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 on-going 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

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

DAY HOSPITAL RECONFIGURATION

EXECUTIVE SUMMARY

This report summarises the identified impact of changes to Day Hospital reconfiguration in Fareham and Gosport and East Hampshire.

The report identifies that whilst the relocation of services had been achieved from the Lawns to St. James's hospital, there have been a number of less positive effects due to increased travel distances. The closure of Cedarwood has been more successful.

In both cases targeted cost savings were made and the impact to patients has been minimised by the skilled intervention of staff.

Finally, there are opportunities to re-examine the arrangements in East Hampshire and progress model in both areas, particularly East Hampshire, to a more therapeutic outcome focused care.

NOTE

This report has been prepared by Hampshire Partnership NHS Trust.

May 2006

Day Hospital Reconfiguration

Background

Elderly Mental Health Services were asked to consider cost saving and efficiency initiatives within their services and the rationalisation of day hospitals was identified, from five to three.

The net result of this was that the three Day Hospitals providing services for East Hampshire and Portsmouth City should be combined into two, both to be located at the St. James's site, resulting in the closure of The Lawns in Leigh Park. In Fareham and Gosport, Cedarwood based at St Christopher's Hospital in Fareham combined with Phoenix Day Hospital based at Gosport War Memorial Hospital.

Shortly after this it was agreed that Elderly Mental Health Services should be transferred either to Portsmouth City or to Hampshire Partnership NHS Trust.

The project released funds towards the financial position of the PCTs and minimised the impact on patients.

Review of current position

This document summarises the impact of changes that have taken place. To do this, the review has drawn information from the following sources:

1. An audit conducted by New Generation service involving day hospital patients

2. Examination of project from Hampshire Partnership perspective

3. Feedback from the Acting Locality Manager

4. Feedback from staff and general observations

THE LAWNS RELOCATIONS TO ST. JAMES

The provision at The Lawns, Leigh Park, a service for functional and organic patients was merged into Goddard Day Hospital (organic) and Beaton Day Hospital (functional) .

Achievements

1. The project was achieved on time.

2. There was no significant problems or complaints highlighted during the process

3. Projects release of savings previously identified.

4. Staff has been relocated.

5. Day Hospital Service is still available, with places more than matching current demand.

6. Audits showed that patients report positive experiences of staff attending Day Hospital.

7. There is no reported evidence of negative impact to clients discharged from the day hospitals prior to merger (i.e. readmissions etc.)

Disadvantages and challenges

1. Problems have been reported with difficulties in travel and distance to travel from Havant area has been a factor that has influenced some people not to attend, or for clinicians to carefully consider, prior to referral, whether a long journey is appropriate.

2. Problems with transport arrangements have occurred which again has not been received positively by the patients or by staff who have been subjected to routine disruption. These problems have been experienced in other services.

3. Transport costs have increased.

4. No opportunity was taken to re-examine the model of care being provided.

5. The service is no longer considered local.

6. The decision was not popular with representative groups.

7. The audit that focused on this locality's changes reported recommendations including: that in future more involvement of service users and carers should take place during similar changes, and a re-audit should take place in 12 months.

Following the split of services between Hampshire Partnership NHS Trust (HPT) and Portsmouth City PCT. Goddard Day Hospital is now managed by Portsmouth City PCT and Beaton Day Hospital by HPT, both are working to provide separate services by July 2006. This will result in Beaton Day Hospital providing services for Organic and Functional patients (on different days). This change will see the introduction of a more therapeutic outcome focused model of care.

Further the Oversight and Scrutiny Committee have tasked Hampshire Partnership to review the decision to move East Hampshire Services to St James and to see if there are any opportunities now to move the service back locally. Hampshire has agreed to do this and have been talking to Social Services about opportunities to do this in a way that would be received positively by patients and are achievable. Initial conversations with commissioners (EHPCT commissioning) are favourable to this approach.

CEDARWOOD RELOCATION TO ARK ROYAL

The provision at Cedarwood, St Christopher's Hospital, Fareham, a service for functional and organic patients was merged into Ark Royal Day Hospital (Organic and Dementia) in Gosport .

Achievements

1. The project was achieved on time.

2. There was no significant problems or complaints highlighted during the process

3. Projects release of savings previously identified.

4. Staff have been relocated.

5. Day Hospital Service are still available, with places matching current demand.

6. Audits showed that patients report positive experiences of staff attending Day Hospital particularly those relocated

Disadvantages and challenges

1. Problems with transport arrangements have occurred. These problems have been experienced in other services.

2. Transport costs have increased.

3. No opportunity was taken to re-examine the model of care being provided, however the provision at Ark Royal was one of the more progressive within the service at the time and the audit conducted in this locality complemented the service on this.

