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. Maternity Services in South East Hampshire

2.1. The PCT has confirmed that it will be developing proposals for maternity services in south east Hampshire in collaboration with key stakeholders. It is anticipated that the PCT will go to formal consultation on this issue in the week commencing 16 July.

2.2. Portsmouth PCT, having already consulted on the proposals for the Mary Rose stand alone birth centre on Portsea Island, will not be participating in the consultation.

2.3. The briefing paper that was circulated by the PCT on the process being followed was previously circulated to members and is attached at Appendix One.

Recommendation

2.4. Members highlight any additional information they require from the PCT.

3. Closure of Maternity Beds and Review of Maternity Services in South West Hampshire

3.1. SUHT has confirmed that, due to a delay in the rehabilitation services moving from the Ashurst site the opening of the new centre will be delayed until the autumn.

Recommendation

3.2. Members note that this work is now progressing.

4. South Central SHA: Review of Community Hospitals

4.1. In 2006/07 South Central SHA has signalled that its intention to review community hospitals in its area and that it wished to engage HOSCs in this process.

4.2. The South Central HOSCs met with the SHA on 8 June and continued to raise a number of specific concerns about the review process. The vice Chairman has written to the SHA Chief Executive on this matter (see Appendix Two).

4.3. Work is currently focusing on the identification of bids for capital funding for community hospitals across the south central area. The most recent up-date from the SHA is attached at Appendix Three.

Recommendation

4.4. That the Committee is kept apprised of progress with this work

Items for Action

5. West Sussex PCT: Acute Service Reconfiguration

5.1. West Sussex PCT launched an 18 week consultation on proposals for reconfiguring acute and emergency services on 25 June. It is not anticipated that the formal consultation document will be available until 11 July. The proposal is accessible on the PCT web site and the PCT Board has taken legal advice indicating that this is sufficient to satisfy the duties relating to formal consultation.

5.2. The most recent up-date from West Sussex PCT and consultation document is available at http://www.southeastcoastfff.nhs.uk/Home/West-Sussex.aspx

5.3. The first meeting of the Joint HOSCs met on the 4 July, with Cllrs Ellis and Buckley attending on behalf of Hampshire. Meetings will be held fortnightly during the period of consultation.

5.4. Initial concerns about the decision of the PCT Board to proceed have been raised with the Joint Committee Chairman (see Appendix Four). Hampshire District Authorities, MPs and P&PIF have been kept apprised of the Hampshire HOSC's involvement and views.

Recommendation

5.5. Members are apprised of the progress of the Joint West Sussex HOSC.

5.6. Members are circulated with a copy of the formal consultation document when this is available

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: South East Hampshire Maternity Services Briefing

1. Background

There are currently four birth centres in South East Hampshire, run by Portsmouth Hospitals NHS Trust:

· the Mary Rose birth centre (co-located with the main unit at St Mary's Hospital, Portsmouth) 8 beds

· Blake, Gosport, 12 beds

· The Grange, Petersfield, 8 beds.

· Blackbrook, Fareham (temporarily closed since July 2005). 10 beds

However over the last few years there has been uncertainty about the future of these centres. In November 2004, Portsmouth Hospitals Trust, Portsmouth City PCT, East Hampshire and Fareham & Gosport PCTs published a Joint Strategy for Maternity Services. This was followed by a public consultation, `A healthy future for mothers and babies', between January and April 2005. The consultation focused on future plans for the Mary Rose Birth Centre -currently co-located with the main obstetric unit at St Mary's but due to transfer to Queen Alexandra Hospital in 2009.

The responses to consultation process were generally in favour of a stand-alone birth centre on Portsea Island when the main Maternity Unit moves in 2009, rather than a birth centre located at Queen Alexandra with the main obstetric unit. The PCTs responded as follows:

· Portsmouth City PCT agreed it would proceed to develop business case for stand alone unit and investigate the deliverability and affordability of this option.

· The Joint Board of Fareham and Gosport and East Hampshire PCTs called for a wider review of maternity services across Portsmouth and South East Hampshire and proposed that they undertake an option appraisal of different maternity service models.

