Hampshire County Council Health Overview and Scrutiny Committee Item 4 26 May 2009 Inquiries Received and Action Taken Report of the Chief Executive

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

Topic/inquiry	Source	Action Taken	Comment
Mental health services at Andover War Memorial Hospital	HCC members	Cllrs Mrs West and Mrs Kerley to provide an up-date on progress. The Trust is continuing to work with staff and key stakeholders to develop a way forward and will be reporting progress at the May meeting. Outline proposals are attached at Appendix One.
Recommendation: Lead members continue to act as the link with Hampshire Partnership in taking this work forward.
South East Capacity Plan	Members	The update requested by members from NHS Hampshire is attached at Appendix Two.	Progress with community hospitals and supporting services will be of particular interest.
Recommendation: Any additional information requested by members is provided by the PCT.
South Central Ambulance Trust Performance	HOSC Chairman	Additional performance information is attached at Appendix Three. Additionally some members have had an opportunity to go out on an ambulance shift and visit the new Headquarters at Otterbourne.
Recommendation: The HOSC continues to monitor closely ambulance performance in Hampshire.
Closure of the Minor Injuries Unit at Havant War Memorial Hospital	Hampshire PCT	The nurse led minor injuries unit at this facility has been temporarily closed due to high levels of staff sickness. It is expected that this will affect two to three patients a week.
Recommendation: Members are advised if this service is to reopen.
Access to health services for people who are homeless	HOSC members	An update from the PCT on progress with developing a strategy for commissioning services fro people who are homeless is attached at Appendix Four.
Recommendation: Members are provided with any further information requested
Swine Flu: state of readiness in Hampshire	NHS Hampshire	The PCT has arranged to provided members with a verbal briefing on the arrangements in place should there be an outbreak of swine flu in Hampshire.
Recommendation: NHS Hampshire provides any additional information required by members.
LINk work programme	LINk Chairman	June to November 2009 the LINk work plan will include: · Phlebotomy services in Gosport · OOH services- with a specific focus on the patient experience and possibly complaints · Ambulance Services- with a specific focus on the patient experience and possibly complaints · Maternity services (working with a mum to be) December 2009- March 2010 · Social care in nursing homes · Patients experience of hospitals · Bed blocking (possibly linked to dementia) · Patients/clients outcomes (e.g. return to independent living) · Access to talking therapies
Recommendation: members note work plan for the LINk and the action being taken to avoid duplication in relation to OOH and Ambulance services

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 Foundation Trust and NHS Hampshire

Andover Area Older Peoples Mental Health Service

Update to Hampshire Overview and Scrutiny Committee

1.0 Purpose

1.1 In February 2009 NHS Hampshire and Hampshire Partnership NHS Trust (now Foundation Trust, HPFT) presented to the Hampshire Overview and Scrutiny Committee (HOSC) the patient and public engagement work on the development of services for older people with mental health needs in Andover. The NHS currently supports inpatient beds in the Allan Gardiner Unit in Andover but has not enabled the community services to adequately develop. The engagement work highlighted the need for better support, improved working with other agencies and enhanced service provision. The Story Boards that were used as the basis for the discussions are attached at Annexe 1.

1.2 The purpose of this document is to update the HOSC on progress that the organisations have made in designing an improved pathway of care.

1.3 In light of the significant and effective engagement of patients, carers and the public that has helped formulate the proposed care pathway presented in this paper, the HOSC is asked to agree that a further period of formal public consultation is not required and that the service improvements can proceed.

2.0 Background

2.1 In 2008 Hampshire County Council and NHS Hampshire published the Joint Hampshire Commissioning Strategy for Older People's Mental Health and in 2009 the National Dementia Strategy was published. These documents share many common aims and NHS Hampshire and Hampshire County Council are clear that any proposal for service development must make progress towards achieving these aims.

2.2 The engagement work in Andover began in November 2008 and has involved more than 200 members of the public. On 23 April 40 representatives from local groups and statutory and voluntary organisations took part in a successful Stakeholder Event. This was attended by Councillor West and Councillor Kerley.

2.3 Stakeholders confirmed that their views had been fairly represented in the feedback from the engagement meetings and they then heard some examples of good practice in the development of older people's mental health care that could be implemented in Andover. The participants worked together on tables to develop care pathways for people with dementia and these pathways form the basis of the proposals set out in this paper.

