AT A MEETING of the HAMPSHIRE, SOUTHAMPTON, PORTSMOUTH AND ISLE OF WIGHT HEALTH SCRUTINY JOINT COMMITTEE held at The Civic Centre, Southampton on Tuesday, 16 March 2010

PRESENT

Members Officers

Councillors:

Hampshire Keith Chapman David Pryke

Peter Edgar Martin Combs

Ray Love David Crosby

Anna McNair Scott (Chairman)

Portsmouth David Horne

Isle of Wight Margaret Webster Marian Jones

Southampton Edwina. Cooke (Vice-Chairman) Caronwen Rees

Apologies were received from Councillor Pat West (Hampshire)

1 MINUTES

The Minutes of the meeting of the Joint Committee held on 1 December 2009 were confirmed as a correct record.

2. SOUTH CENTRAL STRATEGIC HEALTH AUTHORITY - PROVISION OF PRIMARY ANGIOPLASTY SERVICES (PPCI)

Representatives from the Health Authority and Ambulance Service gave an update on progress being made on the provision of Primary Angioplasty services across Hampshire and the Isle of Wight, They outlined the proposals which was to create centres of clinical excellence with catheter labs where Primary Percutaneous Coronary Intervention ( PPC! - Angioplasty) was available 24 hours a day and providing a gold standard treatment for certain heart attacks. Details were given of the involvement of local people and the feedback received. The feedback was split between the mainland and the Isle of Wight.

The feedback from the mainland included:

_ Broad acceptance of proposals in Portsmouth and Southampton

_ Praise from patients for the PPCI service

_ Concerns about ensuring service is equitable across county

_ Concerns about ambulance response times especially in rural areas

_ NHS Hampshire should understand staffing/training issues that are holding back introduction of PPCI at all local centres

_ Need to communicate effectively across different parts of service

_ Concerns that additional funding would be required

_ Comments about the need for consistent information and access to care after a heart attack

The feedback from the Isle of Wight included:

_ Concerns that IoW will be getting a `second class' service

_ Concerns about emergency conveyance and response times

_ Concerns about discharge arrangements

_ Concerns over transport for relatives and carers to mainland hospitals

Following a presentation to the Isle of Wight Scrutiny Panel on 2 February 2010 the Panel had

accepted that a `mini PPCI centre' at St Mary's was not feasible at the present time and therefore supported the proposal that from April 2010 suitable patients will receive PPCI treatment at Queen Alexandra Hospital, Cosham. The Panel also urged the Primary Care Trust to:

_ seek an early introduction of the night-flying air ambulance

_ investigate further ways to alleviate the stress and cost on patients and their relatives in travelling to and staying on the mainland

_ undertake the public awareness exercise, including town and parish councils.

It was necessary for patients to receive reperfusion within 120 minutes of the call and on the whole, on the mainland, patients could be transferred to a unit within 40 minutes of the call and reperfusion could be carried out within the required 120 minutes. On the Isle of Wight it was recognised that the Solent presented a significant barrier to achieving the required timescale but national guidance recognised that in some areas thrombolysis was an acceptable alternative. However from 1 April 2010 there would be an enhanced service for a small number of eligible patients to be air lifted to Queen Alexandra Hospital and this service would be increased over a number of years offering around 100 patients, 24 hours a day, transfer to Queen Alexandra Hospital by air ambulance for PPCI.

The next steps were to agree full implementation of the PPCI programme for Hampshire with planned commissioning of the full 24 hour service from April to October 2010. With regards the Isle of Wight they were currently awaiting confirmation of air lift starting in April 2010 and then 24 hour extension of PPCI at Portsmouth. In advance of service going live and beyond there will be an awareness campaign using poster resources and tailored material for Isle of Wight residents. NHS Isle of Wight was currently in discussions with transport providers exploring how patients and relatives might be assisted and talks were taking place with Portsmouth on how some of the Island's concerns could be addressed. Queen Alexandra Hospital had confirmed that relative accommodation was available on site if required.

Members agreed that the issues that had previously been raised had now been addressed.