The option appraisal on maternity services was completed in 2006. The Option Appraisal concluded that the following be provided:

· Main Maternity Unit

· Co-located Birth Centre Unit

· Stand-alone Birth Centre Unit 1

· Stand-alone Birth Centre Unit 2

The response of the Joint Overview and Scrutiny Committee to the conclusions of the option appraisal was that these represented a significant change in service provision and that a public consultation would be required.

A new PCT for Hampshire was established on October 1, 2006 and local NHS organisations resumed discussions on the future of maternity services in Portsmouth and South East Hampshire in January 2007.

Between January and May this year a project was established to make recommendations on the pattern of birth centre provision in South East Hampshire taking account of additional data and work undertaken since the 2006 option appraisal. Some of the conclusions from this work are detailed below.

2. Project conclusions

Number of births

There has generally been a reduction in births over the last 10 years in South East Hampshire. Births are expected to decrease by a further 7.2% by 2026 (over 300 births per annum. However there is variation across the four borough council areas, these are:

· Havant: 11%

· East Hampshire: 14%

· Gosport: -15%

· Fareham: +14%

Models of care

Various models of care have been considered as part of the recent maternity services project. After reviewing current local practice and best practice from other birth centres three service models, all of which are clinically safe and also viable in terms of midwifery staffing, were identified.

· Model 1 (Midwife staffed unit) provides a Midwife and a Health Care Support Worker at all times in the birth centre. This model reflects current practice at the Blake birth centre, Gosport.

· Model 2 (Unstaffed unit) does not provide continuous staffing of the birth centre. A mother going into labour notifies the on-call system. Two Midwives are called and travel to be present at the birth centre for the delivery. This model reflects a new service currently being piloted at the Grange, Petersfield.

· Model 3 (Maternity care assistant staffed unit) provides continuous staffing of the birth centre with Maternity Care Assistants. Midwives are called in when required for deliveries. This model differs from Model 1 in that continuous staffing is maintained at the birth centre but this does not include a qualified Midwife. This model reflects similar birth centre units in South West Hampshire and Oxford.

Capacity

There are currently 88 beds across the whole of Portsmouth and South East Hampshire (10 at Blackbrook temporarily closed since July 2005, 8 at the Grange currently on `birth only' model).

In 2009 when the new facilities at Queen Alexandra are complete PHT have concluded that they will need 71 beds. If these proposals go ahead in 2009 these will be located at:

Main unit 63 beds

St Mary's stand-alone 6 beds

Standalone/c0-located unit 26 beds

Total 95 beds

Utilisation

Local stand alone birth centres are underused. Even when all the birth centres were open and operating normally (in 2004) the stand-alone birth centres were running at only 42 per cent capacity.

Costs and national tariff

The total maternity service provided to Hampshire and Portsmouth City PCTs last year cost £15.4m. This was £0.8m more than Portsmouth Hospitals Trust's income from the PCTs. When the new maternity facilities at Queen Alexandra Hospital are in place (2009) PHT estimate that they will cost an extra £1m per annum.

On this basis, PHT project a potential deficit on maternity services to be in the region of £1.8m per annum.

The current shortfall of £800k is being addressed by the Trust in a number of ways including:

_ Encouraging women from a wider area to use our services, benefiting from the state of the art facilities and accommodation in the new hospital

_ The extra money and future costs for these new facilities has already been built into Trust financial planning

_ Encouraging staff to work together to consider ways of improving their processes and bringing about better quality patient care

Hampshire PCT cannot commit additional funding to the development of birth centres in South East Hampshire. The PCTs view is that this should be considered and addressed within the overall funding arrangements for all services each PCT commissions from PHT. This recognises that, at this stage of the development of national tariffs, it is inevitable that there will be variations in terms of deficits and surpluses across the full range of services provided.

Listening to local views

Throughout the project Portsmouth Hospitals NHS Trust and Hampshire PCT have been talking to local women, their families and carers, local clinicians (midwives, health visitors and GPs) about local maternity services. Since April this has involved regular meetings with local clinicians, visits to a number of service user groups and meetings with voluntary organisations.