1. The decision was not popular with representative groups.

2. The audit in this locality made minor operation recommendations.

Summary

The rationalisation of day hospitals was achieved in both areas without significant problems; however the most notable compromise was the lack of local facilities in the East Hampshire area and reported travel problems. In both areas positive feedback has been received regarding the alternative provision.

Hampshire Partnership NHS Trust are currently reviewing this and hope that it can be addressed.

Appendix Two

Southampton University Hospitals Trust 28^th June 2006

The Challenge for this Year

Introduction

I would like to brief you on a challenge that the Trust has set itself for this financial year and which marks a significant turning point for the organisation. There are two important and closely related goals that we want to have achieved by April 2007. The first is to make fundamental changes to the way we deliver care so that for the first time in our history we put the patient experience right at the heart of everything we do. The second is to achieve financial balance and we know that this will be a challenge for the organisation for the next few years.

The financial situation for SUHT

As a result of discussions across all NHS organisations in Hampshire & Isle of Wight, we need to reduce the cost of running our hospitals by £26 million pounds for the year. Although this is a large number and represents a serious challenge, we have an excellent record of reducing our underlying cost base and between 2003/04 and 2005/06 made savings of £42 million pounds.

Putting patients first

We have already started to ask how we can change what we do to improve the experience patients have of being cared for by us. It is essential that we answer this question because patient choice will be a dominant factor in our success in the near future.

The key improvements patients are telling us they want can be summarised as:

· Access - Being able to see specialists more quickly after GP referral and being admitted for treatment as soon as possible after diagnosis.

· Efficiency - Having all tests required on a single visit to outpatients rather that having to attend on a number of different occasions.

· Length of Stay - Being discharged as quickly as possible once acute hospital care is no longer necessary.

The Trust is committed to meeting these preferences and this will require us to operate much more efficiently in terms of how we process patients and the information we hold about them. If we do this, we will also bring down the cost of offering our services and will need fewer beds and members of staff to care for higher numbers of patients. This will give us an opportunity to achieve a balance between what we spend and what we earn and to shift more resources towards supporting the very ill or injured, which is an area where there is great need and we have great expertise.

Our service change plans for the year 2006/07

The approach we are taking to re-designing our services this year includes making the following improvements:

· Offering day surgery wherever possible and pushing our rates of day surgery up to 75% of all non-emergency operations.

· Re-organising outpatients so that patients are more thoroughly assessed when they attend but come back on fewer occasions.

· Improving the speed and efficiency with which we discharge patients who no longer need to be in an acute hospital and reducing the average length of stay of our patients.

· Enabling patients to receive follow-up care at their GP surgery.

· Unblocking a common barrier to discharge by making sure the support patients require either in their homes or in a community setting is in place and ready for them by the date on which we expect they are able to leave our hospitals.

How we will reduce costs this year

We need to make cost-savings that will allow us to focus our resources on the frontline services and achieve financial balance. While this will mean a difficult period of change for some of our teams, this work will benefit the organisation for future years when we can expect there will be less money in the system for NHS hospitals. We are now discussing at board level proposals for making the Trust fundamentally more efficient in a number of ways including:

· Reducing the size of our headquarters in line with the recent move to a divisional structure in which five operating divisions are now responsible for running patient services.

· Changing the numbers, or the mix of skills staff have in some areas by re-designing services, using new technology, outsourcing tasks or giving them to different people in the organisation.

· Sharing certain support functions with other NHS organisations.

· Reducing the cost of medical staff where they are working overtime for which we make a costly pay supplement.

· Working to reduce our purchasing costs.

· Making maximum use of every square metre of outdoor and indoor space.

What this means for staff across the organisation

Specifically, we now intend to begin a period of full consultation with staff over the following proposed changes:

· The reduction in the number of beds we will need as a result of seeing and treating patients more quickly. We plan to use 140 fewer beds than our current number of over one thousand.

· Reforming the roles and rotas of clinical staff so that we ensure they are not required to work excessive hours. This costs the Trust significant sums of money.

· Reducing our management costs by reducing the number of staff working in Trust headquarters.

· Using a third party to type and send clinic letters which we know has a dramatic impact on the length of time it takes for those letters to be issued.

The outcomes of these consultations cannot be firmly predicted in advance, but our plans suggest that as a result of these changes we will be need to make something in the order of 90 redundancies across the Trust. However, we will seek to reduce the number of `whole time equivalent posts' that the organisation has on its books by 564. It can often be misrepresented that this higher number equates to the number of redundancies that will be made and I can re-assure you that this will not be the case.

