Archived decisions

Agenda Item 6

HAMPSHIRE COUNTY COUNCIL

Report

1. Summary and Purpose

1.1. The purpose of this report is to alert Members to proposals from the NHS to vary or develop health services provided to people living in the area of the Committee.

1.2. Proposals that are considered to be substantial in nature will be subject to formal public consultation. The nature and scope of this consultation should be discussed with the Committee at the earliest opportunity.

1.3. The response of the Committee will take account of the Framework for Assessing Substantial Change and Variation in Health Services agreed by the Hampshire, Isle of Wight, Portsmouth and Southampton Joint Committee in March 2005. This places particular emphasis on the duties imposed on the NHS by Section 11 of the Health and Social Care Act 2001.

1.4. This Report is presented to the Committee in 2 parts:

_ Items for information: these alert the Committee to forthcoming proposals from the NHS to vary or change services. This provides the Committee with an opportunity to determine if the proposal would be considered substantial and assess the need to establish formal joint arrangements

_ Items for action: these set out the actions required by the Committee to respond to proposals from the NHS to substantially change or vary NHS services.

1.5. This report and recommendations provide members with an opportunity to influence and improve the delivery of health services in Hampshire and therefore support the delivery of the Corporate Strategy aim of maximising well being.

Items for Information

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

2.1. The in response to the recommendations at the last meeting the Chairman has written to the Trust noting the strong support in Surrey for the planned changes and acknowledging the efforts of the Trust to engage with stakeholders as fully as possible in the latter part of the consultation exercise.

2.2. In response to the continued concerns of Hampshire stakeholders the HOSC reaffirmed its view that these changes have not been demonstrated to be in the interests of the Hampshire residents that will 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 will 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. It will be open to this group to report its findings to the HOSC as it considers appropriate.

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

2.3. The Response from the Trust to these recommendations is attached at Appendix One

Recommendations

2.4. No further action is required by the HOSC at this point in time

2.5. The Steering Group be invited to provide feedback to the HOSC on progress in 12 months time

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

3.1. No further information has been received about progress with the Judicial Review challenge to the SHA.

Recommendation

3.2. Members are kept briefed on progress with the Judicial Review.

Items for Action

4. Hampshire Partnership NHS Foundation Trust: Proposals to modernise adult mental health rehabilitation.

4.1. Further to the presentation on the planned consultation on proposals to modernise adult mental health services in Hampshire the Trust has alerted the Chairman to a decision to take urgent action to close the units subject to consultation on the grounds of safety. The letter from the Trust setting out its case for taking this action is set out at Appendix Two.

4.2. The initial response from the Chairman and the subsequent exchange of correspondence about this matter is attached at Appendices Three, Four, Five and Six. Concerns about the pressures on PICU (Psychiatric Intensive Care) services have continued to be expressed by both local MPs and staff. As a consequence additional clarification was sought from the Trust on the following points:

_ the availability of acute beds  across the Trust over the last two weeks  - including numbers and % occupancy

_ is it the case that in order that a patient could be admitted to Winsor Ward at Woodhaven a portable bed had to be erected in an office.  Has a situation such as this arisen anywhere else in the Trust in the last two weeks

_ Is Ellingham still taking admissions. Have there been any instances where a patient requiring admission has not been able to access PICU provided by the Trust over the last two weeks.

_ what was the occupancy of PICU beds across the Trust in the over the last two weeks- please give numbers and %

4.3. The Chairman has asked for feedback from the Local Improvement Team operating in the area and this will be shared with the HOSC at the meeting on 24 November.

Recommendation

4.4. That the HOSC confirms if it is satisfied:

_ With the case made by the Trust for the urgent closure of Ellingham and Rivendale.

_ That there is sufficient flexibility in access to PICU facilities

5. West Sussex PCT: Acute Service Reconfiguration: West Sussex Primary Care Trust - Acute Service Reconfiguration

5.1. West Sussex PCT has confirmed that it is not taking forward proposals to change the configuration of maternity services, in-patient paediatrics and emergency surgery in West Sussex.

5.2. A final meeting of the JHOSC will be held on 2 December to confirm that the proposals put forward by the PCT have been abandoned.

Recommendation

5.3. That the Committee formally notes the intention to disband the JHOSC.

6. South Central SHA: Provision of Primary Angioplasty Services

6.1. As reported at the last meeting NHS Hampshire will be leading the consultation for Hampshire, Portsmouth, Southampton and the Isle of Wight on plans to provide access to this service.

6.2. Members from each of the local authority areas affected have already indicated that these changes are likely to be significant and should therefore be subject to formal consultation. A meeting of Portsmouth, Southampton Hampshire and Isle of Wight HOSCs has been convened on 1 December to consider this matter in greater depth.

Recommendations

6.3. The Joint Hampshire, Portsmouth Southampton and Isle of Wight HOSC formally scrutinises the proposals for primary angioplasty.

6.4. All Members of the Hampshire HOSC will be provided with an opportunity to share their views on the proposals with the Joint HOSC.

