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

2.1. No further information has been received about the next steps in this consultation.

Recommendations

2.2. Members are kept up-dated on the progress of the Joint Committee, taking account of the SHA review

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

3.1. The response of the Trust to the issues raised with the Committee by professional staff is attached at Appendix One.

3.2. Cllr Adrian Evans has been invited to sit on the steering group that will oversee the opening of the new facility at Ashurst.

Recommendation

3.3. Members are apprised of any change in the anticipated opening date of the new Birth Centre at Ashurst.

4. South East England SHA: Acute Service Reconfiguration

4.1. Further to the correspondence received from the SHA covering Surrey and Sussex, West Sussex PCT has written to the Committee indicating that proposals for change are being developed. No detailed information was included and specific information has been requested with regard to the services that are currently used by Hampshire residents and section 11 engagement with local people and key stakeholders as well as details of any discussions that have taken place with Adult Services.

4.2. Confirmation has been received that Hampshire PCT and South Central Ambulance has not been approached about the proposals. It is not yet clear if PHT has been included in the development of the options by West Sussex. The Chairman has written to the PCT setting out the expectations of the Committee (Appendix Two).

Recommendation

4.3. Members agree a working group to consider any proposals to vary services that will have an impact on Hampshire residents.

5. Department of Health: Development of LINks

5.1. A briefing paper on the anticipated role of LINks is attached at Annexe Three.

5.2. The evidence sent to the Health Select Committee to inform its review of patient and public involvement in the NHS is attached at Appendix Four. This was based on the response provided by the Committee to `A stronger Local Voice' last Autumn

Recommendations

5.3. That the Committee continues to work with lead officers and members within the County Council to inform the establishment of the LINks for Hampshire County Council

5.4. That the Committee notes the evidence provided to the Health Select Committee at Appendix Four

6. Department of Health: Consultation on Non Emergency Patient Transport

6.1. Further to the discussion at the last meeting of the Committee a draft response to the Department Health consultation document has been prepared.

6.2. Members of the Committee were been invited to share views on the proposals as has the Environment and Transport Policy Review Committee. These have been incorporated into the draft at Appendix Five.

Recommendations

6.3. The draft response agreed to incorporate any additional comments or amendments from members.

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

SUHT response to issues raised with the Committee by professional staff

Dear Councillor Ellis

Thank you for the email responses that have been forwarded to us by Denise Holden. We recognise that there has been huge affection for existing local facilities, as that has been a strong message throughout the Maternity Services Consultation. During our section 7 engagement and involvement process we were clear in our message through discussion with the public and staff, and with the storyboards, that maintaining the status quo was not a realistic option. There were those who could see beyond support for their local birth centre and did provide a useful contribution to the process. We note that the email responses are from staff and from the public.

Since 21^st August we have been engaged in a staff consultation with the support of our Human Resources department and involvement from the Trade Unions of the RCM and Unison. We have held regular staff meetings in all areas in which staff have had the opportunity to voice their opinions and concerns directly to the management team or by contacting the consultation office via the your views count email, the dedicated phone line or by letter. They had chosen to do so collectively and individually. There has also been the opportunity for staff to have 1:1 discussions with a senior midwifery manager or a human resources manager. Until the SUHT Trust Board made the decision on The 21st November 2006, there had been a lot of uncertainty and it was difficult for some staff to consider future plans. Some of the comments that are contained in the anonymous emails reflect that frustration. However we have listened to staff and have considered their views. We recognise that the model for the single standalone birth centre would benefit from two Maternity Care Assistants at Band 3 rather than the housekeeper role as proposed and we will continue to develop that model incorporating staff views. Through our recent 1:1 discussions with the Maternity Care Assistants it is anticipated that there will be no redundancies due to redeployment opportunities meeting staff needs.

We want to reassure the Committee that we have responded in a timely way to all correspondence that has been received to the consultation office, including those that have requested more detail. There was a small delay in answering queries from two members of the Choose it or Loose it Campaign who asked for response to 130 questions some of which required discussion and input from other healthcare professionals. However once these had been answered they were published on the SUHT public website as requested. We in no way wished to ignore the valuable comments made by the public in the Romsey groups during our focus group work and the comments that were published in the consultation document were a `flavour' of the responses made during this time.

