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 the Corporate Strategy aim of maximising wellbeing 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: Responsive Services - Engaged Communities Conference- 1 March 2007. Draft Headlines from Feedback

· Patients and the public do not differentiate between the roles of different agencies providing health and social care. They can quickly become cynical and disengaged if they do not see that their contributions are able to make a difference to service delivery.

· Communities of interest vary according to the issue under consideration- thought needs to be given to the most effective way to engage the key stakeholders

· If key stakeholders, such as those present at the event are not clear about each others respective roles how can we improve the way in which we work in partnership

· Partnership working and engagement requires ongoing commitment and investment

· Local members are frequently the focal point for concerns in the communities they represent.

· Good local networks do exist in a number of areas - how can we use these to best effect

· We need to improve the way in which we communicate and share information/evidence. The interface between organisations is a frequent barrier in this respect.

Appendix Two

VISIT TO TAMERINE RESPITE CARE UNIT 5.4.07

A very warm welcome awaited us at Tamerine. The front door was round the back of the property, which is a detached bungalow set in quite a large garden. The approach was via a concrete path with flower tubs and hanging baskets and an attractive bed of shrubs and flowers. This gave a feeling, as you entered the property, of coming home.

· On arrival we were introduced, by Jan Ellis Brown Unit Manager, to members of staff on duty and also the only service user present. Also present was Diane St Angelo, Hants Partnership Service Manager.

· Tamerine is a 4 bedded unit with 2 bathrooms with hoists and equipment for wheelchair service users.

· 11 staff plus Jan Ellis Brown are employed. 2 or 3 staff on duty for both am and pm shifts. 1 staff member on at night depending on service users staying. This would be either "up and awake" or "sleepover", again dependant on service users staying. There is an on call service, day or night, for both management and clinical. Staff stated response time is good.

· Average stay for service users is either Friday- Monday or Monday-Friday.

· Weekends are always full. Friends and compatible groups are catered for whenever possible.

· All catering is done on site by the staff who all have food hygene certificates. Service users are encouraged to assist with the purchase of food and the preparation. Staff sit down to eat the main meal with the service users.

· The food budget is approximately £28 per person per week.

· Special diets are catered for and a large bowl of fresh fruit was in the centre of the table.

· All special dates are celebrated.

· The access to the Utility Room is through the kitchen. This causes some concern re dirty washing being taken across the corner of the kitchen. The staff do all the washing.

· Sensory equipment, games and puzzles were also in evidence.

· Plants for a sensory area in the garden have been purchased but as yet not planted.

· One bedroom has been identified as not being large enough, this would reduce the capacity of the unit, making it not financially viable. However there is ample space to extend.

· Main drainage has been highlighted as a problem to extending the building but with up to date equipment such as "Saniflow systems" perhaps this would no longer be the envisaged problem.

· There is no plan or commitment to redevelop so that it could be registered by CSCI. All other homes in Hampshire are run by Social Services and since Hampshire Partnership stated that they were providing social and not health care perhaps this accounts for the impasse we seem to have reached. The property, at present, is owned by Hampshire Partnership Trust. Prior to this transfer it was run by the E Hants PCT Cluster, hosted by learning disabilities and commissioned by Health. Referrals used to be via Community Nurses, the last referral was over 9 years ago!!

· The windows have been identified as needing replacement and there is money in the budget to undertake this work fairly soon.

· Training of staff is ongoing and is now organised by the Unit Manager.

· Medication is booked in on arrival, kept in a locked cupboard in the office.

· All service users have a Care Plan. We considered these to be well maintained and the information included was excellent. They also have a Risk Assessment Summary in their Car Plan Profile.

· Tamerine is unregulated by any external body but there are monthly Audits now undertaken for all unregistered homes. Tamerine had an unannounced visit earlier this week.

· Tamerine is not DDA compliant at present, but nothing major requires doing to make it compliant. It has never had an inspection for this. No emergency buzzers in bedrooms.

· We did notice an electrical box high on one of the bedroom walls. This powers the hoist in the next door bathroom, but should be boxed in.

· All radiators had covers over them.

· Kitchen cupboards have lock on some of the doors but these are not always locked so that service users can help themselves if they wish.

· Door handles and light switches were all at wheelchair level.