3.0 Proposed Care Pathway

3.1 Early diagnosis

The National Dementia Strategy states that good quality early diagnosis and intervention will be available for all. This would be achieved in Andover by enhancing the current Memory Clinic with increased Consultant, Nurse and Psychologist input. The proposed service would be nurse led. The Older Persons Community Mental Health Team (CMHT) would develop their liaison role with Primary Care colleagues to improve awareness and encourage early referral.

Elderly people are more likely to have un-diagnosed depression which leads to poorer health outcomes and the CMHT would work with Primary Care colleagues to increase awareness.

Memory Matters is a course of eight sessions for patients and carers to help them understand and cope with dementia and these would continue to be available in Andover.

3.2 Improved support in the community

A new Older Persons CMHT base in the Allan Gardiner Unit would allow health and social care colleagues to work more closely together. Outpatient clinics and some therapy sessions would be held in the new suite.

There is a willingness from Hampshire Partnership NHS Foundation Trust and Hampshire County Council Adult Services to examine the possibilities of offering more flexible day care for people with dementia with specialist therapy input being delivered on a sessional basis. Planned programmes of day therapy for people with functional disorders would be provided in the community in partnership with the voluntary sector.

An enhanced CMHT for Older People is proposed to provide a more flexible and responsive service. The enhanced CMHT would be able to respond more quickly to avert a developing crisis and would provide an Intensive Support Service at home through staff with specialist mental health skills working on a seven days a week basis. This may potentially prevent admission to a hospital or care home.

Older people may have other physical health problems as well as mental health needs and it is particularly important that they are not admitted to hospital un-necessarily. Discussions have started with the Practice Based Commissioners to include consultant psychiatric advice in the planned Elderly Assessment Centre in Andover. This should enable people to remain at home supported by primary care and the Intensive Support Service.

3.3 Admission to specialist mental health beds

Specialist assessment and treatment may require admission to an acute psychiatric ward for older people. Medical staff must be available as well as qualified mental health nurses. This is not always the case in the Allan Gardiner Unit. There is capacity for an average of three to four patients at any one time in the Stefano Olivieri Unit at Melbury Lodge in Winchester and for another patient at Elmwood Ward at Parklands Hospital Basingstoke. It is proposed that patients from the Andover area that in future require admission to a specialist mental health unit will receive the service from Melbury Lodge or Parklands. It is expected that the planned service developments in the community would provide alternatives to admission for a number of people so those requiring hospital admission would decrease. However a maximum of around 40 patients per year would need to travel a longer distance than currently is the case to receive inpatient care. Discussions are underway with Winchester and Eastleigh Healthcare Trust and a financial contribution to the existing transport scheme between Winchester and Andover is proposed.

3.4 Improved intermediate care

The National Dementia Strategy recommends that people with dementia need improved intermediate care. Patients who are admitted by Winchester and Eastleigh Healthcare Trust to Kingfisher Ward in the Andover War Memorial Hospital with confusion as well as a physical condition should have high quality care for their total needs and moves to other wards should be reduced to a minimum. The proposed enhancement to the current CMHT would provide specialist medical advice into Kingfisher Ward. Dialogue is underway with Winchester and Eastleigh Healthcare Trust to agree how this would be implemented.

There are occasions when people would benefit from Step Up or Time to Think beds in a residential or nursing home rather than admission to a hospital ward. The proposed enhanced CMHT would provide specialist advice and support to residents and their carers who use these beds. This service does not yet exist in Andover but work is on-going with colleagues in Adult Services to explore the future development possibilities.

3.5 Improved care in nursing and residential homes

The number of residents in care homes who have mental health needs is increasing. A specialist mental health nurse adviser is proposed to offer a service to help improve the knowledge and skills of care home staff and give better support to residents whose behaviour is challenging. Under these proposals the Consultant Psychiatrist would be able to offer advice when needed. This would give the potential to reduce the number of patients admitted from care homes to hospital.

3.6 Improved end of life care

End of life care for people with dementia should be of high quality and this must be achieved by ensuring staff in all environments have the right skills to support both patients and their carers. Work is beginning to promote skills development as part of the end of life strategy being developed by NHS Hampshire. This work would involve partnership working with other agencies leading to new service specification for inclusion in commissioning contracts with nursing homes.

