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 the Corporate Strategy aim of maximising well being.

Items for Information

2. Hampshire PCTs: Hampshire Child Health & Maternity Services: A discussion Paper

2.1. The interest of Members in this work has been drawn to the attention of the new Hampshire PCT

Recommendation

2.2. That Members are updated on progress with this initiative at their November meeting.

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

3.1. PHT has been asked to confirm when the Grange will reopen. No date has yet been given.

3.2. Portsmouth City HOSC has written to the PCT confirming the position of Hampshire about future service configuration of maternity services, including the view that the birth centre configuration is not contingent on the retention of this service on Portsea Island

3.3. The new Hampshire PCT has been apprised of the concerns of the HOSCs

3.4. It is anticipated that Blackbrook will not close in the new year as previously suggested by the PCT.

Recommendations

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

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

4.1. Comments from members in the capacity plan agreed at the last meeting were sent to the SHA.

4.2. The response from the SHA to the issues raised by members was circulated electronically on the day it was received. This is attached at Appendix One.

4.3. No issues have been raised by Adult Services.

Recommendation

4.4. Members advise the Chairman of any outstanding issues to be addressed.

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

5.1. Further to the joint committee meeting on 19 July the recommendations from the Committee are attached at Appendix Two (previously tabled).

5.2. Adult Services has not indicated any concerns about the recommendations

5.3. The first progress report from the PCT is available from the scrutiny manager

Recommendations

5.4. That the Committee continues to be up-dated on progress with this work through the joint committee.

6. North Hampshire PCT: Changes to services at Homefield House

6.1. As requested the PCT has untaken section 11 regarding plans to move patients from this facility

6.2. North Hampshire PCT had always anticipated that only a small number of residents would benefit from a transfer from Homefield House to the new unit being developed at Parklands Hospital.

6.3. Over the summer clinical staff have assessed the continuing care needs of each Homefield House resident, and the Consultant for Older People's Mental Health is not recommending that any residents be transferred from Homefield House.

6.4. The PCT is therefore contacting each resident's family and/or carers to cancel meetings that had been arranged to consider options for future care, unless the family/carer still wish it to proceed.

6.5. The Patient and Public Involvement Forum has been informed about this change.

7. North Hampshire PCT: Modernising Alton Hospital

7.1. The PCT has provided some additional information about the changes to the physical environment at Alton Hospital. This is attached at Appendix Three

7.2. Additional information has been requested with regard to the section 11 engagement that underpinned the development and the actual range of services that will be provided from the Hospital

Recommendation

7.3. Members receive the additional information requested.

Items Requiring Action

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

8.1. Further to up date provided at the last Committee meeting SUHT convened a meeting of all stakeholders to discuss the way forward. This confirmed that

· The current configuration of services is not sustainable given the anticipated rise in births in coming months.

· There are specific concerns about the safety of the service provided at the Princess Ann Hospital which means that the choice is to proceed with consultation, or take urgent action to ensure that services, specifically care in labour, are not compromised.

· All present agreed that it would not be satisfactory for the situation to reach the point where short term urgent action was required.

· Formal consultation commenced on 21 August and will close on the 20 October

· Issues to be addressed included confirmation of the range of services to be provided in local settings, interim arrangements to enable mums to be to access a midwife led birth centre should changes to current service patterns be agreed and the need for clarity about the way in which these changes would link with the wider strategy for maternity and child health services.

8.2. Members were apprised of the outcome of this meeting on 2 August and circulated electronically with the consultation document on 18 August.

8.3. Details of the section 11 engagement that had taken place were included with the consultation document .

8.4. General points and questions to be raised with SUHT are attached at Appendix 4

Recommendations

8.5. Members agree the additional issues to be raised with SUHT and are circulated with this information when it is received.

8.6. Any issues relating to the adequacy of section 11 engagement, or the interests of the population served are flagged to the Chairman by the 12 October.

8.7. SUHT provides the Committee with an update on the outcome of the consultation process and the next steps at the November meeting.

9. South West Alliance PCTs: Neurology Rehabilitation Services

9.1. No additional issues were raised by members in relation to the proposals.

9.2. The formal consultation does not conclude until 25 September. The PCT has agreed to provide members with a paper to be tabled giving and indicative position based on the responses to the consultation received up to 22 September .

