Contact: Denise Holden ex 7338

e-mail: [email protected]

Summary and Purpose

1. The report attached at Appendix One sets out the progress made with the work programme of the Committee agreed by members in 2006/07 and the draft programme for 2005/06.

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

· Issues raised by Members over the last year and discussed in Committee

· Topics identified by key partners (Patient and Public Involvement Forums, NHS organisations and District Councils)

· National policy developments that will have an impact on the health of local people

· Local issues that will have an impact on the provision of health services to people living in Hampshire

3. The approach outlined builds on and consolidates previous work undertaken by the Committee, taking account of the feedback received from organisations that work alongside the Committee. This provides a flexible framework through which the Committee can give informed comment and feedback on a range of issues affecting the health of local people and allows the Committee to respond in a timely manner to proposals from the NHS to substantially vary health care provision. This enables the Committee to take action when opportunities to improve local service delivery are identified.

4. The work programme for the coming year has therefore been based on three core work strands, underpinned by a commitment to building effective working relationships and communications with our partner organisations:

· Reviews of health services- thematic cross cutting reviews of health services in the area of the Committee. The review programme focuses on specific topics of interest or concern to the Committee and identifies opportunities for improvement.

· Health Inquires- provides a route through which our partner organisations can raise issues with the Committee. This allows action to be initiated speedily, without resort to a formal review and enables good practice to be drawn to the attention of members.

· Substantial variations or developments- as a statutory consultee of the NHS the Committee will respond to proposals that will have a significant impact on service delivery to people living in Hampshire. If the proposal affects services outside the area of the Committee this may include statutory joint arrangements with other health overview and scrutiny Committees.

5. To make the best use of the resources available to the Committee, issues raised with the Committee have been evaluated to ensure that they do not duplicate other scrutiny or review activities and have the potential to influence or improve the topic under consideration. The four criteria used in this process are included in the report.

6. The report provides the context within which the Committee is able to influence and improve the delivery of health services to people living in Hampshire. As such it supports the delivery of the aim of maximising wellbeing as set out in the Corporate Strategy.

Recommendation

7. The Committee approves the annual report for 2006/07 and the draft work programme for 2007/08.

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:

Published works

Documents that disclose exempt or confidential information as defined in the Act.

File Location

None

Appendix One

Hampshire County Council

Health Overview and Scrutiny Committee

Report on Progress Spring 2006 to Spring 2007

Introduction from the Chairman

This report provides an update on the work of the Health Overview and Scrutiny Committee (HOSC) in 2006/07. Once again I must express my thanks to the Committee members and officers for their hard work during the year. Health and health services remain of intense interest to local people and this is reflected in the range of issues raised with the Committee.

The year has seen extensive reorganisation in the local NHS. In July 2006 the Hampshire and Isle of Wight Strategic Health Authority (SHA) and Hampshire Ambulance became part of their respective NHS South Central organisations. Also, in October 2006 the seven Primary Care Trusts (PCTs) in the County merged to become a single Hampshire PCT.

Due to these reorganisations I no longer have observer status on the SHA Board, which now covers an area from the Isle of Wight to Milton Keynes. There are however regular meetings with the SHA Chief Executive and HOSCs from across this area. I do now sit as an observer member of the Hampshire PCT Board, an opportunity that was not open to the HOSC when there were 7 PCTs in Hampshire.

The alignment of Hampshire County Council and Hampshire PCT boundaries and the joint appointment of Director of Public Health, are welcome developments that provide improved opportunities for coordination and cooperation between the NHS and Local Government.

The Care at End of Life Review report which was brought to the Committee in January, has attracted a significant amount of positive comment. It makes a number of wide-ranging recommendations which have the potential to significantly influence the experience of those who require such care. The follow-up of local progress with the recommendations made in the Care at the End of Life Review will be a key theme in our 2007/08 work programme. Other areas that will be of interest to the HOSC in 2007/08 include:

· NHS dental services

· Mental health services

· Out of Hours Care

· Public health and Well Being

· Commissioning care for local people

The Committee has continued to place emphasis on building effective working relationships locally and nationally. In March 2007 we co-hosted an event with the Healthcare Commission. Entitled `Responsive Services - Engaged Communities' this explored opportunities to strengthen partnership working across Hampshire. Participants included local authority members as well as patient, public and voluntary representatives and the NHS. We have also initiated discussions with the Local Government Association about opportunities for closer working across health and social care at a national level to complement work we are taking forward locally. We will continue with our efforts in this are in 2007/08.

