Issue - meetings

To consider the report of the Chief Executive on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee. This report covers the following topic:

·         Southern Health: New Mental Health Inpatient Beds Update

The Committee received a report of the Chief Executive on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee. This report included an update from Southern Health NHS Foundation Trust on developments to increase their inhouse inpatient bed capacity.

RESOLVED:

That the Committee:

1.    Note and welcome the update from Southern Health regarding the opening of the new Cherry Ward at Parklands Hospital in Basingstoke, providing 18 beds for female acute mental health patients.

2.    Request written confirmation when the Abbey Ward at Antelope House in Southampton is opened, for circulation to the Committee.

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

a)    Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups: Integrated Primary Care Access Service update

b)    Hampshire Hospitals NHS Foundation Trust: Trauma & Orthopaedics Transformation update

c)    Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups: Whitehill & Bordon Health and Wellbeing Hub update

At the start of this item, Councillor Jonathan Canty declared a pecuniary interest due to working for a charity that lobbies regarding orthopaedic services. He left the meeting while this item was discussed.

Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups: Integrated Primary Care Access Service update

The Committee received a written update from Commissioners regarding Integrated Primary Care Access Services across Fareham, Gosport and south east Hampshire. It was noted that while electronic options had been developed in response to the pandemic, contact by phone would still be available for those that couldn’t access the electronic option.

RESOLVED:

The Committee note the update and request a further update in late 2021 regarding plans for these services from April 2022.

Hampshire Hospitals NHS Foundation Trust: Trauma & Orthopaedics Transformation update

The Committee received a written update from Hampshire Hospitals NHS Foundation Trust providing an update on the transformation of their trauma and orthopaedics services.

RESOLVED:

The Committee note the update and request a further update in early 2022.

Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups: Whitehill & Bordon Health and Wellbeing Hub update

The Committee received a written update from commissioners regarding the development of a health and wellbeing hub for the Whitehill and Bordon area.

RESOLVED:

The Committee note the update and request a further update in late 2021 if the situation has developed.

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

a)    Southern Health NHS Foundation Trust: Becton Centre Closure

b)    Southern Health NHS Foundation Trust: Out of Area Beds Update

a)    Southern Health NHS Foundation Trust: Becton Centre Closure

The Chief Executive of Southern Health NHS Foundation Trust gave a verbal summary of the written report provided (see Item 9 in the Minute Book) regarding the proposed closure of the Becton Centre. It was reported that the Trust planned to move the services and teams currently based at the Becton Centre to other locations, as the building was no longer fit for purpose.

RESOLVED:

The Health and Adult Social Care Select Committee support the planned closure of the Becton Centre.

b)    Southern Health NHS Foundation Trust: Out of Area Beds Update

The Chief Executive of Southern Health NHS Foundation Trust gave a verbal summary of the written report provided (see Item 9 in the Minute Book) regarding the development of additional inpatient mental health bed capacity. It was noted that the Trust would be opening a new 10 bed female PICU at Antelope House in Southampton, and a new 18 bed female acute mental health ward at Parklands Hospital in Basingstoke, later in 2021.

RESOLVED:

The Health and Adult Social Care Select Committee note the update.

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Action

a)    Southern Health NHS Foundation Trust: Proposed Closure of Willow Ward (inpatient unit for adults with learning disability and challenging behaviour)

Items for Monitoring

b)    Southern Health NHS Foundation Trust: Out of Area Beds Update

Written only updates:

c)    Andover Hospital Minor Injuries Unit (Hampshire Hospitals Foundation Trust and commissioners)

d)    Orthopaedic Trauma Modernisation Pilot (Hampshire Hospitals Foundation Trust and commissioners)

e)    Integrated Primary Care Access Service (Clinical Commissioning Group Partnership)

a)    Southern Health NHS Foundation Trust: Proposed Closure of Willow Ward (inpatient unit for adults with learning disability and challenging behaviour)

The Committee received a letter and briefing note from the Chief Executive of Southern Health NHS Foundation Trust regarding the proposed closure of Willow Ward (see Item 9a in the Minute Book). Members heard that the 6 beds at the unit had never been fully occupied and in the last few years occupancy had been around two or three patients. At the current time one patient remained and discussions were underway to agree alternative care plans. The intention was to close the unit, once that patient had been moved to alternative supported living accommodation. Instead of inpatient care, care packages would be developed to support such individuals in other settings in future.  

