Archived decisions

REPORT OF THE

HEALTH OVERVIEW AND SCRUTINY COMMITTEE

PART II

    INQUIRIES RECEIVED AND ACTION TAKEN

    1. The Committee continues to receive inquiries from partner organisations and County Councillors. At the last meeting Members were alerted to inquiries about:

    NHS Hampshire Rapid Appraisal Plan Including Southeast Capacity Plan

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

        · Oak Park Hospital, Havant - the Southeast 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.

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

      To this end a scrutiny panel has been established to consider the issues.

Minor Injuries Unit, Havant War Memorial Hospital

      NHS Hampshire presented a briefing paper on the Havant Minor Injuries Unit (MIU). 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

    2. The responses made by the Committee influence and improve the delivery of health services in Hampshire and, in doing so, support the Corporate Strategy aim of maximising well being.

    3. This report arises from consideration of the report by the Committee on 29 September 2009 which is on Hantsweb at:

    /decisions/decisions-docs/090929-hovasc-R0921095627

    PROPOSALS TO DEVELOP OR VARY NHS SERVICES

    1. The Committee is continuing to monitor proposals from the NHS to substantially vary health services including:

    Winchester and Eastleigh Healthcare NHS Trust: Future Developments Requiring Action

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

        · Meeting 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

        · 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.

    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

Letters received from Dr. Julian Lewis MP and a member of staff at the unit expressing concerns to some of the proposals, were circulated at the meeting. 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 as an issue and it was confirmed that if the proposed Oak Park, Hospital, Havant did not go ahead the Beaton Ward at St. James' would 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.

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

The Committee had expressed a number of concerns about Surrey and Borders NHS Trust's proposals to reconfigure inpatient mental health services to three sites based in Surrey. NHS Hampshire and Adult Services had indicated that they were now supportive of the broad direction of travel proposed by the Trust, as was Surrey County Council. The Trust had now written indicating its intention to proceed with the proposed reconfiguration of services.

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 was noted. Taking these points into account the Committee took the view that a referral to the Secretary of State is unlikely to be successful.

In response to the continued concerns of Hampshire stakeholders the Committee reaffirmed 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.

    2. The responses made by the Committee influence and improve the delivery of health services in Hampshire and, in doing so, support the Corporate Strategy aim of maximising well being.

    3. This report arises from consideration of the report by the Committee on 29 September 2009 which is on Hantsweb at:

    /decisions/decisions-docs/090929-hovasc-R0921095613

              ANNA McNAIR SCOTT

              Chairman.