7. NHS Hampshire: Proposals to cease the development of Oak Park Hospital

7.1. Further to the discussion at the last meeting the Chairman wrote to the Interim Chief executive of NHS Hampshire setting out a number of points of concern. This correspondence and the response from NHS Hampshire is attached at Appendices Seven and Eight respectively.

7.2. The additional information sent by NHS Hampshire was circulated electronically to all HOSC members on 4 November 2009.

7.3. Two elected members have been nominated by East Hampshire District Council and Havant Borough Council to attend the formal Panel looking at this proposal. It is anticipated that this Panel will begin meeting formally early in the New Year.

7.4. An update from NHS Hampshire on the stakeholder engagement that is taking place is included at Appendix Nine.

Recommendation

7.5. Members confirm if they are satisfied with:

_ The stakeholder engagement that is taking place prior to any formal consultation of this matter

_ the approach proposed for alternative service provision should Oak Park Community Hospital not proceed.

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

N/A

2. Impact on Crime and Disorder:

N/A

Appendix One: Surrey and Borders response to Hampshire HOSC- 24 Hour Assessment and Treatment Way Forward

Thank you for your letter formally advising us of the decision of your Committee with regards to our recent consultation Our Future Your Say for Hospital Services and our planned way forward.

We recognise and appreciate the continued concerns of your Committee members on behalf of your residents. I would like to assure you of our commitment to providing high quality services for the people of North East Hampshire and ensuring that these changes benefit them as well as the people of Surrey.

We welcome your constructive recommendations for how we can continue to work with our Hampshire partners to secure these benefits for your population and to provide you with the assurance you require. I can confirm that we are happy to establish a North East Hampshire Steering Group which will oversee the implementation of the planned changes in North East Hampshire. We have already commenced our work to establish this group and have prepared a draft terms of reference and membership which has been informed by our discussions with you and also with our colleagues in Hart and Rushmoor Borough Councils whom we visited in September. We have already agreed with both Councils that they would review the terms of reference and advise us of their comments and who will represent them on the membership. I attach a copy of the current draft for the consideration of your Committee members from whom we would also welcome comments and suggestions. We are mindful that, at your last meeting, some of your members expressed a desire to be explicitly linked with this new Steering Board and I would be particularly grateful if you could confirm who this will be and their preferred contact information.

Whilst you have not asked us to comment specifically on your second recommendation I wanted to assure you of our commitment to continuing to work effectively with NHS Hampshire and Hampshire County Council Adult Services on both their work to review commissioning of inpatient services and access to community services.

Thank you again for your continued attention and focus on supporting effective change and improvement for people with mental ill health in North East Hampshire.

Steering Group Terms of Reference:

Appendix Two: Letter from Hampshire Partnership- 2 October 2009

Mental health services in Hampshire and the need for temporary urgent action

I am writing further to the Health Overview and Scrutiny Committee (HOSC) meeting on 29 September 2009 and the update I gave on the development of mental health services in Hampshire.

At the HOSC meeting I highlighted that the Trust Board were meeting that same day to consider the feedback from staff on the proposed developments in service, the engagement work to date with stakeholders and the advice from the HOSC in order to agree next steps.

I am writing to report the outcome of the Trust Board meeting.

The Trust Board reflected upon the advice from the HOSC and the feedback from staff and other stakeholders in relation to Rivendale Rehabilitation Unit in Fareham and Ellingham Psychiatric Intensive Care Unit in Totton. The Board have decided to defer any final decisions until we have completed a further period of stakeholder, service user, public and staff engagement and consultation. This will continue over the next three months and we will report progress as requested at the next HOSC meeting in November. I will confirm a start date for the formal public consultation element of our engagement in due course.

With regard to Crowlin House in Southampton, the Board have decided to include it in a wider review of our rehabilitation services to develop more personalised care. We will therefore not be proceeding with this proposal in its current form and for this reason proposals around Crowlin House will not feature in the engagement and consultation in the coming weeks.

As I reported to the HOSC, there are significant service pressures being experienced within our services, due in large part to the number of vacant posts being held for staff in the event that they need to be redeployed if these proposals are approved.

We have an absolute commitment to our service users to maintain safe, effective services which maintain the standards of quality we are proud of. However the service directors and senior clinicians are giving strong advice to the Board that it is unsustainable to continue with such high numbers of posts being filled by temporary staff.

In the light of the decision to undertake further engagement in relation to the proposals for affected services, the Trust Board has decided to take temporary `urgent action' to ensure we maintain safe and effective services to our service users and ensure sustainable working conditions for our staff. This temporary urgent action will involve:

1. Short term closure of Rivendale Rehabilitation Unit for a four month period

2. Short term closure of Ellingham Psychiatric Intensive Care (PICU) Unit for a four month period

3. Secondment of the staff from these two units (under existing terms and conditions) into areas where they have expressed an interest during the staff consultation period.