· The staff were reassured that the meetings called by Mr Gough cannot be used by the PCT as public consultations.

My final comment on this visit is that this home had a lovely atmosphere with very kind and caring staff.

Report prepared by Veronica Holland

S E Hants Network

(Hampshire Primary Care PPI Forum)

VISIT TO RUSSETS CARE HOME 28.3.07

On arrival at Russets the outside of the building looked like a delivery area with cars and vans parked everywhere, making the entrance difficult to locate.
A poorly maintained hedge and trees were planted across the front boundary. No pots with flowers or flowerbeds welcomed anybody to the building, it looked very dreary.

On entering the building the reception desk was slightly to the left of the front door and the window of the desk was actually round the corner. Not very welcoming.

On arrival Maureen Silk, Nigel Allsop (Portsmouth City Health Forum) Ruth Smith And Veronica Holland (S E Hants Network (Hampshire Primary Care PPI Forum)) were met by Philip Jones, Acting Service manager and Andrew Cooper, Manager of Russets. We sat in the Dining Room, a fairly large airy room to ask questions of each other.

· Russets is a 15 bedded unit, very hotel like in appearance. Some effort is being made to make it more homely with photos of service users and staff doing activities and on outings.

· Russets can accommodate Tamerine service users now although on certain weekends it can be very tight. Future availability could not be guaranteed.

· The building was provided under PFI. This includes cleaning, transport and catering contracts. There is no specific budget held by the Unit for food, the PFI specification is to provide meals to a specific standard and portion size.

· Meal times: Breakfast 7.30 - 9.30. Lunch 12.00 - 1.30. Evening Meal 5.30-7.00.

· Special dietary requirements need to be given to the Unit in advance of the service user coming to stay.

· A six week rolling menu is provided which has recently been adapted so as not to provide service users in day care with the same meal for lunch and evening meal as these are provided by the same PFI contract.

· It was pointed out, by Nigel Allsop, that the menus were not nutritionally balanced. This however might be difficult bearing in mind the service users and their likes and dislikes.

· A kitchen is available to service users for drinks and fruit at all times.

· Work is in progress on a visual representation board of food available to assist service users, who perhaps cannot understand or remember a menu, with their choice of food.

· Each service user will eventually have an in depth and constantly updated Care-Plan. These appeared to be really good although for new or agency staff a significant amount of detail needs to be read and absorbed for each service user.

· 70 Care-Plans in total have to be completed. At present 35 have been done.

· The Unit has a 4 week maximum stay but the average stay is 2 or 3 nights.

· We only saw 2 service users as we went on a conducted tour through the lounge area, we were not introduced to them although they showed some interest in us. As we left at 4:00pm more service users were arriving from Day Centre activities, again we were not introduced to them. I felt that this was very poor since we were in essence a visitor in their home.

· 28 staff are employed at the Unit. Shift patterns are done on a rota system but this must be difficult to achieve because of service user requirement and number of service users at any one time. They aim for 5 staff on duty per shift with 2 waking staff plus 1 sleepover per night. Agency staff available if required.

· Age range of service users 18-65.

· There is an "in-house" activity organiser for art and crafts, disco's etc.

· An external activity organiser for outings etc.

· Internet access is also available for service users.

· A magnificent sensory room has been recently provided.

· A dedicated arts and crafts room is also available, in which are also stored some musical instruments, which the Unit Manager is hoping to get up and running very shortly.

· A fund raising day has been organised on 15 April.

· The Unit Manager is also organising a quiet sensory garden - most is completed. There are just a few more shrubs to be planted. Wooden furniture is provided on the patio areas and also around the lawn areas for service users and staff.

· Plans are in place to use an unproductive area of garden to put in raised beds for potting on plants for use by wheelchair users.

· An updated fire drill is not in place.

· There is a B grade RSO on duty at all times.

· There is an A grade RSO also on duty at night.

· There is no requirement for medication to be given during the night.

· We found the building to be extremely warm. The heating is provided by under floor cables, which makes regulating heating very difficult - it takes a long time to warm up and cool down.

· Following a meeting with Tamerine service user carers a summary sheet is now being sent home with service users after their stay. This just says something along the lines that they slept well and had a good time.

