Archived decisions

Item 2

AT A MEETING of the HEALTH OVERVIEW AND SCRUTINY COMMITTEE of the COUNTY COUNCIL held at The Castle, Winchester held at The Castle, Winchester on Tuesday, 29 September 2009.

PRESENT

Chairman:

p Councillor Anna McNair Scott

Vice-Chairman:

p Councillor Pat West

Councillors:

Co-opted Members:

Councillors:

p Marion Kerley

p Ray Love

p Peter Luffman

a John Marsh

Also in attendance Councillor Felicity Hindson MBE, Executive Member for Adult Social Care.

9. DECLARATIONS OF INTEREST

Members were mindful that, where they believed that they had a personal or personal prejudicial interest any matter to be considered at the meeting, they should normally, at the time of the debate, declare their interest, and having regard to the circumstances described in paragraphs 9, 10, 11 and 12 of the County Council's Code of Conduct, consider whether to leave the meeting whilst the matter was discussed save for exercising any right to speak in accordance with Paragraph 12 of the Code.

The following members declared a personal interest:

Councillor Brian Collin - wife employed by NHS

Councillor Phryn Dickens - employed by NHS

Councillor Peter Edgar - does work for NHS

Councillor Peter Luffman - Healthcare Worker

Councillor Marian Kerley - Member of Andover War Memorial Hospital

League of Friends

Councillor Pam Mutton - daughter employed by NHS

Councillor Pat West - daughter-in law employed by NHS.

10. CHAIRMAN'S COMMUNICATION

a. Queen Alexandra Hospital, Cosham

The Chairman reported that arrangements had been made for Members to visit Queen Alexandra Hospital on 23 October 2009.

b. South Central Health Overview and Scrutiny Committees

The Chairman reported that arrangements had been made for the next meeting of the South Central Health Overview and Scrutiny Committees to take place on 10 November 2009 at Wokingham and that she and the Vice-Chairman would be attending.

c. NHS Hampshire Chief Executive

The Chairman reported that Debbie Fleming had recently been appointed as the new Chief Executive of NHS Hampshire.

d. New Forest Birth Centre

The Chairman reported that the New Forest Birth Centre would be holding an event on 2 October 2009 to celebrate its first year and that all Members were invited to attend.

e. Ambulance Service Visits

The Chairman reported on her time out with the ambulance service and suggested that Members share details of their visits via email.

11. MINUTES

The Minutes of the Meeting of the Committee held on 28 July 2009 were confirmed as a correct record, and signed by the Chairman.

12. WORK PROGRAMME

The Chief Executive presented the Committee's Work Programme and outlined the progress being made on the review of Therapy Services for Children with Severe Disabilities and Complex Care Needs (Item 4 in the Minute Book).

RESOLVED:

That the Committee's Work Programme be approved subject to the issues raised at this meeting.

13. PROPOSALS TO DEVELOP OR VARY NHS SERVICES

The Chief Executive presented a report on proposals to develop or vary

health services in the area of the Committee (Item 5 in the Minute Book). He presented the report in two parts which comprised items for information which alerted the Committee to forthcoming proposals from the NHS to vary or change services and items for action required by the Committee to respond to proposals from the NHS to substantially change or vary NHS services.

Under Items for information he gave details on:-

a. Winchester and Eastleigh Healthcare NHS Trust: Future Developments Requiring Action

The Chief Executive of Winchester and Eastleigh Healthcare NHS Trust gave an update on the progress made which included:

· Having met all waiting time and access targets in 2008/09

· Infection rates remaining among the best in the country

· Quality indicators underlining improvements

· Latest GP survey showing satisfaction levels are higher overall

· Increased numbers of staff

· Cleaner hospital than ever

· Capital investments - £11m this year

· Improved privacy and dignity for patients

· Being on target for new Outpatients department at Andover - January 2010 or earlier

He explained the forthcoming financial implications which included NHS funding from 2010 becoming worse, unavoidable cost pressures such as pay awards and efficiency savings of 7% to balance the books. Progress was being made to overcome these financial implications, £6m had already been saved through a robust service improvement programme and another £5m savings had been identified. A £3m gap was still outstanding to enable the Trust to break even. They were currently looking at working with partners to see what could be done to drive up efficiency whilst safeguarding quality, proposals were:

· Unscheduled care - involving GPs

· Stroke - partnership across a network supports a consultant led 24hr service

· Andover Birth Centre - promoting it more to partners and the public

· Breast care services - already a shared service with Basingstoke

· Neuro rehabilitation - working with Southampton to look at sharing this

· Elderly care - area of expertise at Winchester and Eastleigh Healthcare NHS Trust so they could work with partners better

· Vascular and spinal surgery - models of care with Southampton allow local pre and post operative care and specialised surgery

· Hospital services not in hospitals - they were keen to provide services in community settings - eg Bordon contract

He stressed that patient safety and quality was of prime importance and would not be compromised.