As with previous years we are keen to share the work we have done as widely as possible. This report therefore sets out:

· Our approach to health overview and scrutiny in Hampshire (Section 1)

· The achievements of the Committee over the last year, (Section 2)

· The outline work programme for 2007/08 (Section 3)

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

Cllr Dr Raymond Ellis, C.Chem FRCS

Chairman, Health Overview and Scrutiny Committee

Section 1: Our approach to Health Overview and Scrutiny

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

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

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

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

Health and health services in Hampshire are complex, with different priorities in different communities. The network of working relationships that has now been established demonstrates the commitment of the Committee to ensuring that, to the fullest extent possible, it is the local community that has the greatest influence on the development of health services in a particular area. This local influence has been a recurrent theme as the work programme has rolled forward and remains a central feature of the work of the Committee. The introduction of `Hampshire Action Teams' (HATS) provides an additional route through which elected Members can raise issues of local concern with the Committee.

In order to make the best use of limited resources the Committee is committed to ensuring that work programmes are as effectively targeted as possible and that the scrutiny process is both influential and credible. The approach to health scrutiny adopted by the Committee therefore places emphasis on ways of working that are:

· Challenging but not confrontational

· Evidence based

· Able to improve service delivery

The role of the Committee as a `critical friend' has been established, and relationships with partner organisations, particularly the local NHS have continued to mature. The financial pressures facing local health and social services, and the potential impact these may have on local people makes it vital that the Committee maintains a constructive dialogue with these organisations and other partners.

The forward work programme of the Committee set out in Section 3 of this report takes account of feedback received from elected Members, P&PIFs, District Councils and NHS organisations in Hampshire. It reflects work that the Committee must do, specifically:

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

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

Issues that may benefit from a more in-depth review are also identified . The following four criteria have been developed to guide Members when selecting topics for review:

· Capacity to influence and improve the service under consideration

· Timeliness and relevance to local health services

· Issues not under consideration elsewhere

Issues not subject to other scrutiny or performance monitoring activities

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

The Annual Work Programme of the Committee draws together four main work strands and is designed to allow the Committee to take action in response to both planned and unplanned issues that are brought to its attention :

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

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

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

· Health Inquiries: This work strand was designed to provide the Committee and partner organisations with a route through which issues could be raised and acted on outside the formal consultation or review process. This allows the Committee to maximise opportunities to influence and improve health services without recourse to a full review or formal consultation. It also provides a means by which developments in health can be drawn to the attention of the Committee.

Section 2: The Achievements of the Health Overview and Scrutiny Committee in 2006/07

This section of our report summarises the work undertaken by the Committee during 2006/07 to influence the delivery of health services across the County. The Committee has continued to act independently in responding to issues and has sought to take account of evidence from all interested parties when coming to a view.

Relationships and Communication

Relationships with the NHS and partner organisations are regarded as a key priority for the HOSC. The past year has both relied on the strength of established working relationships with NHS organisations and key individuals. There have been considerable pressures and uncertainties arising from extensive reorganisation. Consequential changes in remits and responsibilities have required greater attention than normal to be given to maintaining effective and constructive contact.

NHS organisations have faced significant challenges in order to achieve financial balance further underpinning the need for good communications.

The framework for assessing the impact of changes in the configuration of health services designed by the Committee in 2005 has been helpful in informing this dialogue.

Members regularly receive updates and information about local and county-wide issues either at the formal Committee meetings or separate `bespoke' events. Examples of topics covered in this way includes the future of NHS services in Southeast Hampshire, and the transfer of the Department of Medicine for Older People from Primary Care Trust, to Portsmouth Hospitals Trust management.