3.7 Future developments

The proposed service developments would address many of the issues raised by older people with mental health problems in the Andover area. Further improvements would be made as the service is reviewed and as resources are available.

There is a need for a dementia advisor to help patients and carers navigate along the journey from the point of diagnosis. The service is planned to be commissioned for local people through NHS Hampshire and Hampshire County Council and would probably be provided by a voluntary sector provider.

4.0 Inpatient services reconfiguration

4.1 It is proposed that as the community services are developed, the eight beds in the Allan Gardiner Unit are closed and the ward space is returned to Winchester and Eastleigh Healthcare Trust. This would allow the strategic development of that part of the hospital and this is supported by the Healthcare Trust. Patients from Andover with dementia who need hospital admission would be admitted to Stefano Olivieri Unit at Melbury Lodge in Winchester or to the Elmwood Ward at Parklands Hospital in Basingstoke. Patients from Andover with functional needs are already admitted for assessment and treatment to the Stefano Olivieri Unit and this would continue.

5.0 Staffing

5.1 The nursing staff working in the Allan Gardiner Unit are experienced and have valued skills in caring for older people who have mental health needs. Every effort would be made to retain the staff and Hampshire Partnership NHS FT would offer each of them a post within the Trust. As many as possible would be offered jobs in the Andover area. Hampshire County Council has also expressed interest in making posts available in the services that they provide.

5.2 The new model of care would require staff to work in new ways and they would be supported and encouraged to develop their knowledge and skills. The Trust would follow appropriate staff involvement and consultation processes.

6.0 Funding of Services for Older People and mental Health Needs in Andover

6.1 All organisations across the NHS are looking at better and more efficient ways of delivering high quality care. The development of the current services within the Andover area would provide a better level of community support and admission avoidance for the people of Andover and begin to deliver on the Hampshire Joint Commissioning Strategy. The proposed developments also ensure that all patients who are in receipt of care would in future continue to receive the care they require without the need for additional funding.

6.2 NHS Hampshire funded £1,894,159 for Older Peoples Mental Health Services in Andover in 2007/08. This increased in 2008/09 by £310,174 mainly due to increases funding of Continuing Healthcare patients.

6.3 The proposed model of care would allow funding to be released to develop the proposed care pathway. It would also enable a reduction in the costs of providing inpatient care, to partially offset the growth in Continuing Healthcare expenditure across the whole system.

6.4 NHS Hampshire has ambitions to develop the future parts of the proposed care pathway in Andover area, namely Elderly Assessment Unit Step Up/ Step Down Beds. The investment for the services would be made by recycling money across Hampshire from within acute general hospitals and inpatients beds into preventative schemes in the Andover area amongst others.

6.5 It is anticipated that the proposed model of care in the Andover area would deliver high quality care to more people than is available now, whilst reducing the number of bed days required in both mental health services and acute hospital services.

7.0 Implementation

7.1 The Board of Hampshire Partnership NHS FT has approved a business case to develop community based services by releasing resources held in the Allan Gardiner Unit.

7.2 The Board of NHS Hampshire are meeting on 28 May 2009 to consider commissioning the service proposed in this paper.

7.3 Implementation of this proposal would be dependent on the decision taken by the Hampshire Overview and Scrutiny Committee. Detailed implementation planning would commence on 1 June 2009.

May 2009

Hampshire Partnership NHS Foundation Trust and NHS Hampshire

Andover Area Older Peoples Mental Health Service

Update to Hampshire Overview and Scrutiny Committee

May 2009

ANNEXE 1

Example Storyboards from Engagement

Your Choice....

How do you want us to provide mental health services for older people in the future?

Your Choice - Mental Health Services

One in four people will suffer from mental health problems at some point in their lives.

The local NHS needs to make sure that the right services are in place if older people need mental health services. We also want to do everything we can to help older people stay well and to make sure that they can be treated as close to home as possible.