The proposal to relocate the Royal Hampshire County Hospital Outpatients Department to Avalon House, Winchester was now not an option but there was a possibility of some of the Trust's office functions being relocated there. He confirmed that the Committee would be advised on any proposals that would impact on services provided by the Trust at the earliest opportunity.

RESOLVED:

That the Trust, through the nominated Councillors (Councillors Brian Collin, Pam Mutton and Pat West) maintains regular contact with the Committee, and reports back formally on future development plans as they are developed.

b. Winchester and Eastleigh Healthcare NHS Trust: Provision of Surgical Dermatology Services

The Chief Executive of Winchester and Eastleigh Healthcare NHS Trust reported that, following the departure of its Surgical Dermatology consultant, discussions had been held with NHS Hampshire and a broad agreement had been reached that the service would continue to be provided at current levels by the Trust. A business case to support this was being agreed with NHS Hampshire. The Trust would continue to provide those components of the current service that it could during the appointment of a replacement consultant.

RESOLVED:

That the arrangements for the provision of surgical dermatology services at Winchester and Eastleigh Healthcare NHS Trust be noted and the Committee be advised when the replacement consultant is in post.

Under items requiring action he gave details on:-

c. Hampshire Partnership NHS Foundation Trust - Proposals to Modernise Adult Mental Health Rehabilitation

The Chief Executive and Medical Director of Hampshire Partnership NHS Foundation Trust advised the Committee on the progress that had been made with services for older people in Andover and what had been happening with mental health services across Hampshire. They outlined the vision for the future which included:

· Personalised care based on individual need

· `Whole' person focussed

· Carers supported

· Anti-stigma and discrimination

· Employment and stable, appropriate accommodation for service users

· Engagement on proposals had included staff consultation from June to September 2009, engagement with service user and carers, a governor focus group, stakeholder events and one to one meetings planned for October 2009 and discussions at public meetings including the Annual General Meeting.

They gave details of rehabilitation and Psychiatric Intensive Care Units plans which were:

Rehabilitation-

· Rivendale - care plans in place to safely discharge all patients by end October 2009

· Crowlin House had a core of long stay individuals and care plans were less well advanced and plans for these services would be taken seperately

· More people supported independently with capacity to absorb new referrals

· Staff redeployment was expected to be fully successful

· There were two stakeholder events arranged for mid October 2009

· Following this the Trust would consider the next steps

Psychiatric Intensive Care Units-

· Fewer beds were required to meet the needs of our patients - there was an increasing number of vacant beds.

· There was capacity in remaining Psychiatric Intensive Care Units to absorb new referrals

· Staff redeployment was expected to be fully successful

· There was a stakeholder event arranged for mid October 2009

· Following this the Trust would consider the next steps

The Chairman circulated letters that she had received from Dr. Julian Lewis MP and a consultant psychiatrist expressing concerns to some of the proposals, copies of which would appear in the Minute Book. The Medical Director agreed to look at the issues raised in the letters.

Hampshire LINk agreed that mental health services were moving forward in a positive way, NHS Hampshire said that it was important that patients must be cared for safely and appropriately and Adult Services were keen to see that services kept pace with the challenges ahead. The future of beds at St James' Hospital Portsmouth was highlighted and it was confirmed that if the proposed Oak Park, Hospital, Havant did not go ahead the Beaton Ward at St. James' would have to continue to take patients.

Members agreed that the proposed changes did constitute a substantial service change under the provisions of Section 244 of the National Health Service Act 2006.

RESOLVED:

That:

i. the changes to services proposed by Hampshire Partnership NHS Foundation Trust be considered substantial under the provisions of Section 244 of the National Health Service Act 2006.

ii. under the provisions of Section 242 of the National Health Service Act 2006 Hampshire Partnership NHS Foundation Trust involves and consults patients in planning service provision, developing and considering changes and making decisions about the service operates.

iii. Hampshire Partnership NHS Foundation Trust carries out engagement with stakeholders prior to any formal consultation.

d. Surrey and Borders Partnership NHS Trust - proposals to Reconfigure 24 Hour Assessment and Treatment (Inpatient Mental Health Services)

The Chief Executive reported that following the meeting on 31 March 2009 when a number of concerns about Surrey and Borders NHS Trust's proposals to reconfigure inpatient mental health services to three sites based in Surrey were expressed NHS Hampshire and Adult Services had indicated that they were now supportive of the broad direction of travel proposed by the Trust, which had also received strong support from Surrey County Council. The Trust had now written indicating its intention to proceed with the proposed reconfiguration of services and the outcome of its consultations was shown as appendices two and three of the Chief Executive's report.