Recommendation

9.3. Members consider if there is any further action to be taken with regard to the consultation, or the interests of the population affected by the changes.

10. Department of Health: A Stronger Local Voice: A Framework for Creating a stronger local voice in the development of health and social care services.

10.1. The final response of the Committee is attached at Appendix 5

Recommendation

10.2. The Committee is advised of the outcome of the consultation process

11. Hampshire County Council Social Services: Consultation on the eligibility criteria for accessing community services

11.1. Adult services launched this consultation on 1 September. It will run to the 27 November.

11.2. The document is accessible on the HCC website.

11.3. Some key questions or adult services are attached at Appendix 6

Recommendations

11.4. Members agree the key questions to raise with adult services

11.5. Members are provided with indicative results of the consultation at their meeting in November

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

A Strategy for Sustainable Services in Portsmouth and South East Hampshire; a new direction for hospital and community service in Portsmouth and South East Hampshire

Thank you for your letter commenting on the above paper. I think from the outset it is important to reiterate the background to and intended purpose of this document. The local health organisations in South East Hampshire have evolved their plans from the strategic direction set by the former Portsmouth and South East Hampshire Health Authority in the late 1990s and the requirements implicit within the Portsmouth Hospitals Trust PFI development. The Capacity Map was collectively produced specifically in response to a Strategic Health Authority request to explicitly demonstrate the collective synergy/linkage and sequencing of the envisaged significant capital developments in Portsmouth and South East Hampshire. Given the impending organisational change, it was felt very important as we move forward, to have broad clarity of future strategic direction whilst equally recognising the schemes in the Capacity Map are at different stages in the planning process and have varying levels of stake-holder engagement. The latter point will be addressed fully in the next planning phase as the Business Cases for individual schemes are progressed.

I acknowledge the OSC's comments on timings and the resulting implications on service delivery. In particular, it is true that the timing of the Fareham Community Hospital changed over recent times. Fareham and Gosport PCT were originally planning for the hospital to be complete in 2010. However, during the development of the Capacity Map it became clear that schemes would have to be phased in order to manage the financial affordability impact. The Fareham Community Hospital is now proposed in two phases. The first phase consisting of outpatients and diagnostics is planned for 2010, the second phase providing day hospitals for older people and older people with mental health needs and the replacement birth centre is planned for 2012. As you know the future disposition of Maternity Services including birthing centres is subject to the outcome of the SE Hants Maternity Services Review. I set out below the response to the points detailed in your letter. Clarity about the affordability of the plans for service delivery You are right to point out that there are risks associated with assuming that new developments will be funded from increasing efficiency. However this is not a new expectation and indeed part of the rationale for the new developments is that they will enable new ways of working that are more efficient and effective. It is accepted that the provision of new buildings increases costs associated with the building, however new buildings also provide an opportunity to re-design services. Health services that are provided in older buildings often have to compromise efficiency due to the physical constraints of the building. This plan gives the local NHS the opportunity to re-design buildings and services. We will expect clear benefits realisation plans to be included within business cases. The other risk you highlighted was that the plan relies on the South East Hampshire Health Community working in concert. This plan illustrates the close co-operation and consideration of each other's priorities of the organisations involved. The Capacity Map will be used by successor organisations to test individual business cases. Therefore, any business cases that deviate from the Capacity Map will be questioned and the impact on the whole economy can be assessed.

