Archived decisions
Item 6
Hampshire County Council
Health Overview and Scrutiny Committee
Report on Progress Spring 2008 to Spring 2009
Introduction from the Chairman
This report provides an update on the work of the Health Overview and Scrutiny Committee (HOSC) in 2008/09. I would like to thank Committee members and officers for their commitment and hard work during another busy year.
2008/09 has seen increased emphasis on PCTs as commissioners of services. The internal organisational split in PCTs between their commissioning and service provider roles has occupied a considerable amount of attention within those organisations.
Hampshire PCT, along with all other PCTs in England will be expected to have enabled sufficient separation between their provider services and commissioning role to avoid potential conflicts of interest by April 2009. This is a profound organisational adjustment, and one which opens the way for a wider variety of provider services in the future.
Financial challenges continue to exercise NHS organisations as PCTs and provider trusts attempt to achieve a workable balance that will satisfy the competing demands of providing reasonable access to high quality and efficient services at a reasonable cost to the NHS and public purse.
The development of a Hampshire Local Involvement Network (LINk) as a replacement for the Patient and Public Involvement Forums continues slowly, and the LINk may begin to play a role in monitoring experience of the NHS and of social services by patients and service users during the next year.
I continue to have regular meetings with the Chief Executive of the SHA Board, attend board meetings of Hampshire PCT and maintain active contact with other NHS organisations in the County. This engagement with the NHS is an essential part of building and strengthening a productive working relationship with health partners.
In addition to my role as Chairman of the Hampshire HOSC, I am also Chairman of the South Central Health Overview and Scrutiny Committee's Joint Meeting which comprises a network of HOSCs from all local authority areas served by the South Central SHA. I also attend the Hampshire, Southampton, Portsmouth and Isle of Wight Health Scrutiny Joint Committee. These committees allow issues of common concern to be discussed and sometimes addressed more effectively than by individual HOSCs.
We have continued to monitor progress against the recommendations of the Review of Care at End of Life, which has been taken forward by a steering group led by Dr Mark Rowland, the SHA lead for End of Life Care and now Clinical Director. We will maintain our interest in the development of this work, as well as with out-of-hours and unscheduled care services.
In the autumn of 2008 I chaired a review panel set up to look at proposals to add fluoride to the drinking water supplies in Southampton and parts of Southwest Hampshire. Water fluoridation is not legally considered a change to health services, however the County Council wished to provide a `cogent' response to the consultation about the proposals (as required by the water consultation regulations) so at the request of the County Council, a HOSC review panel was set up in September to consider the issue.
Following the decision of the SHA to fluoridate water in parts of Southampton and South Hampshire, the Review panel will meet to discuss possible ways forward.
Ambulance response times in Hampshire towards the end of 2008 gave cause for concern. However the figures for early 2009 show some improvement, and we will be continuing to monitor performance.
As ever, the Committee will be very vigilant about `temporary' closures and the quality of engagement with the public in service planning and change.
The report sets out:
· Local progress with health scrutiny (Section 1)
· The achievements of the Committee over the last year, including joint scrutiny arrangements (Section 2)
· The outline work programme for 2008/09 (Section 3)
Further details on the work of the Committee can be found on our website at www.hants.gov.uk/healthscrutiny
Cllr Anna McNair Scott
Chairman, Health Overview and Scrutiny Committee
Section 1: Local Progress with Health Scrutiny
Health Overview and Scrutiny is a statutory responsibility for local government. It is intended to ensure that decisions about health services are taken with due regard to the people affected. The legislative framework within which the Committee functions, allows Members to consider any aspect of health that affects the population of Hampshire. It also places very specific duties on the NHS with regard to consultation, information and responses to any recommendations made by the Committee.
The Committee is a statutory consultee on any substantial change being considered by the NHS and has the power to refer contested decisions about health services to the Secretary of State for Health or to Monitor in the case of Foundation Trusts. A summary of the main powers of the Committee, and the duties placed on the NHS, is attached at Appendix One.
Arrangements are in place to allow these powers to be delegated to allow for specific proposals affecting the health of local people to be considered by a joint committee or, in exceptional circumstances, by another scrutiny committee set up by local government.
As its role has evolved, the Committee has been mindful that it is not the only, or even the main form of engagement between the NHS and local government. Services are increasingly being jointly commissioned across health and social care and this is likely to increase as new policy initiatives are implemented.
