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 Local Involvement Networks (LINks) 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: HAMPSHIRE PRIMARY CARE TRUST. FORDINGBRIDGE HOSPITAL - UPDATE TO HAMPSHIRE HEALTH OVERVIEW AND SCRUTINY COMMITTEE: 22^ND JULY 2008

1. Ford Ward is a self contained purpose rehabilitation and palliative care unit at Fordingbridge Hospital. In November 2007 Hampshire PCT commissioned an independent investigation into a series of ongoing concerns regarding patient safety. Due to these concerns the PCT decided to suspend admissions to the Ward in November 2007 until the investigation was complete.

2. The following statement was made to the Hampshire Health Overview and Scrutiny Committee on 25 March 2008: "A very early draft of the investigatory report into the care of inpatients at Fordingbridge Hospital has been received by Hampshire Primary Care Trust. The PCT is meeting with the investigatory team to discuss this draft whilst, in parallel, legal and compliance checks on the report are undertaken. It is anticipated that the PCT will consider the final report in May 2008."

3. Care Services have utilised the recommendations from the investigation report ahead of the publication of the report to ensure that timely and appropriate actions could be taken.

4. An overview of the action plan is attached which includes recommendations together with the actions required. All actions have been addressed to the point that the Care Services Board and PCT Board have confirmed their support for the reopening of Ford Ward scheduled for 22 July 2008. When all internal human resource matters have been concluded the full action plan will be released.

ACTION PLAN - Fordingbridge Hospital

For OSC 22 July 2008

Appendix Two: Hampshire Health Over-view and Scrutiny Committee Briefing Paper. South East Capacity Plan Refresh. 7 July 2008

Introduction

Hampshire Primary Care Trust and its predecessors have been developing the provision of a new state of the art community hospital to serve the Havant and surrounding locality for many years. Following detailed consultation with the public and other public sector stakeholders it is proposed that the new community hospital will be constructed on the existing Oak Park site, in Havant. It is programmed that construction will commence on site in first quarter 2009 with the community hospital becoming operational by the end of December 2010.

Oak Park community hospital forms an integral part of a hub and spoke model of care for South East Hampshire. The aim of this model is to provide fit for purpose facilities, close to patients homes within their demographic locality. Acute services such as emergency and complex care will be provided from the redeveloped Queen Alexandra Hospital which brings together acute services from St Mary's and the Royal Hospital Haslar. All other none acute community services being provided from these community hubs will do so within the following areas:

Petersfield Community Hospital, fully operational

Oak Park Community Hospital, new build planned for December 2010

Fareham Community Hospital, new build planned for December 2010

St Mary's Community Hospital, partially operational

Gosport Community Hospital, under redevelopment, planned for June 2009

Oak Park community hospital will replace the services at Havant War Memorial Hospital and Emsworth Cottage Hospital. In addition to this all in-patient Older People's Mental Health assessment and treatment beds will move from St James Hospital in Southsea. Oak Park community hospital will also undertake some services that are currently provided in acute settings including out-patients and diagnostics.

Oak Park Community Hospital will be procured by Hampshire Primary Care Trust (HPCT) using its Local Improvement Finance Trust (LIFT) partner Solent Community Solutions. This procurement route differs from historically traditional procurement routes followed by the NHS as HPCT are not required to raise public capital monies but alternatively lease these health care buildings from its LIFT partner over the term of the agreement.

Following construction completion of the new Oak Park community hospital Havant War Memorial and Emsworth Cottage Hospital will be surplus to local requirements. Emsworth GPs are currently looking for new premises for their surgery and one option under consideration is the Emsworth Hospital site. If following further consideration by Emsworth GPs they wish to relocate to the hospital site , HPCT will be able to treat them as a priority purchaser which would enable the GP's to purchase the site.

