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. Review of Maternity Services in South West Hampshire

2.1. Further to the discussion about the delays in the opening of Ashurst Birth Centre a letter setting out Members concerns was sent to SUHT. This is attached at Appendix One, with the response received at Appendix Two.

2.2. Hampshire PCT P&PIF has also copied the HOSC into a letter raising a number of issues about the proposed new facility with the PCT. This is attached at Appendix Three.

2.3. SUHT has been asked to ensure that a suitable member of the management team is present at the HOSC meeting on 5 February to answer any additional questions that members may have.

Recommendations

2.4. Members receive any additional information requested from SUHT.

2.5. SUHT provides the HOSC with regular up-dates on progress with the development of the Ashurst site.

3. Specialist Palliative Care Services in South East Hampshire

3.1. Hampshire PCT has alerted the HOSC to formal notification from Portsmouth PCT of its intention to withdraw from existing arrangements for commissioning specialist palliative care services in south east Hampshire.

3.2. It is not yet known how this action will affect the existing team or the range of services offered and the Joint HOSC has asked that Portsmouth City PCT completes the framework for assessing the nature of the changes proposed.

Recommendations

3.3. That the PCT provides the HOSC with full details of the anticipated impact of the proposals on services delivered to the residents of southeast Hampshire.

3.4. That Hampshire HOSC, if appropriate in discussion with Portsmouth HOSC, comes to a view on whether these changes are substantial.

4. Surrey and Borders Partnership NHS Trust: Improving Adult Mental Health Day Services

4.1. Surrey and Borders NHS Trust has alerted the HOSC to a consultation on these services.

4.2. Hampshire Adult Services have confirmed that it is not anticipated that these changes will have an impact on people in Hampshire.

4.3. Surrey HOSC, Rushmoor Borough Council and Hart District Council have been made aware of the proposals.

4.4. Further to an inquiry from the Hampshire PCT P&PIF, adult services have provided a short paper that includes the impact of the changes on services for people with anxiety and depression (Appendix Four).

Recommendation

4.5. Members highlight any additional information required.

5. Application for Foundation Trust Status: Southampton University Hospitals Trust

5.1. The Joint Health Overview and Scrutiny Committee for Hampshire, Portsmouth, Southampton and the Isle of Wight considered the SUHT proposals for Foundation Trust status at its meeting on 3 December.

5.2. The response of that Committee to the proposed arrangements is attached at Appendix Five.

Recommendation

5.3. Members Receive a copy of the response of the Trust to the issues raised by the Joint Committee.

Items for Action

6. West Sussex PCT: Acute Service Reconfiguration

6.1. At the close of the consultation process West Sussex PCT had received 42 alternative options for reconfiguring services in West Sussex. These will be evaluated by Sir Graeme Catto as part of the work of the options assessment panel. The report and recommendations that result from this work should be available by the end of January.

6.2. In addition to the original hurdle criteria developed by the PCT, Sir Graeme will consider issues of accessibility and health inequalities, as well as the need to avoid considering services in isolation. He has indicated that he does not see a diminution in A&E services and that current services should continue into the future with agreement to enhance some services on one site where it is clinically appropriate to do so.

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

Recommendations

6.4. Members are kept apprised of the progress of the Joint West Sussex HOSC.

6.5. Once the PCT has agreed the further options for consideration (14 February, the officers in consultation with the Chairman and nominated members come to a view about the nature of the impact of the proposals on Hampshire residents and health services.

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: Ashurst Birth Centre -HOSC letter to SUHT ( 3 December 2007)

Ashurst Birth Centre

I am writing to in response to the e-mail exchanges between SUHT and our scrutiny team office and your letter to Denise of 31 October, all of which were shared with Members at our meeting on 27 November.

I am also aware that you contacted our office last week to explain why SUHT were unable to attend our last HOSC meeting as requested. This was deeply disappointing and members expressed concerns on a number of issues that require a response, a number of which have been shared with you previously. These are set out below:

· What are the causes of the delay and why, in a major project such as this, were these not identified as part of the planning process

· Details of when the new facility will be open and timelines that will support this

· The capital investment that the Trust is making to ensure that the new centre meets the standards set out in the original consultation document. It would be helpful to include an indication of how much these costs have increased as a result of these delays and confirmation that this will not adversely impact on the refurbishment and equipping of the new centre.

· What steps have been taken to inform local women and staff about the reasons for the delays and ensure that suitable information is provided to allow them to exercise choice. In particular we need to know what has been done in those areas that have lost their birth centres.

