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. Winchester and Eastleigh Healthcare NHS Trust: Outpatients Department relocation

2.1. WEHT has advised the HOSC that it is currently exploring the feasibility of relocating some outpatient's services to another site in Winchester, possibly former HCC offices in Chesil Street.

2.2. It is anticipated that further information will be provided after the Trust Board meeting on 25 February.

Recommendation

2.3. WEHT provides the HOSC with regular up-dates on progress with this initiative.

3. Assisted Conception Services in South Central Strategic Health Authority area

3.1. The Specialist Commissioning team for South Central SHA has confirmed its intention to go to consultation on the provision of assisted conception services across the SHA area. The intention is to agree a single set of criteria for accessing these services to ensure that there is consistent and equitable provision.

3.2. Details of the proposals to go out to consultation have yet to be received.

3.3. Additional information about the specific changes proposed the number of patients affected in each PCT area and the funding available to support the provision of these services has been provided at the request of South Central HOSCs. The need to demonstrate clearly engagement with key stakeholders, including patient support groups, in drawing the proposal together has been stressed.

3.4. Any HOSCs considering the proposals to be substantive in nature will need to form a formal joint committee to consider the matter.

Recommendations

3.5. That the additional information requested is circulated to all members once it is received.

3.6. That the Chairman of the HOSC, taking account of any feedback from members, comes to a view about whether the changes proposed are substantial in nature and sets in place arrangements for responding to the consultation as appropriate.

Items for Action

4. West Sussex PCT: Acute Service Reconfiguration

4.1. The response of the Independent Reconfiguration Panel to the referral from the JHOSC has been suspended by the Secretary of State pending the outcome of discussions about proposals to merge the Royal West Sussex NHS Trust (St Richard's, Chichester) and Worthing and Southlands Hospitals NHS Trust.

4.2. At this stage it is not expected that any changes resulting from these discussions will lead to changes in services to patients.

Recommendations

4.3. Members are kept apprised of the progress of referral and any move to reconvene the JHOSC to consider the response from the Secretary of State.

4.4. Cllr Wright and Cllr Buckley continue to represent the views of Hampshire at any further JHOSC meetings

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

5.1. The SHA Board will meet to consider the outcome of the consultation and make a decision on whether to add fluoride to drinking water as requested by Southampton City PCT on 26 February.

Recommendations

5.2. Members are apprised of the outcome of the SHA Board meeting on 26 February.

5.3. The Review Panel takes forward the work associated with the delivery of recommendations 11, 12 and 13.

5.4. If necessary planned work programmes are adjusted to allow appropriate officer support to continue to be provided to members on the Review Panel.

5.5. That the findings of the Review panel are circulated as widely as possible locally and nationally.

6. Surrey and Borders Partnership NHS Trust: Proposals to reconfigure 24 hour assessment and treatment (inpatient mental health services)

6.1. The response of the HOSC to the proposals for reconfiguring 24 hour assessment in Surrey is attached at Appendix One.

6.2. The Trust will attend the HOSC meeting on 31 March 2009 to confirm the action being taken as a result of feedback from the Hampshire HOSC. A draft document setting out the implications for Hampshire Service is attached at Appendix Two.

6.3. Surrey HOSC is continuing to purse a broader range of issues with the Trust and is working closely with Hampshire to ensure that relevant information is shared. Hampshire was represented at a meeting on 8 January to discuss service improvement.

Recommendations

6.4. The scope for further action to facilitate a constructive resolution of this matter will be explored with Hampshire Adult Services, Hampshire PCT, Surrey HOSC and the SHA.

6.5. Once these options have been exhausted members determine if they are satisfied with

_ The conduct and content of the consultation document

_ That the proposal is in the interests of the population affected in Hampshire.

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: HOSC response to Surrey and Boarders NHS Trust: 26 November 2008

Dear Fiona

Surrey and Borders NHS Trust: Proposals to re-provide 24 Hour Assessment and Treatment. Hampshire HOSC response to consultation.

Many thanks to you and your team for attending our meeting earlier this week. As promised I set out below our formal response to your consultation, which I understand closes on 28 November 2008. I would be grateful if you would advise me of the decision of the Trust Board about how it intends to proceed and any associated timeframes.

On the basis of the evidence received the Health Overview and Scrutiny Committee (HOSC) is not satisfied:

· That there has been sufficient engagement and involvement of key stakeholders in developing the proposals

· With the content and conduct of the consultation process

· That the changes proposed are in the interests of the Hampshire population affected

The HOSC could not therefore support this proposal as it currently stands. We are however keen to see a local resolution of this matter and are mindful that there does seem to be broad support amongst commissioners for the proposed direction of travel. We are suggesting further work is undertaken to address the gaps in information as set out in Annexe One of this letter. This should include further engagement and involvement with stakeholders, including the districts affected and GPs to build consensus on the way forward.

We would like to take you up on your offer of a Hampshire specific document, setting out the implications of these changes for our residents, taking account of community and other supporting services. It may be that this information, suitably adjusted would also be of interest to the Surrey HOSC.

You will note from the points raised in Annexe One that we will expect the additional information provided to take account of the guidance `Changing for the Better'. It would also be helpful if you could confirm the services commissioned from Surrey and Borders NHS Trust by Hampshire Adult Services and Hampshire PCT. We will separately contact both commissioners to confirm that they will work with the Trust to take this work forward.

