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 Partnership NHS Trust & Hampshire Primary Care Trust

Andover Area Older Peoples Mental Health Service

Update to Hampshire Overview and Scrutiny Committee

1.0 Purpose

1.1 The purpose of this document is to update the Hampshire Overview and Scrutiny Committee (HOSC) on the progress and processes of public and patient engagement work on the development of Older Peoples Mental Health (OPMH) services in the Andover area carried out jointly between Hampshire Primary Care Trust and Hampshire Partnership Trust.

1.2 The paper asks the HOSC for its guidance on further process.

2.0 Background

2.1 Changes to services are being made throughout the NHS. The aim is to give people more independence and control over their lives. This means a move away from the traditional services based around hospital beds, to increasing the services provided in the community settings and wherever possible the patient's home. There will continue to be a need for a range of bedded services from hospitals through to intermediate residential and nursing home care, and any plans must ensure there is the right balance for current and future needs.

3.0 Drivers for Change

3.1 Hampshire Primary Care Trust and Hampshire County Council have recently published the Joint Hampshire Commissioning Strategy for Older Peoples Mental Health for the period 2008 to 2013. In developing the strategy consultation was very wide across statutory bodies, voluntary organisations and user groups. Organisations now need to begin implementing the strategy and planning services.

3.2 The strategy identifies challenges within the local mental health services in terms of population changes, growing demand for services and a pressure on resources.

3.3 It identified the key priorities for Hampshire Primary Care Trust and Hampshire County Council:-

· Supporting carers

· Promoting independence and access to universal wellbeing services

· Balancing specialist and generic services

· Pathways in and out of hospital

· Mechanisms to enable organisations and individuals to work together towards shared goals

3.4 In light of these a number of drivers for change in the Andover area have been identified:-

· There is not as wide a range of community services in Andover area as in other areas

· Services are not always integrated with those provided by other care providers

· Not enough people get the care they want in their own home

· Patients who need help quickly in a crisis may have to wait or be admitted to hospital

3.5 There is also an imbalance in the use of resources. Over the 9 month period (January - October 2008) on average 5 of the 8 beds at the Allan Gardner Unit were in use at any one time. The average cost per bed is twice the national average cost for this type of care. As a consequence, resources are being tied up that could be available to improve the range of community services on offer to patients.

4.0 Process of Consultation to date

4.1 The public engagement work has been undertaken jointly by Hampshire PCT and Hampshire Partnership Trust.

4.2 This work involved meeting with a range of local groups, staff, GPs and local elected representatives in Andover area to hear their views about current service issues, what needed to be addressed as a priority and the type of service model that should be developed in the future. The presenters took questions and answers and recorded the views of those present. Sessions lasted from 30 minutes to two hours depending on group size and interest.

4.3 Discussion was based around a set of storyboards presented as flipcharts, a copy of which is attached as appendix 1.

4.4 During the public engagement period the team met with approximately 200 individuals, including members from the following groups:-

· Alzheimer's Society

· Alzheimer's Carers Group

· Age Concern

· Andover MIND

· Mencap

· Hampshire LINk

· Local GPs via Practice Based Commissioning Group

· Princess Royal Trust for Carers

· Local User Carer Reference Group

· Staff from other organisations

· Hampshire Partnership Trust Governors

4.5 The Andover OPMH staff have been fully briefed during the public engagement and in addition have attended two staff workshops.

4.6 A cross organisational steering group was convened to steer the engagement work and project. This includes members for Hampshire Primary Care Trust, Hampshire Partnership Trust and Hampshire County Council.

5.0 Common Themes from discussion with local groups

5.1 The engagement with the various groups, organisations and individuals has revealed three core themes with a number of elements for each, which will need to be considered when options are created and evaluated:-

5.2 A need for Improved Information and Support

Services users, carers, local groups and elected representatives have asked us for:

· Better Information for users and carers to be easily available at the appropriate time.

· Better Information about mental health conditions and how to access services and benefits.

· Support for carers in making life changes.

· Improved resources for carers and patients, signposting and help.

5.3 Improved Working with Other Organisations and Services

Services users, local groups, staff and elected representatives have asked us for:

· In-reach into Nursing/Care Homes to provide education and support to staff to improve patient experience.

