals from the NHS to vary or develop health services provided to people living in the area of the Committee.

1.2. Proposals that are considered to be substantial in nature will be subject to formal public consultation. The nature and scope of this consultation should be discussed with the Committee at the earliest opportunity.

1.3. The response of the Committee will take account of the Framework for Assessing Substantial Change and Variation in Health Services agreed by the Hampshire, Isle of Wight, Portsmouth and Southampton Joint Committee in March 2005. This places particular emphasis on the duties imposed on the NHS by Section 11 of the Health and Social Care Act 2001.

1.4. This Report is presented to the Committee in 2 parts:

_ Items for information: these alert the Committee to forthcoming proposals from the NHS to vary or change services. This provides the Committee with an opportunity to determine if the proposal would be considered substantial and assess the need to establish formal joint arrangements

_ Items for action: these set out the actions required by the Committee to respond to proposals from the NHS to substantially change or vary NHS services.

1.5. This report and recommendations provide members with an opportunity to influence and improve the delivery of health services in Hampshire and therefore support the delivery of Aim 5 (Improving Services) of the Corporate Strategy.

Items for Information

2. South West PCT Alliance/SUHT: Closure of Maternity Beds and Review of Maternity Services in South West Hampshire

2.1. No further information has been received about this proposal.

Recommendation

2.2. Members are advised of the next steps of the review of maternity services in south west Hampshire when these are available.

3. Mid & South West Hants PCTs: Surgical Service Reconfiguration

3.1. No further information has been received about this proposal.

Recommendation

3.2. The Committee is up-dated on progress with the surgical service reconfiguration proposal when this is available.

4. The future of Services in Fareham & Gosport/ South East Hampshire Capacity Plan

4.1. No further information has been received about this plan

Recommendation

4.2. The Committee is advised of any further developments that will impact on the provision of services in this area

5. SHA: Acute Paediatric Services Review

5.1. The response of the NHS and its partners to the review is attached at Appendix One

Recommendation

5.2. Members are advised of the way in which this proposal will now be taken forward.

6. Mid Hampshire PCT: Mental Health Accommodation

6.1. Confirmation has been received detailing the involvement of key stakeholders, including the P&PI Forums.

6.2. The Chairman has indicated that satisfactory section 11 involvement has taken place.

Recommendation

6.3. Members confirm that this is not a substantial service change

7. Blackwater Valley & Hart PCT: Rainbow Assessment & Treatment Group

7.1. Additional information has been provided about this proposal and the relevant P&PIF has confirmed that this is not a substantial service change that needs to be referred to the HOSC.

7.2. The establishment of the self help parents, working in conjunction with the PPIF intends will monitor the new service with particular emphasis on

· Health Visitor provision

· The views of parents

· Feedback from the special educational needs co-ordinator

7.3. Surrey HOSC has been apprised of the changes and will concur with the view of this Committee

Recommendation

7.4. That the Committee supports the views of the P&PIF about the nature of the change

7.5. That the Committee is provided with the evaluation of the service undertaken by the P&PIF after six months.

8. South East PCT Cluster: Maternity Services in South East Hampshire

8.1. The Chairman has written to Portsmouth Hospitals Trust (PHT) asking for dates when the birth centres will reopen. The verbal response received has stated that the centres will reopen when staffing levels permit

8.2. The option appraisal produced by the PCTs was presented to the Joint Committee on 1 March. This has subsequently been revised by the relevant PCTs and will be considered by the Boards in late March

8.3. The recommendations from the joint committee are attached at Appendix Two

Recommendations

8.4. The Committee seeks advice from the IRP about the failure of PHT to provide dates for reopening the birth centres.

8.5. Members are kept up-dated on the progress of the Joint Committee

9. East Hampshire PCT: Transfer of Older Persons Medicine Services

9.1. East Hampshire PCT has indicated its intention to transfer Older Peoples Medicine Services to PHT. The initial date indicated for this transfer was 1 April 2006.

9.2. The Committee has requested that this delay be deferred for the following reasons:

_ There is no clarity about the service specifications or the service model

_ There is no clinical consensus on the transfer

_ The proposal is not in line with the policy direction set out in `Commissioning a Patient Led NHS'.