Consultation with local stakeholders, has identified concerns which have been raised detailing the future use of existing artistic tiles currently located at Havant War Memorial Hospital. HPCT will preserve these tiles which will then be moved to the new Oak Park Community Hospital at its operational stage so that they can continue to be enjoyed by visitors for many years to come.

Background

During the planning for the Oak Park Community Hospital in 2000, bed projections showed that there would be a requirement for an additional 257 beds (including 36 bedded decant ward) when Queen Alexandra was complete and St Mary's/Royal Hospital Haslar beds closed. It was proposed that each area would provide additional beds in the new Community Hospitals to cover the forecast short fall. These beds would be used for post acute hospital rehabilitation. The original plan for Oak Park Community Hospital included the East Hampshire area share of these beds post acute beds.

The Strategic Health Authority, then asked the local NHS to produce an integrated plan demonstrating that each organisation's plans would provide the right level of capacity and was affordable. This plan was called the capacity map and was approved by all the organisation's Boards in 2005. This plan included an updated review of bed requirements and demonstrated that the trend in demand for beds was reducing (largely due to the change in surgical bed use). This change was due to a move from in-patient to day case surgery leading to a reduction in the average length of stay in hospital for many patients. The projections at this point showed that the health system would need no more than 60 additional beds in the community (originally 257 beds) and if the trend continued downwards, then even these may not be required. On that basis, a number of options were produced and the contingency was to keep 60 existing beds at St Mary's, and to review the situation.

At this point, an outline business case was produced for Oak Park Community Hospital and included the beds that were already in the community: 25 intermediate care beds (step up, step down) from Havant War Memorial Hospital. The outline business case was approved by the Hampshire and Isle of Wight Strategic Health Authority in June 2006.

The further development of the plans to full business case stage has led to a change in plans for the older people's mental health service and it is now proposed that 24 assessment and treatment beds from St James Hospital be included in the Oak Park plans to serve East Hampshire residents. This change is facilitated by the development of new older people's day services in Havant, creating some spare space in Oak Park Community Hospital. All of the other services to be provided at Oak Park Community Hospital were either already in the community or to be transferred from acute settings as set out in the approved outline business case.

The hub and spoke model of care for South East Hampshire provides sufficient hospital facilities to meet the need until 2012. The capacity map is regularly updated, using Hampshire County Council small area population projections and the latest activity figures. The need for beds is estimated using 85% bed occupancy rates (as per the recommendations of the National Beds Inquiry). The most recent iteration was completed in June 2008 and shows that there will be some spare bed capacity in the South East Hampshire system in 2012, without the need for contingency beds at St Mary's. However, there may still be a requirement for some contingency beds due to the West Sussex decision to move emergency surgery from St Richard's Hospital to Worthing. The contingency beds will be retained at St Mary's until plans are finalised for West Sussex.

Changes in Bed Numbers

The following tables1 & 2 track the changes in planned bed numbers up to latest plans:

1. SE Hampshire Acute Bed Capacity

· Acute sites include Queen Alexandra, St Mary's & Royal Hospital Haslar - all beds in the Approved planned beds column will be at Queen Alexandra Hospital bar the ISTC beds which are already at the St Mary's Treatment Centre.

2. Oak Park

Minor Injuries/GP out of hours

There are currently four centres providing services to people with minor injuries in SE Hampshire:

Queen Alexandra Hospital, Cosham (Main centre for Accident & Emergency)

Royal Hospital Haslar, Gosport

Petersfield Community Hospital

St Mary's Treatment Centre, Portsmouth

These services are planned to continue operating as now but the Royal Hospital Haslar service will move the Gosport War Memorial Hospital in June 2009. In addition, there is a Nurse led service in place at the Havant War Memorial Hospital. The space for this service is being re-provided in the new Oak Park Community Hospital.

GP out of hours were at a developmental stage when the original plans were discussed for Oak Park. It was anticipated that there may be a requirement for additional bases for this service. The current service does not require additional bases but the Oak Park facility will be able to provide this, if required in future.