4. Releasing some vacancies for permanent external recruitment to take place.

5. Reviewing the position in January 2010 subject to the status of further engagement and decision making at that time.

We have done our best to ensure all affected staff have been personally briefed ahead of this announcement and hope to be in a position to start secondments from the week commencing 19 October. The Trust Board are clear that these secondments are temporary and without prejudice to the outcome of the consultation - all staff will return to their substantive posts in the event that following consultation the proposals are not progressed.

Our commitment to maintaining high quality services whilst ensuring we have a sustainable working environment for our staff have been key considerations. This decision has not been taken lightly and I trust that you will appreciate the reasons for this.

Thank you again for the helpful advice and support that the HOSC has given and I look forward to attending the next HOSC meeting to update you on the position in relation to all these issues.

Appendix Three: Letter from HOSC Chairman - 8 October. Mental health services and the need for temporary urgent action

Thank you very much for your letter of 2^nd October following your Trust board meeting.

I welcome your decision to defer final decisions in relation to the Rivendale Rehabilitation Unit and Ellingham PICU until you have undertaken further engagement with stakeholders, service users, public and staff , and confirm that the HOSC will expect an update at the meeting on 24^th November 2009. While I appreciate that there are occasions where the Trust needs to take temporary urgent action on the grounds of patient or staff safety, I am very concerned that you are effectively closing the services subject to consultation. In particular controversy about Ellingham PICU has been highlighted by recent correspondence from the local MP and member of staff. In our experience services subject to this type of action during a consultation process rarely open and the Trust will inevitably create an impression that decisions about the future of these services have already been taken. This is not helpful.

I welcomed your confirmation that the plans for Crowlin House will now be subject to further review and will wait to hear how the Trust sees this work progressing. I will also need to share the reasons for your urgent action with HOSC members, particularly in relation to PICU. I would therefore be grateful if you could provide me with the following information:

· How many patients will be affected by the closures and where will they be cared for should the Unit close

· What are the occupancy rates for both units over the last 6 months

· What services are available for PICU patients requiring long term placements

· How many vacancies does the Trust have, where and at what grade

· What is the current number of agency staff employed by the Trust, where are they located, in what service and at what grade

· What are the costs of agency staff to the Trust

· What are the clinical implications for services should this action not be taken

· Is the action proposed supported by clinical staff

· Is the action proposed supported by NHS Hampshire

· Will this action impact on other service providers, including Hampshire Adult Services

· How will the impact on services be monitored and reported

You have made clear in your letter that these are temporary arrangements; we will need to know when you anticipate that there will be a resolution to this current problem.

Appendix Four: Letter from Hampshire Partnership - 20 October. Mental health services and the need for temporary urgent action

Thank you very much for your letter of 8th October 2009 and the further queries that Denise has raised. I appreciate your concerns regarding the need for temporary urgent action. I can confirm that the urgent action is temporary and that the Trust will make long term decisions regarding these services only after full consideration of the outcomes of the further engagement and consultation we are undertaking.

I will respond to the questions that you have raised in turn.

How many patients will be affected by the closures and where will they be cared for should the Unit close?

The majority of patients affected by the temporary closures have moved on as a result of progress in their health. Of those who require a transfer to another unit as a result of closure, 2 people on Ellingham have been transferred to other Trust Psychiatric Intensive care [PICU] units, and 2 people at Rivendale have been transferred to Hollybank Rehabilitation Unit in Havant for a period of around 4 weeks before they are ready to return to a community setting. The Trust is confident that capacity exists to meet future demands.

What are the occupancy rates for both units over the last 6 months?

PICU

The occupancy rate for PICU beds has been reducing over the last six months as a result of the successful implementation of improvements in clinical practice, set out in the recent letter from Dr Shawcross (attached). As a consequence of these changes, the Trust has been able to reduce the length of time that individuals need to stay in an intensive care environment, ensuring earlier access to a more appropriate therapeutic environment.

The success of this improvement in clinical practice can be seen by the reduction of the average occupancy for PICU beds across the Trust from 90% (April - June 2009) to 78% (July to September 2009). The average occupancy for Ellingham during these two time periods has reduced from 92% to 74%

The improvements in clinical practice and more rapid transfer of patients to an appropriate therapeutic setting has resulted in, on average, 6.8 empty PICU beds across the Trust. It is anticipated that this trend will not only be maintained, but improved as the improved clinical practice is consistently adopted across the system. We formally review bed occupancy on a weekly basis and in addition we will review after six weeks the pattern of PICU occupancy and report out findings to the HOSC.

Rehabilitation

The average occupancy for rehabilitation beds across the Trust in the period April - June 2009 was 84%. The average occupancy for Rivendale was 70% in this period. The average occupancy for rehabilitation beds across the Trust from July - September 2009 was 77%. The average occupancy for Rivendale was 54%.

Given the bed numbers available this equates to an average of 17 empty rehabilitation beds across the Trust in the first quarter and 24 empty rehabilitation beds across the Trust in the second quarter.

What services are available for PICU patients requiring long term placements?