The needs assessment and demand projections The Capacity Map includes all the known population projections. You are correct to point out that the figures do not include the possible increase of 10,000 homes set out in the South East Development Plan. However, the NHS organisations are aware of these proposals that are part of the South East Plan which is being consulted upon until 23rd June 2006. As soon as the Plan is agreed, the population projections will inform individual Business Cases. We need to reassure you that we utilise the population profiling work undertaken by Hampshire County Council and this informs the planning work we undertake. As it stands, we have some knowledge of the overall proposals for new homes across South Hampshire but will be seeking clarity on the envisaged impact on local population projections as soon as these are published formally by Hampshire County Council. Our understanding at present is that any new housing development is likely to be phased over a ten year period from 2016, that some net increase in population would result, but not necessarily in linear proportion to the increase in housing. It is also unclear what the age profile of any development would encompass, and this would obviously be material to the type of services the NHS might need to provide in response. Once we are clear about the impact on demography, we will reflect this in the development of the individual Business Cases. There is no reduction of community beds in Fareham and Gosport in the capacity plan. However, we do have evidence, locally and nationally, that different models of care, particularly for people with complex needs and chronic conditions, can offer more effective treatment and rehabilitation for people in their own homes. The future development of these services is likely to change the use of hospital beds. This issue was addressed substantially by East Hampshire and Fareham and Gosport PCTs last year in the Elderly Care Bed Review undertaken as part of the financial recovery plans. The outcome of this Review underpinned the consultation on the closure of inpatient beds at Emsworth Victoria Cottage Hospital. The St Mary's NHS Treatment Centre is currently running below capacity in certain areas. The slow take up of Independent Sector Treatment Centre [ISTC] capacity is normal and has been replicated in other ISTCs in the first year of operation. However, we also know that once the public and GPs have a positive experience of the service, the take up of available capacity is likely to increase. Joint partnership working The development of the Hampshire PCT will make joint partnership working easier. I know that work between Hampshire Social Services and PCTs to further develop this has already commenced. In the South East Hampshire area, local working relationships are already both good and productive with a number of examples of partnership schemes working. This will provide a firm foundation to build on. We will look for further tangible evidence of this in future business cases. Interdependencies between QA and community hospitals There is an over-arching vision for the development of a hub and spoke model of acute and community care. This includes the provision of outpatients and related diagnostics, procedures and therapies in the community, with the complex and emergency care being provided at the acute hospital. The workload projections assume transfer of patient activity from Queen Alexandra Hospital to the more local centres outlined in the plans. Detailed projections are being drawn up for each specialty and these will be included in the individual business cases for community hospitals. The original PFI plan developed in 2000 assumed a need for post acute beds to cope with an increase in demand for in-patient care; however the assumed level of growth has not materialised. This is probably due to a number of reasons including the shift from in-patient to day case care, the increase in intensive rehabilitation and the development of intermediate care. Many more patients are being cared for in the community, including in their own homes. This trend is wholly in line with the recent White Paper Our Health, Our Care Our Say and is likely to continue. However should it not, the capacity plan does allow a contingency for additional beds at St Mary's Hospital.

Impact on service provision There are difficulties ^-With the transport systems particularly on the Gosport peninsula and this has been taken into account when drawing up the plans for local community hospitals. Any influence that you can have on easing the transport situation would be appreciated by PCTs as this does have an impact on planning for health services. PCTs accept that there needs to be clear strategy for older people with mental health needs and this will be easier to achieve with a single Hampshire PCT, co-terminous with Hampshire County Council. We will be looking for a clear strategy for this vulnerable group as a priority for the reconfigured PCTs. The LBHU model of re-provision has yet to be agreed. However in the last 18 months the current service users and family carers have been involved in working groups looking at individual needs, wants and wishes and these will be factored into the final plans. There will be further consultation before a business case is produced. The overall direction of travel has the support of local GPs and they are engaged in the planning of local services. The implementation of Practice Based Commissioning will ensure further involvement in the development of services and as plans are refined these will be reflected in future business cases.

Appendix Two

Transfer of Elderly Medicine Services

Joint Committee Findings

Introduction

Members of the Committee received written evidence from PCTs and Hospital Trusts in the South East setting out the reasons for the proposed transfer of Elderly Medicine Services from the PCTs to Portsmouth Hospitals Trusts and the stakeholder engagement that had taken place to test the options open in managing these services.

Feedback and comment on the proposal was invited from invited from local P&PIFs. Members also invited comment from Hampshire Adult Services and Portsmouth City Adult Services with regard to both the transfer proposed and the potential impact on adult care provision.

Members were particularly keen to establish if there would be any service change associated with the change in management services, which would require formal consultation.