As is always the case we will work hard to avoid redundancy wherever possible by helping any people put at risk to apply for other NHS jobs.

Public Consultation

We will be talking to Oversight and Scrutiny Committees (OSCs) and Patient and Public Involvement Forums (P&PIFs) about our plans in the next few days. Very little of what we are planning to do will alter service configuration across the community. Where material service change occurs the Trust will discuss this with its OSCs to ensure that proper engagement and consultation processes will be undertaken. In this instance briefing sessions will be held for all MPs, P&PIFs, OSCs and partner PCTs. There will be extensive internal consultation on these changes as you would expect and this will be occuring throughout July.

Conclusion

Patient choice will dictate which hospitals are successful in the future and we need to make sure we deal with NHS patients as efficiently as any private hospital would. The spin-off of being more efficient is that we can make cost-savings because we need fewer beds, but this does not mean we are cutting back our services and we will see a record number of patients this year.

We must do everything we can to deliver the best possible care to people in the Southampton area even if it means that in some areas we have to let staff go. Medical advances mean we can treat more patients for every pound of investment, especially where the treatments are routine. If we do this we can continue to invest in our specialist services which will mean that local people can continue to see the best doctors in the world, right on their doorstep.

I am confident that patients in Southampton are already starting to feel the benefits of the more efficient way we are running services. When they are called in to see a consultant, I think they are often surprised at how soon they get their appointment compared with a few years ago. When they are told their operation can be done by keyhole surgery and they can go home the same day I think they understand this is a better service than it used to be.

Providing healthcare in the current climate is both expensive and complex. All hospitals in the NHS are being challenged to help more patients with the same amount of money. I firmly believe this is possible, but I am also convinced of the need for NHS hospitals to develop a long-term strategy that clearly defines their goals and what their business will look like in the future. In collaboration with our NHS partners locally, we have now developed an exciting vision for the future of the hospital services we will operate in Southampton. I look forward to sharing this with you over the next few weeks and I hope in the meantime that this briefing is helpful in giving you an understanding of what we want to achieve at the Trust this year.

Mark Hackett

Chief Executive

28 June 2006

Appendix Three

Update on the Reconfiguration of Services at

Emsworth Victoria Cottage Hospital and Havant War Memorial Hospital

1 INTRODUCTION

1.1 This paper provides an update for the board on progress of the changes to Emsworth Victoria Cottage Hospital (EVCH) and Havant War Memorial Hospital (HWMH)

1 BACKGROUND

1.1 During May, June and July of 2005 East Hampshire Primary Care Trust undertook an extensive public consultation on the future configuration of services across Emsworth Victoria Cottage Hospital and Havant War Memorial Hospital.

1.2 Following the outcome of the consultation process East Hampshire PCT board voted unanimously to:

· Consolidate in-patient beds at HWMH

· Close the minor-injury service at EVCH

· Transfer some out-patient services from Havant Hospital to EVCH

1.3 As part of the outcome of the consultation East Hampshire PCT readily agreed to:

· Establish a steering group

· Develop a new assessment and treatment service, to be based at Emsworth Hospital

· Provide detail of the staff and finance issues arising from the reconfiguration

· Provide update on the future developments in the area, primarily the proposed new community hospital at Oak Park, Havant

1.4 Following the decisions outlined in 2.2 in-patient and minor injury services at EVCH were closed on the 30^th September 2005. Planning for the new assessment and treatment service, and the transfer of out-patients clinics commenced in October 2005.

2 STEERING GROUP

2.1 The Emsworth Victoria Cottage and Havant War Memorial Hospitals Steering Group was established in October 2005 the Terms of Reference and membership are given at annex A.

2.2 The group has overseen the development of new services, relocation of existing services and provided a forum for identifying areas for future development.

2.3 Patient satisfaction questionnaires for in-patients, out-patients and patients who receive care from the multi-disciplinary rapid response teams have been developed by the group and are being distributed.

3 SERVICE RECONFIGURATION

3.1 Multi-disciplinary rapid response team

The multi-disciplinary rapid response team was established in December 2005, initially accepting patients from the Emsworth GP practice, but extending to all East Hampshire practices in January 2006.

The team is focused on providing care at home for patients who may otherwise have had to be admitted to hospital. The team membership comprises nurses, an occupational therapist, a physiotherapist and administration support; offering up to five days intensive nursing and/or up to six weeks of therapy to support rehabilitation. The team is fully supported by Hampshire County Council Adult Services, with rapid access to packages of care or short term nursing home placement.