Report prepared by Veronica Holland

S E Hants Network

(Hampshire Primary Care PPI Forum)

South East Hampshire Network

Hampshire Primary Care

Patient and Public Involvement Forum

Russetts and Tamarine Respite Centres

Outcomes of visits by members of the Hampshire Primary Care

Patient and Public Involvement Forum (South East Hampshire Network)

Some further considerations

Tamarine has helped Russetts during the last year when there was high demand for respite.

Russets can accommodate Tamerine service users now although on certain weekends it can be very tight. Future availability could not be guaranteed.

Care at Tamarine was judged to be excellent. The great asset is a long term, dedicated staff who know the service users very well, can give time to individual needs and are sensitive to service users' likes and dislikes.

Some considerations regarding Tamarine

· It has been suggested that one bedroom is not large enough. Not to use this room, would reduce the capacity of the unit, and make it financially unviable. However there is ample space to extend.

· Main drainage has been highlighted as a problem to extending the building but with up to date equipment such as "Saniflow systems" perhaps this would no longer be the envisaged problem.

· There is no plan or commitment to redevelop so that it could be registered by CSCI. All other homes in Hampshire are run by Social Services and since Hampshire Partnership stated that they were providing social and not health care perhaps this accounts for the impasse we seem to have reached. The property, at present, is owned by Hampshire Partnership Trust. Prior to this transfer it was run by the E Hants PCT Cluster, hosted by learning disabilities and commissioned by Health. Referrals used to be via Community Nurses, the last referral was over 9 years ago!!

· The windows have been identified as needing replacement and there is money in the budget to undertake this work fairly soon.

Appendix Three: Surrey and Borders Partnership NHS Trust: Response to consultation on NHS Foundation Trust application- 12 April 2007

I am writing on behalf of Hampshire County Council's Health Overview and Scrutiny Committee in response to your invitation to comment on the above application. Members considered your proposals at their meeting yesterday and asked me to provided the following comments

· It was somewhat confusing that we received two different versions of the application- one running to 6 pages and the other 18 pages. The second document was the most helpful from our perspective

· It was helpful to note that some-one from Hampshire County Council would be represented on the Board of Governors

· We had a number of concerns about the plans for services that you outlined, particularly given that there was little information about how you intend to work in partnership with other service providers. In particular members would ask for further information and clarification on the following

¬ What are the implications to service delivery of fewer hospital sites and less registered social care. How is this being progressed with colleagues in social care and service users?

¬ What is meant be fewer `work and day services' as these are provided by other agencies

· How will systems working and professional networks be managed to ensure equity in access and the development of best practice

· How do you intend to strengthen partnership working if the application is successful?

· Can services be withdrawn if they become financially unviable or fall outside the national tariff rate?

We are writing separately to the Chief Executive outlining our concerns about some recent service changes being taken forward without the opportunity for engagement with either the Hampshire Patient and Public Involvement Forum or this Committee. We would therefore wish to clearly state our expectation that any changes to services that result from the Trust's application being approved will be fully compliant with sections 7 and 11 of the Health and Social Care Act 2001.

Appendix Four

Dear Fiona

Liaison with Health Overview and Scrutiny

I am writing to you further to our meeting earlier this week at which we discussed the changes to Briarwood Rehabilitation Unit services. Members were extremely concerned that, despite the positive communications we had with the Trust late last year, you launched a month long consultation exercise about changes to services without contacting us, Surrey HOSC or the Hampshire Patient and Public Involvement Forum. We are not clear if you contacted Hampshire PCT, which commissions services from the Trust, about your plans.

This is not an approach that fosters partnership working. Sections 7 and 11 of the Health and Social Care Act set out clearly the duty of the NHS with regard to involvement and consultation. We will work with Trusts to respond flexibly to issues; however this requires regular dialogue and communications. This did not happen in this case.

We have had feedback from the Forum that they are not taking further action following the changes and that work is in hand to secure the views of people using these services. I would be grateful therefore if you would arrange to provide the Committee with information about the views of service users affected by the changes in time for our meeting in September. This means we will need the report by 14 September 2007.

Yours sincerely

Cllr Dr Raymond J Ellis C.Chem FRSC

Chairman, Health Overview and Scrutiny Committee