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. This up-date from SUHT is attached at Appendix One.

2.2. It is anticipated that the birth centre will be completed in August, in line with the timetable set out by SUHT.

Recommendations

2.3. Members receive any additional information requested from SUHT.

2.4. SUHT continues to provide the HOSC with regular up-dates on progress with the development of the Ashurst site.

Items for Action

3. West Sussex PCT: Acute Service Reconfiguration

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

3.2. The JHOSC will meet again on 23 July to consider if it is satisfied with the additional information provided by the PCT. All options for action remain open to the both the JHOSC and Hampshire HOSC, including referral to the Secretary of State, should Members consider this appropriate.

Recommendations

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

3.4. Cllr Wright and Cllr Buckley continue to represent the views of Hampshire at subsequent JHOSC meetings

4. South Central SHA: Consultation on proposals to fluoridate water in Southampton and South West Hampshire

4.1. Following a paper to the SHA Board on 28 May, HCC has received a letter (Appendix Two) confirming the intention of the Authority to consult on proposals to fluoridate water in parts of Southampton and south west Hampshire. It is anticipated that this consultation will proceed on 4 August.

4.2. Southampton PCT has asked the SHA to take the consultation in line with the relevant legislation as a means of addressing poor oral health in 7 of 11 deprived areas within Southampton City. The proposal affects 36,000 Hampshire residents as the homes served by the water treatment facilities include part of the populations of Eastleigh Borough, New Forest District and Test Valley Borough. These populations do not have the same dental health challenges as Southampton.

4.3. Advice provided by the Department of Health explicitly excludes the HOSC as a statutory consultee in this matter. Nevertheless the HOSC is able to investigate this issue in its own right and, as requested by the Leader, provide recommendations for discussion by the full County Council in November.

4.4. A letter from the Chairman setting out a number of issues to be addressed by the SHA is attached at Appendix Three. Additionally the SHA is expected to confirm that the response sent by HCC following its meeting on 20 November will be included in the consideration of the responses received. It is anticipated that the SHA Board will come to a view about whether to proceed or not at its meeting in late January 2009.

4.5. A short paper setting out a proposed way forward is attached at Appendix Four.

Recommendations

4.6. Members agree the proposed way forward

4.7. Where necessary planned work programmes are adjusted to allow appropriate officer support to be provided to members on the Review Group.

5. Department of Health: Transforming the Quality of Dementia Care

5.1. The Department of Health has launched the above consultation. Details of this 85 page document can be accessed at http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_085570

5.2. In order to maximise the opportunity to influence the response of central government to this key issue it is proposed that the HOSC, Hampshire Adult Services and Hampshire PCT submit a joint response.

5.3. The consultation closes on the 11 September 2008.

Recommendations

5.4. Members agree to a joint response from Hampshire HOSC, Adult Services and the PCT to the Department of Health

5.5. Any member wishing to include comments or contribute to the consultation should contact the Chairman or scrutiny manager by 15 August.

6. Department of Health: National Health Service Constitution

6.1. Included with the report from Lord Darzi's review of the NHS is a proposal for a legally enforceable constitution for the NHS.

6.2. The draft constitution embraces the following:

_ principles and values of the NHS;

_ rights of patients, the public, and staff;

_ pledges which the NHS will strive to deliver;

_ responsibilities for the public, patients and staff.

6.3. An example of a patient responsibility is that they should take some personal responsibility for their own health. An example of an NHS value is `compassion' - `we find the time to listen and talk .... not because we are asked to but because we care.' The NHS and contracting organisations will be required by law to take account of the constitution. It will be renewed every ten years and accompanied by a three-yearly handbook.

6.4. The consultation will run to the 17 October and can be accessed at http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_085812

Recommendation

6.5. Any member wishing to include comments or contribute to the consultation should contact the Chairman or scrutiny manager by 3 September.

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: New Forest Birth Centre Ashurst

Progress Report

Construction Update

Phase 1 of the New Forest Birth Centre to provide 2 birth rooms, 7 postnatal beds and associated accommodation is currently under construction. The programme is on schedule for a completion date of 19 August 2008 and the project remains within budget.

A plan for parking arrangements within the existing hospital grounds is being developed.

Communications and Marketing Update

Hampshire PCT and SUHT Communication leads have met and a strategy for promoting the `New Forest Birth Centre' has been agreed. A letter to GP practices is being distributed and the development of web based information as a joint initiative between HPCT and SUHT is underway.

Users of the Maternity service along with staff members have chosen the colour schemes for the Birth Centre and the names of the birthing rooms.

The design and content of a promotional leaflet for the Birth Centre has been distributed for wide consultation and will be ready for distribution shortly.

As the opening approaches, opportunities for media coverage will be exploited and this may be focused around fundraising activities for the new centre.