RESOLVED:

That:

i. The strong support in Surrey for the planned changes and the efforts of the Trust to engage with stakeholders as fully as possible in the latter part of the consultation exercise be noted. Taking these points into account the Committee is of the view that a referral to the Secretary of State is unlikely to be successful.

ii. In response to the continued concerns of Hampshire stakeholders the Committee reaffirms its view that these changes had not been demonstrated to be in the interests of the Hampshire residents that would be affected and recommended that :

· Surrey and Borders NHS Trust establishes a steering group comprising of local stakeholders to oversee the implementation of the planned changes in Hampshire. This group would have a specific remit to look at access to community mental health services, the availability of support with travel costs, the care pathways in place to support service users and the effectiveness of local stakeholder engagement and report its findings to the Committee as it considers appropriate.

· the feasibility of the contract for inpatient care being provided by another local NHS Trust be explored as part of the review being taken forward by NHS Hampshire and Adult Services This to be completed before any changes are made to existing provision and reported back to the Committee.

e. West Sussex Primary Care Trust: Acute Service Reconfiguration

The Chief Executive reported that West Sussex Primary Care Trust had confirmed that it was looking at commissioning intentions for maternity services, in-patient paediatrics and emergency surgery, however the timetable for this had slipped. It was not clear how much stakeholder input was informing the process or what impact it would have on Hampshire health services.

RESOLVED:

That the Committee be kept appraised of any further developments relating to this work.

f. Fluoridation of Drinking Water in Southampton and Southwest Hampshire

The Chief Executive reported that the Judicial Review challenge to the Strategic Health Authority had now been given leave to proceed on limited grounds. These were, in summary, that the Regulations did not appear to give effect to what was apparently stated unequivocally by Ministers to be the position at the time i.e. that fluoridation would only go ahead where the local population was in favour. The Judge had therefore ordered that the Secretary of State for Health should become a party to the proceedings. This meant that the Secretary of State would be legally represented at the full hearing and would be asked to explain the apparent differences between what was stated to be government policy and the actual wording of the Regulations. Permission to proceed with Judicial Review on the second ground has been refused. The second ground was that the Health Authority did not have regard to the cogency of the arguments advanced for and against fluoridation. The claimant's solicitors were submitting a renewed application to have the second ground included in the Judicial Review proceedings.

Other Primary Care Trusts considering proposals to fluoridate water in their areas had put these plans on hold until pending the outcome of the legal proceedings.

Given this development the County Council had agreed that the report back to Council on the feasibility of a referendum be deferred until the outcome of the Judicial Review was known.

RESOLVED:

That the Committee be briefed on the outcome of the judicial review.

g. South Central Strategic Health Authority - Provision of Primary Angioplasty Services

The Chief Executive reported that The South Central Specialist Commissioning team had alerted the Committee to the intention to consult on arrangements for providing access to primary angioplasty services in order to improve survival for patients experiencing certain forms of heart attack. NHS Hampshire would be leading the consultation for Hampshire, Portsmouth, Southampton and the Isle of Wight. Members from each of the local authority areas affected had already indicated that these changes were likely to be significant and should therefore be subject to formal consultation. This was likely to commence in the New Year. The outline of the proposal was attached as Appendix four to the Chief Executive's report,

RESOLVED:

That:

i. the Hampshire, Southampton, Portsmouth and Isle of Wight Health Scrutiny Joint Committee formally scrutinises the proposals for primary angioplasty.

ii. all Members of the Committee be provided with the opportunity to share their views on the proposals with the Joint Committee.

14. INQUIRIES RECEIVED AND ACTION TAKEN

The Chief Executive presented a report on enquiries received, the

source of each enquiry and the action taken (Item 6 in the Minute Book). The enquiries related to:-

a. NHS Hampshire Rapid Appraisal Plan Including Southeast Capacity Plan

NHS Hampshire reported that following the rapid appraisal its Board had been requested to give reconsideration to

· Oak Park - the South East capacity map review and the review of use of current local facilities meant this will not meet the Value for Money and affordability challenge in the business case for investment (Appendix A to the Board's report, a copy of which appears in the Minute Book gave for more detail on the appraisal process for Oak Park Community Hospital).