_ It is not clear what section 11 engagement has taken place

9.3. Portsmouth City HOSC shares these concerns.

9.4. The PCT has advised the Committee that the SHA has assumed responsibility for responding to the concerns raised by members.

Recommendation

9.5. That the Committee is provided with a full response to the issues raised with the PCT at its next meeting.

9.6. The views of Adult Services on the response received be formally invited

10. North Hampshire Primary Care Trust: Reprovision of Older Persons Mental Health services provided at Homefield House

10.1. The Committee asked that the following information be provided

· Details of section 11 engagement

· Plans for respite and day care

· Commitments given to patients and their families

10.2. The Primary Care Trust has responded with additional information about the changes to these services. This is attached at Appendix Three

10.3. Adult services have also been invited to share their views on the proposal

Recommendations

10.4. The Committee is provided with confirmation of the next steps to be taken by the PCT, including the plans for engaging key stakeholders

10.5. The P&PIF be invited to comment on the engagement plan

10.6. The Committee is apprised of progress at its next meeting

Items Requiring Action

11. North Hampshire PCT: Changes to the Configuration of Services at Alton Community

11.1. No further information has been provided about this proposal.

Recommendation

11.2. Members are advised of progress with developing the consultation document at the next meeting.

12. Department of Health: Commissioning a Patient Led NHS

12.1. Members have previously expressed their views about the proposals and these were shared with the SHA to inform the final options presented for consultation.

12.2. A draft of a more detailed response to the proposals for reconfiguring the Ambulance services was circulated electronically to Members in early February with a request for any comments by 10 March

12.3. The final response of the Committee to the reconfiguration proposals are attached at Appendices Four and Five respectively

Recommendation

12.4. Members are appraised of the outcome of the consultation at their next meeting

13. Healthcare Commission: Engaging with Patients and the Public

The final response of the Committee is attached at Appendix Six

Recommendation

13.1. Members are advised of the outcome of the consultation when this is published.

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.

File Location

None

Appendix One

SUMMARY OF RESPONSES TO ACUTE PAEDIATRIC SERVICES REVIEW

1. INTRODUCTION

1.1 Hampshire and Isle of Wight Strategic Health Authority commissioned the Office for Public Management to undertake a review of Acute Paediatric Services, commencing in June 2005. The outputs from the work undertaken by the review team comprising of stakeholder meetings and consultation events with parents and young people resulted in an event in September 2005 where initial recommendations were shared with key stakeholders.

1.2 A final report was published in October 2005 with a number of recommendations on the future configuration of acute paediatric services and shared with the Chief Executive Community.

1.3 In order to gain a broad understanding of the views and recommendations the report was shared with a wide range of key stakeholders and responses sought by January 31^st 2006. The following summary highlights the key emerging themes of the responses received.

2. RESPONSES

2.1 Responses were received from the following organisations:

· Isle of Wight Healthcare NHS Trust

· Portsmouth Hospitals NHS Trust

· North Hampshire NHS Trust

· Winchester and Eastleigh Health Care Trust

· Blackwater Valley and Hart and North Hampshire Primary Care Trust

· East Hampshire Primary Care Trust

· Mid Hampshire Primary Care Trust

· Children, Young People and Maternity Network

· Workforce Development Directorate Executive Team

· South West Hampshire Primary Care Trusts Professional Executive Committee

· Children's Leads - Hampshire Primary Care Trusts

· Hampshire Ambulance NHS Trust

· Portsmouth Health Overview and Scrutiny Panel

· Southampton University Hospitals Trust

· Neonatal Network

3. KEY EMERGING THEMES

3.1 The Acute Paediatric Review was welcomed and the recognition that there is a need for change and service improvements to meet the increasingly complex needs of children, young people and their carers.

3.2 There was recognition of the positive comments made in the review report with regard to children's services provided across Hampshire and Isle of Wight. The Hampshire and Isle of Wight Acute Services Review makes recommendations for change, many of which, if implemented, will provide opportunities to build on good practice in both commissioning and service delivery.