There is a wide range of specialist services provided by the NHS within Hampshire for older people who suffer from mental illness:

· treatment provided in the home by specialist teams

· outpatient clinics

· therapies provided in a day unit

· intensive treatment for patients in a crisis

· other sessional services provided in the local community

· care in hospital or nursing or care homes

From the above, the following are available to patients in the Andover area:

· treatment at home

· outpatient clinics at Andover War Memorial Hospital

· therapy or other sessions of treatment at Andover War Memorial Hospital

· treatment as an inpatient at either the Allan Gardiner Unit (Andover) or the Stefano Olivieri Unit (Winchester)

How do you choose the service you need?

There are a number of different factors which will help decide what services are best for you. They are:

· your mental health needs

· your general health

· how quickly you need to be seen by the service

· the support that is provided by carers or other agencies

· your ability to travel

· your previous medical history

· your past experiences

· your own opinions and preferences

What kind of services do you need in Andover?

The number of people aged over 65 within the Test Valley area is predicted to increase over the next six years, as shown below. This increase is in line with the rest of Hampshire:

Comparison of Growth of population

This means that the number of older people with mental health problems will increase by at least 16%.

We need to work with you to plan the right services to support these people.

What is available in Andover now?

People experiencing mental health problems in Andover do not have the same range of services as other people in Hampshire. The following are available:

· Home and Community Treatment Services - more and more people are being cared for at home or at community clinics. Last year there were 479 patients treated in more than 5,023 home visits or sessions in community facilities

· Outpatient clinics in Andover Hospital - 94 people received their care in 585 outpatient clinic appointments last year

· Inpatient services - over the last few years fewer people have needed hospital care:

o Allan Gardiner Unit - there are eight beds here and 43 people from Andover were cared in this unit for last year

o Stefano Olivieri Unit - there are 15 beds here for Winchester and Andover residents and during the last year 22 people from the Andover area received care in this ward

Outpatient Clinic

Community- based Therapy Sessions

Stefano Olivieri Unit

Are these the right services?

We know that:

· there is not as wide a range of community services in Andover 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

On average only five beds in the Allan Gardiner Unit were used at any one time last year. One to two of the five beds were used by patients waiting for nursing or residential care homes.

Comparison of cost of a bed per day

This means the care is very expensive and is tying up resources that in other areas is being invested to improve the range of community services on offer to patients.

We would like your views on how we use the resources available to us to get the right balance of services locally.

Help us shape the future of mental health services for older people

The local NHS wants to work with local patients and carers to make sure mental health services for older people in Andover meet patients' needs both now and in the future.

We must make sure the services:

· are high quality, safe and modern

· help patients maintain their independence

· offer all the types of care which patients and carers need

· take into account the views of patients and carers

· meet national and local guidance

· are affordable and can be sustained for the future

· are efficiently and effectively used

We need to make sure that:

· mental health services in the community meet the needs of patients now and in the future

· we use resources efficiently to deliver services where people need them

· we work better with other organisations

How can we do this?

We must:

· find out what the local community wants

· plan older peoples' mental health services for the future

· provide services when, where and how they are most needed

· improve the efficiency of the current service to provide care for the predicted increase in population

· give more choice of community-based services for more patients

What have you told us so far?

Hampshire Primary Care Trust and Hampshire County Council who plan and pay for many of these services, recently completed a Hampshire-wide consultation on a Joint Strategy for Older Peoples' Mental Health. A number of groups, organisations and individuals suggested how they would like mental health service to work in the future.

They said that any mental health service should:

· have good co-ordination between community and inpatient treatment

· promote independence

· provide support to carers

· work closely with other organisations providing care to patients.

Locally you have told us that:

· more community services are required in Andover

· patients and their carers need more immediate help, particularly out of hours

· to avoid hospital admission and help patients maintain their independence at home

· community clinics and therapies need to be easily accessible to Andover residents

· general hospital staff better need a better understanding of how to support patients with mental health needs

· inpatient services should be available when needed to Andover residents

How could services in Andover be developed to meet these needs?

We would like to make sure that:

· patients would have quick access to community and inpatient services when they need them

· admission to inpatient wards or care homes would be avoided by the use of better community services

· patients would spend less time in hospital because of better co-ordination into and out of hospital

· people would stay in their homes for longer as there is better support for their carer

· people living in other care settings such as extra care housing, nursing or care homes would benefit from closer working between organisations

What would it mean to mental health services?

Our aim for Andover is to:

· provide high quality mental health care for more patients in or near their homes

· make better use of the resources available to us

· work better with other organisations to provide care in more flexible ways

What services should we be developing?

