Hampshire County Council

Health Overview and Scrutiny Committee Item 7

30 May 2006

2005/6 Annual Report and Draft Work Programme for 2006/07

Report of the Chief Executive

Contact: Denise Holden ex 7338

e-mail: [email protected]

Summary and Purpose

1. The 2005/06 Annual Report is attached at Appendix One and sets out the progress made with the work programme of the Committee that was agreed by Members, and the draft work programme for 2006/07.

2. The work programme proposed, takes account of the following:

· Issues raised by Members during the past year and discussed in Committee.

· Topics for review identified by key partners such as Patient and public Invovlement Forums, NHS organisations and District Councils, that have been raised at area meetings and in one-to-one discussions.

· National policy developments that may have an impact on the provision of health services in Hampshire.

· Profound organisational changes that are being, or will be experienced by most NHS organisations in Hampshire.

· Local issues that have an impact on the provision of health services in Hampshire.

3. The approach outlined builds on past work, and takes into account the feedback from organisations that complement the work of the Committee. The work programme has to provide a flexible framework to allow informed comment on the wide range of national and local issues that affect the health of local people, whilst ensuring that timely responses can be provided to proposals from the NHS for substantial variations to services. It also enables the Committee to take action when opportunities to improve local service delivery are identified.

4. The work programme for 2006/07 has been based on four key work strands, supported by a commitment to continue building effective working relationships and communications with partner organisations:

· Developing effective working Relationships and Communication

· Proposals to substantially vary or develop NHS services

· Reviews of Health Services

· Health Inquiries

5. To make the best use of available resources such that issues raised with the Committee are evaluated to ensure that it does not duplicate other scrutiny or review activities, and that such issues that are pursued have the potential to influence or improve the topic under consideration.

6. The Committee recognises that in addition to its traditional statutory and voluntary partners, it is now appropriate to consider new working relationships. In this regard the Committee has become increasing aware of the need to establish stronger partnerships working arrangements with the Healthcare Commission in support of this. The Committee also acknowledges the potential for the emerging Hampshire Action Teams to bring health issues and concerns to it.

7. The report provides the context within which the Committee is able to influence and improve the delivery of health services to people living in Hampshire. It therefore supports the delivery of Aim 5 of the Corporate Strategy to improve services.

Recommendation

8. The Committee also takes issues and referrals from Hampshire Action Team chairmen where health related concerns come to the attention of the team and are appropriate to be taken forward through the Committee.

9. The Committee approves formal partnership with the Healthcare Commission.

10. The Committee approves the 2005/06 Annual Report and the draft work programme for 2006/07.

Hampshire County Council

Appendix One

Health Overview and Scrutiny Committee

Report on Progress Spring 2005 to Spring 2006

Introduction from the Chairman

This report provides an update on the work of the Health Overview and Scrutiny Committee (HOSC) over this last year. The Committee has not only sought to learn and improve over the last three years of its existence, but it has also had to adapt to a constantly changing environment.

The year has seen many Primary Care and Hospital Trusts struggling to address significant financial challenges, both historical and operating, despite record NHS funding.

The issue of temporary bed closures has been of particular concern to the Committee. In such cases the Committee seeks an assurance from the responsible health organisation that a firm date is given to re-open the beds, and will challenge those cases where closures take place without clarity about a date for re-opening.

Finance and efficiency pressures are causing Primary Care Trusts (PCTs) to re-examine their community health strategies, hence a number of proposals have come to the Committee in relation to changes in how services are delivered and how community hospitals are best used.

This issue is of significant concern to local people and the consultation in the New Forest highlighted the strength of public feeling about these services. The Committee will continue to take a keen interest in proposals to change the way in which community services, are provided.

The Committee remains committed to further developing and strengthening its links with its partners during the next year, particularly to promote issues that cross traditional organisational boundaries, such as public health and wellbeing.

Following the `Commissioning a Patient-led NHS' consultations, and the resulting organisational changes in Hampshire, new relationships will have to be built, and it will be essential for robust mechanisms to be established to support local health interests. We will continue to ensure that our work supports good working relationships and effective communication.