Following the presentation and discussion Members of the Committee resolved the following:

· That the current service would transfer in `steady state' i.e. without change to the way in which services are currently delivered across the area. Any subsequent changes would need to demonstrate compliance with section 11 and section 7 responsibilities. Members therefore accepted that the proposal to transfer Elderly Medicine Services to Portsmouth Hospitals Trust was a management change, and not a service change.

· Members were however mindful that there were a number of concerns voiced about the potential impact of national policy on this highly valued service. This included the roll-out of Foundation Hospitals, the drive to provide as many services in the community as possible and, most particularly, the introduction of payment by results (PBR). Members agreed that it essential that Elderly Medicine Services should not be adversely affected by the impact of these initiatives and therefore made the following recommendations for Trust Boards to consider when deciding if the transfer should proceed:

o Any changes to services over the next 18months would need to take into account the impact of PBR and the way in which this may affect provision of Elderly Medicine Services as well as demonstrating full section 11 compliance. Associated with this is the need for greater clarity about the service to be commissioned and the integrated patient pathway that this will deliver.

o Any reviews of these services must engage more effectively with stakeholders, particularly adult services to strengthen partnership working, specifically with regard to

_ Rehabilitation beds/services

_ Day hospital provision

_ Stroke Teams

_ The interface with Elderly Mental Health Services

· There needs to be clarity about the way in which the integrity of Elderly Medicine Services will be maintained following transfer to Portsmouth Hospitals NHS Trust. In particular current practice with regard to dedicated time spent in the community must be safeguarded including the provision of specialist support to community services and home visiting.

In the absence of other mechanisms to allow democratic input into the development of the commissioning arrangements for these services the Joint HOSC would continue to take a particularly interest in these services. A follow-up meeting will therefore be arranged in 6 months to allow members to determine how the recommendations set out above have been taken forward. Should Trust Boards decide not to implement any of the recommendations then Members will expect to receive a full account of the reasons for this decision.

Closure of Kingsclere and Exton 4 Wards

Members received a report from the PCTs on the impact that the temporary closures of Kingsclere and Exton 4 wards on 2005. The case of change for this closure was outlined and the assessment of the impact ion service provision noted, in particular:

· The improved performance of these services as a consequence of better use of specialist staff

· The additional investment that had been made in community services

· No patients were waiting to receive continuing care across the health economy. The future of these wards had been under review for some time and the PCT had deferred any decision on how to proceed until there was clarity about the way in which the winter pressures had been managed given the change to the configuration of services.

There was also a wider discussion about the continuing demands for these services and members noted that there remained disagreement between stakeholders about the appropriateness of current capacity given this demand. Additionally although reductions in lengths of stay could be beneficial in terms of promoting patients independence, this did have a consequential impact on adult services.

Members made the following recommendations:

· With regard to the proposal to make permanent the closure of Kingsclere and Exton 4, this did not constitute a substantial service change.

· With regard to the wider issues relating to the provision of these services for older people members endorsed the service model presented and the importance of putting the patient at the heart of any changes made to delivery of care. Members did however express concerns about the interface between adult services and the NHS when looking at provision and the apparent impasse that had been reached about the way in which the model of care set out should be delivered. It was essential that current funding pressures did not create barriers to people working together to find solutions in a difficult financial climate. The joint meeting would therefore reconvene in 9 months to hear how this important issue had been progressed.

Appendix Three

Alton Community Hospital

Inwood Ward Refurbishment and re-opening project

June - November 2006

Purpose of the Project

The project has been set up to achieve the following,

· Up grade the environment of Inwood Ward. This will include bringing the ward facilities up to a standard that will meet infection control standards, privacy and dignity requirements for patients, including single sex areas and patient environmental standards.

· Opening of 12 beds to provide care in a Nurse-Led Unit, with medical support from our local GP practice based at Alton Health Centre. The beds will be accessible to both the local and neighbouring communities and North Hampshire Acute trust. A variety of health professionals will have admission rights.

· A review of the Admission Policy and also an update of the patient care pathways both into and out of the Alton Community Hospital. This will also include any changes required in the procedures in Intermediate Care that will enable more patients to be supported on discharge from Alton Community Hospital.

Progress to date - September 1^st 06

· Tender for refurbishment has been let.

· Builders on site at Alton from 23^rd August. Work commenced on refurbishment of ward space on 23^rd August 06.