Overall choice of birth place (including a local service) was valued and there was strong support for a service staffed 24/7 by midwifes. Many women expressed concern at the on-going uncertainty over maternity services and the model currently running at the Grange was not favoured. The `less hectic', homely ambiance of birth centres was highly regarded and port natal breast feeding support was valued. There was some lack of understanding of the role of a co-located unit, but when explained this model was seen as reassuring.

Other themes varied according to area and are summarised below:

· Waterlooville

Women are flexible about travelling (20-30 minutes) and are supportive of the co-located and main unit at Queen Alexandra Hospital, Cosham. A range of factors influence women's decision making around place of birth (distance, perception of safety especially co-located, previous birth experience, location of relatives (looking after siblings, visiting, support) atmosphere of unit).

· Gosport

Blake `as is' highly valued for its relaxed and homely atmosphere, excellent care, one-to-one support with breast feeding and post natal support, The proximity to community is important and travel off the Gosport peninsular was a key concern . The community were open to other birth centre models as long as Maternity Care assistants well trained and midwives contactable if required

· Fareham

Younger mothers felt that Queen Alexandra was a good location (rather than St Mary's) and some preferred the co-located because it was reassuring.

Women valued Blake and also wanted post natal care at home.

Feedback from Fareham Branch of HCFF is that local women want a range of birth place choices to be available.

· Petersfield

Here there was a strong desire to retain the Grange Birth Centre, but to take model of care back to where it was before closure - seen as `birth bus stop' at present. The area has complex patient flows as women travel north to Royal Surrey, West to Winchester, south to Portsmouth and St Richards.

3. Joint Overview and Scrutiny Committee recommendations

The Joint Health Overview and Scrutiny Committee met on June 6, 2007 to consider the outcomes from the project. Having considered a Status Report the Committee recommended:

1. The co-located unit at Queen Alexandra Hospital be included in the options taken forward for formal consultation. The impact this will have on previous commitments to birth centres across south east Hampshire will be clearly set out in the consultation document.

2. Portsmouth City Teaching PCT work closely with partners to ensure that, if taken forward, the co-located unit is offered as a viable choice for Portsmouth women.

3. Provision in Fareham Community Hospital continues to be considered.

4. The further development of options takes full account of the potential impact of any proposed changes in West Sussex.

5. The needs of all the populations in South East Hampshire, including Whitely and surrounding areas, be fully considered in the development of options.

6. The financial, birthrate and populations figures underpinning the proposals be reviewed and reconciled.

7. The Maternity Services Liaison Committee be given a full opportunity to feed into and inform the final options presented for consultation.

8. The draft public consultation document be circulated to the Hampshire Health Overview and Scrutiny Committee before publication: and

9. The Portsmouth Health Overview and Scrutiny Panel be asked to scrutinise the preferred service model being developed for the stand alone birth centre on Portsea Island.

4. Moving forward to public consultation

Hampshire PCT is now developing formal consultation proposals.

Options

Although still under development it is likely that the consultation will propose three midwife-led birth centres with a total of 26 beds.

Service model

The model which will be proposed as part of the consultation will suggest a 24 hour midwifery presence within the birth centre with support from Maternity Care Assistants. A second Midwife is called in to provide birth cover/labour as required.  When in labour the woman would contact the Community Co-ordinator, a senior community midwife with a dedicated phone for labour calls, who is responsible for ensuring that the appropriate midwives attend the Birth Centre to care for women during the labour and birth. After the birth the woman can choose to go home as soon as she and her baby are fit, or can remain in for a couple of days for help and support.

This Unit would be open 24 hours a day, 7 days a week. Women would be booked into this Unit during their pregnancy via the community midwifery service.

Both ante natal and post natal clinics can be run throughout the week within the birth centre, and parent education classes and breast feeding advice and support can be provided.

Consultation process

It is expected that formal consultation will begin on July 16 and run until October 31. A consultation document will be sent to a range of stakeholders on July 16 and made available on the PCT's website and in local libraries.