The report sets out:

· Local progress with health scrutiny (Section 1)

· The achievements of the Committee over the last year, including joint scrutiny arrangements (Section 2)

· The outline work programme for 2006/07 (Section 3)

Further details on the work of the Committee can be found on our website at www.hants.gov.uk/healthscrutiny/

Cllr Dr Raymond Ellis, C.Chem FRCS

Chairman, Health Overview and Scrutiny Committee

Section 1: Local Progress with Health Scrutiny

Health Overview and Scrutiny is a statutory responsibility for local government. It is intended to ensure that decisions about health services are taken with due regard to the people affected. The legislative framework within which the Committee functions, allows Members to consider any aspect of health that affects the population Hampshire. It also places very specific duties on the NHS with regard to consultation, information and responses to any recommendations made by the Committee.

The Committee is a statutory consultee on any substantial change being considered by the NHS and has the power to refer contested decisions about health services to the Secretary of State for Health or to Monitor in the case of Foundation Trusts. A summary of the main powers of the Committee, and the duties placed on the NHS, is attached at Annex One.

Arrangements are in place to allow these powers to be delegated to allow for specific proposals affecting the health of local people to be considered by a joint committee or, in exceptional circumstances, by another scrutiny committee set up by local government.

As its role has evolved, the Committee has been mindful that it is not the only, or even the main form of engagement between the NHS and local government. Services are increasingly commissioned in partnership across health and social care and this is likely to increase as new policy initiatives are implemented. Patient and Public Involvement Forums (P&PIFs) and District Councils each have a role to play in shaping the Committee's understanding of local issues, providing a rich source of intelligence about issues relating to health and health services. Similarly, the Committee needs to have a constructive working relationship with internal service providers, the Cabinet and other scrutiny functions undertaken by local authorities and public agencies.

Health and health services in Hampshire are complex, with different priorities in different communities. The network of working relationships that have now been established demonstrates the commitment of the Committee to ensuring that, to the fullest extent possible, it is the local community that has the greatest influence on the development of health services in a particular area. This local influence has been a recurrent theme as the work programme has rolled forward and remains a central feature of the work of the Committee.

No additional resource has been made available by central government to fund the work of the Committee and this inevitably constrains the range and scope of scrutiny work that can be undertaken. Emphasis has therefore been focused on ensuring that programmes are effectively targeted to enable the scrutiny process to be both credible and influential. The approach to health scrutiny adopted by the Committee therefore places emphasis on ways of working that are:

· Challenging but not confrontational

· Evidence based

· Able to improve service delivery

The role of the Committee as a `critical friend' has been established, and relationships with partner organisations, particularly the local NHS have continued to develop. The financial challenges facing local health services, and the potential impact these may have on local people makes it vital that the Committee maintains a constructive dialogue with these organisations and other partners, including the Healthcare Commission which plays a critical role in overseeing healthcare improvement.

The forward work programme of the Committee set out in Section 3 of this report has therefore been developed in discussion with P&PIFs, District Councils and NHS organisations in Hampshire. It takes account of the work that the Committee must do, specifically:

· Respond to proposals to substantially vary NHS services in the area of the Committee

· Manage referrals from P&PIFs (and other partner organisations)

In addition it identifies issues that may benefit from a more in-depth thematic review. To make the best use of the resources available to the Committee the following four criteria have been developed to guide Members when selecting topics for review:

· Capacity to influence and improve the service under consideration

· Timeliness and relevance to local health services

· Issues not under consideration elsewhere

· Issues not subject to other scrutiny or performance monitoring activities

Section 2: The Achievements of the Health Overview and Scrutiny Committee in 2005/06

The annual Report on Progress of the HOSC for the year from Spring 2004 to Spring 2005 put forward a Work Programme for the coming year. This report brings together the work undertaken by the Committee during the year and shows how it has been able to influence health services across the county. At the same time, it has been important for the Committee to demonstrate its ability to establish its independence and fairness whilst building trust and positive relationships with NHS organisations and other key stakeholders. Because the effectiveness of the Committee demands it establish a reputation for integrity, issues considered by the Committee take account of evidence from all interested parties.