3.3 The acknowledgement that the `current configuration of acute paediatric services is not facing a threat requiring immediate action' allows for `breathing space in which to plan for a managed transition to a service with long term sustainability' allows services to give the recommendations due consideration.

3.4 However, there is an acknowledgement that there is an urgency to address the high bed occupancy, future medical workforce requirements and secondary-tertiary interface in Southampton.

3.5 The scope of the review does not include the interdependencies with maternity and neonatal services and the interdependencies between accident and emergency and out-of-hours are of fundamental importance when considering any future reconfiguration of services.

4. ROLE OF THE CHILDREN, YOUNG PEOPLE AND MATERNITY NETWORK

4.1 There is support for the Children, Young People and Maternity Network to take forward a number of the recommendations in the review. There is recognition that some local recommendations for each Trust can be implemented immediately with no additional cost with support from the Network. In some instances this is already being progressed. The development of guidelines and care pathways is already being progressed by the Network.

4.2 Hampshire Ambulance Trust is keen to work in partnership and to be involved through the network to ensure that the pre-hospital elements of paediatric care are linked to the overall care pathway.

5. COMMUNITY NURSING DEVELOPMENT

5.1 There is acknowledgment of the need for a more comprehensive Children's Community Nursing Services across Hampshire and the Isle of Wight. The difficulty of further development of Children's Community nursing services in the current financial climate was highlighted. The redesign of care pathways across community and acute services may support the developments needed and it is hoped that this work can be supported by the Network.

6. COMMISSIONING ARRANGEMENTS

6.1 Future commissioning arrangements will need to be considered in the light of Commissioning a Patient Led NHS.

7. FINANCE

7.1 There is a need for accurate reference costs to enable meaningful comparison between units, of particular importance with Payment by results .e.g. higher tariffs associated with admission rather than rapid assessment and outreach support- a perverse incentive towards unnecessary inpatient care. The acknowledged differences in the coding of clinical activity between Trusts will need to be resolved as uniformity of coding is essential in order to compare like with like and will be pertinent for both Payment by Results and Choice.

8. CHILD AND ADOLESCENT MENTAL HEALTH SERVICES

8.1 The terms of reference for the review did not include Child and Adolescent Mental Health Services but the review makes a recommendation for a single provider for Tier 4 Child and Adolescent Mental Health Services. This is already the case and the recommendation in the report was reference to a single Tier 3 provider. This issue needs further consultation as there are different models of provision and development across Hampshire and the Isle of Wight.

9. RECOMMENDATIONS FOR CONFIGURATION OF HOSPITAL SERVICES

9.1 More clarity (including an explicit rationale) is needed to explain how recommendations to suggest a single service for Winchester and Basingstoke with management arrangements transferred to North Hampshire Hospitals Trust, was reached.

9.2 The main reconfiguration recommendations of the services in North Hampshire and Mid Hampshire require further detailed work and greater clarity about the particular model that could emerge. There is recognition that this proposal merits very close consideration. Further information is sought on patient flows such that informed decisions can be reached about ambulatory and inpatient service and recommendations for the siting of the inpatient unit.

10. WORKFORCE

10.1 Full attention to the workforce implications is required if proposals relating to the introduction of community based service models and the proposed creation of a single inpatient unit for Mid and North Hampshire.

11. CONSULTATION WITH PARENTS AND THE LOCAL COMMUNITY

11.1 Participation with parents/carers, children and young people and the local community will need to on going and be further developed to support future developments of all services.

12. CONCLUSION AND NEXT STEPS

12.1 The review highlights a way forward with some recommendations that can be implemented in the short term and a direction of travel that requires further detailed information regarding interdependencies of services, financial details and public health information.

12.2 Further work following from the review and the responses received will be channelled through the Children, Young People and Maternity Network in a framework agreed with the Strategic Health Authority. Specifically the Network will be tasked with establishing a standing group to take forward the reconfiguration of services in Winchester and Eastleigh HealthCare Trust and North Hampshire NHS Trust.

12.3 A detailed work programme will be agreed with the Chair of the Children, Young People and Maternity Network by 31^st March 2006 and will be performance managed by regular review meetings by the Strategic Health Authority.