Psychiatric intensive care is a short term intervention used for a period of days or weeks, in line with national guidance and best practice. Prior to the improvement in clinical practice, the average length of stay of individuals on PICU was 40 days, compared to a national average of 26 days. PICUs should not be used for long term placements. Typically patients moving on from PICU will return to an open acute ward, or into longer term intensive rehab in a low secure setting. Work has taken place over the last 12 months to assist around six patients who had inappropriately long stays, into low secure care.

How many vacancies does the Trust have, where and at what grade?

The Trust had 243 vacancies (of which 106 were for qualified staff) immediately prior to decisions on temporary urgent action. The level of vacancies were a consequence of a Trust policy introduced in June 2009, following the recognition that the improvements in clinical practice indicated that we would ultimately need fewer staff providing PICU and rehabilitation beds than we currently employed. We also recognised that some additional staff would be required in other areas including supporting individuals in recovery returning to independent living. Rather than employing staff whom would subsequently need to be redeployed, we held a number of vacant posts.

We believed we could continue to operate with the policy that we enacted back in June 2009, through to the point where a final and definitive decision could be taken with partners and stakeholders on the future of Ellingham and Rivendale. Unfortunately, this position could not be sustained, and temporary urgent action was required,

What are the costs of agency staff to the Trust?

The most recent reported figure is £279,000 for the month of September 2009. This represents 2.3% of the total workforce budget for the Trust. In addition the Trust spent and equivalent sum with NHS Professionals, the NHS internal agency provider.

What are the clinical implications for services should this action not be taken?

The Trust has an absolute commitment to our patients to maintain safe, effective services which offer standards of quality we are proud of.  The level of vacancies has put some services within the Trust under significant pressure. The Board have been monitoring the impact of vacancies on wider Trust services.  In the light of the decision to undertake further engagement /consultation, the Board's assessment, combined with strong advice we have received from our service directors and senior clinicians, has shown that it will not be sustainable to continue with such high numbers of posts being filled by bank and agency without impacting significantly on our ability to provide quality, safe and effective services.

Is the action proposed supported by clinical staff?

The Directorate Service Board, comprising the doctors, nurses, therapists and other professionals involved in delivering our services, developed the original proposals for service and cost improvement. Following engagement and consultation with staff, the Directorate Service Board made recommendations for developing these proposals to the Trust Management Team and then to the Trust Board. The proposals put forward to the Trust Board for decision, including the need for temporary urgent action to maintain safety, were fully supported by the Directorate Service Board and the senior clinicians and service directors across the Trust, including the medical and nurse directors.

Is the action proposed supported by NHS Hampshire?

NHS Hampshire supports the broader drive of the Trust to both improve the quality of services for users whilst at the same time improving productivity. The emerging changes at both Ellingham House and at Rivendale are consistent with this philosophy. With regards to the decision to take short term action around both units, NHS Hampshire recognises that Hampshire Partnership Foundation NHS Trust must have the ability to make urgent operational decisions as necessary to maintain safe care. The focus for NHS Hampshire is to ensure that the urgent operational decision does not compromise the ability of individuals to access care when the require it; nor does it turn into a permanent closure. The integrity and transparency of a permanent decision must stand on its own irrespective of the current status of the service.

We have been working with NHS Hampshire to keep them informed of the rationale behind the urgent action we have taken. They recognise the reasons for the closure, but are working with us to keep the situation under review to ensure that individuals are still able to access care appropriately.

Will this action impact on other service providers, including Hampshire Adult Services?

As set out above no patient will need transfer outside existing Trust services. As such there is no impact is anticipated for other service providers.

How will the impact on services be monitored and reported?

There is already a robust process in place for managing bed capacity, which includes monitoring and management of occupancy, delayed transfers of care and out of area treatments. This information is reported weekly. We also have ongoing clinical governance arrangements in place that review any issues of risk and patient safety on a case by case basis

You have made clear in your letter that these are temporary arrangements; we will need to know when you anticipate that there will be a resolution to this current problem.

We are monitoring the vacancy position on a weekly basis. The improvement in vacancies has been achieved in the main through temporary redeployment of staff and we plan to maintain these measures for a period of 4 months. We believe this is a minimum period to ensure some stability in staffing and to reduce further disruption to staff. Towards the end of this period we will review the position - by which time we may have concluded longer term decisions of the future of services following further engagement and consultation.

The availability of acute beds across the Trust over the last two weeks - including numbers and % occupancy

Acute adult beds across the Trust averaged 93% for the same period. There are 165 acute beds across the Trust.

Is it the case that in order that a patient could be admitted to Winsor Ward at Woodhaven a portable bed had to be erected in an office?  Has a situation such as this arisen anywhere else in the Trust in the last two weeks?

On our acute units there is provision for beds to be made available on a short term basis (for instance overnight) to prevent the need for patients to be moved between units if all other beds are full. These beds are only bought into use on a short term basis after careful consideration of the needs of the patient and where deemed preferable for patient care to other alternatives. The beds are in an environment that is suitable for clinical care. During last week 3 acute beds have been out of action due to estates work and this resulted in more pressure than usual on acute beds across the Trust. Over the last 2 weeks up to 3 contingency beds were brought into use for short periods. All 3 beds that were out of commission due to estates work are now in use again.