· In-reach into Acute Care to provide education and support to staff to better look after patients with mental health needs in acute hospitals.

· A service for younger people with dementia and learning disabilities including Down's Syndrome that meets these care needs.

· Better working with other agencies to provide more joined up working between agencies so that patients get better care.

· Support to GPs to assist in quicker identification of mental health needs in older people and diagnosis of dementia.

5.4 Enhanced Service Provision

Services users, carers, staff, local groups and elected representatives have asked us for:

· Local services for local people within Andover including access to beds when necessary.

· An Out of Hours Service to support carers, particularly during weekends and at night.

· An Intensive Support Service to respond quickly, and visit a patient a number of times daily for a short period, to avoid unnecessary hospital admission.

· The Allan Gardiner Unit should continue to provide mental health services.

· Better End of Life care for mental health patients.

· Improved memory assessment and education services for patients and their carers.

· Improved provision of respite services (bedded and un-bedded) to enable the carer to have breaks from care and enable the patient to remain at home for longer.

6.0 Next Steps

6.1 In order to improve services for patients, the steering group have proposed the following steps:-

1. Draw together all information from the public, patient and clinical engagement to date

2. Using this information key agencies including voluntary sector providers will work together to develop a range of options.

3. These options will be taken to a larger stakeholder workshop to develop a realistic, affordable preferred option.

4. Agree the preferred option with Hampshire PCT and Hampshire Partnership Trust boards

5. Report the outcome of options and preferred option to HOSC

6.2 The above process will allow service users and local advocate groups to shape a realistic, affordable service model. This preferred option will then be adopted as the way forward, subject to Board and HOSC approval.

6.3 The HOSC are asked for advice and comments on the proposed next steps as recommended by the inter agency steering group.

Matthew Shehan

Eileen Spiller

January 2009

Appendix Three

Presentation on Hampshire NHS Campus projects, for HOSC

February 3^rd 2009

What?

· There are 2 projects: the Locally Based Hospital Unit (LBHU) reprovision project and the Hampshire NHS Campus project.

· The LBHU project covered SW Hampshire (New Forest) and Eastleigh areas, and the NHS Campus project is covering Fareham, Gosport, Havant, Liss (Petersfield) and Basingstoke.

· The SW Hampshire project is now complete, and has been recognised as one of best practice by the Dept. of Health; and the Hampshire NHS Campus project is in the initial assessment phase.

Why are there any projects?

· Valuing People (2001), Valuing People Now (2007) and Our Health, Our Care, Our Say (2005) focused attention on the needs of adults with a learning disability and recognised that most of these people did not need to be in-patients, in order to meet their needs.

· What they did need was more choice in where they lived and who they lived with; the right to choose their GP and be able to access all the primary and secondary care services available to the general public; to live in ordinary housing, with adaptations (but only where needed); the right to choose who provided their support; to access the full range of financial benefits they were entitled to and to have the same housing rights as any one else. As in-patients this was not possible.

How?

· Each individual was subject to a comprehensive, holistic assessment process, in order to determine, not just their needs, but their wishes too. This was carried out using a multi-agency team, including advocates, person centred planning (PCP) facilitators, health specialists, current support staff teams, and was lead by Care Managers. The Care Managers, advocates, PCP facilitators and some of the health specialists were appointed specifically for these projects.

· Families were also consulted with at every stage of the process.

· A full time Project Manager was appointed to ensure delivery of the projects.

· The results of the assessment work identified who people wanted to live with, where they wanted to live, any adaptations they needed to be able to lead as independent a life as possible and how many staff they needed to support them. (All these individuals needed 24 hour, 7 day per week support, as they have very complex needs, but some also needed additional staff support at different times of the day and night)

· From this information housing specifications were drawn up, for each group/property, and these were passed to the Housing Partner, who then purchased and adapted properties, or provided new builds.

· The Housing partner could be a Registered Social landlord (RSL) or it could be a Housing Charity, and they were appointed following an open tender process.

· The Housing partner then act as landlords and each person has a tenancy agreement. This gives individuals housing rights.