· Vascular screening - the current model did not appear to be cost effective and this could be a great opportunity to provide an innovative technological solution.

· Improving Access to Psychological Therapies - although this was nationally funded there was no clinical evidence of this being effective and it would not be the priority for the mental health clinical lead.

On the question of Oak Park Hospital, Havant the Board was aware that the building of the new hospital had been envisaged since the 1980s and sought further information on the delivery of all health services within the area before making a final decision, to this end it had established a steering group to identify the options for providing the services needed by the population,

The Committee sought more information on Vascular Screening and Improving Access to Psychological Therapies to enable it to decide whether or not the proposed changes were substantial. With regard to Oak Park Hospital the Committee was of the opinion that if the NHS Hampshire Board decided not to proceed with the building of the Hospital it would constitute a substantial service change. In developing any proposals the Board needed to show that:

· the proposals took account of the current and future health needs of the population affected.

· the adequacy of the stakeholder engagement and involvement arrangements were in place to underpin the planning and development of services in the areas affected.

· the adequacy of the formal consultation process proposed.

The Committee was of the opinion that future proposals concerning Oak Park Hospital, Havant might result in a substantial change and would wish to scrutinise the proposals to ensure that:

· local people and key stakeholders were fully involved in shaping any changes in service delivery

· the proposals put forward for consultation were in the interests of the community affected

To this end it recommended that a scrutiny panel be established to consider the issues.

RESOLVED:

That:

i. NHS Hampshire presents further information on Vascular

Screening and Improving Access to Psychological Therapies to the next meeting of the Committee to enable it to decide whether or not the proposed changes were substantial.

ii. A Scrutiny Panel consisting of Councillors Anna McNair Scott (Chairman); Brian Collin; David Keast and Pat West with an observer from each of East Hampshire District Council, Havant Borough Council and Winchester City Council be established to scrutinise any proposed changes in respect of Oak Park Hospital, Havant.

iii. NHS Hampshire reports back to the Committee in January 2010 on the options open for providing ambulatory and in-patient services, currently planned for Oak Park Hospital in alternative care settings. This would be prior to any formal consultation being initiated.

iv. The Committee be provided with an opportunity to visit the services affected.

b. Minor Injuries Unit, Havant War Memorial Hospital

NHS Hampshire presented a briefing paper on the Havant Minor Injuries Unit which appeared as appendices two and three to the Chief Executive's report. It outlined the conditions treated by the Unit prior to its closure in December 2008 because of staffing problems. A review concluded that the issues of medical cover, diagnostic facilities, staff competencies, the inappropriate environment and risk to inpatient privacy and dignity could not be addressed without major investment. In addition, the low number of patients presenting at the Minor Injuries Unit meant that, even if staff were to be appropriately skilled, they would be unable to maintain the necessary clinical skills required to ensure the service is safe and of a high quality. To enable existing staff to be skilled to the level required in a MIU would take a minimum of one year. The Committee noted the situation but was concerned at the way in which the closure had been managed

RESOLVED:

That:

i. The closure of the Minor Injuries Unit at Havant War Memorial Hospital be not considered substantial.

ii NHS Hampshire be advised of the concerns of the Committee about the way in which the process was managed and reminded of the need to ensure that service closures on the grounds of patient safety should only be short term in nature.

iii. NHS Hampshire provides further information on the pattern of

current and future provision for minor injuries for Havant and the surrounding area to the next meeting of the Committee.

.

j. Minor Injuries Unit, Gosport War Memorial Hospital

NHS Hampshire had been asked to respond to concerns that the lack of publicity and public information about the new Minor Injuries Unit is resulting in some patients attending Queen Alexandra Hospital Accident and Emergency when they could be treated more locally.

RESOLVED:

That:

i. NHS Hampshire provides details of the publicity and communications strategy that has taken place in Gosport/Fareham to ensure that people are aware of the closure of the Royal Haslar Hospital Accident Treatment Centre and the range of services provided at the Minor Injuries Unit at Gosport War Memorial Hospital at the next meeting of the Committee.

ii. Additional information be provided about the monitoring in place to ensure that attendance at Queen Alexandra Hospital Accident and Emergency is appropriate.

k. Health and Wellbeing Partnership Strategy Consultation

The Draft Strategy and response from the Committee were attached at Appendices Four & Five to the Chief Executive's report.

RESOLVED:

That the draft response on the Health and Wellbeing Partnership Strategy Consultation be agreed