Public Consultation

Over the last year, Oak Park Community Hospital plans have been the subject of a number of public exhibitions and presentations to key stakeholders including the local council and community groups. Architects, planners and local health representatives have given presentations and explanations, responding to all questions by the public. These meetings and the input from stakeholders have been documented and used to refine the design of the new hospital.

At the request of the Hampshire Health Over-view and Scrutiny Committee, meetings have also been held with key stakeholders to explain the capacity map and to include them in the latest update. The feedback from those stakeholders is that they understand the way that the bed numbers have been forecast and that there have been changes in medical practice over time but they do not feel able to explain this to the people that they represent. It was agreed that further public meetings were not required as they would be unlikely to reach more people than had already attended the meetings. Stakeholders have suggested that the local NHS achieve this via a communication campaign. The PCT has agreed to lead on this campaign.

Annexe A lists the most recent Oak Park Community Hospital stakeholder engagement events that have taken place locally.

Current Position

The outline business case for Oak Park Community Hospital was completed post production of the original Capacity Map work in 2005 and was approved by the PCT Board in June 2006. It is a large scheme and requires Department of Health approval in addition to Strategic Health Authority. Due to its size and the complexity of the Oak Park scheme, early LIFT documentation was considered inadequate to cover the amount of risk involved and approval for the scheme has been delayed as a result. HPCT has now agreed a clear way forward with the Department of Health which sets out all milestones which need to be achieved and will be submitting updated documentation to secure approval in October 2008.

The planning application is due to be submitted to Havant Borough Council planning department in August 2008. If all goes according to plan, the hospital will be commissioned by December 2010.

Planning for future changes

Stakeholders acknowledge that buildings last for many years, while service plans change more frequently. Therefore, the NHS must provide buildings that are capable of adapting to change, reducing and expanding capacity.

In response to this, Oak Park Community Hospital has been designed and developed to a high specification in line with all NHS guidance which enables it to be easily adapted and change its use if required to meet an ever changing need for the delivery of modern health care within the community e.g. Standard sized (larger) rooms will be provided to allow for maximum flexibility of use with adjacent land to be retained by the PCT to allow for any future expansion of the facility.

Following in depth consultation with local stakeholders it has become apparent to HPCT that the public are keen for the development of the Oak Park site to take place as early as possible.

Appendix Two Annexe A

OAK PARK COMMUNITY HOSPITAL

Informing & Engagement Involvement

Appendix Three: Letter to Hampshire Partnership- Service Provision at Andover War Memorial Hospital. 18 June 2008

Dear Mr Yeo

Mental Health Services at Alan Gardner Unit, Andover War Memorial Hospital

I understand you have very recently taken up your post, and I look forward to meeting with you in the near future. You may be aware that a number of local and County Councillors in the Andover area are receiving persistent rumours about future plans for the Alan Gardner Unit. A statement from the Trust was tabled at our last meeting, however members continue to be deeply concerned that proposals are being developed without the opportunity for key stakeholders to inform this work.

Proactive engagement with all stakeholders at the earliest possible stage in planning services is a key part of effective patient and public involvement, and I hope that this will continue to be an integral part of Hampshire Partnership's approach to service development.

As a number of HOSC members have a significant interest in both the future of the Allen Gardner Unit, as well as in mental health services in the Andover area, I would be grateful if you could ensure that we are alerted to any emerging service changes at the earliest opportunity. I look forward to hearing from you in the near future.

Yours sincerely

Cllr Anna McNair Scott

Chairman, Health Overview and Scrutiny Committee

Appendix Four:

24 HOUR ASSESSMENT AND TREATMENT PROGRAMME

BRIEFING PAPER

JUNE 2008

1.0 Purpose of the Briefing Paper

This paper aims to provide an update to the Surrey and Hampshire County Councils' Health Overview and Scrutiny Committees on the Trust's 24 Hour Assessment and Treatment Programme to upgrade its acute inpatient facilities.