Consultation (see consultation spreadsheet)

· As much information as possible is collected from the service users, however, in most cases they do not have verbal communication, so others close to them are also consulted. Each service use has a communication plan.

· Families and staff are an extremely valuable source of information and support and so are included in every stage of the process. There is a Project Structure to ensure the delivery of the Projects and this includes a Communication task group. This group is responsible for drawing up a Communication Action plan and implementing it. One of the tools used is a newsletter which is published quarterly. This is sent to all the stakeholders including, relatives and staff. As service users all have their own individual means of communicating the advocates and support staff have a key role in passing this information on to people, in the most appropriate way.

· The Project Manager and Lead Commissioner, from Hampshire PCT, have recently met with Mark Hoban, MP to explain the project to him, in person, as he had written to enquire. A letter is also going out to all the MP's who have constituents in the different areas.

Outcomes

· The Hampshire Campus project is still in the assessment phase, and needs to be completed by end of 2010 (Valuing People Now). This is going to be a difficult deadline to meet, as there are 72 people in the project, but we are on track at present.

· The SW project was completed in November 2008. 66 people were moved from LBHU's. Of these a small percentage moved to residential homes, because of their needs, and so the majority of people moved into their own homes.

· A DVD has been produced to capture the process of the projects and the outcomes for people.

· The results have been truly amazing! In general terms people have become much more active, grown in confidence, are much happier, are making more choices, and are now part of ordinary communities. We were always confident that this would improve people's lives, we just never realised how much!

Jo Hooper

Project Manager

January 2009

Hampshire NHS Campus Project

Plan and Record of Communications and Engagement Activity held as part of Service Change

We aim to carry out informing and engagement activity that will:

· Take account of the individual communication needs of service users

· Ensure that service users, their relatives and staff shape the development and implementation of the project

· Meet the statutory duty to engage under Section 242 of NHS Act 2006

· Meet the requirements of equality legislation

The entries below are in addition to ongoing meetings which the care managers and advocates have with service users, families and staff to inform the assessment process.

Following extensive discussion at Communication task group meetings it was felt that service users would be kept informed by advocates and support staff, who could then adapt communications and information to individuals, depending on their needs.

Key: Pink areas: Information to relatives

Yellow areas: Information to professionals

White areas: Information to professionals, via Communication Task Group

Brown areas: Information to MP's/ Councillors

Appendix Four: Letter to SCAS Chief Executive 22 December 2008

South Central Ambulance Performance Times

I am writing by way of follow-up to the presentation you gave to Hampshire and the Isle of Wight HOSCs on 9 December. I understand that this was very helpful in setting out the challenges facing the ambulance service and that one of the issues discussed included options for other models of care to be commissioned by PCTs. One of the models that generated strong member interest was the suggestion that PCT commissioners may wish to agree to differential response times for calls to rural and urban settings. This would be a significant change from our perspective and a matter of deep concern given the rural nature of much of Hampshire. We have asked Hampshire PCT for their views on this matter and they have confirmed that this is not a change that they consider to be viable or acceptable and they will not therefore be pursuing this further.

Hampshire as a county seems to be consistently the worst performing division in the South Central area, particularly when the response times for the urban areas of Portsmouth and Southampton are excluded. Although we are aware of the national reports of additional pressures on ambulance services my sense is that this is an issue that we would like to follow up more formally as a HOSC. We are receiving an increasing amount of anecdotal information about long waits, sometimes up to an hour, for an ambulance to arrive at the scene of an accident. Looking at your website the performance data for Hampshire for the week commencing 14 December show that just 58.34% of category A calls were responded to in 8 minutes.

I know that there is some additional information outstanding from the 9 December meeting that you are arranging to be sent to us. Once we have this we will be better placed to decide how best to proceed. In the meantime if there is any further information you can send us which would help us to understand what is being done to improve the performance of the ambulance service in Hampshire this would be greatly appreciated.

Yours sincerely

Anna McNair Scott

Chairman, Health Overview and Scrutiny Committee

Cc Hampshire HOSC members, South Central HOSC Chairmen, Gareth Cruddace, Chief Executive, Hampshire PCT, Jim Easton, South Central SHA, Sarah Smart, South Central SHA

Appendix Five: SCAS response: 23rd December 2008

Thank you for your letter regarding Performance times. Myself and colleagues

prepared and presented a comprehensive presentation to the combined Hampshire,

Portsmouth, Southampton and Isle of Wight HOSC meeting on the 9th December

2008.