· Recruitment of staff to Inwood Ward started after a Recruitment Open Day which yielded 73 applications. To date we have appointed the new Ward Manager, Staff Nurses, qualified nurses, health care assistants and a ward clerk. As of 4^th September 06 there are only 2 posts still to recruit to. Staff appointed will be in post on October 1^st 06 to allow for a full and thorough induction to the PCT, Intermediate Care and the other 3 community hospitals within the cluster.

· Documentation on admission criteria, rehabilitation pathway and the operation policy have been completed and shared with the Implementation Group.

· The new Service Level Agreement for medical cover is in negotiation with regards to changes in times of visits and attendance at multi-disciplinary team meetings. This work will be complete before the opening of the ward to ensure that appropriate medical cover is in place.

· The provisional opening date for the 12 beds on Inwood Ward will be during the second week in November. Daily monitoring of the work is underway to ensure very early warning for any unforeseen problems that may delay the completion of the works. This is being undertaken by Sarah Garland, Matron and she is being supported by a member of the PCT's Estates Team.

Gill Dunnachie

Head of Hospital & Intermediate Care Services

4 September 2006

Appendix Four

South West Hampshire

Changes to Maternity Services

General Points and Questions

· It is helpful to have confirmation that all NHS stakeholders are supportive of the consultation. Given the organisational changes that will come into effect from 1 October it would be helpful to have confirmation that the outcome of this process would be supported by Hampshire PCT, but that this would be consistent with the development of a Hampshire wide strategy for maternity and child health services as previously discussed by the Committee. This point is not clear in the document and there remain issues about choice and equity of access, particularly with regard to Eastleigh and the surrounding area

· It was difficult from the presentation of the public health information to understand what the projections are for the need for maternity services in the area. You reference demand as a reason for not maintaining the status quo (para 5.1) but this information is not detailed.

· We noted that of the 3,000 births in the area just 11% took place in stand alone units and that the rising birth rate is bringing more women to the Princess Anne, not increasing the use of the stand alone birth centres

· It is helpful to have the value of maternity care assistants so clearly described, particularly given the pressures on the recruitment and retention of the birth centres

· It would be helpful to have your assurance that all funding released from any changes to the configuration of these services will be directed to providing maternity care

· There was little detail about the way in which the integration between maternity and child health services would be progressed. Whilst it is helpful to have this referred to in the document there is a need to a clear commitment to taking this work forward, linked with the strategy referred to above.

· We welcomed confirmation that whatever way forward is agreed, women will continue to have current levels of access to antenatal, homebirth and postnatal care.

· Accessibility is important- including travel. How are issues such as car parking, bus services and travel time (all of which are referred to in your document) ranked by women

· Given the move to practice based commissioning, can you confirm the views of GPS about your proposals

· If the birth rate is continuing to rise as suggested why aren't the PCTs commissioning these services providing more funding. This would be in line with the move to national tariffs for health services. These will include maternity care.

· Noting the efforts to increase the use of birth centres, has consideration been given to providing access to midwives through GP practices. This could help women be aware of the choices open to them at an earlier stage

· What elements of the NSF will these changes deliver. This is cited as a key criterion in deciding how to proceed ( para 4.7) but is not developed in the document

· What scope is there for women in the south west/western areas of Winchester to access the birth centre at Romsey

Appendix Five

To whom it may concern

A Stronger Local Voice': A Framework for creating a stronger voice in the development of health and social care services.

Thank you for inviting our comments on the above document. We appreciate the opportunity to share our views and hope that the summer period did not adversely impact on the feedback you have received.

There are some specific issues that we would wish to raise in reply to the proposals. These are attached below and include responses to the questions raised. A number of points relate to some inconsistency in the content of the document and ambiguity about the way in which some terms were used. In particular we would hope that there can be clarification about the way in which the legislative framework will be adjusted to ensure that there is a common understanding of the role of both health and social care in terms of the involvement and engagement of local people. This point is particularly important given the increasing blurring of the boundaries between health and social care.