2.0 Background - Setting the Scene

2.1 Overview

Surrey and Borders Partnership NHS Trust was established on 1^st April 2005 from the 3 founder Trusts of Surrey Hampshire Borders, North Surrey Partnership Mental Health and Surrey Oaklands Trusts. The Trust became an NHS Foundation Trust on 1^st May 2008.

The Trust was formed to bring together the provision of mental health and learning disabilities services across the county of Surrey (all boroughs), North East Hampshire (Rushmoor and Hart) and Croydon; a population of some 1.3 million.

A single Trust was established as the best vehicle for achieving the following:-

o clear focus, critical mass and leadership to achieve major service improvements inherent in which is the full implementation of the national service frameworks and achievement of targets;

o longer term viability, stability and strength to build service improvements and develop a mixed range of providers including, for example, the voluntary sector;

o an organization built from the bottom-up with a clear locality focus set within a strong and supportive framework and;

o sensible and sound organizational infrastructure that supports high quality and financially efficient services inherent in which is integrated health and social care working.

Source: Commissioner's paper (Elaine Best) 2004/05

2.2 Strategic Direction - Service Plan

The Trust developed its Strategic Direction in its first 2 years of operations. Our service plan will deliver a service model which is based on the following key features:-

o Whole systems approach to delivering health and social care support

o Optimising strategic partnerships

o Person centred approaches to enable choice

o Mainstreaming - ensuring access for all

o Integration - creating virtual health and social care teams

o Changing professional roles

To achieve the key principles of the service model the Trust is moving away from traditional images and delivery to describe its services as:

o 24 hour assessment and treatment

o Specialist community services

o Psychological medicine

o Continuing care - health

o Community care - social

o Day services and work services

As part of our consultation on becoming a Foundation Trust (February - April 2007) we consulted on our Strategic Direction for these services this included our need to create new buildings for inpatient care and treatment on fewer sites" (Surrey and Borders Partnership NHS Trust consultation on Foundation Trust application).

2.3 Estates Strategy and Master Plan

One of the Trust's first pieces of work with its stakeholders, to "shape the culture" for the new organisation through the development of its Vision and Values, identified environments as a key priority for the Trust to work on improving. This has been enshrined as one of the Trust's four core values to "create respectful places".

The Trust inherited considerable estate portfolio on its creation. Overall the quality of the Trust's estate is poor. None of the inpatient units are considered to be "fit for purpose" and or able to provide modern therapeutic environments for people when they are acutely ill. (The exception being the Victoria and Albert wards at Farnham Road Hospital, Guildford extensively refurbished in 2004/05). The need for the replacement of these units through rebuild or extensive refurbishments had been identified by each of the founder Trusts and wider health and social care communities prior to the establishment of SABP.

There are 6 major SABP locations affected by the 24 Hour Assessment & Treatment programme:-

Farnham Road Hospital (Guildford)

Ridgewood Centre (Frimley)

Services on the St Peter's Hospital campus (Chertsey)

Services on the Epsom Hospital campus (Epsom)

Services on the West Park Hospital campus (Epsom)

Services on the Farmfield site (Gatwick)

Services in Farnham Centre for Health (Farnham)

Three of the Trust's units are influenced by the strategic plans for the general acute and community hospital campuses on which they sit. These are Abraham Cowley Unit, the Department of Psychiatry and Farnham Hospital. Two of the Trust's units have been subject to the development and approval of a previous Strategic Outline case by the founder Trust (Wingfield Ward and Noel Lavin Unit) involving stakeholders, including commissioners in Surrey and Hampshire.

The Trust's Estates Strategy v4 July 2006 was endorsed at the Trust's public Board meeting on 27^th July 2006. It sets out the Trust's intention that "all 24 hour care environments and community team bases will be improved by 2012".