The approach to health scrutiny adopted by the Committee and described in the following work strands are drawn from national guidance and discussions with partner organisations. A summary of the relevant sections of the Guidance is included at Annex Two.

The Work Programme of the Committee draws together four main work strands:

· Relationships and Communication: From its inception the Committee has been cognisant of the need to be able to work in partnership with other agencies when discharging its responsibilities in relation to health overview and scrutiny. Experience reinforces the need for the Committee to ensure that an extensive network of key contacts is built and maintained to support a challenging but constructive approach to health overview and scrutiny.

· Proposals to vary or develop NHS services: Any proposals for service change from the NHS should be discussed with the Committee at an early stage, in order to agree whether or not the proposal is considered substantial. In determining if a proposal is substantial, the Committee considers the impact of the change on patients, carers, and the public who use, or have the potential to use a service.

· Reviews of Health Services: This strand of work was identified by the Committee to provide thematic cross boundary reviews of health services. These consider specific areas or services that are of interest or concern to the Committee and identify opportunities for improvement.

· Health Inquiries: The `health inquiries' work strand was designed to provide the Committee and partner organisations with a route through which issues could be raised and acted on outside the review process. This mechanism allows the Committee to maximise opportunities to influence and improve health services without recourse to a full review as well as providing a means by which developments in health can be drawn to the attention of the Committee.

Relationships and Communication

Establishing and maintaining constructive relationships with the very complex and extensive range of NHS bodies across Hampshire and beyond is a continuing challenge, particularly as one NHS reorganisation seems to follow another. Understanding how the NHS and its partner organisations and agencies interact and impact on patient `journeys' and experience is crucial to ensuring Hampshire residents receive high quality care.

The success of the HOSC in developing this aspect of its activity can be determined by its explicit investment in arranging area meetings with key stakeholders such as NHS organisations, District Councils and P&PIFs in different parts of the County.

Relationships with NHS bodies and partners is also evidenced by the increasingly frequent recourse of NHS organisations to the HOSC when contemplating service changes. In response the HOSC will typically put questions to the organisations that serve as guidance to help ensure the organisation meets statutory requirements, and patients are able to inform the decision-making process.

To facilitate better understanding of the complex NHS structures and implications of changes, Members receive briefings on national initiatives, and presentations on local changes are often provided at HOSC meetings by invitation, such as Planning for a Pandemic and Commissioning a Patient-led NHS.

Reports by P&PIFs now play an increasingly important part in informing the Committee on matters ranging from cleanliness in hospitals to commenting on adequacy of patient and public engagement concerning specific NHS plans for change.

As partnership working increases between NHS, local authority and voluntary sector partners, the effectiveness of partnership working is now emerging as an issue of specific interest to the Committee.

Proposals to vary or develop NHS services

This year has seen the practical usefulness of the Framework for Assessing Substantial Change and Variation in Health Services. The Framework (available at www.hants.gov.uk/decisions/decisions-index/index-docs-6158 ) which was agreed at the end of last year, has provided structure and guidance for NHS organisations that need to test with the HOSC whether their plans for change might be considered `substantial', and thus may be subject to formal consultation.

The Framework also provides a set of criteria through which the scope or potential effects of planned changes can be evaluated. This helps make the Scrutiny process more consistent and objective

Proposals to vary or develop NHS services have continued to come to the HOSC throughout the year. All proposals for varying NHS services considered by the Committee, with any associated reports or comments, are included in agenda papers.

Responses to consultations since April 2005 have included:

· Changes to Day Surgery and Rehabilitation Services at Andover War Memorial Hospital (May 05)

· Changes to Community Service Configuration in Emsworth and Havant (July 05)

· Modernising Community Services in Southampton (July 05)

· Acute Paediatric Services/Maternity Services Strategic Health Authority Review (July 05)

· Strategic Health Authority: Commissioning a Patient-led NHS consultations (Sept 05):

· PCT configurations

· Strategic Health Authority configurations

· Ambulance Service configurations

· Elderly Mental Health Services - Day Hospital Provision (Nov 05)

· Healthcare Commission: Engaging with Patients and the Public (Jan 06)

· Department of Health: Commissioning a Patient-led NHS (Jan 06)

In addition the Committee funded additional work in the New Forest and Romsey in response to a highly controversial and adversarial consultation about the future of community hospital beds.