The consultation process will be managed by a steering group made up of the chief executives of Hampshire PCT and Portsmouth Hospitals NHS Trust, representatives from Fareham and Gosport and East Hampshire Patient and Public Involvement Forums and the Maternity Services Liaison Committee.

Throughout the formal consultation Hampshire PCT will continue to engage with service users and their families by visiting local mother and baby groups, Sure Start programmes, National Childbirth Trust meetings, voluntary sector meetings, Children and Family Forum meetings and a variety of other forums for mothers, fathers, families and hard to reach groups such a teenage mothers and black and ethnic minorities.

The PCT will also run a series of drop-in events for local services users and interested parties in Waterlooville, Havant, Emsworth, Hayling Island, Fareham, and Gosport. Lee on Solent, Whitely, Horndean and Petersfield. Storyboards and leaflets will be produced to support the drop-ins and the user groups and details of the consultation will be available on the PCT's website.

The PCT will continue to involve the Overview and Scrutiny Committee, Patient and Public Involvement Forums, the Maternity Services Liaison Committee and local councillors as the consultation progresses.

The PCT and Portsmouth Hospitals NHS Trust will also continue meeting regularly with local midwives, health visitors, GPs and other clinicians to ensure their views are heard.

Members of the public will be able to comment on the proposals in writing, by email or via the website.

Hampshire PCT's Board will consider the outcome of the consultation at its meeting on November 22, 2007 and make a decision about the way forward.

Notes:

Portsmouth City PCT birth centre proposals

Portsmouth City PCT is developing proposals and a business case for a free standing birth centre on Portsea Island. This reflects the outcome of public consultation undertaken in 2005.

Current proposals are to develop a unit of up to six beds, on the St. Mary's Hospital site, following the transfer of maternity services on that site to Queen Alexandra Hospital in 2009.

The PCT Board meeting in May, 2007 considered proposals which took account of the three models of care. The Board agreed to develop a birth centre based on a maternity care assistant staffed unit. This is consistent with the PCT's position following public consultation in 2005, so no further formal consultation will be undertaken by Portsmouth City PCT.

Appendix Two: Hampshire HOSC; Vice Chairman's letter to SHA

Meeting with South Central HOSCs: 8 June 2007

I am writing further to Friday's meeting, which I suspect we all found unsatisfactory on a number of levels. I do however feel that it provided a useful purpose in as much as it highlighted clearly that we need to address and clarify the way in which the SHA and HOSCs work together. I understand that Diane and Denise have already had an initial discussion about how this may be improved, however I felt that there would be a benefit in setting out my thoughts to give a member perspective.

Firstly I was struck by the high handed approach of the Department of Health to the bidding process for the capital funding for community hospitals. This cuts across all the work on strategic planning currently being taken forward by PCTs. I understand that the deadline for these bids has now been changed yet again to the end of July. Whilst I appreciate this is not the fault of the SHA I do think that our dissatisfaction with such a deeply unhelpful approach to capital planning needs to be articulated.

Secondly I do feel that further thought needs to be given to the way in which you engage with HOSCs particularly if you are seeking to inform your decision about bids to go forward. We have already indicated that we are willing to engage in some of the difficult discussions that need to take place about community services, however to do so we need timely access to information and a real opportunity to influence the debate. Agendas that go out at the last minute and incomplete information are not the best way to secure this input and I am sure you will have picked up on this point at the meeting. For information, the law requires that local authorities send there agenda to Members at least 5 clear days before a meeting. We are therefore used to having the papers in advance. You will also be aware that the way in which the PCTs presented their business cases did not tie in with the criteria you had developed, making any objective evaluation impossible. I was pleased therefore that time precluded any contribution from the HOSCs to the prioritisation of the bids that the SHA now needs to undertake.

Finally I think that we now need to move forward and build on the lessons that have come from this experience. We are intending to strengthen and formalise the network of South Central HOSCs and the meeting structure. I am sure we would welcome the thoughts of the SHA about how it would wish to work with us where there are issues, such as the community services review, which are of significant mutual interest. I believe that Diane will be discussing this with you and look forward to hearing your views on this in the near future.