The HOSC has continued to develop its working relationships with District Councils, holding meetings through the year. In addition the HOSC ensured that P&PIFs were able to contribute to the work of the Committee and the Chairman of the Hampshire PCT P&PIF is a formal observer at HOSC meetings as are the Chairmen of the Portsmouth, Southampton and Isle of Wight HOSCs.

Referrals from key stakeholders continue to play an important role in informing the Committee of emerging issues. This feedback is an important element in confirming that NHS bodies have engaged properly with patients and relatives or carers when considering service change.

The effectiveness of partnership working across the public sector increasingly arises as an issue of interest, and sometimes concern, to the Committee.

Additional work undertaken by the Committee in 2006/07 included responses to the Healthcare Commission's Annual Health Check assessment of primary care and acute trusts in Hampshire.

Proposals to Develop of Vary NHS services

Proposals to vary or develop NHS services have continued to come to the HOSC throughout the year and are the principle route through which Members can be alerted to forthcoming proposals to change health service provision. All proposals for varying NHS services considered by the Committee, with any associated reports or comments, are included in agenda papers.

Responses to consultations since April 2006 have included:

· Hampshire PCTs: Hampshire Child Health and Maternity Services: a discussion paper (May 06, July 06)

· South West PCT Alliance/Southampton University Hospitals Trust: Closure of Maternity Beds and Review of Maternity Services in South West Hampshire (May 06, July 06, Sept 06, Nov 06, Jan 07)

· South East PCT Cluster: Maternity Services in South East Hampshire (May 06, July 06, Sept 06)

· Strategic Health Authority: Acute Paediatric Services Review (May 06)

· Mid and South West Hampshire PCTs: Surgical Services Reconfiguration (May 06)

· The Future of Services in Fareham and Gosport/South East Hampshire Capacity Plan (May 06, Sept 06)

· North Hampshire PCT: Reprovision of Older Persons Mental Health Services provided at Homefield House (May 06)

· Merger of Hampshire and Isle of Wight Strategic Health Authority with Thames Valley Strategic Health Authority (March 06)

· Merger of the seven Hampshire PCTs into one Hampshire PCT (March 06)

· Merger of Hampshire and Thames Valley Ambulance Trusts (March 06)

· North Hampshire Hospital Trust: Foundation Trust Consultation (May 06)

· South West Alliance PCTs: Neurological Rehabilitation Services (July 06)

· Department of Health: A Stronger Local Voice: A framework for creating a stronger local voice in the development of health and social care services (July 06)

· North Hampshire PCT: Modernising Alton Hospital (Sept 06)

· Hampshire County Council Adult Services: Consultation on the eligibility criteria for accessing community services (Sept 06, Nov 06)

· The Rainbow Centre Service Change: feedback from the Patient and Public Involvement Forum (Nov 06)

· South East England Strategic Health Authority: acute services reconfiguration (Nov 06, Jan 07)

· Department of Health: development of Local Involvement Networks (Nov 06, Jan 07)

· Department of Health White Paper: Strong and Prosperous Communities (Nov 06)

· Department of Health: Consultation on Non Emergency Patient Transport (Nov 06, Jan 07)

Reviews of Health Services

The two areas of review identified by the Committee in 2006/07 were:

· Public Health and Well Being- taking forward the mapping exercise initiated by the Committee in 2005/06.

· Out of Hours Services- following a review undertaken by the former Hampshire Strategic Health Authority a series of actions were identified by the NHS. The Committee has indicated its wish be kept informed of progress with the implementation of the recommendations made in the original review.

Progress achieved in 2006/07 was reported back to the Committee in March 2007. Although changes in the configuration of NHS services in Hampshire had a significant impact on the roll out of the public health and well being agenda, as well as progress with implementing the Out of Hours Review, the Committee noted the following:

· The appointment of a Joint Director of Public Health, working closely with the well being leads in Adult Services

· The Improvements to Out of Hours services in south west Hampshire following the award of the contract for this work to the former Hampshire Ambulance Service.

The Committee expects to see further progress made with both these areas in the coming year and has therefore identified a number of further areas of work to be delivered in 2007/08.

In addition to the above the Committee was able to respond to a direct request from the Executive Members for Adult Services to review Care at the End of Life. This took place between August and December 2006 and was formally submitted to the HOSC in January 2007. The report and supporting recommendations will be closely followed up by the Committee through 2007/08.