Reviews of Health Services

As part of its Scrutiny function, the HOSC has undertaken strategic level reviews of Health issues over the year. Examples of this include, Hampshire Health Overview and Scrutiny Committee Review of Public Health and Wellbeing in Hampshire, and, Hampshire Health Overview and Scrutiny Review of Out-of-Hours Services in Hampshire.

In this way the Committee is able to play a positive and constructive role in the provision and development of health services for the people across the whole of the County.

Additional work undertaken by the Committee included responses to the Healthcare Commission's Annual Health Check process with primary care and acute trusts in Hampshire.

Health Inquiries

Throughout the year issues are brought to the attention of the Committee by Members and partners, such as the P&PIFs. Examples of these include:

· Cleanliness in Hospitals

· Access to counselling services

· Car parking at hospitals

· Closures of hospitals

· Closure of Birth Centres

· Neurology referrals

Joint Committees

South East of England colleagues with similar health scrutiny responsibilities meet regularly during the year. Issues of general concern, and cross boundary matters are raised.

In Hampshire, Joint HOSCs are held approximately every three months to consider issues of general or cross-boundary concern.

Joint HOSCs also meet formally on an ad hoc basis to address specific issues.

Examples of issues considered by Joint Committees over the last year include:

· The Chairman of this Committee, on behalf of SE England Health Scrutiny Committees, wrote to Government expressing concern about the Funding Formula used by the Department of Health. This has emerged as an issue of significant concern to all Health Scrutiny Committees in the South East

· The proposed transfer of the Upper Gastrointestinal Cancer Unit from Frimley Park to the Royal Surrey County Hospital in Guildford. The catchment area of Frimley Park Hospital includes more than 50% Hampshire residents. This Committee is taking the lead in this matter, but this is of interest to Committees in Surrey and Sussex whose areas are also affected by Cancer Network plans.

· Hampshire Ambulance Estates and Service Reconfiguration plans.

· In partnership with Portsmouth City Council and the Isle of Wight Council, considerable attention has been given to plans for the configuring maternity services in Portsmouth and the South East Hampshire area.

Another example that was brought to the attention of the Committee by a local MP was the issue of the apparent inconsistency of compliance by PCTs with National Institute of Clinical Excellence Guidance with respect to access to IVF treatment and Screening for Down's Syndrome for pregnant women. The Committee was subsequently pleased to learn that from January 2006 eligible couples were able to access treatment, and criteria for accessing these services have now been agreed across all PCTs in Hampshire and the Isle of Wight. Also Down's Syndrome screening has been made available for all pregnant mothers since April 2006.

Section 3: Outline Work Programme for 2006/07

During early January 2006, Hampshire Overview and Scrutiny Committee arranged area meetings at venues in different parts of Hampshire. The meetings provided opportunity to engage with District Councils, NHS organisations and P&PIFs. These stakeholders were invited to provide written feedback to the Committee on three issues:

· Looking ahead: What are the main challenges for health services in your area?

· Making a difference: What are the top three issues for health overview and scrutiny in the coming year?

· 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?

Over and above the more local issues and concerns identified at the area meetings that will feed into the Work Programme for 2006/7, wider concerns were discussed that impact on local or county health provision, such as:

· The funding formula for health spending

· National targets

· National policies and initiatives, such as Payment by Results and Patient Choice.

Main Challenges identified

The main challenge identified by all categories of stakeholder was extensive NHS reorganisation and the consequent disruption interfering with management focus, functions and planning.

NHS Organisations were also very concerned about managing finances whilst trying to manage public expectations.

Local authorities had concern about how, if there is to be one PCT for Hampshire, it will be possible for local communities exercise influence on health spending for the communities.