Susan Sylvester, Children's Services Lead, February 6 2005

Appendix Two

Portsmouth, Hampshire and Isle of Wight Joint Health Overview and Scrutiny Committee (Maternity)

Recommendations arising from the meeting held on Wednesday, 1 March 2006 in The Guildhall, Portsmouth.

That

1. The Joint Committee considers that all the options for the future delivery of maternity services identified by the NHS at this meeting would constitute a substantial variation of services under Section 7 of the Health and Social Care Act and should therefore be subject to a process of formal public consultation.

2. The options consulted upon should clearly and transparently outline the effect each model would have upon the current provision of services, should not include any which are not considered to be viable and should include the current delivery model.

3. The Joint Committee is unable to take a view on any of the options identified at this meeting or on any other possible future options until it has heard the views of patients and the public

4. The Joint Committee expects that previous commitments given by the local NHS to take account of Portsmouth City PCT's plans to develop a Full Business Case for a stand alone birth centre on Portsea Island to be fully reflected in any proposals that are taken forward, and made clear in the above mentioned public consultation.

Appendix Three

Dear Councillor Ellis

Reprovision of Older Persons Mental Health Services at Homefield House, Basingstoke.

I am writing in response to your letter received on 10^th February 2006 about North Hampshire PCT's plans to reprovide services from Homefield House. The Hampshire Health Overview and Scrutiny Committee have requested further information on three issues and this is provided below:

1. Section 11 engagement with patients and their carers and relatives

Please find enclosed the PCT's communication and engagement plan. This has been developed with the full involvement of the stakeholder Project Implementation Group, with representation from Hampshire Partnerships NHS Trust, Shaw Healthcare, Hampshire County Council Adult Services and the Alzheimer's Society.

The PCT is actively investigating national best practice in respect of Section 11 engagement. We have reviewed our plans with the Care Services Improvement Partnership (CSIP) and reference has been made to a number of key reports, including:

· Everybody's Business - CSIP, 2005

· Listen to us: involving people with dementia in planning and developing services - Northumbria University, 2005

· User and Carer Involvement in Dementia Care - National Institute for Mental Health in England, 2005.

The principles and practice from these will inform the implementation of the engagement plan.

You will note that in addition to making sure patients and their family/carers are fully informed, our aim is to develop a decision-making framework which ensures that the interests of these vulnerable older people are fully protected.

The PCT is securing advice on what constitutes best practice in moving vulnerable older people. Should any individual resident wish to move, this will be planned and managed in line with best practice guidance on the timing and management of such a move.

2. Plans for day care and respite care services

The PCT will continue to commission appropriate levels of respite care at Homefield House in line with historical usage. In line with the recommendations of the joint review of services for older people with mental health needs undertaken in 2003, the PCT intends to commission three respite beds plus additional community psychiatric nurse support.

The PCT intends to continue to commission historical levels of day care services from Homefield House.

3. Information and understanding given to patients and their carers or relatives when admitted to Homefield house.

North Hampshire PCT (as the successor organisation to North and Mid Hampshire Health Authority) has inherited and accepted the commitment given to residents admitted to Homefield House before April 2004. The commitment is to fund their nursing home care at Homefield House for as long as they continue to require it. Whilst these residents did not go through the continuing care assessment processes on admission, for those individuals whose health needs indicate it, continuing care assessments are being undertaken.

Residents who have been admitted to Homefield House after April 2004 have been managed through the processes for determining eligibility for NHS funded continuing care. Applications for NHS funded continuing healthcare are considered and approved by the PCT Panel. Those people and their relatives, carers or representatives admitted to Homefield House in this way have been informed that eligibility for NHS funded continuing care is not for life and is subject to joint review by NHS and Hampshire County Council Adult Services.

I hope this provides you and you colleagues on the Oversight and Scrutiny Committee with the information you need. If you require any further information or clarification please do not hesitate to contact me.