Health Inquiries

Issues brought to the attention of the Committee by Members and partners, such as the P&PIFs, include:

· Ambulance Service Estates Strategy

· Aldershot Health Centre Development

· Proposed Transfer of Upper Gastro-Intestinal Cancer Surgery from Frimley Park to Royal Surrey County Hospital, Guildford

· The Future of the Lawns Day Hospital, East Hampshire

· The Closure of Midhurst Hospital

· Changes to Neurology Rehabilitation Services (Southampton University Hospitals Trust)

· Changes to Community Services for Children with Terminal and Life Threatening Illnesses

· Changes to Pancreatic Cancer Care (Hampshire Strategic Health Authority)

· Delays in discharge from hospital

· HIV Counselling Services (Southampton University Hospitals Trust)

· Changes to Service Configuration at Havant and Emsworth

· Closure of Kingsclere and Exton 4 Elderly Care Wards (St. Mary's Hospital)

· The Future of Community Hospitals

· Partnership Working with the Healthcare Commission

Joint Committees

South East of England Local Authorities with health scrutiny responsibilities meet regularly during the year. Issues of general concern, and cross boundary matters are raised. A specific issue identified in 2006/07 related to the development of proposals for reconfiguring acute and maternity services in West Sussex.

HOSCs in Hampshire and the Isle of Wight meet four times a year under the Chairmanship of Cllr Dr Ellis, to share information and identify issues that require further action by the Committees. This allows arrangements for the establishment of formal Joint Committees to be put in place as required.

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

· Centralisation of Pancreatic Cancer Services

· Cancer Care Phase in Southampton

· Maternity Services (Southeast Hampshire)

· Child Health and Maternity Strategy

· Developments at the Royal South Hampshire Hospital.

· Services for People with Learning Disability in Southeast Hampshire

· South Central Ambulance Service - implementation of Call Connect

The establishment of the new South Central Strategic Health Authority, with plans for major service reconfiguration necessitate the establishment of a network of HOSCs in the South Central area. This work was taken forward by Hampshire and funding was secured to provide support to the network in 2007/08.

Section 3: Outline Work Programme for 2007/08

Building on feedback from partner organisations the HOSC will continue to use the four work strands identified to form the work programme for the coming year. A commitment has therefore given to the following actions

Relationships and Communication

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

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

Proposals to vary or develop NHS services

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

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

Effective arrangements will be in place to enable the Committee to provide a constructive contribution to the following consultations:

· Maternity Services Reconfiguration in Portsmouth and SE Hampshire.

· South Central Strategic Health Authority Review of Community Services

· West Sussex PCT proposals to reconfigure acute services

Reviews of Health Services

The Committee will continue to take an active interest in the rollout of the Public Health and Wellbeing agenda across Hampshire. This will include specific work with regard to:

· The development of Public Health support and advice across Hampshire

· The objectives delivered in 2006/07

· The identification of priorities for 2007/08

· Mapping of plans and programmes being progressed across Hampshire

The Committee will continue to keep under review the implementation of proposals to improve Out of Hours services, including related action identified in the `Care at the End of Life' report.

The Committee will vigorously follow-up progress with the delivery of the `Care at the End of Life' recommendations in accordance with the identified timeframes.

Health Inquiries

The Committee will continue to receive information on, and initiate action in response to, issues raised by Members and partners.

Annex One

Hampshire County Council

Health Overview and Scrutiny Committee

Summary of the Responsibilities of Local Authority and NHS Bodies

Powers of local authority overview and scrutiny committees

Overview and scrutiny committees may:

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

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

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

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

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

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

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

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

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

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

Duties of local NHS bodies

NHS bodies must:

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

Attend before committees to answer questions, subject to exemptions;

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

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

Annex Two

Hampshire County Council

Health Overview and Scrutiny Committee

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

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

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

Relationship building

Processes for effective scrutiny

Strategic scrutiny

Operational scrutiny

Relationship building

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

Processes for effective scrutiny

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

Strategic scrutiny

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

Operational scrutiny

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

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