Appendix Three: South Central SHA; Community Services Bidding Process Update

Executive summary:

Progress on evaluating Community hospitals bids as part of the Community services framework is being made. This paper is provided as a briefing for the next stages of prioritisation of Community Service developments.

Background

The SHA set an objective in 2006/7 to develop a framework around community services. This was to support our role in community services as in all other areas as

· Regulator of commissioning and PCTs, developing strategies and operating plans to improve capability and capacity to assess health need and organise health and social care accordingly.

· A system developer, developing a complimentary suite of system reforms which are designed to give patients better quality, responsiveness and choice.

· A performance enhancer, improving organisational and individual capability to meet our obligations to Government, stakeholders and the patients we serve.

· Champion of patient, public and taxpayer aspirations, better understanding the nature of the 4 million people we serve and working with partners who share our goals and aspirations.

As per SHA Governance and Operating Framework;

`Our Health, Our Care, Our Say' the White Paper laid out a vision of delivering more care closer to patients' homes. To support this policy nationally £750m capital funds were identified. Recent DoH requirements have set a timetable of submission of all bids to a final timetable of June 2007, now amended to end of July 2007, for access to this fund.

Our framework for Community Hospitals has been developing as part of the process of understanding best practice in the delivery of Community Services. There is much scope for strengthening community services, but this must be laid within PCT approaches to commissioning. Since the DoH timetable required prioritisation of schemes before July 2007 for developments up to 2011, it was appropriate to use our emerging investment framework to facilitate prioritisation.

Progress to date

Any work on community services is dependent on a commissioning strategy. Each PCT in association with its Local Authority and other partners needs to develop this strategy. Across South Central the progress on community services commissioning is emergent with some areas more developed than others.

The role of the Health Authority at this stage therefore is to encourage and support the development of local commissioning strategies and facilitate performance improvement. The SHA also has a role in prioritising bids for DoH funding. NHS South Central has received bids totalling over £150m. Our notional allocation was to be advised to us on 31 May (and is now expected at the end of June). It will not exceed £75m, of which we have already received over £12m (Gosport War Memorial, Hampshire and Royal Southampton Hospital being the recipients).

NHS South Central work has so far sought to understand what factors would indicate an investment grade community hospital/facility. This aims to move our thinking into a more commercially based mindset of ensuring our service responses are targeted to gain greatest benefit for our patients/consumers. This has led to a set of principles for the investment grade facility.

I. Principles

· The investment grade facility is in the right place with a viable catchment population;

· Is interfaced with at least one of:

- primary care anchor team

- acute hospital provider

- or, part of community hospital chain provider

· Has a modernised service offering that gives >5yr fit with PCT commissioner strategy;

· Has a clear role within long term conditions management programmes and networks;

· Provides a wider range services (Local Government, Independent provision etc);

· Has effective governance;

· Demonstrates quality of provision.

These principles are interpreted in each case by a series of measures; these have been discussed and agreed with PCT Community leads (see Appendix 1). The PCT supplied information against these measures, this then gets applied to the facility and grading of facilities determined as below.

Categories

A - Appropriate location, viable population, strong service mix, well integrated, modern

B - Appropriate location, viable catchment population, limited competitors, offers a range of services, integration limited

C - Location and/or catchment issues, i.e. significant competitors or limited catchment population, limited range of services, integration and governance issues

D - Major issues re viability of catchment population, with strong alternatives/competitors close by, limited range of services, integration and/or governance issues, old stock

Applying these principles to current hospitals and then applying them to any proposed new development enables us to grade hospitals according to their contribution to improving health and meeting known health needs.

Methodology

All current hospitals requesting funding have been reviewed against the framework. The future grade of this provision after investment has also been assessed.

Other factors that have also so far been deemed as significant to decision making are;

· Deprivation

· Growth in population

These factors are all utilised to determine a shortlist of community hospitals for funding.