Capacity Update

The SUHT Maternity Service is currently undertaking a detailed review of capacity to inform the detailed functional content to be included in Phase 2 of the Birth Centre. The area to be occupied in Phase 2 has been identified within the draft lease documentation.

Appendix Two: Letter to HCC alerting members to consultation on proposals to fluoridate water in Southampton and South West Hampshire

16 June 2008

Cllr McNair-Scott,

Chair

Hampshire HOSC

Dear Cllr McNair-Scott,

At a Board meeting held in public on 29 May 2008, South Central Strategic Health Authority (SCSHA) approved the decision to enter into a public consultation in Southampton and parts of South West Hampshire about water fluoridation. You will be aware that this is in response to a request by Southampton City PCT to the predecessor SHA to consider fluoridation in the Greater Southampton area.

It must be emphasised that no decision to fluoridate water supplies has been taken, and that the decision made at the Board meeting relates solely to proceeding to a public consultation. It is important that before any decision is made, that everyone who lives and works in the area has the opportunity to look at the available facts and have their say.

The consultation, which will last a minimum of 12 weeks, is planned to begin during August and will be an open and transparent process which will be widely publicised in the press.

The SHA will be in touch with you again in the near future to continue this process of engagement with you and to provide an opportunity to meet on this issue prior to any formal consultation beginning and provide you with further information.

Yours sincerely

Olga Senior

Director of Communications and Corporate Affairs

Appendix Three: Letter to South Central SHA

Dear Mr Easton

SHA consultation: Fluoridation of Water in Southampton and South West Hampshire

I am writing further to the letter of 16 June from your Director of Communication and Corporate Affairs alerting the Hampshire Health Overview and Scrutiny Committee (HOSC) to the fact that this consultation was forthcoming. Whilst it would have helped our scheduling to have been aware of this work earlier in the year we are nevertheless keen to contribute to the consultation process. We have also noted with disappointment the exclusion of this proposal from formal scrutiny by the HOSC. This emphasises the importance of adherence to the relevant Cabinet Office Guidance as this process rolls forward.

We understand the SHA is intending to go to consultation in August and would ask that the following points are taken into account:

_ There are wide-ranging views on this issue and it is essential that the SHA provides enough information to local people about the arguments for and against fluoridation to help them come to an informed view. Selective use of the available literature has previously been criticised from an ethical point of view and we would hope that any documentation and supporting material provided by the SHA will properly reflect the different positions of proponents in a balanced and measured way.

_ This is a complex issue and commencing formal consultation in August when many people are away may limit opportunities for debate and discussion. We understand that the SHA is intending to extend the recommended period of consultation to take account of this point and would welcome confirmation of the expected dates as soon as possible.

_ This issue is likely to be of intense local interest and as such democratically elected representatives should have had full opportunity to feed views into this debate. We are setting in place arrangements to ensure that the SHA receives detailed comments and recommendations from the County Council however our meeting cycle means that we will not be able to provide this until 20 November. I would be grateful if you would confirm that this is acceptable and will still be able to inform the deliberations of the SHA Board. I believe that Southampton City Council have made a similar request.

We very much appreciated confirmation from the SHA that the findings of the initial stakeholder views had been withheld because of the concerns raised by the former Chairman of the HOSC and look forward to working with you and your staff as this process rolls forward.

Yours sincerely

Anna McNair Scott

Chairman, Health Overview and Scrutiny Committee

Appendix Four: Hampshire County Council

Health Overview and Scrutiny Committee: Review of South Central SHA proposals to fluoridate water in Southampton and South West Hampshire

Background

1. The South Central Strategic Health Authority (SHA) is intending to go out to consultation in August 2008 regarding the proposal to fluoridate the water at two distribution plants serving part of the population in Southampton and south west Hampshire. The proposal has been put forward by Southampton Primary Care Trust (PCT) to help redress dental health inequalities in the city of Southampton, as other methods have so far failed to make an improvement. Fluoridation is presented as having the potential to reduce levels of tooth decay in the areas receiving fluoridated water. The proposal affects 36,000 Hampshire residents as the homes served by the water treatment facilities include part of the populations of Eastleigh Borough, New Forest District and Test Valley Borough. These populations do not have the same dental health challenges as Southampton.

2. Historically fluoridation has been a controversial issue. In September 1977 Hampshire County Council accepted a recommendation from the Policy and Resources Committee that proposals to fluoridate water put forward by the Health Authority `did not command widespread support from the public at large and should not be pursued'. The controversy has not diminished over time there are passionate and articulate arguments put forward both for and against the addition of fluoride to water. A local newspaper has already initiated a campaign on the issue.