You are right to highlight that a bed was erected in a multi faith room on Woodhaven Ward last week. This room does not meet acceptable standards and we would not intend that this room would ever be used again for this purpose. The use of this room was discontinued immediately.

Is Ellingham still taking admissions? Have there been any instances where a patient requiring admission has not been able to access PICU provided by the Trust over the last two weeks?

Ellingham has not been taking admission for the last two weeks. There have been no circumstances where a patient has been unable to access a PICU bed during this period.

What was the occupancy of PICU beds across the Trust in the over the last two weeks- please give numbers and %?

PICU beds averaged 82% occupancy for the period 1-14 October 2009. This is from the total of 31 beds.

I trust that I have responded fully to the questions raised.

I am aware through the queries raised that there is a keen interest amongst HOSC members to understand more about these matters. To this end I would like to offer the opportunity for HOSC members to meet with senior clinicians and have a tour of inpatient and PICU services at one of our locations. I hope that this would enable the HOSC to conduct a fuller scrutiny and see first hand the needs of our service users. Please let me know if this would be of interest and if there is a date and time that might suit as we will endeavour to fit in with your availability.

Appendix Five: Letter from HOSC Chairman - 28 October. Mental health services and the need for temporary urgent action

Thank you very much for your letter of 20 October setting out your response to the queries raised by the HOSC. It was helpful to have such a detailed reply and I appreciated the additional comments from the Trust's Directorate Service Board.

I do understand the pressures that the Trust is facing with the number of vacancies and the wish to reduce the Trust's dependency on agency and locum staff.

Although it is for the Trust to determine what action to take to ensure patient safety I remain concerned about `urgent action' that will last for a period of four months. As you know front line staff have expressed anxiety about the proposals and this taken together with an average occupancy rate of 93% gives rise to real continued concern that pressures on staff may build as we move into the winter period. The flexibility required within these services can be quickly compromised if there is an unanticipated increase in the need for acute care, as evidenced by the use of contingency beds described in your letter

I would be grateful if you could provide the HOSC with some additional information about how the level of occupancy described by the Trust compares with that of other similar Trusts and what mechanisms are in place to manage any increase in demand for acute services. It would also be helpful if you could give further information about the steps being taken to address the issues raised by staff and build confidence in the action being taken by the Trust.

I do think it would be a good idea for our members to visit the inpatient and PICU services and will be in touch with you again with some possible dates in the near future. In the meantime could you advise me when you will be able to provide details of the engagement and involvement activities that are planned prior to consultation and the likely timeframes for this process.

Appendix 6: Letter from Hampshire Partnership - 10 November

Mental health services and the need for temporary urgent action

Thank you very much for your letter of 26 October 2009 and for highlighting the further information that the HOSC have requested relating to the temporary urgent action and the current operation of adult services within the Trust. I will address each question raised in turn -

1. How does the level of occupancy described by the Trust compare with that of other similar Trusts?

There is no national Department of Health data routinely available on bed occupancy compared between trusts. However we are part of an Audit Commission benchmarking group of 43 Trusts that share data and we are currently engaged in benchmarking work for acute beds (excluding PICU) from which the following draft data for the period April - June 2009 is drawn. This data will be finalised in the next few weeks and we will share prior to the next HOSC meeting if we receive it.

Bed occupancy rate - HPFT 11^th highest of 43 Trusts (i.e. 10 Trusts had higher bed occupancy during the period in question).

We are awaiting data on readmissions that will provide some evidence on the effectiveness of discharge.

The data should however be treated with some caution as there may be some variability in the classification of acute beds used - i.e. we cannot be certain we are comparing like with like. The validity of the data will be improved in the final version.

2. What mechanisms are in place to manage any increase in demand for acute services?

Managing service capacity is at the heart of our operational management function. We have a range of measures and processes in place to do this effectively, including:

· Investment in the acute care support team, which manages the pathways of individual patients through the system of acute care and ensures that patient journeys are not unnecessarily hindered. As a result we have an excellent record in managing within Trust bed capacity (i.e. not needing to seek beds with other providers), unlike many mental health trusts. We also have a very low percentage of delayed transfers of care, significantly below the national threshold of 7.5%.

· We have bed utilisation plans which cover acute, PICU and rehab beds and these plans are supported by operational policies and contingency plans in the event of a surge in demand.

· We are about to embark on a major piece of work with the NHS Institute for Innovation & Improvement, focussing on the acute care pathway. We will be identifying three areas for targeted improvement, one of which is likely to be patient experience.

· We know we have further improvements to make in reducing lengths of stay and so think we are confident that we can become more efficient with use of beds, without altering the thresholds for access to care.

· We are not susceptible to the winter bed pressures more typical in physical care as a result of bad weather, respiratory problems, flu etc. The main risk here is one of ill health to staff and we are well advanced for instance in our H1N1 vaccination programme.

3. What steps are being taken to address the issues raised by staff and build confidence in the action being taken by the Trust?