3.0 24 Hour Assessment and Treatment Programme

3.1 Governance Structure

The Trust has established a 24 hour Assessment and Treatment Programme Board to oversee the development of options for the future provision of its inpatient facilities. Membership of this Programme Board includes senior representation from Surrey PCT, Hampshire PCT and County Council and people who use services and carers. Additionally the design of the new services is being developed through a user group structure which ensures active clinical engagement and further involvement of people who use services and carers for each of the care groups i.e. older people, adults and learning disabilities.

3.2 Involvement and Consultation

During 2007/08 the Trust began its pre-consultation work with stakeholders to start to develop the potential options for the re-provision of inpatient facilities in addition to building this into the governance structure described above.

To assist with this process and to ensure the options are well informed and robust the Trust has engaged the services of two external agencies to support its work

o Mental Health Strategies, a well respected research and market intelligence consultancy specialising in mental health services, to lead the option development work with stakeholders

o Laing O'Rourke as its building design and build partner

3.2.1 Pre-Consultation work

The Trust is keen to ensure that as many stakeholders as possible are involved in all stages of the project and, whilst committed to consulting fully publicly on the final options for the reprovision, has also built considerable pre-consultation work into its programme. This has included:-

o Operations Directorate's Service Improvement Manager, Fiona Davies visits to various stakeholder groups to inform them of the project and ways in which they can get involved e.g. the local Area Groups of the Trust's Forum of Carers and People who Use Services (FoCUS),

o The Trust wide Mental Health Acute Care Forum receives an update as a standing item on its agenda

o The PPI Forum had previously been kept advised of the project's progress and the emerging Surrey LNK's has been briefed on the impending need for public consultation

o Update reports have been received by the Trust's Care Environment and Amenities and Service Improvement Committees throughout 2007/08. These are Trust governance committees upon which people who use services and carers are members

o Stakeholder short-listing workshop held on 10^th March. Attendance at the workshop is listed in Appendix A together with the criteria used to develop the shortlist by those people participating

o An exhibition stand at the Trust's 14^th May Express Yourself event attended by 850 members of staff, people who use services, carers and partner agencies

o The Trust's newly established Council of Governors received a presentation on the Trust's service plan for 0809, highlighting the impending consultation, at its first meeting on 21^st May 2008

o Extraordinary meeting of the Programme Board plus invited stakeholders on 19^th May to further shortlist the options the Trust for further work prior to consultation (see Appendix B)

3.2.2 Public Consultation

The Trust intends to undertake a full public consultation on the short-listed options to determine the future of its inpatient facilities.

SABP has discussed the participation of the emerging Surrey LNKs in the consultation process which they are keen to do.

The Programme Board has a full communications plan which extends beyond the formal consultation process and continues to engage stakeholders throughout the design and build stages post consultation.

The outcome of the public consultation will inform the development of the Outline Business Case for the Trust's approval to take forward the plans. The current aim within the programme plan is to consult for 12 weeks from September 2008 (exact dates to be confirmed) in order to ensure the programme can continue on its current timetable and result in improved facilities for the people who use services, carers, visitors and staff by 2011/12.

4.0 Decision Making Criteria

The workshop on 10^th March and Programme Board meeting on 19^th May have used the following criteria to assess the options for the reprovision and decide on the most viable options to consult on for the reprovision.

4.1 Critical Success Factors

The Critical Success Factors agreed by the Programme Board are:-

Critical Success Factor	Definition
1. Strategic Fit	The option is consistent and creates synergies with other strategies at national and local level.
2. Value For Money (VFM)	The option provides reasonable economies of scale and scope and efficiencies, whilst maintaining standards of effectiveness in the delivery of care.
3. Achievability	The option is deliverable within the time constraints, site constraints, planning constraints and with acceptable processes for decanting and construction.
4. Supply Side Capacity and Capability	The option is feasible in terms of projected staffing capacity and skill mix.
5. Potential Affordability	The option is deliverable within the affordability envelope and agreed financial strategy.
6. Co-location and Critical Mass	The option is consistent with agreed principles for co-location and critical mass.