We spent considerable time answering questions and discussing how best to engage

with stakeholders and found suggestions from your colleagues along these lines

helpful. I had assumed that this process would be in place of the individual HOSC

meetings, although I would be happy to attend the Hampshire HOSC should you wish.

We realise that variation in response times is a sensitive issue. SCAS is not

proposing differential response times for different areas. We are presenting the fact

that this is, and always has been the case, and trying to explore with stakeholders and

commissioners what is an acceptable model given that SCAS' current targets are

region-wide. Your colleagues had some useful suggestions on this from their

involvement with the Hampshire Fire & Rescue Service which we are taking forward.

Oxfordshire & Buckinghamshire Division.

I want to increase confidence in the Ambulance Service in Hampshire, although I am

aware it has had problems in the past. The service is now much improved and

continuing to improve very quickly. When Performance Improvement Plans were first

developed to meet the new "Call Connect" standards in 2006 Hampshire was one of

the lowest performing services in the country. Hampshire Division of SCAS achieved

the new national standard of 75% of Category A calls in September and October of

this year, and performance for the year to date exceeded that of our Oxfordshire &

Buckinghamshire Divisions.

With regards to differential performance, SCAS has been improving performance in

every area, urban and rural. Hampshire PCT performance on the 8 minute response

time standard improved from 45% in April 2007 to 65% in April 2008 and from 47% in

October 2007 to 70% in October 2008. For any organization these are dramatic

improvements. You are right that all Ambulance services are struggling to perform

with the exceptional call volumes that we have experienced since the beginning of

December. You have quoted probably the worst performing week of the year in your

letter!

The Ambulance service in Hampshire who responds to around 750 calls a day, on a

very few occasion there are delays as a consequence of the pattern of calls. We

recognize that these are unacceptable and investigate the route causes thoroughly.

We continually plan and adjust our resources to respond to every patient effectively. I

would be happy to investigate the delays you mention if you could provide me with the

time and location. I am pleased to say that the performance improvement in the

service this year has led to a reduction in complaints to the Trust.

I look forward to working closely with you and colleagues and am happy to attend the

Hampshire HOSC at any time in the future.

Appendix Six: Follow-up letter to SCAS: 20 January 2009

South Central Ambulance Performance Times

Thank you for such a prompt response to my letter of 22 December and arranging for us to receive the additional information about the performance of SCAS, including the delayed turnaround times that can be experienced at Accident and Emergency Departments.

Now that I have had the chance to review these reports and discuss key issues with colleagues I think there are some specific areas where it would be helpful to have additional information. These are:

· How the Trust reviews the reasons for ambulance response times that miss national targets, particularly for Category A calls. We would be interested in the actions you take with regard to response times that exceed 30 minutes, including how this data is collected and any patterns or trends identified. It would be helpful to know how many Category A calls in Hampshire were not responded to within 30 minutes in the year to date.

· As I indicated in my e-mail of 24 December we are receiving anecdotal reports through both local the media and elected members of ambulances failing to attend following a Category A call. I would therefore appreciate additional information about the way in which information about ambulances failing to respond to a Category A call is collected and analysed, the number of occasions on which this has happened in the current year and the reasons for this.

· The information relating to the performance of SCAS by ward area in Hampshire. I know that your colleague has spoken to our officer about the difficulties you are experiencing in replicating this information although it was possible for this to be provided last year. It would be enormously helpful if you could provide this analysis.

· We have scheduled an update from SCAS about the new CAD system for our meeting in July, once it has had a chance to bed in. However if you have any information about its impact to date we would be most interested to have this. We have had some reports that there have been problems with the duplication of ambulances responding to a call out.