A number of staff at Ellingham expressed public concern about the reduction in PICU bed availability. A series of measures have already been taken to address these concerns, including a number of meetings with the CEO, other Executive Directors and senior staff from the Directorate, both on a group and individual basis. Staff side have also been closely involved throughout. The rationale for the different operation of PICU services in recent months and the reductions in length of stay have been fully explained. The Trust has been clear with staff at Ellingham that there is no implied criticism of the work of the unit, on the contrary there is good evidence that Ellingham fully played its part in the more effective management of patient care that has enabled fewer people to be inpatients in PICU when they are ready for transfer to other services. Staff at Ellingham managed the transition to temporary closure extremely well.

Staff at Rivendale have expressed some concerns but have also managed the transition to temporary closure extremely well. Feedback from the listening events with service users and carers has been very positive in terms of looking at new ways to provide care for people with longer term needs.

I have given a commitment that the differing views and issues raised by staff will continue to be explored and carefully considered as part of the further engagement and consultation that is planned.

4. Could you advise me when you will be able to provide details of the engagement and involvement activities that are planned prior to consultation and the likely timeframes for this process?

Three events, attended by 33 service users, have been held as part of the Directorate engagement with service users. The theme of these events was around rehabilitation and recovery. Also two listening events, attended by 31 service users and carers, were held in October. There were many constructive ideas about working with different models of care to deliver better outcomes, and participants were supportive of the Trust's commitment to look at improvements.

Another three events are planned for November and the Trust is also planning a wider event involving a range of stakeholders and staff and encompassing all aspects of service strategy for adult services in mid December, to pull together the different strands of work prior to planned public consultation in the New Year.

I will of course give a full update on progress with engagement and proposed next steps at the HOSC meeting on 24^th November 2009.

Appendix Seven: Letter to NHS Hampshire from HOSC Chairman re plans to cancel the development of Oak Park Hospital - 9 October 2009.

Thank you for arranging for Richard Samuel to attend our meeting on 30 September to set out the PCT's reasons for the current review of the plans for Oak Park Community Hospital. It was also helpful to have the input from Inger and Susanne.

As you will be aware this is a matter of significant concern to local people, not least because the planning has taken place over a number of years, the first phase has been completed and changes to services locally, including the closure of Emsworth Victoria Cottage Hospital has been predicated on the building of this new community hospital. Given the reassurances about cost, sustainability and need for this hospital from the NHS you will be aware of the anger that many feel about the current position.

We are aware that the PCT is currently pausing to take stock of the options that are open in moving forward. Hopefully this will provide an opportunity for the views and feedback from local people to be taken into account in a more considered way. This is a matter that will be formally considered by the HOSC but before doing so there are a number of points that we would wish to raise and information that we would find helpful. These are set out below and I would be grateful if you would arrange for our correspondence and your response to be shared with the Board when it next considers this matter.

Having now had an opportunity to consider the criteria used for the Rapid Appraisal process, and take account of the guidance relating to major changes in NHS services `Changing for the Better' we have a number of concerns about the emphasis on financial considerations that underpin the criteria developed by the PCT and the way in which these were applied to Oak Park. Although the PCT has an obligation to take account of the financial environment it is also obliged to meet the needs of the population it serves. Department of Health Guidance is clear that any changes need to be based on best clinical evidence and in the interests of patients. Additionally there should be clear clinical leadership underpinning any proposals. This is a difficult balance to maintain but it is essential if there is to be public confidence in the planning process. We are not aware of any work of this nature taking place in relation to Oak Park and were given repeated assurances as late as May 2009 that this development was required, was affordable and would proceed. The total turnabout of a long planned project in the space of just a few weeks does not instil confidence that the suggested cessation of the project is any more than an opportunistic short term measure.

Even is it is accepted that the criteria applied were a possible starting point for more in-depth discussion and debate with local people we would also challenge the assumptions that seem to have been made about the Oak Park scheme. The PCT's own finance paper, which was also on the Board agenda for September meeting stresses the need to `treat patients in an appropriate location with emphasis on managing patients in a community setting'. This is recognised as being both cheaper and of greater benefit to patients. A short- term solution to financial constraints facing the PCT could erode this opportunity and potentially generate further pressures in the future when budgets are even tighter. The problem of servicing the PFI at Queen Alexandra would seem to be having a direct and detrimental affect on community services in the area. This would not be in the interests of the population of south east Hampshire. Havant has some of the most deprived wards in England and is a priority area for public services. The impact of any change to health care provision in the area must take this fact into account.

It is also essential to be clear that Oak Park is the culmination of a series of developments in south east Hampshire which are only now approaching completion. Action has already been taken with regard to closing one Cottage Hospital and reducing services at another. Both of these buildings by the PCT's own assessment are deemed as being unsuitable for purpose, as has Havant Health Centre. The costs required to address these deficits have not been taken into account and the comment made in 7.1 of the briefing paper prepared for the PCT is misleading in suggesting that existing facilities are in good condition.