4.2 Benefits Criteria

The Benefits Criteria agreed by the Programme Board are:-

Accessibility. To be accessible, taking into account the income, mobility and travel patterns of service users, carers, visitors and staff. To support integrated and flexible access for inpatients to the care they require from other health and social care services	24.67
Modernised Care. To provide effective inpatient assessment and treatment linked to a modern range of community orientated mental health care services. Promote high quality clinical care for people, who require inpatient treatment (including ability to access the facilities they need within the site). To provide a therapeutic environment with access to internal and external space	21.33
Patient focus. To challenge stigma and encourage links with local communities and avoid institutionalisation.	13.00
Staff focus. To support the efficient use of staff resources and promote staff development and retention.	16.00
Safety. To be safe for staff and patients.	11.67
Flexibility. To provide flexibility for future changes in volume and client group in each facility.	8.67
Timing/deliverability Promote continuity and minimise disruption during the transition. Be deliverable within the agreed timescale.	4.67

5.0 Impact and Health Needs Assessment

Within the programme Mental Health Strategies have provided expert advice and benchmarking data to inform the number of beds required to meet the health needs of the local population using national best practice data. This analysis and service level has been agreed by both the Hampshire and Surrey Primary Care Trusts. In addition the PCTs' commissioning intentions for mental health services has been informed other commissioned strategic reviews of health needs in the areas they serve; Tessa Crilly report 2004/05 (Surrey and Hampshire) and Professor Wilson (Surrey only).

The Programme Board have been particularly concerned to assess the impact of each of the options on accessibility to services. This has featured as one of the key benefit criterias used at each of the options appraisal workshops and has been weighted significantly as one of the key areas of anticipated impact on communities. The option appraisal workshops were provided with an analysis of travel times both by car and public transport to assist with their assessment of options against this accessibility criteria.

6.0 Next Steps

This is a significant programme of work for the Trust and one of its key priorities to secure the improvements to its facilities which the vulnerable people it serves deserves.

The Trust is keen to discuss the consultation and ongoing communication and involvement requirements with the Overview and Scrutiny Committees in Surrey and Hampshire to ensure that these offer the greatest opportunity to involve its communities in this important piece of work.

Appendix A

24 Hour Assessment & Treatment Programme

10^th March Short-listing Workshop

1.0 Attendees

2.0 Description of Workshop Methodology

The Short Listing workshop was conducted on March 10th from 10 a.m. - 4 p.m. and attended by Trust staff, members of service user and carer groups, representatives from the PCT and members of the design team appointed to assist the completion of the Outline Business Case.

The workshop was divided into 6 tables and each table discussed whether options met the Critical Success Factors and then voted in terms of whether the option was likely or unlikely to meet the Critical Success Factors. If a majority of tables voted that the option was unlikely to meet the Critical Success Factors then the option was eliminated.

After a discussion on the meaning of the Benefits criteria signed off by the Programme Board, each attendee was given 7 votes to distribute between criteria according to importance. The votes under each heading were then expressed as percentages of total votes cast. On this basis weightings were assigned to each of the criteria.

The options deemed likely to achieve the Critical Success Factors were then assessed against the benefit criteria the idea being to reduce the list by eliminating any that are clearly unlikely to meet the scheme's minimum criteria. The scores were then subjected to the agreed weightings.

At the outcome of this workshop the number of shortlisted options remained high with eight new-build/refurbishment or ('intra-site') options, three site combinations (`inter-site options') and a `do minimum' option

The short listed options were to be subject to a financial and non-financial appraisal to create a preferred option for the Outline Business Case. Consultation will be sought with staff and user/carer groups through the project's User Groups.

The final options appraisal will be conducted in the Project Implementation Team with representatives invited from the each service area, each User Group and the PCTs.