District Councils have had a role to play in shaping the Committee's understanding of local issues, providing a rich source of intelligence about issues relating to health and health services. Similarly, the Committee has a constructive working relationship with internal service providers, the Executive, the Cabinet and other scrutiny functions undertaken by local authorities and public agencies.
Local Involvement Networks (LINks) are the new body responsible for representing communities and providing opportunities for them to influence the development of the health and social care bodies that service their areas. LINks have the right to visit some services, and make reports and recommendations to the Committee, partnership bodies such as the Local Strategic Partnership, as well as commissioners of health and adult social care.
Health, and health services in Hampshire are complex, with different priorities in different communities. In order to improve working relationships between Health and Social care, Hampshire PCT has three operational areas that fit with the County Council's three social care areas. These arrangements help strengthen local influence on services provided in each area.
The network of working relationships that has now been established demonstrates the commitment of the HOSC to ensure that, to the fullest extent possible, it is the local community that has the greatest influence on the development of health services in a particular area. This local influence has been a recurrent theme as the work programme has rolled forward and remains a central feature of the work of the Committee.
Emphasis has therefore been focused on ensuring that programmes are effectively targeted to enable the scrutiny process to be both credible and influential. The approach to health scrutiny adopted by the Committee therefore places emphasis on ways of working that are:
· Challenging but not confrontational
· Evidence based
· Able to improve service delivery and better outcomes for patients
The role of the Committee as a `critical friend' has been established, and relationships with partner organisations, continue to develop positively; the relationship with Hampshire PCT has been particularly productive. The drive to reduce costs in the system will continue to put pressure on local health services to find savings or make difficult choices; the potential impact these may have on local people makes it vital that the Committee maintains a constructive dialogue with these organisations and other partners.
The forward work programme of the Committee set out in Section 3 of this report has therefore been developed in discussion with District Councils and NHS organisations in Hampshire. The LINk will be included in discussion once it is fully functioning.. It takes account of the work that the Committee must do, specifically:
· Respond to proposals to substantially vary NHS services in the area of the Committee
· Manage referrals from partner organisations or Members
In addition, it identifies issues that may benefit from a more in-depth thematic review. To make the best use of the resources available to the Committee the following four criteria have been developed to guide Members when selecting topics for review:
· Capacity to influence and improve the service under consideration, including patient experience
· Timeliness and relevance to local health services
· Issues not under consideration elsewhere
· Issues not subject to other scrutiny or performance monitoring activities
The approach to health scrutiny adopted by the Committee and described in the following work strands is drawn from national guidance and discussions with partner organisations. A summary of the relevant sections of the Guidance is included at Appendix Two.
The Work Programme of the Committee draws together four main work strands:
· Relationships and Communication: From its inception the Committee has been aware of the need to be able to work in partnership with other agencies when discharging its responsibilities in relation to health overview and scrutiny. Experience reinforces the importance attached by the Committee to ensuring that an extensive network of key contacts is built and maintained to support a challenging but constructive approach to health overview and scrutiny.
· Proposals to vary or develop NHS services: Any proposals for service change from the NHS should be discussed with the Committee at an early stage, in order to agree whether or not the proposal is considered substantial. In determining if a proposal is substantial, the Committee considers the impact of the change on patients, carers, and the public who use, or may use a service.
· Reviews of Health Services: This strand of work was identified by the Committee to provide thematic cross boundary reviews of health services. These consider specific areas or services that are of interest or concern to the Committee and identify opportunities for improvement.
· Health Inquiries: The `health inquiries' work strand was designed to provide the Committee and partner organisations with a route through which issues could be raised and acted on outside the review process. This mechanism allows the Committee to maximise opportunities to influence and improve health services without recourse to a full review as well as providing a means by which developments in health can be drawn to the attention of the Committee.
Section 2: The Achievements of the Health Overview and Scrutiny Committee in 2008/09
The Committee continues to provide an active and constructive influence in the planning and delivery of health services for the people of Hampshire. The Committee maintains its commitment to taking an independent, impartial approach to considering evidence and ensuring that the views of all relevant stakeholders are taken into account.
Relationships and Communication
Constructive and open relationships with NHS and other partner organisations are essential to the ongoing work of the Committee and to maintaining trust. Following the previous turbulence in local NHS bodies, 2008 has seen the PCT continue to strengthen its capacity to meet its commissioning role. As the pressure to provide better and more responsive services in the community increases, so does closer working between the County Council and the NHS, with more joint commissioning, and closer integration of some services. Good communication between the HOSC and Hampshire PCT is well established and grows stronger, while Hampshire's interests continue to be taken up with South Central-wide organisations such as the SHA and the Ambulance Service.