Additionally there needs to be more recognition of the existing infrastructure that exists to support the accountability of public services, including representation by democratically elected members, LSPs and LAAs. The LINks need to be complementary to these arrangements and must not duplicate functions that are already embedded in, and working on behalf of, local communities.

The 4 principles outlined to underpin the new arrangements are helpful but there does need to be further work with regard to the accountability of the LINk, not only in terms of how it identifies and feeds back the views of patients and the public, but also in the way in which it relates to local services. At present the Forums, and indeed Health Overview and Scrutiny Committees (HOSCs) are expected to seek local resolution prior to referring an issue for further investigation; any such referral being supported by evidence. This is an important way of securing local action and should be retained in the new arrangements.

Whatever their source referrals should follow a transparent and time limited process that ensures that different views are heard and responded to. Inevitably there will be decisions taken on behalf of populations that some will find difficult. A clearly defined process for dealing with the issues raised by different communities will ensure that any decisions made take account of the views expressed and are based on informed evidence. In order to keep this process streamlined and simple we do not believe it will be helpful for both LINks and HOSCs to be able to refer issues to PCTs and SHAs as this could result in multiple and conflicting representation to these bodies. Given the HOSCs strategic interest in commissioning we consider that they should be the route through which this representation is made, taking account of the principles referred to earlier.

It is unfortunate that the referral process to the Secretary of State was not considered as part of the changes envisaged. We have found this process dilatory and unhelpful in the two instances where we have requested that an issue be subject to further investigation by the Independent Reconfiguration Panel. Perhaps consideration can be given to sharpening this process to align it more closely with the 4 principles included in the document.

There has been significant variability in the hosting arrangements for the Patients Forums and a number of concerns that funding has not been available to support the activities of individual Forums in discharging their statutory duties. If public funding is to be properly monitored and controlled we would suggest that there is greater flexibility in the options open to Local Authorities in ensuring that the LINk is supported appropriately. Local circumstances vary widely, and it should be open to local discretion to determine the best way to support this function. Rather than talking about model contracts it may be more helpful to set out a range of quality requirements that will be expected of any support provided to the LINk.

Hampshire County Council is currently in the process to introducing new arrangements to increase the engagement between local councillors and different communities across the county. We would be prepared to look at the way in which the LINk function could be aligned with this work to add further value to mechanisms for engaging and involving local communities across health and social care.

Specific comments:

Establishing the LINks

· We would support the proposition that LAs with social service responsibilities be appropriately funded to make arrangements for supporting the LINks. This money will however need to be proportionate to the support required to allow the LINk to function effectively and ring fenced to ensure there is clarity about how it is spent.

· If the LINks are to work across health and social care then the legislative framework to support this needs to be explicit. This is not currently the case and there is no clarity about how this will be addressed in the proposal.

· The document quite rightly points out that LINks will not be the only source through which commissioners, HOSCs and others access the views of the population affected by a particular proposal. It is unfortunate that this important distinction is not maintained throughout the document and some statements seem to infer that the LINk will supplant, rather than work with existing engagement mechanisms. It is particularly disappointing that the role of elected members, whether county, district or parish in representing the views of their population is not acknowledged. We have commented separately about the need for locality commissioning arrangements to address this omission and consider that the proposals for the LINks provide a good opportunity to address this point.

· Locally our HOSC is already taking feedback from partner organisations, including Patients Forums to inform our forward work programmes. This is supplemented by evidence to ensure that the work that we do is both targeted and able to improve service delivery. The LINk will therefore be one of a number of partners that inform the way in which we work.

· There is ambiguity about the extent to which LINks will gather their own intelligence or make sure health and social care do this in their own right. HOSCs currently undertake the latter function fairly effectively however if the LINk were able to provide more detailed patient/user/community views on an issue then this would be helpful. If the LINk is gathering its own information then it must have the resource to do this effectively. Similarly it must be made clear that the LINk is not in its own right the voice of community it serves. This has been a difficulty for some Patients Forums.

· There is no recognition of the skills it takes to secure meaningful feedback from different communities and process this to provide objective information or evidence for action. Patients Forums have been continually frustrated by not having the resource to undertake this type of work.

· Priorities around communities have already been set by LAAs & LSPs; LINks should not either duplicate this process, or cut across effective work that is already taking place in communities.