We will make special arrangements to receive feedback from the Trust and other stakeholders at our meeting on 31 March 2009. In the meantime please do contact me if you have any queries about our expectations.

Annexe One: Surrey and Borders NHS Trust: Proposals to re-provide 24 Hour Assessment and Treatment. Hampshire HOSC response to consultation.

The consultation document does not at present take account of the requirements set out in `Changing for the Better' which specifies the information to be produced in support of changes to the configuration of services. As a minimum we expect a business case setting out the clinical and patient benefits of the options (although there is only one in this case). This should:

1. Be explicit about the number of people - patients, doctors and other clinical staff -affected and the resultant benefits for each group. Taking account of the points raised by your Director of Nursing at the meeting it would be helpful to understand any pressures on staff recruitment and retention at present and the anticipated benefits to these staff resulting from the changes proposed;

2. Outline how patients, the public and other community stakeholders have been involved prior to the production of the consultation document and how their views have informed and influenced the development of the options that will be consulted on. Both the PCT and Adult Services have expressed reservations about both the consultation process and what the proposal may mean for Hampshire residents. We will wish to be clear about their support for any proposals that come back to the Hampshire HOSC in March. Additionally we will be looking for evidence that local stakeholders, including the districts affected and other stakeholders, have been able to feed into and inform the development of the Trust's plans;

3. Show that the option is affordable and clinically supported/viable;

4. Show that any planned savings that may arise are realistic and achievable within the specified timetable. We are aware that the Trust has been asked to make savings by Surrey PCT but are not aware if this proposal is a result of this requirement ;

5. Outline how the proposed service changes will tackle health inequalities. We are not aware of any equalities or health impact assessment or the implications this may have for our residents and were unable to get confirmation that this had been undertaken at our meeting;

6. Demonstrate linkage to relevant Joint Strategic Needs Assessments, Local Area Agreements and broader PCT commissioning plans. We are not aware of this work having taken place- indeed this point is reinforced by comments from key commissioners;

7. Be explicit about how the proposed changes impact on local government services and the response of local government where appropriate. We are not clear if acute Trusts, the police or other public sector services that will be affected have contributed to the formulation of the proposal;

8. Be explicit about how the proposed changes impact on other public services, informed where appropriate by Compact principles and undertakings as appropriate.

9. The option presented should also include a detailed analysis of the impact on travelling times and distances, identifying the impact on pedestrians and public and private transport users as well as the ambulance service. Further to the comments made in the meeting we would also appreciate approximate costs of public transport from the main centres of population to the current sites and those proposed.

10. Good practice as set out in the National Health Service Framework requires that these services are provided as close to peoples homes as possible and it is essential that there is clarity about the impact that the changes will have on the client group you are serving. Particular consideration needs to be given to S17 leave;

11. Implementation plans (even in outline) should be part of the pre-consultation business plan and need to be published for at the same time as consultation on major service changes. This should include the impact on the workforce and any recruitment and other staffing implications;

Additional comments on the content of the consultation document:

· The focus of the document is on a physical setting, there is no information about the community infrastructure supporting the units;

· We have now had confirmation of the number of inpatients that may be affected from Hampshire (circa 300) but do not know what community services are currently provided or how many people are using them. The document does not give any detail about overall patient numbers affected by the various proposals;

· It is not clear how assertive outreach or crisis management will operate in community settings to prevent hospital admission. If Crisis Resolution and Home Treatment Teams are based in the new hospital settings (see page 5) this implies significant travel to support people living in Hampshire. We have had anecdotal feedback that suggests that there may be some communications issues with the Assertive Outreach team, which operates out of Basingstoke for NE Hampshire residents and the current inpatient service. The impact of the proposed move to Guildford could cause this situation to deteriorate further;

· Concerns have been expressed about quality of the Crisis Resolution and Home Treatment team, which is already and appropriately based at the in-patient unit at the Ridgewood Centre, have also been expressed. If these services operated from Guildford that could be difficult, due to distance, if there is a satellite base in NE Hampshire away from the management that could also be difficult to manage. The Approved Mental Health Professionals are also reported to be concerned about quality of services at present. We will need to be satisfied that robust arrangements are in place to co-ordinate services that may be geographically distant;

· Reference is made to proximity to community services being an element that informed the decision about location of services but we have no way of understanding what this means without description of the model of service provision.

· Feedback from members and other stakeholders at the meeting indicated strong support for a fourth centre to be considered. If this has been discarded as a result of previous stakeholder engagement then we need to understand the basis for this. You will recall that our initial interest in this matter was generated by a letter from our Director of Adult Services last March, which was based on concerns about the way in which the physical sites were being selected. It would therefore be helpful to see an estate rationalisation option study showing how the existing historical estate is to be developed into a three `centres of excellence' model. Reference was made to a number of key criteria and their weightings that were used as the basis of your decision making. We would like to understand clearly your choice of criteria and assigned weightings. We would expect to see that your decision model is robust, takes into account accessibility issues and convincingly demonstrates that the three site solution meets your forecast objectives for clinical and patient outcomes