I do understand the point that you make about attending our meetings and the challenge this presents for SCAS working across the entire South Central area. To the fullest extent possible we do work with our colleague HOSCs to share information and minimise NHS staff time involved in attending these meetings It is however important to differentiate between basic information provision and engagement and the more formal interest individual HOSCs may have in scrutinising the performance of SCAS. As I have said previously we remain concerned about the performance of the ambulance service in Hampshire, if other HOSCs have similar concerns about the performance of SCAS in their areas we will work with them to address these issues together. Otherwise we will be considering how we can most effectively take this work forward in our own right and will need to engage with you accordingly.

Anna McNair Scott

Chairman, Health Overview and Scrutiny Committee

Cc Hampshire HOSC members, South Central HOSC Chairmen, Gareth Cruddace, Chief Executive, Hampshire PCT, Jim Easton, South Central SHA, Sarah Smart, South Central SHA

Appendix Seven: BRIEFING NOTE RE: TRANSFER OF SPINAL SURGERY

Winchester and Eastleigh Healthcare NHS Trust (WEHCT) and Southampton University Hospitals NHS Trust (SUHT) are finalising plans to transfer spinal surgery from Winchester to Southampton.

Both trusts have previously signalled their intention for this to happen for some time. The move away from single handed surgeons to teams has long been recognised as best clinical practice because it increases the expertise on offer and can also cut waiting times.

Spinal surgery is an extremely complex and delicate field of surgery, often requiring highly specialised and complex equipment, in addition to highly trained staff.

It is anticipated that around three patients a week will now have their surgery in Southampton rather than in Winchester. The management of patients will transfer to SUHT completely in January. A service level agreement between the two trusts clearly sets out the commitment to continue to provide diagnostic, outpatient, pre-assessment and follow-up appointments as before at either Winchester or Andover.

The transfer supports the twin aims of providing clinical excellence whilst keeping services local where appropriate.

Southampton is a centre of excellence for spinal surgery and already takes the most complex cases from across the south of England. It is the first service in the country to have combined the neurosurgical and orthopaedic aspects of spinal surgery within a single centre.

The Southampton spinal service operates a `hub and spoke' model in partnership with local hospitals to ensure that patients receive their care close to where they live - but are able to access highly specialised surgery when they need it.

The switch to a service provided by a team, rather than an individual, will shorten waiting times for patients and increase access to the service. The surgical team will be able to treat as many patients as before and so there should be no negative impact on patients, other than further to travel for the small number of spinal patients who require surgery.

SUHT and WEHCT already work in partnership in some surgical areas, namely urology, ophthalmology and ear, nose and throat as well as complex cancers. The spinal transfer is a further example of collaborating in the clinical interests of patients.

Appendix Eight

Southampton University Hospitals Trust

Update for Hampshire Health Overview and Scrutiny Committee

Subject: Foundation Trust Application

Overview

Southampton University Hospitals Trust is pleased to report that its Foundation Trust application has reached the final stage. This involves a rigorous assessment of the Trust by Monitor, the independent regulator of Foundation Trusts.

Monitor has informed the Trust that it has been included in a batch of Trusts being processed for an anticipated authorisation date of early summer 2009. The earliest date from which the Trust can anticipate functioning as a licensed Foundation Trust is 1^st May 2009.

The assessment process

The initial phase of the assessment is a historic due diligence process in which Monitor will scrutinise the Trust's track record for financial and corporate governance. Monitor will also interview clinical leaders and a wide range of staff to test the level of involvement of clinical teams in the Trust's business plans and strategy. Another set of questions are expected to be directed at establishing whether the Trust is legally constituted. The assessment ends with a board to board meeting with Monitor at which the Trust's Board of Directors will be questioned about the application.

Membership and Elections

The Trust will give Notice of Election to form its first Members' Council at the end of January 2009 and the process being followed means the Council will be in place by the end of March 2009. The elections are being run by Electoral Support Services (part of the Electoral Reform Society) on the basis of a Single Transferrable Vote.

Much work has been undertaken to support the involvement of the membership in the election and more than 200 public members have expressed an initial interest in standing.

Membership recruitment continues and is currently targeting younger members who are currently under-represented in the membership profile. Public membership remains stable at around 13,000 members.

Any queries about membership, elections or any other aspect of the Foundation Trust application would be welcome.

Ali Ayres, Director of Communications and Public Engagement [email protected]

023 8079 6241

www.suht.nhs.uk