· HOSCs already provide a mechanism through which local services can be held to account. Unless the role of the LINk is complementary to this in terms of gathering additional information and experiences local arrangements that are currently working well will be undermined. The proposal as currently set out duplicates and confuses this distinction.

· No mention is made of the way in which the LINk will be held to account for its performance or the delivery of its statutory responsibilities. This is a significant omission that needs to be addressed. Your reference to the host organisation developing and managing a governance structure does not address this issue in the depth required.

· Recruitment to these new bodies will inevitably be based on the perceived influence that the LINk can exert in the planning and delivery of local services. The way in which some Patient Forum members have been treated over the past 18 moths has devalued and marginalised their role. CPPIH has generated a bureaucracy that militates against Forums active and timely engagement to shape services that are important to local people. It will take time to address these perceptions. One way may be for there to be early identification of Local Authorities that can demonstrate how LINks are able to contribute to building effective local engagement across health and social care communities.

Overview and Scrutiny Committees and Commissioning

· We have already referred to the need for clarity about the different roles of LINks and HOSCs. It is unfortunate that these were not better articulated in the document. Nevertheless we welcome the emphasis placed on the continued role of the HOSC. We believe that we can point to evidence of the way in which our role has influenced both the planning and delivery of local services. Equally the role has given elected members a clear function in terms of ensuring that health and other services are held to account to the population they serve.

· Whilst we would agree that there is an important role for HOSCs with regard to commissioning we would support the intention not to limit their role to this area of activity. We have already considered a number of issues associated with the quality of service delivery as well as commissioning issues, OOH being a case in point where there are outstanding concerns about delivery that need to be addressed alongside commissioning arrangements.

· If the LINk can refer matters to the HOSC then it would be sensible for a reciprocal arrangement to be in place to allow HOSCs to refer issues to the LINks for further investigation and local views.

Simplifying and strengthening the duties to involve and consult

· We do not consider that the prospectus is necessarily the right vehicle for responding to local people. This will vary according the issue and should be agreed locally with the HOSC(s) and LINk(s) affected.

· We would welcome the new PPI resource suggested

A stronger voice in regulation

· We would agree that national regulatory bodies should have feedback from both HOSCs and LINks to support their assessment of services in a particular area. We have already begun to explore how this can most effectively be progressed locally and will continue with this work in coming months. We will take account of the future role of the LINk in informing this work and are already considering how new arrangements we are setting in place can inform the way we proceed

I hope you find these comments helpful and look forward to hearing how the proposal will now be taken forward. If you wish to pursue our offer of modelling the way in which these new arrangements could work in practice please do contact me.

Appendix Six

Changes to eligibility criteria for community care

Key Questions

· What is the current and projected level of need for these services in Hampshire broken down by `substantial' and `critical'

· What impact assessment has been undertaken and is this available

· What level of savings will be generated by the change to only providing services for people whose needs are judged to be critical (between Jan 07 and March 07; April 07 and March 08)

· What needs assessment process will be applied and how has this been agreed with partner organisation

· Application of the criteria implies the exercise of judgement- what mechanisms will be in place to ensure that the policy is applied fairly and consistently across Hampshire

· What will the impact of these changes be on other service providers, including the NHS, voluntary sector and informal carers

· What will the impact of these changes be on services that are dependent on multidisciplinary team working, such as continuing care, admission avoidance, palliative/respite services, chronic care management

· Will this change impact adversely on the ability of people to be keep their independence and stay in their own homes

· What progress has been made with agreeing continuing care criteria with the NHS

· What impact will these changes have on peoples ability to remain in their own homes

· What appeal process is in place and how is this shared with clients and their families/carers

· What arrangements are in place to resolve differing professional views of a clients needs

· Will these changes mean that adult services will not become involved until a crisis point is reached? Does this transfer acceptable additional pressures to families and carers

· To what extent will carers' assessments continue to inform these decisions

· Has there been any assessment of the scope for the County to secure greater cost effectiveness in service provision by purchasing these services from the voluntary/private sector

· Has there been any assessment of the scope for securing greater cost effectiveness in providing these services through pooling budgets, joint appointments and integration with other service providers