To support people with mental health problems you need a choice of services to suit individual need. Here's a flavour of what could be available...

Community Assessment and Treatment Services

This service provides assessment and treatment in patients' homes or very close by. It helps people to maintain their independence at home and is designed to provide support to as many patients as possible. The service offers therapeutic care, help with medicines and helps organise support from other services.

Memory Assessment Clinics

Specialist memory nurses provide rapid assessment and treatment of early memory problems. The clinics offer support, training and advice for patients and carers, helping with quick access to memory drugs and future support

Intensive Support Services

The specialist service provides intensive support at home over a short time. It is for patients and carers who need support suddenly and provides rapid re-assessment and treatment. It helps people remain in their own home during the short crisis and provides an alternative to hospital or nursing home admission

Nursing and Residential In-reach Services

This is a specialist service that provides advice, assistance, training and direct care to nursing and residential homes. It helps people retain their independence within the nursing or residential home, avoiding hospital admissions.

Day Therapy

Day therapy provides assessment and treatment services locally, helping people maintain their independence. The service offers therapy sessions, help with medicines and support from other services. Patients normally attend for therapy a few hours each week.

Inpatient Services

An `inpatient service' is a safe ward area, usually for 15 to 22 patients. Patients are usually admitted to inpatient wards if they have not benefitted from the other services at home or in the community or if they are at risk of harm. It provides assessment and treatment of patients.

Working with Partners

There is a range of innovative solutions that can support people with mental health problems provided in partnership with other organisations. These include Supported Housing, Extra Care, Residential and Nursing Homes.

"support to continue to live a

'normal' life where possible"

"a 24 hour number to call

if there is a problem or crisis"

What are your thoughts?

"home care staff often do not understand

issues around mental health and dementia,

we would like them to have better

understanding"

"staff in the general hospital setting do not understand issues around mental health and dementia, we would like them to have better understanding and more training in this area"

Appendix Two: NHS Hampshire. South East Capacity Plan Up-date -May 2009.

This paper provides a short progress report on the key projects that affect capacity in the South East Hampshire area.

Queen Alexandra Hospital (QAH)

· The main hospital building at QAH is due to complete 15 June 2009.

· The project is on target.

· A very complex commissioning process commences 16 June and is scheduled to last 4 weeks.

· The commissioning process has been reviewed and approved by an external independent panel of experts

· During the 4 week commissioning process, some services will move from the Royal Hospital Haslar and St Mary's Hospitals to QAH. This includes the main maternity unit, oncology, gynaecology among others.

St Mary's Community Hospital

· The Planning application has been submitted for the planning development which will lead the St Marys Community Hospital on the current St Marys site put in April

· Work is continuing to produce a business case which will be finalised following planning consent

Fareham Community Hospital

· Fareham Community Hospital is under construction

· Construction completes March 2010 followed by a commissioning period with occupation by end of May 2010

Oak Park Community Hospital (OPCH)

· Planning permission granted for OPCH Feb 2009

· Section 106 agreed in detail April 2009

· Business Case being developed

Gosport War Memorial Hospital (GWMH)

· The main construction work related to the redevelopment of GWMH completed Jan 2009

· There are a number of project underway to complete the commissioning phases

· Planning consent has been received for the new GP surgery onsite and the changes to the car park were agreed with the planning authority May 2009

· All of the services that were temporary decanted offsite, apart from the GP's, have returned to the Hospital

· Services will move from the Royal Hospital Haslar to the GWMH during June and July

· Phlebotomy services from the Royal Hospital Haslar and GWMH will move to local GP's surgery's in Gosport and South Fareham on 3^rd July 2009

Appendix Three. South Central Ambulance Trust. Performance in Hampshire- January -March 2009.