Yours sincerely,

Debbie Glenn

Chief Executive

Enc: Communications and engagement plan

CC: Martin Coombs

Appendix Four

Dear Sir Ian

Hampshire Ambulance Reconfiguration

Additional Issues for Consideration

I am responding on behalf of the Health Overview and Scrutiny Committee to the formal consultation on the reconfiguration of Ambulance Services. In his reply to the SHA in September our Chief Executive stated that he would support further exploration of local solutions to reduce the duplication of functions supporting emergency services across Hampshire. He indicated fire and ambulance services as a possible combination that would preserve local knowledge whilst minimising management costs and overheads. In addition we had anticipated that the formal consultation on the configuration of Ambulance Services would take full account of the direction of travel set of in ` Taking Healthcare to the Patient: Transforming NHS Ambulance Services'. In particular we noted the following principles set out in that document:

· That services should be designed round the needs of the patient and the care provided by frontline staff

· That services should work in an integrated way with other health and social care providers in their local area.

Our view was that this approach was entirely consistent with `Keeping the NHS Local' and other key policy documents.

Clearly the position has changed since that time, particularly with regard to fire services. Having had an opportunity to review the consultation document on the configuration of Ambulance Services, published by the Department of Health on the 14 December, we have deep reservations about the proposals and the impact that they may have on front line emergency care. The suggested configuration with Thames Valley, which will combine 4 separate ambulance services, is not supported by any evidence of either savings that could be achieved or quality improvement in service delivery. We have reviewed the document in detail, and our comments are appended, the broad areas of concern are as follows:

· The recently Published White Paper on Health Care Outside Hospital reinforces the ongoing shift in the NHS towards community based primary and secondary care services. The intention is that patients receive care as close to home as possible, particularly in rural areas where there is greater difficulty in accessing traditional district hospital and Accident and Emergency Services. As a mobile resource, with highly trained staff, the ambulance service is able to play a key role in providing a continuum of care close to people's homes. Hampshire is a predominantly rural county with significant areas that are difficult to access.

· Local knowledge is a fundamental pre-requisite to ensuring that emergency services are able to reach people as quickly as possible. We have already experienced significant difficulties with a local Out-of Hours provider that used a call centre in Birmingham. Action has now been taken to address this problem but these proposals could undermine this progress.

· It is clear that the ambulance service has a key part to play in co-ordinating the range of out of hours and unscheduled care that people need. The skills that ambulance staff have in call handling, providing clinical advice and working with partner organisations are developing well in Hampshire. We believe that this will be lost if the services are reconfigured as suggested. We would therefore wish to propose that further work is done to explore how ambulance services can be configured to act as a single point of telephone access for the range of unscheduled, urgent and emergency care that is required, including mobile health services in Hampshire working in partnership with health and other service providers.

· There is no indication of the additional resources that will go the ambulance services as a result of these mergers. Our experience locally has been that reorganisation on this scale inevitably incurs costs.

· The new roles for ambulance staff envisaged have enormous potential to improve the services provided to our population. There is no indication that the merger will increase capacity to invest in and develop these skills, or that the arrangements will extend the resources available to support training programmes.

· The proposal is in direct contradiction of the move to strengthen commissioning and make service delivery more local. This could add to rather than reduce the administrative burden on ambulance services, effectively imposing another layer of bureaucracy.

· The geographic boundaries proposed are an administrative convenience. They do not reflect patient flows (for example in the north east and south west of Hampshire)

· The suggestion that Patient Transport Services, which comprise of many community and voluntary sector providers, could be run from such a remote organisation is untenable.

· No work appears to have been undertaken to evaluate the causes of the variation in funding levels across the country. The figures for Thames Valley/Hampshire funding to population ratio is the lowest in the country, despite the fact that we are joint third in terms of calls per square mile.

· We do accept that there is a case for centralising procurement and technology. This is however quite distinct from the suggested merger of services.

· There has been no risk assessment of the impact of these proposals

We would therefore reject the proposed merger of Hampshire Ambulance with Thames Valley, on the grounds that it is not in the interests of either our population or the NHS in Hampshire. We would also ask that further work be done to test:

· The procurement and other `back of office' activities that could be provided on an SHA or national basis to achieve greater efficiency

· The scope for the ambulance service to provide the initial point of contact for all unscheduled, emergency calls, including out of hours for Hampshire.