3. A letter from the Chief Dental Officer in February 2008 states that `as the fluoridation of water is undertaken by water undertakers within the powers of the Water Industry Act 1991, we do not consider it to be a `substantial variation or change to health services'. Therefore the Hampshire Health Overview and Scrutiny Committee (HOSC) is precluded as a statutory consultee in this case. The HOSC will not therefore be required to form a joint committee with Southampton City to consider this matter but can investigate the issue in its own right and, as requested by the Leader, provide recommendations for discussion by the full County Council.

4. In coming to a view on the proposal the SHA is required to `have regard to the extent of support of the proposal and the cogency of the arguments advanced'. In doing so the SHA cannot base its decision on a simple count of the responses but needs to take account of:

_ The quality of the evidence presented

_ The relevance of the representation to the health arguments in relation to fluoridation

_ The nature of the individual/body making the representations. In particular `attention may need to be given to representative bodies' and when analysing the responses to understand... `the methodology used to gain members input into the responses'.

5. The HOSC will therefore take a keen interest in the means by which the SHA manages the decision making process and carefully consider the options open to it if there are any concerns about the impact of this decision on the health of people living in Hampshire.

6. The consultation document produced by the SHA states that `the SCSHA is not specifically required to assess the scientific or ethical arguments in favour of water fluoridation before proceeding to consultation, although it may wish to take these into account when making the decision'.

Scope of the Review

7. In order to most effectively influence the views of the SHA it is essential that the Review Group appointed to take this work forward carefully considers the range of evidence and authoritative arguments for and against the proposal from Southampton PCT. The polarised positions that exist cross both professional and lay interests in this matter, as such the evidence presented will require careful examination and assessment, with a particular focus on the `cogency' of the views expressed. This is a complex issue and will be challenging for members in such a short timeframe.

8. It is also essential that local people are clear that the County Council and other local authorities affected are consultees in this process. It would be appropriate however for the Review Group to ensure that the evidence considered is available to any interested parties intending to respond to the SHA. The Review Group will also seek to maximise democratically elected member input into this process by working closely with all local authorities affected.

Aims:

9. To provide an informed, considered opinion to the Strategic Health Authority regarding the acceptability of the proposed fluoridation scheme which affects Hampshire residents.

10. Evaluate the content and conduct of the consultation exercise and the way in which the feedback received is weighted and presented to the SHA Board.

Process:

a) Review written evidence, from national and international sources, regarding the fluoridation issue

b) Invite written and verbal evidence and comment from key experts and local stakeholders

c) Taking account of the evidence received, scrutinise the proposals and how they may impact on the population affected

d) Weigh up the case and come to a conclusion regarding the suitability/desirability of the scheme

e) Monitor the content and conduct of the consultation and the weighting of the responses received by the SHA Board.

Terms of Reference

11. The terms of reference of the Review Group will be:

12. To consider the benefits and risks associated with the artificial fluoridation of water supplies to people living in south west Hampshire, recognising the intended benefits for target populations in Southampton City, and to reach a view on whether the proposal should be supported as a public health intervention.

13. This will include consideration of:

a. The effectiveness of water fluoridation in improving oral health

b. The availability of alternative strategies for securing this objective

c. The potential benefits and risks associated with the fluoridation of water, taking account of the available evidence

d. The ethical issues raised by the proposal

e. The legal and technical matters to be addressed

f. The views of relevant experts and key stakeholders.

g. The content and conduct of the consultation exercise and the way in which the feedback received is weighted and presented to the SHA Board, taking full account of Cabinet Office Guidance.

Exclusions

14. The review will not be inviting comment from the general public, as they will be able to make their views known directly to the SHA as part of the consultation exercise.

15. Feedback provided that is anecdotal or based on individual experience. All commentaries of this nature received will however be passed to the SHA for its consideration

Deliverables

16. The Health Overview and Scrutiny Committee Review Group will produce a report setting out its views, including a recommended position to be discussed by full County Council on 20 November 2008. This report and the views of the County Council on the proposal will then be provided to the SHA in time to inform their decision, expected in late January 2008.

Review Group Membership

17. The Chairman of Health Overview and Scrutiny Committee, Cllr Anna McNair Scott, will appoint a panel of Councillors to form the review group which will weigh up the evidence, to be largely drawn from the members of the Health Overview and Scrutiny Committee.

18. Observers with speaking rights will be invited from New Forest District Council and Eastleigh Borough Council, Test Valley Borough Council and Hampshire LINK.

19. All County Councillors will be alerted to this work and invited to attend the evidence giving sessions.

Key Dates

· Thursday 4 September 2008 - initial meeting of review group

· Thursday 25 September 2008 - first select committee evidence giving session

· Monday 6 October 2008 - second select committee evidence giving session

· Tuesday 28 October 2008 - review group meet to agree conclusions

Impact on other work

20. This is unplanned work to be taken forward in the coming year. If this proceeds there may be a consequential impact on planned work programmes as additional work associated with this review will be managed within current support team capacity.

Appendix Four