Category A 8min Performance - Hampshire Division

Data between 01/02/2009 & 30/04/2009

Key	Range
	0% to 9.99%
	10% to 19.99%
	20% to -29.99%
	30% to -39.99%
	40% to -49.99%
	50% to -59.99%
	60% to -69.99%
	70% to -79.99%
	80% to -89.99%
	90% to 100%

Category A 19min Performance - Hampshire Division

Data between 01/02/2009 & 30/04/2009

Key	Range
	0% to 9.99%
	10% to 19.99%
	20% to -29.99%
	30% to -39.99%
	40% to -49.99%
	50% to -59.99%
	60% to -69.99%
	70% to -79.99%
	80% to -89.99%
	90% to 100%

Category B 19min performance - Hampshire Division

Data between 01/02/2009 & 30/04/2009

Key	Range
	0% to 9.99%
	10% to 19.99%
	20% to -29.99%
	30% to -39.99%
	40% to -49.99%
	50% to -59.99%
	60% to -69.99%
	70% to -79.99%
	80% to -89.99%
	90% to 100%

	Hampshire PCT Cat A 8min Performance
	Urban
		Performance %
	Area	Q1	Q2	Q3	Q4
		Feb - Apr	May - Jul	Aug - Oct	Nov - Jan
	Fareham	88.17
	Havant	85.20
	Andover	83.33
	New Milton	83.03
	Winchester	80.00
	Gosport	78.71
	Eastleigh	78.44
	Waterlooville	77.27
	Basingstoke	72.40
	Totton	70.19
	Locks Heath	68.63
	Semi Urban Areas
		Performance %
	Area	Q1	Q2	Q3	Q4
		Feb - Apr	May - Jul	Aug - Oct	Nov - Jan
	Lymington	82.56
	Ringwood	82.26
	Romsey	78.57
	Hythe	77.61
	Alton	77.27
	Lee-on-the-Solent	76.92
	Hayling Island	74.49
	Petersfield	72.88
	Bordon	70.18
	Fawley	66.00
	Stubbington	63.27
	Rural Areas
		Performance %
	Area	Q1	Q2	Q3	Q4
		Feb - Apr	May - Jul	Aug - Oct	Nov - Jan
	Rural Hampshire	60.58

Appendix Four:

HAMPSHIRE OVERVIEW AND SCRUTINY COMMITTEE

PRIMARY CARE FOR THE HOMELESS PROJECT

UPDATE MAY 2009

1. INTRODUCTION

1.1. This paper provides the Hampshire Health Overview and Scrutiny Committee [HOSC] with an update on the progress of the implementation of the project to provide effective primary care services for people who are homeless. At the last meeting of the HOSC, a paper was presented providing the background to the project and some of the public health data associated with the population in question. The paper also set out the process by which NHS Hampshire was seeking to understand the services provided in Primary Care to those in forms of temporary accommodation and rough sleepers.

1.2. Following initial work focussed on the service provided at the Trinity Centre in Winchester, the project has extended in scope to look at services accessed and service models throughout Hampshire.

2. SURVEY OF PRIMARY CARE SERVICES PROVIDED TO HOMELESS PEOPLE

2.1. A survey was undertaken in early April 2009 of all GP Practices to ascertain their policy with regard to the care of the homeless. By the end of April, 102 practices had replied (from 147) and so a full analysis has not yet been possible. Comments from practices show that most provide care on a temporary basis to those without an address and that at least 50% of respondents have registered patients who are homeless.

2.2. During March, an audit was undertaken of the service at the Trinity Centre in Winchester and of the service commissioned from Victoria Practice in Aldershot.

2.3. Early analysis of the Trinity Centre Service Audit shows:

· 35 GP Appointments and 8 nurse appointments provided during the month;

· 31 patients were seen in 45 attendances, of whom 30% were female and 70% male;

· 68% of the patients were already registered with a GP;

· the average age of attendees was 30;

· more younger patients were already registered with a GP than older patients;

· 15 contacts had temporary accommodation and 3 used the night shelter, 21 were recorded as rough sleepers and 5 in permanent accommodation.

2.4. Further analysis of this and the smaller GP practice led service in Aldershot is now required to understand the clinical needs met by the service.

2.5. The service level agreement with Hampshire Community Health Services had been renewed at a level to reflect the service delivered at the Trinity Centre to March 2010.

3. NEXT STEPS

3.1. Over the next 2 months, NHS Hampshire will focus on:

· a comparative analysis of the two current models to determine how best to meet needs for the future;

· Further analysis of responses from GP practices to identify and "hot spots";

· Ensure that appropriate arrangements exist for transfer of information for registered patients seen at Trinity to avoid any clinical risk.

An update report will be presented to the HOSC in July 2009