Members receive presentations and reports at HOSC meetings that keeps the Committee well informed about health issues and plans that affect the people of Hampshire. Examples include achievements and progress in improvements in End of Life services following the HOSC's review in the previous year; also the PCT's southeast Hampshire capacity plan to meet the needs of residents and patients in that part of the county.
The HOSC values and continues to build on its working relationships with district councils. Meetings with each district are held during the year, and the HOSC includes representation from the districts via The Hampshire and Isle of Wight Local Government Association.
In addition, the Chairmen of the Portsmouth, Southampton and Isle of Wight HOSCs are invited as formal observers at HOSC meetings. Arrangements will be put in place to replace the PPI Forums when the LINk begins to function in Hampshire.
Referrals from stakeholders continue to play an important role in informing the Committee of emerging issues. This feedback is an important element in confirming that NHS bodies have engaged properly with patients and relatives or carers when considering service change.
In the context of the new Local Area Agreement, increased joint commissioning arrangements and joint or integrated delivery of health and social care, the continued development of effective working relationships with an increasing range of stakeholders will be essential for the Committee.
Proposals to Develop or Vary NHS Services
Proposals to develop or vary NHS services have continued to come to the HOSC throughout he year. Members are thereby alerted to forthcoming proposals to change health service provision. All proposals for varying NHS services are considered by the Committee and any associated reports or comments are included with agenda papers to ensure members are properly informed about proposals to change health service provision.
Responses to consultations and other proposals to develop or vary services since April 2008, have included:
Winchester and Eastleigh Healthcare Trust
· Proposed relocation of outpatient services
Surrey and Borders Partnership Trust:
· Proposed reconfiguration of inpatient adult mental health services
Southampton University Hospital Trust:
· Maternity Services - Ashurst birth centre development and opening
South Central Strategic Health Authority:
· Whilst the HOSC was not a formal consultee in the consultation on proposals to fluoridate water in Southampton and Southwest Hampshire, nevertheless the County Council requested the Committee to look at the proposals and make recommendations.
· Assisted conception Services in South Central SHA area
West Sussex PCT:
· Acute Services Reconfiguration Joint HOSC with West Sussex
Department of Health:
· Consultation on Transforming the Quality of Dementia Care
· Consultation on National Health Service Constitution
Health Inquiries
Healthcare Commission:
· Annual Health Checks for Trusts
Hampshire PCT:
· Fordingbridge Hospital temporary ward closure
· Southeast Capacity Plan
· Oak Park Hospital development
· Access to services by homeless people
· GP engagement with locality commissioning
· Changes to GP premises
· Referrals to pain clinic in Southeast Hampshire
· Access to short breaks for children
· Services provided at Milford on Sea War Memorial Hospital
· Separation of commissioning role from providing community services
· Unscheduled Care pilot in Winchester area
· Healthy Horizons
· Financial position update
· Temporary closure of Minor Injuries Unit at Havant War Memorial Hospital
· NHS Campus (with Adult Social Services)
· Temporary reduction of services at Countess Mountbatten Hospice (with Southampton University Hospitals Trust)
Winchester and Eastleigh Healthcare Trust:
· Mental Health Services provided at Andover War Memorial Hospital (with Hampshire PCT and Hampshire Partnership Trust)
· Annual Plan for 2008/09
· Transfer of Spinal Surgery to SUHT
Southampton University Hospital Trust (with Hampshire PCT):
· Temporary reduction of services at Countess Mountbatten Hospice (with Hampshire PCT)
· Progress on gaining Foundation Trust status
South Central Ambulance Trust:
· Ambulance performance in Hampshire
· Ambulance routing and road closures
Department of Health:
· Consultation on changes to GP dispensing
Reviews of Health Services
Care at End of Life: the Committee continues to monitor progress on this major review undertaken in 2007
Fluoridation of water supplies in Southampton and Southwest Hampshire: South Central Strategic Health Authority conducted a consultation on water fluoridation in Southampton. Because a decision to fluoridate Southampton's water would also affect residents in Southwest Hampshire, the County Council requested the HOSC to establish a review panel to conduct a major review to provide an informed view for the County Council to respond to the consultation. Full Council unanimously agreed with the Review Panel recommendation to oppose the proposal. The consultation and phone poll consultation by the SHA both indicated public opposition to the proposal, however at a meeting on 26 February 2009 the SHA board decided to support the proposal
The Committee continues to have an interest in out of hours and unscheduled care services, the plans for their development, commissioning and implementation. Members expect to be updated by the PCT on developments through 2008 at the HOSC meeting in May 2009.