There are not `large' numbers of babies who cannot wait to be born as mentioned in email 11. Last year the number of babies who were born without the attendance of a healthcare professional in the New Forest and Romsey were 5. The year before that it was two. There appears to be no correlation with areas such as Hedge End and Botley to the east of Southampton, who do not have a standalone birth centre, with a potential rise in the number of babies born without attendance. In fact it is more random than that with areas showing peaks and troughs on a year on year basis. We do not anticipate that this will change and we certainly refute the idea that we are putting the lives of mothers and babies at risk. We also have a commitment from South Central Ambulance NHS Trust that they will continue to provide the same level of service to women in the local areas. We wish to reassure the Committee that through our robust reporting system we will continue to monitor adverse outcomes and will report any concerns back to the Birth Centre Steering Group who will be monitoring the proposed interim and permanent arrangements.

We have carefully considered the interim arrangements, as the Ashurst site will not be available until May 2007. Through our presentations to the Committee we have been clear that the birth rate is continuing to rise in Southampton and there is no sign that this will change. This is putting the service under increased pressure and we need to provide a safe service for women. The majority of women from the New Forest and Romsey give birth in the Princess Anne Hospital so we need to free up the resources from our underused birth centres in order to deliver safe care. Closing Romsey and Lymington will maximise these resources. Antenatal, homebirth and postnatal care at home will still be delivered in the local areas. Women will continue to have a choice of a standalone birth centre facility for birth and postnatal support.

We have acknowledged the concerns about transport and we have assurances from South Central Ambulance NHS Trust that women will be able to access emergency transport in labour. We want to reassure the Committee that we will continue to engage in discussions on transport for health and social needs with Local and County Council transport forums and our commissioning partners, Hampshire PCT. These members will be represented on our Birth Centre steering group and travel will be discussed as a regular agenda item.

In terms of the consultation process it has been acknowledged unanimously by your Committee that there are no concerns. We welcome the opportunity to involve Adrian Evans a member of your committee as an observer to the Birth Centre steering group. We hope we have addressed your concerns from the emails that you have received and look forward to continuing our relationship in the development of our new standalone birth centre at Ashurst.

With best wishes

Yours sincerely

Karen Baker Sarah Marsh

Divisional Director of Operations Project lead

Women and Childrens Division Maternity Services Review

Appendix Two

Letter to West Sussex PCT; 17 January 2007

Dear Brian

Creating an NHS Fit for the Future

I am writing further to your recent letter and subsequent conversation with our health scrutiny officer Denise Holden on the 4 January.

In the absence of any additional information on the way in which the changes you are currently considering will impact on Hampshire residents I thought that it may be helpful to write to confirm our expectations with regard to both the development of the proposals for consultation and information we need as a Health Overview and Scrutiny Committee in coming to a view ion the nature of these changes (i.e. whether they are substantial from Hampshire's perspective).

1. Developing Options for Change: as part of the section 11 engagement activities we would expect to see clear evidence of the way in which patients, the public and key stakeholders have been able to feed into and shape any proposals put forward for consultation. It is of concern therefore that neither Hampshire PCT, nor South Central Ambulance Trust was aware of the work you are taking forward when we raised this with them recently. Other key stakeholders from Hampshire that could be impacted on by the changes would include Portsmouth Hospitals NHS Trust and Hampshire Adult Services.

2. Information for Health Overview and Scrutiny: Key information for us will be the patient's flows and services that will be affected by the changes, not only in terms of Hampshire residents using services in West Sussex, but also West Sussex residents that could use services in Hampshire. We would also find information about the proposed timing and content of any consultation helpful as well as the case of need and evidence base underpinning the proposals, the improvements to be achieved for service users and the impact of the options considered on community and other services. This will enable us to determine how we need to link into any joint scrutiny arrangements that need to be set up.

My main concern at this juncture is the speed with which these proposals may come forward for consultation. Candy Morris' letter of the 1 November helpfully highlighted the need for PCTs to work with HOSCs to support the establishment of any joint arrangements where these were required in order to avoid prolonging any period of uncertainty. The information outlined above will be crucial to informing this process, which in turn will need time to be properly set up.