· What is the scope for re-instating the facilities at Lymington and Romsey until such time as the new centre at Ashurst is open.

· What briefing has gone to the Trust Board on this issue and when

· Progress with ensuring that the Ashurst site is accessible via public transport and has suitable car parking. This was specifically highlighted to you in our letter of 6 November 2006 and reflected similar comments made by the PCT.

Noting the comment in your letter of 31 October that the arrangements at Hythe are working well Members would be interested to know how this is being monitored and whether there have been any occasions when this facility has been unable to meet demand for the service provided. Members also reported anecdotal comments that, following the closure of the Lymington facility, there had been two instances where women had given birth in the offices used by midwives and one where a woman had given birth in a car. I would be grateful if you would verify if this is the case, and if so, why these incidents happened in this way.

Your communication with us on this issue, which is of such intense interest to Members and local people, has been poor. A delay in opening this birth centre of over a year is significant particularly where the service changes proposed have been so controversial and the Trust has acted to close some facilities. It is essential that the HOSC is kept apprised of what is happening if members are to retain confidence in the process being followed.

I would be grateful if you could ensure that the information requested is provided by 17 December and ensure that, in accordance with the legislation, a senior manager attends our next HOSC meeting on the 5 February 2008 to answer any additional questions that members may have.

Appendix Two: Ashurst Birth Centre- SUHT response to HOSC (17 December 2007)

Ashurst Birthing Centre

Thank you for your email dated 7^th November, your letter of 3^rd December and subsequent discussions. In my letter of 31^st October 2007 I did indicate that I was personally unable to attend the Hampshire OSC meeting on 27^th November, due to childcare commitments. I again apologise for any anxieties this may have caused you or the Chairman of the OSC. I remain willing to meet on any other occasion to discuss points you have on the development.

Naturally, I am disappointed at the delay in commissioning the new birthing centre as I outlined in my letter of 31^st October 2007 to you. There is a service available to mothers in the New Forest for a birthing centre at Hythe Hospital, which has continued to operate since the consultation completion. We receive positive feedback from the women who use the service and service quality is good. The answers to your specific concerns are:

_ What are the causes of delay?

These have been around the financing of the totality of the works to create the new Ashurst centre. The infrastructure to support the new facility needed major upgrading, which was not made clear on the original option appraisal. This infrastructure related to issues such as drains, electricity supply and other works. These have been resolved between Hampshire PCT and the Trust and we are tendering to start the works.

In addition we have been dealing with the detailed design of the facility with staff and this takes time. On reviewing the scheme I think we should have dealt with these more effectively and I am confident we are now back on track.

_ What is the remedy to the situation?

The remedy to the causes of the delay has resulted in my personal intervention to ensure resource plans are in place and the design issues accelerated. These are completed. The centre will be of sufficient size to deliver the service levels in the consultation with the ability to expand the facility further should patients increasingly use the facility so we can offer good value for money for the taxpayer. I have already outlined the planned opening date in my letter to you dated 31^st October. The Trust will be investing over £650,000 into this scheme underlining our commitment to its delivery.

_ What has been done to inform women about the delay?

The Trust has issued a press release in the media on this issue. In addition a positive choice for women wishing to use birthing centres remains in place at Hythe Hospital. Women continue to have choices of home birth, a birthing centre or the midwifery led unit at Princess Anne Hospital. I will ensure that further communications are progressed to all service users and staff. We are eagerly awaiting the opening of the new Ashurst Centre to provide a much needed purpose designed environment.

_ Trust Board

The Trust Board was briefed about the delay and redesign issues on 2^nd October 2007.

_ Scope for reopening facilities

There is no ability to resource the reopening of the facilities we closed following consultation for the reasons outlined in the consultation paper about maintaining safe intrapartum care. The Hythe Centre is available.

I can assure you that we are doing all in our power to open the centre. I have agreed with Richard Samuels, Director of Corporate Affairs, Hampshire PCT to review our construction and commissioning plans with an independent quantity surveyor to assure the PCT and the OSC of this.

Appendix Three: Letter from Hampshire PCT P&PIF to Hampshire PCT (18 January 2008)

Maternity Services in West Hampshire

I have been asked to convey to you the concerns raised by Forum members in the New Forest and ETVS Networks with regard to the situation at Ashurst and the Maternity Services Consultation carried out in West Hampshire.

Members understand that the true financial cost to complete works to enable the buildings at Ashurst to be fit for the purpose of homing a Maternity Unit is in the region of £1m, with this being cut back to £800,000. It is believed this is to be funded by SUHT £300,000 and Hampshire PCT £500,000.