During 2009, the Committee will seek to follow up on a review of Therapy Services provided to children originally undertaken during 2004/05.
Joint Committees
Joint Health Overview and Scrutiny Committees may be permanent where NHS organisations provide services to more than one HOSC area, and standing joint committees consider issues of common interest. In addition, joint committees may be set up solely to undertake scrutiny of a specific issue of common concern to more than one HOSC.
Hampshire, Southampton, Portsmouth and Isle of Wight Health Scrutiny Joint Committee is a permanent committee, now under the chairmanship of Cllr Mrs Erica Oulton, Chairman of the Isle of Wight HOSC. Over the last year, the following issues have been considered:
· Joint Hampshire commissioning strategy for older people's mental health
· Dentistry
· South Central Ambulance Service
· Fluoridation of water supplies in Southampton and Southwest Hampshire
The West Sussex Health Overview and Scrutiny Joint Committee was established to examine the proposals by West Sussex and Brighton and Hove City PCTs. Of particular concern was the proposed re-configuration of acute health services and Maternity Services.
Following referral of this issue to the Secretary of State for Health, it was subsequently proposed that the Royal West Sussex NHS Trust (St Richards Hospital, Chichester) and Worthing and Southlands Hospitals NHS Trust be merged. The response of the Independent Reconfiguration Panel to the referral from the Joint Health Overview and Scrutiny Committee has been suspended by the Secretary of State pending the outcome of the proposed merger.
The merger has now been agreed and is on course to take place on 1 April 2009. It is not expected that any changes resulting from the merger would lead to changes in services to patients. West Sussex Primary Care Trust is now considering the implications and the issue of a revised Fit for the Future plan.
In addition to the Joint Committees, the chairmen and lead officers of the South Central Health Overview and Scrutiny Committees meet regularly under the chairmanship of Cllr Anna McNair Scott to consider issues of interest or concern that affect the South Central area as a whole. Over the last year, the following issues have been considered:
· Local Involvement Networks (LINks)
· Learning from major service reconfiguration
· Specialist commissioning
· Role and location of GP led health centres in the South Central area
· World Class Commissioning
· Infection control
· Specialist commissioning
· Public and patient engagement strategy in the context of specialist commissioning
Section 3: Outline Work Programme for 2009/10
Building on feedback from partner organisations, Hampshire Action Teams and Members, the HOSC will continue to use the four work strands identified to form the work programme for the coming year.
Relationships and Communication
The Committee will continue to engage actively with partner organisations across Hampshire, and one-to-one meetings as appropriate.
The Committee will develop links with the Local Involvement Network and other partners who are in a position to comment on health provision and the effectiveness of joint health and social care arrangements. It is anticipated that increasingly Hampshire Action Teams will provide intelligence about health issues in their areas.
Proposals to vary or develop NHS services
The Committee will continue to use the Framework for Assessing Service Change. This documentation has been very effective in helping to clarify and evaluate the extent and implications of proposals of NHS organisations to vary or develop services.
The Committee will continue to be informed by proposed changes by NHS bodies to vary or change services and will respond within agreed timescales.
Health Inquiries
The Committee will continue to receive information on, and initiate action in response to, issues raised by Members and partners.
Particular issues for further consideration and action during 2009/10 may include:
· South Central Ambulance Service performance
· PCT commissioning
· Community-based services
· Therapy services provided to schools
Reviews of Health Services
The Committee will continue to take an active interest in progress against the HOSC's Review recommendations, and developments in Care at End of Life in Hampshire. The work has been taken forward by the Review Implementation Project Steering Group, a groups that is jointly led between Hampshire PCT and Adult Services.
The Committee will also resume an active interest in the planning and delivery of Out-of-Hours and unscheduled care. Responsibility for strategy and planning rests with Hampshire PCT.
As in previous years the Committee will carry out any major reviews of services as and when they arise.