Between December and the end of April the team has received 127 referrals to the service, avoided 62 admissions to hospital and made in excess of 600 visits. Patient, family and referrers feedback regarding the service has been very positive, patient questionnaires are being distributed and will provide valuable data to inform future development of the service.

3.2 In-patient service

In-patient services were consolidated into HWMH from the 30^th September 2005. Over October, November and December staffing requirements were finalised and staff from Emsworth Hospital and Havant Hospital were slotted into the new structure or into other services. Unfortunately we were unable to place one part time member of staff.

In the six months prior to the closure of EVCH beds occupancy levels at HWMH were 80% and at EVCH 69%. Since the closure HWMH bed occupancy has been consistently above 85% and for a number of weeks has been over 90% occupied. These occupancy rates are in the context of four outbreaks of Noro virus over the winter months, thus restricting access to beds.

To enable the increase in occupancy a significant amount of work has been done on improving discharge planning. The ward team leader at Havant Hospital was a recipient of a PCT award for excellence for the discharge planning work and the leadership of the team through the time of change.

The effect of the discharge planning work can be seen in the table below.

A number of patient environment improvements have been supported by the Friends of EVCH and the Friends of HWMH, these include the provision of new privacy blinds and the purchase of new televisions.

3.3 Out patient service

Two general surgery out-patient clinics have been transferred from HWMH to EVCH and an ophthalmology clinic is planned to move from Havant Health Centre to EVCH in the near future.

There has been an increase in the number of phlebotomy clinics held at EVCH from one to two per week.

3.4 Minor injury service

The figures for 2004/05 gave a combined attendance for HWMH and EVCH of 1551, an average of 129 attendances per month. A concern has been the reduction in the number of minor injury attendances at HWMH, the table below demonstrates this:

Of the total number (139), 27 patients required transfer to A&E or an alternative service giving approximately 20% attendances as inappropriate.

The steering group are aware of the concerns and are monitoring the activity closely. If the reduction is maintained the clinical and operational viability of the service has to be questioned.

3.5 Allied health professional clinics

The physiotherapy department have established a Balance and Safety group at EVCH for suitable patient's from the local community, these would typically be patients at risk of falls. The Friends of EVCH have provided parallel bars, steps, a therapy stool, two wide neuro treatment plinths and a tall mirror to support the group and enhance the quality of service provided.

Out-patient physiotherapists are planning to locate a Back Conditioning group to EVCH. The Friends of EVCH are also supporting this service development.

3.6 Other service changes

In addition to the above services the following teams or services are now based or planning to move to EVCH:

· Boundary East child and family team, with health visitors, primary mental health workers, school nurse, community nursery nurses

· Local district nursing store

· Red Cross medical loans

A new District Nursing clinic is operating from HWMH on Saturdays and at Bank Holiday weekends.

4 LINKS TO OTHER AGENCIES

4.1 The multidisciplinary rapid response team works closely with Hampshire County Council Adult Services to ensure patients receive the care they need to remain safely at home. This service collaboration is essential and has been an example how the two health and social care agencies can deliver a quality service for patients.

4.2 The establishment of the steering group has facilitated links to all key stakeholders thus informing the future development of services for this locality.

4.3 The relationships between the respective hospital `Friends' and the health services has been very successful, with the Friends being an integral part of the steering group and supporting some of the new services that have been developed. Further to this the steering group has provided an opportunity for local people to discuss with health and social care professionals issues that are of concern to them.

5 FINANCIAL IMPACT

5.1 In the consultation document East Hampshire PCT identified the costs associated with providing in-patient and minor injury services at EVCH was given as £380,796, with anticipated savings of £300,000 a year recurring.

5.2 In last six months of 2005/06 savings of £100,000 were achieved when compared with the previous six months expenditure.

5.3 It anticipated that the full £300,000 savings will be achieved in 2006/07.

6 WORKFORCE IMPLICATIONS

6.1 Of the 24 staff (14 whole time equivalent) providing in-patient and minor injury services at EVCH, 23 were matched to positions within the PCT. Regrettably 1 part time member of staff was made redundant as we were unable to find suitable or alternative employment.

7 FUTURE DEVELOPMENT

7.1 An open day at EVCH, showcasing the various developments and available local services, is planned for July 2006.

7.2 The success of the multi-disciplinary rapid response team has led to plans to establish a service for Fareham and Gosport residents. This service should available from September 2006 (subject to recruitment).