Other themes included partnership working at a local level if there is one PCT, and potential loss of health services because of strong financial pressures. Transport was another common concern for access to health 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?

P&PIF respondents echoed some of the issues identified by other stakeholders, such as preventative health, and how effectiveness of new health organisations might be measured.

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 seemed to indicate that the area events had provided a positive contribution to good working relationships. The HOSC expects to build on and further develop good working relationships.

There seems to be an emerging sense of how the `independence' of the HOSC enables it to function as an objective partner to District Councils, NHS bodies and P&PIFs.

P&PIF respondents tended to see scope for better inclusion within the health system, sometimes better support from their Forum Support Organisations, and for more effective engagement with bodies such as the HOSC.

Work Programme 2006/07

The Committee's work programme for 2006/07 promises to be even more challenging than previous years. It will build on and develop work undertaken previously, but will also have to adjust to new NHS structures in a fluid environment. The Committee will continue to respond to and follow up issues brought to its attention by Members and partners.

It will be particularly important in the new context for Members and P&PIFs to monitor health provision in their areas at a time of great change and transition in health.

The work programme for the year will have pro-active elements, whilst being prepared for the need to respond to issues raised by Members and partners. The programme will therefore include:

Relationships and Communication

· The Committee will continue to actively engage with partner organisations through the area meeting structure and one to one meetings as appropriate

· As a matter of key importance, the Committee will be looking to consolidate links with P&PIFs or their successor organisations, and partners who are in a position to comment on health provision and the effectiveness of practice-based commissioning in the locality.

· The HOSC website will be reviewed to improve accessibility.

Proposals to vary or develop NHS services

· The Committee will continue to use the Framework that has been so effectively employed this year to assess or evaluate the extent and implications of proposals by NHS bodies to vary or develop their services.

· The Committee will continue to be informed of proposed changes by NHS bodies to vary or change services and will respond within agreed timescales.

· Effective arrangements continue to be in place to enable the Committee to provide a positive role in the following consultations such as the Maternity Services Reconfiguration in Portsmouth and SE Hampshire.

Reviews of Health Services

· The Committee continues to have an active part in the rollout of the Public Health and Wellbeing agenda across Hampshire via the Members of the HOSC working group. This will include specific work with regard to:

· The development of locality commissioning

· The development of Public Health support and advice across Hampshire

· The development of cross-agency and partnership working

· The Committee continues to monitor and contribute to the ongoing developments in Out-of-Hours and unscheduled care in Hampshire. The approach taken to support this work will be in conjunction with the lead taken by the Strategic Health Authority, and with PCT commissioners and provider services.

· The Committee continues to develop arrangements for monitoring progress with responsible bodies to whom it has made recommendations.

Health Inquiries

· The Committee will continue to receive information on issues raised by Members and partners

· The Committee will continue to keep Members informed of action taken and new information

· Particular issues for further consideration and action during 2006/07 will include:

· Review of the revised South East Hampshire Capacity Plan

· The impact of the new dental contract on NHS services in Hampshire

Annex One

Hampshire County Council

Health Overview and Scrutiny Committee

Summary of the Responsibilities of Local Authority and NHS Bodies

Powers of local authority overview and scrutiny committees

Overview and scrutiny committees may:

· Review and scrutinise any matter relating to the planning, provision and operation of health services in the area of the committee's local authority;

· Make reports and recommendations to local NHS bodies and to its local authority on any matter reviewed or scrutinised using the overview and scrutiny of health power;

· Require the attendance of an officer of a local NHS body to answer questions and provide explanation about the planning, provision and operation of health services in the area of the committee's local authority;

· Require a local NHS body to provide information about the planning, provision and operation of health services in the area of the committee's local authority, subject to exemptions outlined the Health and Social Care Act 2001;

· Establish joint committees with other local authorities to undertake overview and scrutiny of health services;

· Delegate functions of overview and scrutiny of health to another local authority committee;

· Co-opt Members of the overview and scrutiny committees of district councils onto the committee as full Members (County Council committees only)

· Be able to report to the Secretary of State for Health:

· Where the committee is concerned that consultation on substantial variation or development of services has been inadequate;

· Where the committee considers that the proposal is not in the interests of the health service.