It appears from the result of the recent Maternity Services Consultation in East Hants that the restrictions on the number of birth centres has been relaxed, in light of these two issues, the Networks put the following to you:

1. As the reduction in number of birth centres in East Hampshire has been relaxed, the maternity services in West Hampshire ought to be re-assessed in the interests of equality of services.

2. The financial information supplied to the public within the West Hampshire Maternity Services Consultation concerning Ashurst was seriously inaccurate, being quoted as £70,000.

The Members, therefore, question the validity of this consultation within the meaning of the Act.

3. The growth in provision of services at Lymington, New Forest Hospital was intentionally kept at a slow pace due to the prospect of the Hospital being run by a private provider. The part of the hospital initially planned to home a birthing unit remains empty. In view of the reversion of this hospital to NHS management Members believe that the change in circumstances warrant fresh consultation with correct financial figures.

Members would appreciate a response to their comments within the statutory 20 days and also ask that you provide data on the number of "Births before attendance" which occurred pertaining to patients from the New Forest area during the last 12 months and during the previous 12 month period.

Appendix Four:

Briefing for Councillor Hindson:

"A new design on day services: improving adult mental health day services in Surrey Heath and North East Hampshire"

Consultation period 1^st October 2007 - 8^th January 2008

Background

The adult mental health day services in Surrey Heath and North East Hampshire have been under review by the Local Implementation Team (LIT) during the last year. The Community Services subgroup has been developing a model of service based on recovery, social inclusion and user-led services, designed to fill the gaps identified in previous consultation and mapping exercises.

Part of the existing day services are provided by Surrey and Borders Partnership Trust at Willow House (Aldershot, Hampshire) and Beech House (Frimley, Surrey), where service users from both Hampshire and Surrey attend both centres. During the time that the review has been underway, Surrey & Borders Partnership Trust identified in their Financial Recovery Plan for 2007/2008 that Trust day services at Willow House and Beech House needed to reduce their running costs for Surrey residents by £100,000 due to a reduction in the Trust's service level agreement with Surrey PCT. There is no reduction in the funding from Hampshire PCT. It was therefore agreed that the redesign of Trust services would be part of the overall review.

Current services

The main elements of existing day services in North East Hampshire and Surrey Heath are briefly listed in the Appendix. below.

Proposed model of service

The proposed model of service focuses on a wellbeing centre and outreach from there into community venues and mainstream services. The centre will involve partnership working between Surrey & Borders Partnership Trust, voluntary and community sector providers (funded in the main by Hampshire County Council and Hampshire Primary Care Trust), and primary care services. There will be a significant outreach function to encourage mental health services to operate in community settings and to encourage mental health service users to engage with mainstream services where appropriate, in line with Department of Health commissioning guidance issued in the document `From segregation to inclusion' (2006).

Site

As part of financial recovery the Trust cannot continue to maintain both centres at their current rate of use, and there are no capital funds available as part of this review to purchase any additional building space. An option appraisal was therefore carried out on the two sites to see which would be most suitable to house the wellbeing centre. Using the criteria of space, accessibility, environment, acceptability to service users, political acceptability, social inclusion, ease of achievement, flexibility and recruitment of staff, Beech House in Frimley was the favoured option. However this decision will not be made until the consultation period is complete. To date opinions have been mixed but have tended to favour Beech House except for current attendees of Willow House in Aldershot. Transport would be made available for those who found it difficult to travel to Beech House. In addition, there are rooms set aside in Aldershot Centre for Health to replace Willow House in due course, and it may be possible to use these facilities as a satellite base in Aldershot if the main centre of operation becomes Beech House. In any case there will be as much focus as possible on using community venues across the locality.

Community and voluntary sector services

The community and voluntary sector services, including activities at the wellbeing centre, would be overseen by a co-ordinator and operational group, including service users, carers, commissioners and providers, to ensure that the aims of social inclusion, user-led services and recovery model were being fulfilled. There is a small amount of funding available from Hampshire PCT and charitable funding sources will also be accessed, from which new services planned include:

· Social enterprise café at the wellbeing centre, with plans to expand social enterprise activities in due course e.g. computer training

· Information resource for users and carers

· Activity based groups such as living skills and arts

· Support time and recovery worker

· Administration hours for the centre

· User led buddying scheme

These will be in addition to existing services which will be part of the total service overseen by the co-ordinator.