7.3 Changes to community nursing will take effect from September 2006 with integrated nursing teams providing community nursing and intermediate care services for the locality. Improvements in the management of patients with long term conditions, e.g. COPD, heart failure, complex conditions, will be effected by the introduction of Community Matrons to the teams. It is hoped that the above changes to the community nursing teams will facilitate even closer working with Hampshire County Council Adult Services.

7.4 The planning for a new community hospital at Oak Park in Havant continues. The NHS LIFT stage 1 business case was approved by the board in May 2006 and is now with the Strategic Health Authority for approval. It then will be sent to the Department of Health for approval which is not expected until September 2006. Assuming all approvals are in place we expect to start on site in September 2007 with completion and occupation by December 2009. The gap of a year between approval and start on site is due to the detailed planning process and further business case approval.

8 CONCLUSION

9.1 The board is asked to note progress.

ANNEX A

Emsworth Victoria Cottage and Havant War Memorial Hospitals

Steering Group

Terms of Reference

Purpose:

· Monitor and evaluate the impact of the changes for both inpatients from Emsworth and outpatients at Havant.

· Influence decisions on service development.

· Facilitate links and feedback with the wider community.

Membership:

Agenda and minutes distributed for information to:

Chair:

Jan Gough, Age Concern Hampshire

Administration:

Cluster PCTs

Reporting:

Reports to respective organisations

Frequency of meetings:

To meet monthly - 3^rd Tuesday of each month from 2 - 3pm.

Appendix Four

REPORT RE KINGSCLERE AND EXTON 4 TEMPORARY CLOSURE

Introduction

In 2005 the Department of Medicine for Older People temporarily closed Exton 4 Ward and Kingsclere Ward, both at St Mary's Hospital. The rationale for closure was:

· A review of all the bed audits undertaken in the health economy in the last few years indicated that there were too many inpatient beds and there was a need to redefine inpatient bed allocation to meet the needs of the population of Portsmouth Health Economy.

· To work towards the PFI model of service delivery for the new Queen Alexandra Hospital

· There was a large amount of temporary workforce used within these wards and the temporary closures were a contribution to the Trust's financial recovery plans.

· Both environments were of poor quality and failed to meet the DOH guidelines relating to single sex accommodation and privacy and dignity.

Exton 4

Exton 4 was a 26-bed mixed sex acute medical ward for older people at St Mary's for the year 2004/05 the total acute activity (ie the number of patients admitted to acute beds) was 3134 with an average length of stay of 15.17 days.

The total activity for 2005/06 has indicated that with fewer beds, the access to services has increased by admitting 90 more patients than 2004/05 with the average length of stay reducing to 12.56 days.

This has been achieved by internal changes to working patterns for some key clinical staff. Financial savings were made through the reduction of the temporary workforce and redeploying staff into the remaining wards. There were no staff redundancies relating to this bed reduction.

Kingsclere

This was a 19-bed Continuing Care Unit serving the City of Portsmouth. It was one of two Continuing Care Units, the other being Jubilee House (25 beds) which also serves Portsmouth City.

Kingsclere was located on the East Wing site of St Mary's Hospital and following several audits using national NHS audit tools, it had been established for some time that the accommodation was sub-standard.

The original plan was to relocate Kingsclere to the main St Mary's site (West Wing) as the East Wing is scheduled for demolition during 2006 in any event.

However, during 2005, with the application of Government Policy regarding continuing care and Home of Choice it became apparent that the total number of Continuing Care beds available for Portsmouth meant that both Kingsclere and Jubilee House were half empty. Not only was the situation difficult in terms of the Trust's overall financial position, it was also questionable as to best use of tax payer's money.

In July 2005, as a result of the number of empty Continuing Care beds, the Trust took the decision to temporarily close Kingsclere.

A project plan was published and project group formed. Application of DOH guidance (HSC 1998/48) on the movement of Frail Elderly Patients was applied and a copy of the project plan was submitted to the Portsmouth OSC.

Kingsclere closed towards the end of September 2005 with all patients moved safely to other care settings, some being able to return to their own homes.

All staff were redeployed as per Exton 4 applying the Trust's redeployment policy and there were NO redundancies.

However, some staff elected to leave the Department of Medicine for Older People and continue their service in the NHS with our colleagues in Elderly Mental Health at St James' Hospital. In all cases where this occurred, it was at the employee's request for personal reasons.

Today there is NO waiting list for patients (not only Portsmouth City but across the Health Economy) waiting to receive NHS Continuing Care. In fact, we currently have empty beds within this care sector.

9 June 2006