· The role of the emergency practitioner, integrated into out of hours and unscheduled care networks to provide an alternative source of advice in the community, reducing the need for hospital admission

· The scope for other providers to taken on the running of ambulance services, working alongside local partners in the voluntary sector, health and social care

I hope you find these comments helpful and look forward to receiving your comments on the question we have raised as well as the outcome of the consultation process.

Yours sincerely

Cllr Dr Raymond J Ellis C.Chem FRSC

Chairman, Health Overview and Scrutiny Committee

Appendix One

Detailed Commentary on the Consultation Document

Appendix Five

Dear Sir Ian

`Commissioning a patient led NHS': proposals to reconfigure Strategic Health Authority and Primary Care Trust Boundaries

I am responding on behalf of Hampshire County Council Health Overview and Scrutiny Committee (HOSC) to the proposals to reconfigure Strategic Health Authority (SHA) and Primary care Trust (PCT) boundaries in Hampshire. You will be aware that we responded separately and in detail, to the proposals relating to the configuration of Ambulance services.

The HOSC supported the views our Chief Executive shared with you about these proposals last September and we remain committed to the direction of travel set out in that correspondence. We therefore wish to confirm our support, albeit with a number of misgivings, for the proposal for two SHAs in the South East region and remain firmly committed to the reconfiguration of PCTs to ensure co-terminosity with local authority adult and children's services boundaries. The anticipated review of Local Government will introduce some uncertainty about the form that this may take in Hampshire. At present this would mean one PCT for Hampshire County. We would not support a configuration of PCTs that splits the Hampshire county area.

The emphasis placed by the Department of Health on regional boundaries remains unhelpful and does not reflect the way in which our communities access health services. This will create avoidable complexities in the arrangements that need to be put in place to support commissioning that is focused around patients rather than administrative expediency. In particular we will wish to see appropriate arrangements put in place to secure services for our communities in the south west and north east of the County and I know that this will be an area of continuing interest to the HOSC.

There are 5 further issues that we would wish to see addressed as part of the restructuring process. These are outlined below:

1. Improved Partnership Working across the NHS and local authorities. We have previously stressed the importance of partnership working across the county to ensure that the changes to the NHS put service users at the heart of the decision making process that supports the planning and delivery of care. Whilst there have been excellent examples of this happening in some parts of the County we believe that more needs to be done to embed this way of working into care provision across Hampshire. More work needs to be done at both strategic and operational levels to engage key partners and build a shared vision of the way in which we meet the needs of our respective communities. The County Council, District Councils and Local Strategic Partnerships all have a role to play in this respect, working with health. We would therefore wish to see tangible commitment from the NHS to taking this work forward, even though this may, in the short term, challenge traditional patterns of working. Existing vehicles to support the delivery of this agenda, such as the local area agreements, can be developed and strengthened to support further progress with partnership working.

2. Commissioning arrangements that are responsive to local needs and accountable to local communities. We have already highlighted the need for organisational structures that are able to balance a strategic overview with robust arrangements for local commissioning across communities and neighbourhoods. The series of seminars that you initiated to explore this further have provided a helpful opportunity to explore this issue further. Many of the concerns expressed by local government about the reconfiguration proposals centre on the perception that highly valued local links will be lost as PCTs in particular become more remote and less responsive to the differing needs of our communities. We therefore welcomed the emphasis placed on aligning practice based commissioning (PBC) areas with district council boundaries. We would now wish to see further work on commissioning arrangements to ensure that there is scope for genuine flexibility across our communities and the `clout to commit' in response to differing local needs. This of course presupposes the existence of effective mechanisms to assess health needs.

If commissioning is to be driven by the patient needs, as opposed to historic activity, then we need to understand clearly how services will be accessed as well as the quality and value for money that they represent. This is a major piece of work in its own right and is essential if we are to be successful in ensuring that services are provided as locally as possible. To succeed there will need to be early action to design a framework able to support the differing `tiers' of commissioning that are required well as clarity about the different health needs of the diverse populations that we serve in Hampshire. We would also wish to explore further the way in which elected members can contribute to the commissioning process.