Surrey and Borders Partnership Trust services

The Trust services will focus on an evidence-based specialist day treatment service within the wellbeing centre for people with a psychotic illness or personality disorder, who have not had a tailored service before, and an outreach service for people with anxiety or depression, providing psycho-educational groups in community settings and the wellbeing centre. Support time and recovery workers will be recruited to help service users engage in services and support them with the transition to alternative community day services when their treatment within this service is complete. These services will be for people who are in receipt of secondary care mental health services. The activity based groups which used to be a part of the service will no longer be run and people whose mental health problems do not meet the criteria for these services will be able to access other services run by community and voluntary sector organisations and primary care.

Consultation so far

During December and into January, the latter part of the consultation period, existing Trust services are coming to an end and new services are being piloted to allow for further feedback into the consultation period. The user development worker is running a number of activity based groups for people who can no longer access those through the Trust, and there are support groups for people who will continue to access the Trust services once they are re-established. Five consultation events were held in November around the locality and are further three events are planned for December, and the proposal document has been widely circulated.

Feedback from the consultation so far has raised the following issues:

· General positive support for the idea of a well being centre, use of recovery model, social inclusion and use-led focus

· Concern about a change in service over the Christmas period when people can feel vulnerable, however groups are in place to provide support during this time and on into January

· Concern at the removal of £100,000 from Surrey funding

· Insufficient information in the proposal document about the development of non-Trust services, this is being addressed in a revised document

· Support in the main for services for personality disorder and psychosis although some feel that diagnosis should not dictate the service available

· Concern at the loss of activity based services, although these are to be re-established through community sources and groups developed by the user development worker as far as funding will allow

· Concern that some people with anxiety and depression will no longer be able to access psycho-educational courses - if people do not meet criteria for secondary services this is true, but there are courses also run in primary care and there will be a focus on joint working between different elements of the service.

· Some feel that the anxiety and depression service should still be building-based, and indeed some groups could happen at the wellbeing centre but these services are easier to move towards mainstream venues than highly specialist personality disorder and psychosis services

· Most feel that two centres should be maintained but if there can only be one most favour Beech House, except current users of Willow House and North East Hampshire GPs - it may well be possible to retain a satellite base in Aldershot and community venues will be used around the locality.

Appendix: Summary of Current Services

Appendix Five: Application for Foundation Trust Status: Hampshire, Southampton, Portsmouth and Isle of Wight Scrutiny Joint Committee Response (4 January 2008)

Thank you for attending our meeting on the 3 December to discuss the above proposals from the Trust. It was helpful to be able to discuss a range of issues and build our understanding of the plans and programmes that will support your application for Foundation Trust status.

Members are broadly supportive of your proposals for Foundation status and in particularly your wish to excel across a number of specialist service areas, building on a national and international reputation. It will however be important to balance the way in which local people use and access more generalist services provided by the Trust, or ensure that suitable alternative options are in place. In particular we would ask that the Trust gives careful consideration to the way in which it will continue to work with other health and social care providers operating across the catchment area of the Trust.

Members would be interested to have your response to the following questions:

· What improvements to services will Foundation status bring for patients that would not otherwise be available? How will these be evaluated?

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

· There is a trend towards increasing regionalisation of specialist services, what impact will that have on your proposed portfolio of services?

· What services do you consider will be vulnerable under the proposed arrangements?

· How will resources be directed to primary care to support additional investment in community and primary care services and build capacity in communities?

· What would the impact be of a `single service delivery system' and how would equity in access be ensured across the area?

· What are the options for providing routine of routine elective care currently provided at SUHT in other care settings?

Specific comments that members would wish to raise in relation to the proposal document include:

General Observations: The document was clearly set out and brief, with a focus on the proposed governance arrangements.

The vision set out in the proposal does imply a shift of some services to different care settings. We will expect to be kept informed of these at the earliest opportunity. It is critical that service changes of this nature are discussed with the relevant local authority overview and scrutiny committees to determine if they are substantial.

Governance and Membership Arrangements: It is difficult to determine if the public membership is appropriate without further information about the percentage of patients using general (as opposed to specialist) services provided by the Trust. It would be helpful to have this information.

The patient membership should reflect the balance of general and specialist services, particularly as some patients will be referred for specialist care from well outside the area. Opportunities for children and other groups (e.g. such as people from different ethnic backgrounds) to have input to discussions about service delivery need to be clearly set out.

Alongside the Council members there needs to be robust arrangements for engaging with the public and other key stakeholders, alongside the membership of the Trust.

I do hope that you find these comments of helpful. It would be helpful to have a response to the questions we have raised by 7 March 2008 in order that we can share them at our next meeting. In the meantime may I wish you every success with your application.