I therefore look forward to hearing from you.

Appendix Three

Local Involvement Networks (LINKs)

What are they?

LINKs are networks which will be established to facilitate greater community engagement in Health and Social Care services. The LINKs will replace existing Patient Public Involvement (PPI) forums following the recent Local Government and Public Involvement in Health Bill. Legislation to dissolve the PPI forums and allow for LINKs to be established will be passed in 2007 with the likely timescale for LINKs to be active from early 2008.

The fact that LINKs are a network rather than a forum is mentioned a lot by the DoH as an important change in these bodies. LINKs are very much seen to be a mechanism to engage more widely with an entire geographic community unlike PPI forums which had a limited engagement dimension. The exact way in which the LINKs are to be constituted has been left open for local determination as long as the LINKs meet the criteria set out in part 11 of the bill. They will be assessed on this in their annual report and through inspection by the Audit Commission.

What will they do?

As set out in Part 11 153 (1) of the Bill, each local authority must arrange for means to carry out the following activities -

153 (2)

(a) Promoting and supporting, the involvement of people in the commissioning, provision and scrutiny of local care services*;

(b) Obtaining the views of people about their needs for, and their experiences of, local cares services; and

(c) Making -

(i)Views such as are mentioned in paragraph (b) known, and

(ii)Reports and recommendations about how local care services might be improved

To persons responsible for commissioning, providing, managing or scrutinising local care services.

(* In this section of the Bill, care services means services provided as part of the health service in England or services provided as part of the social services functions of a local authority. Local care services in relation to a local authority means -

(a) care services provided in the authority's area; and

(b) care services provided in any place for people from the area)

Section 154 of the Bill sets out the criteria for how the local authority ("A") will arrange to undertake the activities specified under section 153 (2).

154 (2) In this section, a reference to a `local involvement network' is to -

(a) a person who, in pursuance of the arrangements, is to carry on in A's area activities specified in section 153 (2) for that area: or

(b) any other means put in place under the arrangements for the carrying on in A's area of activities so specified for that area.

As set out in the bill, the following bodies cannot be a LINK in any given area:

The host organisation

Any local authority in that area

A National Health Service trust

An NHS foundation trust

A Primary Care Trust

A Strategic Health Authority

`What will LINKS do?

Their function will be:

· Promoting and supporting the involvement of local groups and individuals from across the community to influence the commissioning, provision and scrutiny of health and social care services;

· Obtaining the views of local groups and individuals about their health and social care needs;

· Gathering the views of local groups and individuals about their experiences of health and social care services;

· Conveying these views to organisations responsible for commissioning, providing, managing and scrutinising health and social care services;

· Enabling local groups and individuals to share their skills and experience in order to influence the development and improvement of local health services;

· Supporting people within the community to make their voices heard, including people who find it hard to participate in traditional ways or do not choose to;

· Supporting the commissioners and providers of health and social care services to engage with the local community, and in particular those groups and individuals who find the services they need difficult to access;

· Act as a hub within a network of user-led and community based groups in the area covered by the host local authority, providing a channel of views and information between these groups and the local health and social care organisations;

· LINKs will set their own agenda and focus on issues of concern to local people and seek to influence change; and,

· LINKs will be required to report on their activities and expenditure to the public, to health and social care bodies, the relevant local authority, the Secretary of State for Health, and other interested organisations

Taken from the Government response to `A stronger local voice' Dec 2006, p. 37

Powers of inspection - LINKs will have power to inspect NHS sites but it is expected that only a small group of members from each LINK will have that power of inspection.

Reporting mechanisms - LINKs need to produce an annual report each year setting out how they have achieved the activities set out in the Bill.

How will they be set up?

The host organisation - Local Authorities have a duty to commission a host organisation to start up the LINK in their area. The budget will be held by the host organisation for the LINK and the annual report that the LINK produces will need to set out how the LINK has achieved the criteria specified in the bill.

Membership organisation - The LINK will be a membership organisation formed from anyone who is interested in joining over the age of 18.

Local flexibility in how LINKs are to be developed - The exact criteria about how LINKs will be constituted has been left fairly loosely defined by the Secretary for State and according to the Democratic Health Network, this has been done deliberately to enable local LINKs to form in ways appropriate to their area.