3. Clarity about the delivery of the public health and health improvement agenda. Linked with commissioning, a second recurring theme in the discussions that have taken place since last September has been the need for closer working with regard to the health improvement and well being agenda. Examples of excellent partnership working and joint appointments already exist, public health in the South West being a case in point. We would wish to see good practice shared and disseminated across the county to allow for our shared commitment to this work to progress still further.

4. Business continuity and leadership during the transition. We have previously commented on the disruption caused by the local management restructuring last year as well as the financial challenges facing the health economy in Hampshire. Since your appointment in June we have seen real progress made to address the budgetary position and improve delivery against national targets. In particular we have welcomed your leadership, which has provided a more strategic and coherent approach to planning health services reducing inter-organisational conflict and fragmentation. The introduction of payment by results, PBC, choice and the proposed shift of care from acute to community services will bring further challenges that will require clear and consistent leadership. We are therefore deeply concerned that the disruption caused by the restructuring will shift attention away from these issues and that the progress achieved may be lost.

5. Capacity and Capability. Linked to the above point, and regardless of the final decision about the form of the restructuring, is the need for there to be a swift move to the new structure and appointments confirmed as quickly as possible. Commissioning arrangements in particular need to be clear and transparent if the real benefits for our population are to be achieved. Historically commissioning has not been a particular strength in the NHS and locally arrangements have, on occasion, appeared fragmented and inconsistent, with limited understanding of what is being commissioned and why. This will need to be addressed at the earliest opportunity.

I hope these views are helpful and look forward to working with you to deliver the challenging agenda that faces both local government and the NHS.

Yours sincerely

Cllr Dr Raymond J Ellis C.Chem FRSC

Chairman, Health Overview and Scrutiny Committee

Appendix Six

To whom it may concern

Consultation: Engaging Patients and the Public

I am writing on behalf of Hampshire County Council Health Overview and Scrutiny Committee (HOSC) to the above consultation which was published on the 15 December. It was unfortunate that the Commission launched three important consultations in December, as the Christmas and New Year break inevitably cuts across the engagement process. This point may be worthwhile considering for future consultation exercises. It would also be helpful if paragraphs were numbered.

We would applaud the intention of the Commission to put the experience of patients at the heart of your work. We are concerned however that you approach will duplicate much of role of both Patient and Public Involvement Forums (Forums) as well as HOSCs; the 5 key areas you identify highlight this point well. This is a poor use of resources and fails to recognise the statutory role that both the Forums and HOSCs have in ensuring that services are responsive to the needs of patients. We expect the Commission to work with us on this challenging agenda and not duplicate local arrangements that are already delivering results.

Our preference would be that, rather than `reinvent the wheel', that the Commission places greater emphasis on partnership working to make the best use of existing networks and local intelligence to inform their understanding of NHS performance. It was deeply disappointing for example that your consultation document fails to identify either HOSCs or Forums as partners, instead referring to CPPIH and the Centre for Public Scrutiny. This is not appropriate or accurate and needs to be revised.

The need for greater emphasis on partnership at a local level has been reinforced by the response of the Commission to the recent pilot assessments. Despite the significant additional workload that this imposed on us, with no prior discussion or consultation, we responded to requests for our views from 14 NHT Trusts and PCTs. Each response was tailored around individual experiences of working across various communities in Hampshire and all comments were evidence based. To date we have received no indication of the way in which the Commission has responded to the issues we raised. Further no account has been taken of the considerable burden imposed on our limited resources by the timetables you produced. This needs to be addressed if local intelligence is to be used to maximum effect. We would therefore ask that, in responding to the consultation, the Commission place greater emphasis on improving working relationships with HOSCs, Forums and other stakeholders to secure genuine two-way exchange of information. In this way local intelligence can be used to effectively inform the assessment process, whilst we in turn are able to contribute to clear and objective evaluation procedures.

I do hope that you find this feedback helpful and look forward to receiving the outcome of your deliberations

Yours sincerely

Cllr Dr Raymond J Ellis C.Chem FRSC

Chairman, Health Overview and Scrutiny Committee