In terms of moving forward we strongly endorse the stance taken by the PCT with regard to the need for further work on the alternatives for providing planned services should it be shown that there are other options to providing Oak Park Community Hospital and look forward to receiving the result of this work at our meeting in January. As a HOSC we have always focused on the services provided to local people rather than the buildings housing them. As the proposals stand it is not possible to come to a view about the alternative provision that the PCT is intending to put in place for local people. Any solutions proposed in relation to ambulatory care must be robust and based on a business case for up-grading and securing appropriate facilities.

The lack of information about in-patient provision is a specific concern. The needs of local people for these services (i.e. `step up and step down') and the scope for additional (cheaper) care to be provided in community rather than acute settings should be carefully explored. Elderly mental health is a particular issue and we are surprised that no apparent attempt has been made to discuss the impact that your decision may have with Hampshire Partnership. This is not an acceptable state of affairs. St James' Hospital is not only unsuitable for providing this type of care, but our understanding is that Portsmouth PCT have given notice to Hampshire Partnership of the closure of at least one ward. We are not aware of any alternative provision.

In order to ensure that the Panel set up to look at this work is a fully informed as possible I would be grateful if you could provide us with the following information

· A full copy of the most up to date business case available for the Oak Park Community Hospital

· Confirmation of the costs incurred to date in developing these proposal

· Details of the penalties incurred by the PCT in withdrawing from the scheme, including any penalties from the contractors

· The date when the PCT made the decision not to proceed with the planned development

· Confirmation of the process that the PCT will now go through to secure additional information and the expected timelines associated with this.

It would be helpful to have this information by 8 November. We would also appreciate the opportunity for members of the Panel considering this issue on behalf of the HOSC to visit the different facilities affected by the proposed change. Please do not hesitate to contact me should you require any clarification of the points made above.

Appendix Eight. Response to the HOSC Chairman from NHS Hampshire re proposals to cancel the development of Oak Park Hospital-

Delivering health services for the population of Havant and South East Hampshire

Thank you for your letter dated 9 October 2009, following on from the Health Overview and Scrutiny Committee meeting on 29 September 2009, where Richard Samuel set out Hampshire Primary Care Trust's reasons for the current review of the plans for Oak Park Community Hospital.

I understand that this matter is of significant concern to local people and that planning has taken place over a number of years. The provision of the new hospital was planned to provide more local ambulatory care services and to replace Emsworth Victoria Cottage Hospital and Havant War Memorial Hospital. We are exploring options for providing these services without building a new hospital. We will be reporting to the Board in December and will include your correspondence and our response as part of that report.

I note your concerns and would like to assure you that although the PCT has an obligation to take account of the financial environment we are also keen to meet the needs of the population we serve and any changes will be based on best clinical evidence and the interest of patients. We operate within a continually changing environment and service models evolve even during the design and operation of hospitals.

We are actively engaging clinicians in the review and clear clinical leadership has been established linked to local practice based commissioners, general practitioners and secondary care clinicians. Although the hospital has been a long planned project, it is vital to ensure that the services cannot be provided in a more affordable way. Rather than an opportunistic short term measure this is a vital element of making a case for investment. Our aim is to provide the same quality of services as planned and to ensure that these are sustainable both clinically and financially. We recognise that Havant has some of the most deprived wards in England and is a priority area for public services and this will be taken into account. Our aim remains to treat patients in an appropriate location with the emphasis on managing patients in a community setting.

I accept that Oak Park is the culmination of a series of developments in South East Hampshire but Emsworth Victoria Cottage Hospital and Havant War Memorial Hospital still provide local health services. Neither of these buildings are functionally suitable for long term use and our intention is still to replace them. Havant Health Centre is fit for purpose and in good condition and has been maintained to provide at least 9 years of life. The cost of maintaining these buildings will be included in the appraisal of options.

I welcome your endorsement of our plans to explore alternatives to providing Oak Park Community Hospital and we will feedback to you at the Health Overview and Scrutiny Committee meeting in January. Any solutions proposed in relation to ambulatory care will be robust and based on a business case for upgrading and securing appropriate facilities.

I understand your concern about the lack of information about inpatient provision. You are right that options to meet the needs of local people with these services should be carefully explored and that this will take time. To this end the NHS Hampshire Board has tasked us to report back in 12 months with alternative options and we are working very closely with the providers of these services, including Hampshire Partnership Foundation Trust. I need to correct your impression that no apparent attempt has been made to discuss the impact of our decision to review Oak Park Community Hospital plans with Hampshire Partnership Foundation Trust. They are key members of the Oak Park Review Steering Group and are fully involved. It is both the PCT and Hampshire Partnership Foundation Trust's aim to move older people's mental health patient services from St. James Hospital and this is part of this project. In terms of the closure of one ward at St. James Hospital by Portsmouth City PCT, as you probably know Portsmouth City PCT are re-providing two of their wards and this leaves Hampshire Partnership Foundation Trust services using just part of two other wards. My understanding of the short term plans is for Hampshire Partnership Foundation Trust to combine these services into a single ward at St. James Hospital.

You requested in your letter the following information:

· A full copy of the most up to date business case for Oak Park Community Hospital: I have enclosed the 2006 Stage 1 Business Case, which is the most recent completed business case.