The approach for short-listing for new funding has been as follows;

· Reject all D grade prospective hospitals unless deprivation or population growth would argue for special consideration

· Reject all C grade prospective hospitals unless deprivation or population growth would argue for special consideration

This provides the following shortlist;

Fareham Hospital, Hampshire

St Mary's, Portsmouth City

Oak Park, Hampshire

Moorgreen, Southampton City

Chalfont and Gerrard's Cross, Buckinghamshire

Thame Hospital, Buckinghamshire

Upton Hospital, Slough, Berkshire East

Wokingham, Berkshire West

Bids that were unable to meet hospital short-listing based on the assessment framework;

Woodley Hospital, Berkshire West

Battle Hospital, Berkshire West

Isle of Wight

Oxfordshire diagnostics

Bracknell, Berkshire East

Fenwick Hospital, Hampshire

Isle of Wight and Oxfordshire PCTs submitted bids for different approaches to Community service investment. Prioritisation approaches to these schemes are still being developed.

The £750m national fund has been top-sliced by £250m nationally for Community Ventures. South Central has proposed Berkshire East (Bracknell) and Hampshire (Fenwick Hospital) for this route of support. These were selected due to the involvement of other non-public sector/statutory parties in the development of schemes and the potential for very creative problem solving within them. We await feedback on this.

An estimate of the value of the short listed schemes has been submitted to the DoH giving an NHS South Central bid of £100m. This was required on 31^st May 2007.

Given that the DoH is likely to require NHS South Central to further shorten this list, we continue to work around appropriate further definitions of priority.

We are considering;

· Deprivation and growth factors indicating a priority

· Value for money (improvement/activity per £ investment)

· Revenue source reliability/affordability

· Strategic fit

· Linkage to 5 year SHA aspirations

· Assessment score

· Alternative means of funding (LIFT/land sales etc)

· Population interfaces between schemes.

A proposed approach to the priorities will be taken to Board of Commissioners (PCT CEOs/SHA Directors) in July. The DoH submission date has now been slipped to the end of July.

Diane Hedges, 20/6/07

Appendix Four: Hampshire HOSC letter to West Sussex Joint HOSC

West Sussex PCT Consultation

It was good to see you yesterday and begin to consider how we would collectively work together as a Joint Health Overview and Scrutiny Committee. As we discussed in the pre meeting, from a Hampshire and Portsmouth perspective, whilst one of the options presented has the potential to significantly impact on health services to people living in south east Hampshire and Portsmouth, we are aware that for east and west Sussex the changes proposed are of far greater magnitude for the population. I am sure that the work you have already undertaken through your local task forces will be enormously helpful in informing the views of the JHOSC when we look in more detail at the changes proposed.

As I mentioned, both Hampshire and Portsmouth HOSCs have strong reservations about the decision of the PCT Board to proceed with consultation despite the concerns expressed by all HOSCs affected and without providing us with an opportunity to see the proposals. The working relationships that we have with our own PCTs allow our HOSCs to feed into and comment on proposals prior to the launch of formal consultation. This has proven to be a valuable way of testing the robustness of the case for change being presented, reducing the potential for formal `call-in' or indeed subsequent referral to the Secretary of State. This is very much a local position and with regard to this matter we will be advised by the preferences of members from West and East Sussex as these are the areas that are most affected by the proposals.

The feedback from members and the PCT yesterday highlighted a number of areas where the consultation document can be strengthened and clarified. Other considerations, such as the lack of any Equality Impact Assessment do need to be addressed urgently by the PCT and shared with the JHOSC (as well as presumably the PCT Board). Having now had the chance to read the document properly I do feel that there are a number of issues, such as the financial modelling, population needs assessment and the investment in the community infrastructure that we will now have to try and deal with through the auspices of the JHOSC during the period of formal consultation. Hopefully these will be reflected in the work programme we agree.

The final issue we felt it may be useful to flag is the suggested timeframe presented by the PCT for the JHOSC to respond to the outcome of the consultation process. This does need to be carefully co-ordinated however the PCT should to be clear that flexibility will be required, dependent of the issues raised during the consultation period. It is for the JHOSC, not the PCT to decide the final timeframes for responding to the suggested way forward following consultation. We also need to be mindful of Local Government Elections and the potential impact of a general election next Spring.

With best wishes

Yours sincerely

Cllr Dr Raymond J Ellis C.Chem FRSC

Chairman, Health Overview and Scrutiny Committee