Appendix One
Hampshire County Council
Health Overview and Scrutiny Committee
Summary of the Responsibilities of Local Authority and NHS Bodies
(National Health Service Act 2006 - Part 12 Sections 242 and 244 refer)
Powers of local authority overview and scrutiny committees
Overview and scrutiny committees may:
· Review and scrutinise any matter relating to the planning, provision and operation of health services in the area of the committee's local authority;
· Make reports and recommendations to local NHS bodies and to its local authority on any matter reviewed or scrutinised using the overview and scrutiny of health power;
· Require the attendance of an officer of a local NHS body to answer questions and provide explanation about the planning, provision and operation of health services in the area of the committee's local authority;
· Require a local NHS body to provide information about the planning, provision and operation of health services in the area of the committee's local authority, subject to exemptions outlined the Health and Social Care Act 2001/National Health Service Act 2006;
· Establish joint committees with other local authorities to undertake overview and scrutiny of health services;
· Delegate functions of overview and scrutiny of health to another local authority committee;
· Co-opt Members of the overview and scrutiny committees of district councils onto the committee as full Members (County Council committees only)
· Be able to report to the Secretary of State for Health:
· Where the committee is concerned that consultation on substantial variation or development of services has been inadequate;
· Where the committee considers that the proposal is not in the interests of the health service.
Duties of local NHS bodies
NHS bodies must:
· Provide information requested by the overview and scrutiny committee subject to exemptions;
· Attend before committees to answer questions, subject to exemptions;
· On request, respond to reports and recommendations within 28 days of the request of the committee;
· Consult the local overview and scrutiny committee (including joint committees) on matters of substantial development or variation to services, (in addition to the duty under section 242 of the National Health Service Act 2006 to involve and consult patients and the public).
Appendix Two
Hampshire County Council
Health Overview and Scrutiny Committee
Summary of Key Expectations in the Department of Health Overview and Scrutiny of Health - Guidance
In the Annual Report, useful information is provided about the responsibilities of Members of HOSCs. The Annual Report also notes that interaction between the NHS and its local authority and other partners happens at different levels and in different ways. Local experience and intelligence about how the often complex arrangements work for patients, can come from key statutory partners or independent partners including potentially from LINks when they become fully functional.
The busyness and complexity of the NHS, new national initiatives, and local patient experience can sometimes distract from reflection on the fundamental expectations of Government of the Health Overview and Scrutiny role. Some of these expectations are noted below as a reminder as to why the Committee places importance on:
· Relationship building
· Processes for effective scrutiny
· Strategic scrutiny
· Operational scrutiny
Relationship building
In the Department of Health's, Overview and Scrutiny of Health - Guidance, it was clearly indicated that they expected Health Overview and Scrutiny Committees to work in a challenging, complex environment; "The Government's intention is that the focus of health scrutiny is on health improvement, bringing together the responsibilities of local authorities to promote social, environmental and economic well-being and the power to scrutinise local services provided and commissioned by the NHS". One of the key requirements of the Committee must be to establish and build a network of positive working relationships that will make it possible to achieve the broad aim of `health improvement' as indicated in the Guidance. It is for this reason that the Annual Report explicitly comments on `relationship building' as a key area of the Committee's work.
Processes for effective scrutiny
The Guidance implies its concern that HOSCs should have effective processes for scrutinising issues that are brought to it, for example, it says, "...if the process (of scrutiny) is aggressive, or relies on opinion rather than evidence, it is unlikely to lead to positive or sustainable improvement." It also emphasises that scrutiny must be based on firm foundations, "Members of scrutiny committees need to take a constructive but challenging approach to the role, bringing together evidence and people's experience to identify priority issues and drive forward improvement." The Annual Reports makes clear that establishing and building effective processes for the scrutiny function is another key responsibility of the Committee.
Strategic scrutiny
The Guidance document is helpful in explaining the scope of health scrutiny when it says, "The powers of overview and scrutiny of the NHS enable committees to review any matter relating to the planning, provision and operation of health services in the area of its local authority. It is recommended that best use of these powers will depend on committees scrutinising a health issue, system or economy, not just services provided...". The wider context of local service delivery is therefore of significant interest. Examples of this aspect of the Committee's work are to be found in its raising questions about national funding, or in its Hampshire-wide reviews of health issues.
Operational scrutiny
The Government Guidance also gives due weight to Health Scrutiny's role with respect to local service delivery, "Committees are best placed to concentrate on ensuring that health services address the needs of local communities and that local health and health-related issues are being tackled jointly across local agencies." The sections on Proposals to vary or develop NHS Services, and Health Inquiries in the Annual Report contain examples of this aspect of the Committee's work.
Implicit in the Guidance is the expectation that because, "...the focus of health scrutiny is on health improvement", the remit will inevitably include those areas, sometimes associated with `wellbeing' that can be determinants of health, "...the solutions to matters that are scrutinised, may therefore be the responsibility of a number of stakeholders. In this light the power to scrutinise health services should be seen and used in the wider context of the local authority role of community leadership and of other initiatives to promote and facilitate improvement."