· Confirmation of the costs incurred to date in developing these proposals: which is £2.5 million including costs to the supply chain contractors of £2 million plus £0.5 million spent on improving the Oak Park site itself. There were no penalties incurred in addition to the above.

· The date when the PCT made the decision not to proceed with the planned development: This has not been reached yet as no final decision has been made. However, the PCT did instruct the Project Team to suspend work on the Community Hospital at the end of May 2009 in order to minimise potential abortive costs.

· Confirmation of the process that PCT will now go through to secure additional information and the expected timeliness associated with this: Enclosed are the key milestones for the project and the engagement plan.

If you would like to arrange for members of the panel to visit the different facilities that are potentially affected by this review please contact Marie Preston, Project Manager Community Hospitals, at [email protected], who will facilitate this.

Appendix Nine

ENGAGEMENT PLAN FOR THE DEVELOPMENT OF SERVICES FOR THE POPULATION OF HAVANT AND EAST HAMPSHIRE

OCTOBER - DECEMBER 2009

1. BACKGROUND

1.1. This paper has been drafted to provide the Hampshire Health Overview and Scrutiny Committee [HOSC] with a description of the engagement activity that is underway and/or planned in relation to the development of health services for the population of Havant and East Hampshire.

1.2. The HOSC will know that NHS Hampshire is currently reviewing its plan to provide improved health services for residents of both Havant and East Hants Borough Council areas. This follows a decision in May 2009 to stop further work on the Oak Park Community Hospital project, to review its affordability (in the light of future financial forecasting within the NHS) and to report back to the NHS Hampshire board in September 2009.

1.3. At its meeting in September 2009, the board of NHS Hampshire [DN add in the precise wording of the Board's agreement]. The Board also agreed that the two elements of health services (ambulatory and inpatient) that were planned for the Oak Park hospital be reviewed separately. They further asked that a report on how NHS Hampshire could provide the same ambulatory services in the area, by using existing facilities, be brought back to a meeting in December 2009.

1.4. The board agreed that the review of proposed in-patient services would take longer and asked for a report back on this element of the Oak Park project within twelve months.

2. AIM OF THE ENGAGEMENT EXERCISE

2.1. NHS Hampshire seeks to understand the views and expressed needs of local residents to ensure that local health services for the Havant and East Hampshire are designed around the needs of services users, carers and local people. NHS Hampshire also seeks to use this exercise as a means of informing and reassuring residents of the planning process for health services in the area.

3. OBJECTIVES

3.1. NHS Hampshire will:

· use established communications and engagement existing channels to engage with residents in the Havant, Emsworth, Hayling Island, Rowlands Castle, Horndean, Clanfield, Wecock Farm, Waterlooville and Cowplain areas;

· raise awareness that the review does not mean they will lose services originally planned for the hospital;

· seek their views on two options for providing the proposed improved ambulatory services in the same area

4. ENGAGEMENT ACTIVITIES

4.1. NHS Hampshire is looking to engage with residents in the Havant Borough and East Hampshire District council areas and will be using the following mechanisms to ensure we hear the voices of residents in the area.

Havant Borough Council Citizens' Panel

4.2. We will be using Havant Borough Council Citizens' Panel to consult with 1300 residents living in the borough. The full timetable for this piece of work is as follows:

By October 16                     consultation document agreed

By October 23                     consultation printed, posted and emailed to panel members

November 13                       deadline for returned questionnaires

November 20                       Questionnaires inputted

November 27                       Results collated and presented

4.3. Please note that these dates may well be affected by the postal strike (if it is not called off). Furthermore, we are unable to condense these dates as HBC always gives its panel members a three-week minimum timeframe for the return of any consultation.

Community Fora and boards

4.4. We have been allocated some slots for a presentation and discussion at the following events:

November 10                  Clanfield, Horndean and Rowlands Castle Community Forum

Evening                             Horndean Technology College

November 18                    Havant & Bedhampton Community Forum

13:30                              Civic Offices

November 26                       Warren Park Community Panel

Time to be confirmed        St Clare's Church, Warren Park

4.5. It is also likely that we will be able to present to the Havant older persons' wellbeing meeting on November 18 (time and venue to be confirmed) and we have requested to attend the next 50+ Forum.

In-depth interviews with hard to reach and hard to hear people

4.6. We are commissioning an independent market research company to carry out either some individual in the home interviews with residents in the Leigh Park and Wecock Farm areas who are extremely `hard to reach' and `hard to hear'.

4.7. The home based `depth' interviews will:

· explore people's perception of health services in the area;

· ask how they access these (travel etc);

· ask what health needs they have that are not currently being met;

· explore whether they are concerned that the hospital may not be built but the same services still be delivered; and

· explore their use of health services - both planned and emergency use.

5. FEEDBACK

5.1. It is intended that the findings of these engagement activities will be incorporated into the report to be presented to the NHS Hampshire board in seminar meeting in December 2009. A report will also be sent to the HOSC at the same time.