Timescale for establishing LINKs - Current DoH timescales seem to suggest that Local Authorities should be setting up their broker agency to establish the LINK in late 2007 with LINKs starting to get underway in early 2008.

What might LINKs look like? - There has been some suggestion that LINKs could be a virtual network or they may contain a physical base e.g. in a shop. LINKs will cover the local authority area of the Authority responsible for Social Care provision so Counties and Unitaries will have LINKs.

The `early adopter' areas - There will be early pilot LINKs launched soon and these will be presented as good practice for other areas to follow. The pilots will be in the following areas:

South Dorset

Medway

London Borough of Kensington and Chelsea

Hertfordshire

Manchester

Doncaster

County Durham

Appendix Four

Hampshire County Council

Health Overview and Scrutiny Committee: 8 January 2007

Response to Health Committee Inquiry: Patient and Public Involvement in the NHS

What is the purpose of Patient and Public Involvement

1. We consider that the purpose of effective Patient and Public Involvement is to provide a route through which those making decisions about services are required to test and shape proposals in a way that takes account of the views of those actually using and funding services. There are a wide variety of institutional, professional and bureaucratic interests that are able to influence this decision making- this can lead to a situation where decisions about service delivery can be taken without account of its impact on those using services. Patient and Public Involvement, if effectively delivered can balance this influence and enhance accountability to patients and the public.

What form of P&PI is desirable, practical and offers Value for Money

2. Patient and Public Involvement must be understood and influential in the context of the system in which it operates. Public services such as health and social care are immensely complex and this is likely to increase given the programme of policy reforms that are now starting to emerge. It is essential that there is flexibility to tailor Patient and Public Involvement activity around local circumstances and the issue to be addressed. A prescriptive, `one size fits all' approach is will not work. Equally effective Patient and Public Involvement needs to work alongside, and not duplicate existing systems. It therefore needs to be distinctive in the work that it does. We have not yet been able to ascertain how LINks will meet these requirements.

3. Current proposals for LINks do not recognise the infrastructure already in place to allow for engagement with communities and support the accountability of public services, including representation by democratically elected members, LSPs and LAAs. The LINks need to complement the infrastructure in place to support these arrangements and not duplicate functions that are already embedded in, and working on behalf of, local communities. In this sense it is difficult to see how LINks will be different from other existing forms of engagement, particularly taking account of the changes set out in `Strong and Prosperous Communities', which will strengthen the existing overview and scrutiny function of Local Government and provide a route for challenging issues of concern to communities through the `community call for action'.

Why are existing Patient and systems being reformed after only 3 years

4. Despite the initial efforts to bring the new system to life there has been little or no practical support with the delivery of the Patient and Public Involvement remit at front line level. Problems with FSOs have seen some go into liquidation and others simply not cope with the level of input required. Other FSOs have worked well. Funding for the FSO contracts limited what could be offered and failed to take account of the skills it takes to secure meaningful feedback from different communities and process this to provide objective information or evidence for action. Patient and Public Involvement Forums have been continually frustrated by not having the resource to undertake this type of work.

How LINks should be designed to relate to and avoid overlap with existing local structures including:

Remit & level of Independence

5. Developing the point above we would ask that there is absolute clarity about the distinctive role that the LINk could bring to building effective community engagement and involvement across health and social care. They also need to be able to work across patient pathways that do not map easily with their geographic area. Hampshire for example is a large and diverse county. Some services, such as ambulances, now run across both Hampshire and Thames Valley whilst others are focused on practice based commissioning areas or district boundaries. LINks have to be able to respond to these very different models of care provision.

6. If different groups with competing interests are part of a LINk, how can they give an independent view of an issue. How can the LINk be held to account if it fails to fairly reflect the perspective of the community that it is supposed to serve because of conflicts of interest in its membership.

Membership and Appointments

7. 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.

8. Equally there needs to be clarity about how LINks draw their views together and what perspective will shape these views. The old CHCs were required to take account of the `public interest' in coming to a view, HOSCs have to consider the impact of any proposals on the population affected, locally elected members can represent the views of their individual constituencies (and are directly answerable through the democratic process), the NHS has to take account of the views of current and future service users. Voluntary sector, independent and professional organisations are able to reflect other interests and views. LINks must be able to add value by drawing together views that otherwise it would not be possible to access.