24 Hour Assessment & Treatment Programme

19^th May Extraordinary Programme Board plus Stakeholders Workshop

1.0 Attendees

2.0 Description of Workshop Methodology

A special meeting of the Programme Board was held to review the shortlisted options (from 10^th March workshop) against the critical success factors, rank them in order against the benefits criteria and agree which options to carry forward for a financial appraisal.

The workshop included clinician, service user, carer and commissioner representatives as well as senior managers and directors from the Trust. The meeting was facilitated by the Laing O'Rourke P21 team engaged by the Trust.

A workshop to shortlist options had previously been held on 10^th March 2008. Following that workshop, the number of options remained high, with eight new-build/refurbishment or ('intra-site') options, three site combinations (`inter-site options') and a `do minimum' option.

Participants were grouped in tables, each consisting of a cross-section of Programme Board members and invited stakeholders. The workshop included representatives of both Surrey and Hampshire PCTs. The facilitators explained the process as a whole and the benefit criteria. Each group discussed the options and agreed scores, or took an average of individual scores. The group scores were recorded and an average of the three groups was taken.

Based on the results it was agreed that the leading options plus back up options would be subjected to an economic appraisal to determine the preferred option on value for money grounds.

Appendix Five: Access to Tier Four Mental Health Services

NHS services for people with personality disorders have been defined in terms of 6 tiers, graded from mild severity, low cost and high volume at Tier 1, through to extreme severity, high cost and low volume services at Tier 6. South West London and St Georges Mental Health NHS Trust has historically managed a Tier 4 service from the Henderson Hospital in Surrey provided to clients drawn from across south east England.

The service has temporarily closed and a public consultation on the provision of Tier 4 residential services will commence in September 2008 with a report on the outcome expected in May/June 2009. No Hampshire resident currently uses the Henderson service.

Because of the size of the population served, the Tier 4 consultation will be undertaken jointly by 62 PCTs across 4 Strategic Health Authorities (and 4 specialist commissioning groups). West Kent PCT will lead the process, with South East Coast SHA performance managing the process. In order to ensure legal compliance, it has been necessary for each of the 62 PCTs to formally support the establishment of a time limited Joint specialist Commissioning Group committee for the sole purpose of agreeing the process and deciding final outcome of the consultation. This support has been sought on the basis that the final decision of the committee would be binding on all members.

Appendix 6: Specialist Palliative Care Services at Southampton University NHS Trust

Due to extreme operational pressures compounded by consultant staff sickness, the Specialist Palliative Care Service at Countess Mountbatten House, which is part of Southampton University Hospitals NHS Trust, will be restricting referrals to the Community service as from today, Monday 9 June for a period of five weeks, recommencing full services on Monday 14 July 2008.

We are actively recruiting medical staff and nursing support and will have this in place by Monday 7 July 2008.

Patients should be referred as usual from General Practitioners and, as always, the referrals will be screened by the Palliative Medicine Consultants. They will contact the General Practitioner to establish the urgency of input and to discuss alternative methods of seeking help for these patients. If the referral is taken by telephone, the secretaries will ask for the easiest form of contact.

Regrettably, referrals from Consultants and Clinical Nurse Specialists cannot be accepted directly during this period.

If you have any questions about this, please contact Sarah Shahid, Care Group Manager, Cancer Care at Southampton General Hospital, tel 023 80 795294 For any clinical issues, please contact Dr David Butler, acting Lead Consultant at Countess Mountbatten House, tel 023 80 475302. We will update you by Monday 30^th June at the latest.

We will be monitoring the impact of this step. We will attempt to minimise the impact for patients as much as possible and thank you for your understanding at this time.

Appendix Seven: Briefing Paper for the Health Overview & Scrutiny Committee

Community Palliative Care Service provided by Southampton University Hospitals Trust (SUHT) at Countess Mountbatten House - Update

Summary

This Briefing Paper is intended to answer questions raised recently about the Community Palliative Care Service provided by SUHT at Countess Mountbatten House in Southampton.