Duties of local NHS bodies

NHS bodies must:

· Provide information requested by the overview and scrutiny committee subject to exemptions;

· Attend before committees to answer questions, subject to exemptions;

· On request, respond to reports and recommendations within 28 days of the request of the committee;

· Consult the local overview and scrutiny committee (including joint committees) on matters of substantial development or variation to services, (in addition to the duty under section 11 of the Health and Social Care Act 2001 to involve and consult patients and the public).

Annex Two

Hampshire County Council

Health Overview and Scrutiny Committee

Summary of Key Expectations in the Department of Health Overview and Scrutiny of Health - Guidance

In the 2004/05 Annual Report, useful information was provided about the responsibilities of Members of HOSCs. The Annual Report also noted that interaction between the NHS and its local authority and other partners happens at different levels and in different ways. Local experience and intelligence about how the often complex arrangements work for patients, can come from key statutory partners or independent partners such as P&PIFs.

The busyness and complexity of the NHS, new national initiatives, and local patient experience can sometimes distract from reflection on the fundamental expectations of Government of the Health Overview and Scrutiny role. Some of these expectations are noted below as a reminder as to why the Committee places importance on:

· Relationship building

· Processes for effective scrutiny

· Strategic scrutiny

· Operational scrutiny

Relationship building

In the Department of Health's, Overview and Scrutiny of Health - Guidance, it was clearly indicated that they expected Health Overview and Scrutiny Committees to work in a challenging, complex environment; "The Government's intention is that the focus of health scrutiny is on health improvement, bringing together the responsibilities of local authorities to promote social, environmental and economic well-being and the power to scrutinise local services provided and commissioned by the NHS". One of the key requirements of the Committee must be to establish and build a network of positive working relationships that will make it possible to achieve the broad aim of `health improvement' as indicated in the Guidance. It is for this reason that the Annual Report explicitly comments on `relationship building' as a key area of the Committee's work.

Processes for effective scrutiny

The Guidance implies its concern that HOSCs should have effective processes for scrutinising issues that are brought to it, for example, it says, "...if the process (of scrutiny) is aggressive, or relies on opinion rather than evidence, it is unlikely to lead to positive or sustainable improvement." It also emphasises that scrutiny must be based on firm foundations, "Members of scrutiny committees need to take a constructive but challenging approach to the role, bringing together evidence and people's experience to identify priority issues and drive forward improvement." The Annual Reports makes clear that establishing and building effective processes for the scrutiny function is another key responsibility of the Committee.

Strategic scrutiny

The Guidance document is helpful in explaining the scope of health scrutiny when it says, "The powers of overview and scrutiny of the NHS enable committees to review any matter relating to the planning, provision and operation of health services in the area of its local authority. It is recommended that best use of these powers will depend on committees scrutinising a health issue, system or economy, not just services provided...". The wider context of local service delivery is therefore of significant interest. Examples of this aspect of the Committee's work are to be found in its raising questions about national funding, or in its Hampshire-wide reviews of health issues.

Operational scrutiny

The Government Guidance also gives due weight to Health Scrutiny's role with respect to local service delivery, "Committees are best placed to concentrate on ensuring that health services address the needs of local communities and that local health and health-related issues are being tackled jointly across local agencies." The sections on Proposals to vary or develop NHS Services, and Health Inquiries in the 2005/06 Annual Report contain examples of this aspect of the Committee's work.

Implicit in the Guidance, and in the recent White Paper, is the expectation that because "the focus of health scrutiny is on health improvement", the remit will inevitably include those areas, sometimes associated with `wellbeing' that can be determinants of health, "...the solutions to matters that are scrutinised, may therefore be the responsibility of a number of stakeholders. In this light the power to scrutinise health services should be seen and used in the wider context of the local authority role of community leadership and of other initiatives to promote and facilitate improvement." In this vein, the recent Committee review of Public Health and Wellbeing, is a prime example of the Committees commitment to fulfilling the Government's expectations of health scrutiny.