Funding and Support

9. 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 clarity about what it is that LINks are expected to deliver and flexibility in the options open to Local Authorities in ensuring that this is supported appropriately. Local circumstances vary widely, and it should be open to local discretion to determine the best way to support the delivery of this function. Rather than talking about model contracts that replicate previous arrangements it may be more helpful to set out a range of quality requirements that will be expected of any support provided to deliver the role of the LINk.

Areas of Focus

10. HOSCs already provide a mechanism through which local services can be held to account and are increasingly influential in the areas in which they operate. They are separate from the executive/service provision arm of local government and the NHS. Our view is that this function has considerably strengthened both decision making processes and the way in which democratically elected representatives can influence the way in which services are delivered to our populations. LINks need to complement and not duplicate this function and we have expressed considerable disquiet at proposals that seem to confuse our respective roles.

11. If their role is to be one of gathering additional information and experiences it needs to be equally clear what added value this brings given the fact they will not be the only route through which the service commissioners, HOSCs and others access the views of people affected by a particularly proposals. It would not be helpful if the introduction of the LINks undermined local arrangements around community engagement that are currently working well.

12. As currently proposed we believe that LINk will confuse, rather than compliment existing engagement mechanisms and those proposed through `Strong and Prosperous Communities'.

Appendix Five

Hampshire County Council

Health Overview and Scrutiny Committee 30 January 2007

Draft Response to National Consultation: Eligibility Criteria for Patient Transport Services

Background

Further to the discussion at the last meeting of the HOSC on 28 November a draft response to the Department Health Consultation document has been prepared. Members of the Committee have been invited to share views on the proposals as has the Environment and Transport Policy Review Committee. These have been incorporated into the draft response set out below.

General Comments

It would be helpful if each paragraph were numbered.

If the criteria are intended to be a statement of principles that should support local action by PCTs commissioning PTS services then they need to be stated more clearly, particularly with regard to what is a requirement and what is discretionary.

As currently set out the criteria do not meet the stated intention of the document indeed parts refer to the text as guidance (see section 4). This ambiguity is not helpful. The reference to the national standards (see section 11) further confuses the status of the draft criteria. If the intention is to provide consistency in service provision across the NHS without compromising the need to accommodate different local circumstances then these points need to be addressed.

The reference to the `home' PCT being responsible for the costs associated with PTS is helpful as this is an area that has caused difficulty in the past.

There is no indication of the modelling that has taken place to identify the costs of implementing these proposals- reference to finance manuals are not sufficient for this purpose.

Changes to the eligibility criteria that widen access to people seeing any health care professional, not just a consultant, will be welcomed by the public but could have a significant impact on demand for these services. Many PCTs have severe financial problems and it is essential that there is clarity about the cost consequences of providing services. The statements about the way in which Payment by Results tariffs include the costs of PTS are also unhelpful- if this is the case then providers can make their own arrangements.

The duty of care referred to under section 6 needs to reflect the fact that providers have a responsibility to ensure the PTS is of a safe and adequate standard. Consideration must also be given to how circumstances where this standard cannot be met will be managed. There are specific issues regarding the way in which some of our most vulnerable patients, such as those with dementia are handed over to appropriate staff when they reach their destination that require further consideration.

We would question if it is reasonable for patients exercising choice to receive the full costs of their transport reimbursed. The definition of need should be adjusted to take this into account.

Agreement about medical need has caused problems with access to these services in the past. It is interesting therefore that the definitions applied in the document include staff that may not be clinically qualified and may not be working for the NHS. If local PCTs are expected to fund these services they should be able to determine who has the authority to commit to this expenditure. Comments in section 3 and 4 are contradictory on this point.

The arrangements for private patients are cumbersome and probably unworkable. NHS Trusts should pay directly for any use of these services for private patients.

It is disappointing that the document does not give greater weight to the need for stronger partnership working with local authorities to provide appropriate transport. This would strengthen to the statements made by `Our health, our care our say' and given added impetus for local action. It is nonsense for example that the need for PTS can be exacerbated by hospitals not allowing buses to stop close to entrances.