RESOLVED:

That the proposals for PPCI across Hampshire and the Isle of Wight be endorsed

3. CHILDREN'S CARDIAC SURGERY SERVICES

Representatives of the NHS Specialist Commissioning Group gave a presentation on the proposals for Children's Cardiac Surgery Services in England. The principles being that the NHS must provide only the very highest standard of care for children and their families regardless of where they live or which hospital provides their care. Centres should provide care that was based around the needs of the child and the family which took account of the transition to adult services. All relevant treatment, other than surgery, should be provided as locally as possible to the family and clinical standards should be agreed and met by all centres.. Details were given of the current 11 heart surgery centres in England, the nearest being Southampton, and the planned approach for change. Currently some centres could not provide safe 24 hour care. Enough surgeons were needed in each centre to meet day to day needs eg. Operating in theatre, on call for emergencies, ward rounds and outpatient clinics. It was necessary for surgeons to be learning from each other and to be able to work in centres to give them exposure to a large range of procedures. It was proposed that there should be four consultant paediatric surgeons in each centre with enough doctors and nurses to provide 24 hour care and a minimum of 400 paediatric procedures each year. The network model of care would be for tertiary paediatric centres, paediatric cardiology centres and paediatric cardiology periphery services. The benefits for children and families would be:

_ Better access to 24 hour care

_ Better access to surgical centres with expertise in complex procedures

_ Better clinical outcomes (mortality and morbidity)

_ An NHS workforce that is highly trained and expert

_ Surgeons will mentor and learn from each other

_ An effective network that improved planning, delivery and communication

_ Strengthened Specialist Children's Liaison Teams

_ A national network of surgical centres collaborating in he interests of patients.

The key milestones were that centres would submit initial proposals in March/April 2010; Evaluation of centres against designated criteria would take place in May/June 2010; Recommendations published and formal public consultation September - December 2010 and the post-consultation and designation decision January 2011. Details were given of the Expert Review Panel, the Public Consultation Process and Stakeholders. The centre for Public Scrutiny would be asking Health Overview and Scrutiny Committees with an interest to establish a National Joint Statutory Health Overview and Scrutiny Committee.

RESOLVED:

That the formal consultation on the proposals for Children's Cardiac Surgery be presented to the Joint Committee.

4 PROVISION OF CHILDREN'S NEUROSURGERY SERVICES

A review of Children's Neurosurgery Services had been requested by some members of the British Paediatric Neurosurgeon's group which was part of the Society of British Neurological Surgeons. Details were given of the current centres and the need for change. Currently only three centres out of fifteen could provide a separate paediatric neurosurgical on-call rota and some children are seen in an adult setting. A steering group had been established. To date a national stakeholder event had been held in November 2009, a draft quality framework had been developed, a working group had been established to identify potential models of care and a patient/user group had been established. An Information gathering exercise would take place in March - May 2010, the models of care group would report in May 2010, assessment of centres would take place November - December 2010 and recommendations delivered for consultation during 2011.

RESOLVED:

That f the formal consultation on the proposals for Children's Neurosurgery be presented to the Joint Committee.

5 SOUTH CENTRAL AMBULANCE SERVICE - REVIEW OF RURAL PERFORMANCE

The Chairman reported on the review that Hampshire, Oxfordshire and Buckinghamshire had carried out on rural ambulance services, a copy of the review report had been circulated. To date the Secretary of State had acknowledged the report and a formal response was awaited from the ambulance service and the commissioners.

RESOLVED:

That an update be presented to the next meeting.

6 SOUTHWEST BURN CARE NETWORK

The Chairman reported that following the Joint Committee's involvement in the provision of burns services in southwest England the commissioning group had given an update on progress and responded to the issues the Joint Committee had raised.

7 UPDATE FROM LOCAL AUTHORITIES

Isle of Wight

The Isle of Wight had been in discussions with the air ambulance on the availability of air ambulance for heart attack patients and the provision of a 24 hour service. The Care Quality Commission had provided a briefing on the work of the Commission and its relationship with Health Overview and Scrutiny Committees. The Local LINk was now regularly attending meetings.

Portsmouth

A review of alcohol related hospital admissions was now in progress. The review would include a visit to the Guildhall Walk area in which the City's nightclubs were now situated, arrangements to go out with Street pastors and ambulance crews and a visit the Accident and Emergency at Queen Alexandra Hospital

Southampton

Southampton had been continuing to look at obesity and obesity treatment. The Panel had also heard from the PCT on the proposed establishment of Solent Healthcare through the integration of Southampton Community Healthcare and Portsmouth Community and Mental Heath Services. Following a referral from OSMC the panel have also agreed to consider the implications of Hampshire Partnership Foundation Trust's review of services to develop more personalised care once details are available. The full Council would be requesting the Strategic Health Authority to hold a referendum of the fluoridation of drinking water in Southampton and southwest Hampshire.

Hampshire

Hampshire with Buckinghamshire and Oxfordshire had been looking at ambulance response times in rural areas. And the Health Overview and Scrutiny Committee had been concentrating on NHS Hampshire's proposals not to proceed with the building of Oak Park Hospital, Havant; Therapy Services for School Children and mental Healthy Services.