Background

The SUHT Specialist Palliative Care (SPC) Team based at Countess Mountbatten House (CMH) provide an NHS specialist palliative care service for patients with advancing cancer and for their families.

The restriction of referrals to the Community Service of the Specialist Palliative Care Team commenced on June 9, 2008 for an anticipated period of five weeks.

During this period, all referrals to the SPC Team have been screened, triaged and managed by the SUHT Palliative Medicine Consultants, resulting in the caseloads for most of the Clinical Nurse Specialists working with the patients in the community returning to manageable levels.

Alternative arrangements

The SUHT Specialist Palliative Care (SPC) Team agreed to prioritise patients during this five week period.

A letter was also sent to GPs in the western wards of Fareham, the Gosport area and the east of Southampton area border, from the SPC Team based at The Rowans Hospice in Waterlooville. This letter included an offer to see any patients GPs wanted to refer, with an assurance that if patients needed to be admitted to a hospice bed they could still access Countess Mountbatten House.

The effect on patients

The expectation was that, based on the current rate of referrals, there would be approximately 75 community referrals for the whole service that would require triaging by the consultants (there were 80 in five weeks leading up to the closures).

To date, Consultants have triaged 65 community referrals, (48 from Hampshire Primary Care Trust) resulting in plans for either ongoing support when the community service is reinstated, or direct admission to the inpatient unit at Countess Mountbatten House. The indications are that only one patient from Hampshire Primary Care Trust (PCT) has been admitted as a direct result of the restriction on the community service.

15 patients have been seen by the hospital palliative care team at Southampton General Hospital and these have not been referred onto the community team (approximately 2/3 of these were from Hampshire PCT). In addition, five patients have been seen by the palliative care team at the Royal Hampshire County Hospital in Winchester and these too have not been referred onto the community team (all of these patients are from Hampshire PCT).

The current status and plans for reopening

The plan is to resume normal service on July 14, 2008.

An additional Band 6 Clinical Nurse Specialist (CNS) has been appointed to work across the community service supporting the current CNSs. This post is currently filled through a secondment from the inpatient unit at Countess Mountbatten House. Further support has also been allocated to the community team, including appropriate administrative support.

The Consultants and CNSs have discussed new ways of working in order to prevent this situation from reoccurring.

The locum Specialist Palliative Care Consultant post has not been filled but this post has been re-advertised and there are plans for six months locum support.

Staff issues

The PCT is satisfied that SUHT took appropriate staffing action following recognition of staffing problems within the service in May 2008 and responded to a deterioration in nursing capacity vs. demand by commencing recruitment. This took place prior to SUHT's decision to reduce service provision on a temporary basis.

It is disappointing that the situation was approaching critical before actions were initiated, and this issue will be discussed further with Trust in order that actions can be agreed to avoid any repetition. Smaller specialist services such as specialist palliative care are unfortunately relatively vulnerable.

Lead Consultant sickness absence was probably more difficult to foresee, although the PCT does not believe that this alone would have caused curtailment of services. The service will recommence in full (see above) but SUHT has acknowledged that in the event of an extension/recurrence of such absence, a staffing contingency will be required.

Funding

An additional £450,000 per annum was made available by local PCTs commencing April 01, 2008. This was in return for a commitment from SUHT to maintain the existing service levels. Additional investment has since been agreed between the organisations to enable the commencement of specialist palliative care services for Motor Neurone Disease; an early date for this to begin is being sought.

A shortfall has occurred in funds which were agreed to be raised through the Countess Mountbatten 30^th Birthday Appeal. The Countess Mountbatten Hospice Charity Limited (formerly Friends of Countess Mountbatten House) has made a very kind offer to support that shortfall in 2008/09, subject to prior assurances regarding the need for, and use of, this funding.

PCTs are working with SUHT and have requested income and expenditure budget information in order that we can be assured that investment is being effectively applied to improve services, a further meeting is scheduled to review this information.

11^th July 2008