RESOLVED:

The Health and Adult Social Care Select Committee:

1.    Consider that the engagement undertaken in relation to this service change is appropriate.

2.    Support the proposed closure of Willow Ward and replacement with a community-based service as in the interest of service users and the local health system.

b)    Southern Health NHS Foundation Trust: Out of Area Beds Update

The Committee received an update from the Chief Executive of Southern Health NHS Foundation Trust regarding out of area mental health placements (see Item 9b in the Minute Book). Members heard that patients were sometimes treated in beds outside of the Hampshire area if there wasn’t capacity to accommodate them in facilities in Hampshire. The Trust had been working to reduce the number of patients treated outside of Hampshire and there were none in this category on the meeting date.

It was highlighted that some patients were accommodated in beds run by other providers in Hampshire (up to 23 beds contracted from private providers), and these were not counted as Out of Area placements by NHS England. However, the Trust was planning to address it’s inhouse capacity over the next year or so, so that patients being treated by other providers could be reduced.

Members commented that Southern Health had in previous years reduced it’s inpatient bed capacity, and the current reliance on other providers suggested a revised assessment of an appropriate number of beds for the Hampshire population was needed.  

The Chief Executive confirmed that the Trust would be happy to respond to the points raised in the deputation on this topic following receipt of the details.

RESOLVED:

The Health and Adult Social Care Select Committee:

1.    Note the update and welcome the reduction in use of out of area beds.

2.    Note the intention to explore increasing inhouse bed capacity to reduce reliance on other providers, and request a further update when progress has been made in this regard. (written update in January 2021 requested)

c) Hampshire Hospitals NHS Foundation Trust and commissioners:

Andover Hospital Minor Injuries Unit Update

The Committee received a written only update regarding the Minor Injuries Unit at Andover Hospital (see Item 9c in the Minute Book).

RESOLVED:

The Health and  ...  view the full minutes text for item 219

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

a.    Modernising our Hospitals and Health Infrastructure Programme - Hampshire Hospitals Foundation Trust

b.    Building Better Emergency Care Programme – Portsmouth Hospitals Trust

a. Modernising our Hospitals and Health Infrastructure Programme - Hampshire Hospitals Foundation Trust 

Representatives from the Hampshire Hospitals Foundation Trust outlined accelerated plans for modernizing services with £5 million received from the Health Infrastructure Programme (HIP).  This funding is a catalyst for much needed and multifaceted changes in primary care, mental health, a new midwife unit, ambulance services, to the meet the changes and challenges of the growing population. 

Building improvements come at significant cost and have been identified to be on the plan.  These changes, implemented in close collaboration with partners, will allow for the provision of services closer to home and benefit patients and staff in terms of wellbeing, flexible for future needs, and even in addressing pandemics.  

Engagement has continued through June and July alongside considering various sites which will be reviewed in September with stakeholders and a pre-consultation business case for approvals with formal consultation to follow.

The clinical vision and focus are for the right care in the right place at n the right time and the capacity to care for people using digital technology and innovation with support to access services quickly to maintain their health.  Centralized emergency services for offering the best care and outcomes with an outstanding, brilliant staff who can be retained and providing high quality innovative care with a focus on research and training. 

Covid has accelerated working in new ways and connecting services for the better.  The joining up of services and users needs to be an equal partnership in this journey.  Slick, efficient, and first-class services will help patients feel they are in control of their lives again with the support of health care partners and adults’ services.  There is a need to ensure that the new ways and technologies adopted will develop and nurture the right relationships in providing care and services.

Currently consultations are at a midway point with staff and public using video meetings and new ways of engagement.  It has been possible to reach more residents and to run daily meetings with different parts of the geography and various groups and partner organisations in north and mid-Hampshire.  

In response to questions, Members heard:

While some services will be digital, a location hub is necessary for clinical services.  Similar endeavours around the country are being looked at for examples as this is a long-term opportunity to make significant improvements.

With regards to the development of diagnostic services post-Covid, they may be helpful in general practices and community care locations.  However, the picture is evolving, with each aspect of diagnostics being considered, alongside innovations to meet a national need for diagnostic hubs.  

In terms of timelines, this project is different from previous ones undertaken in that it is a government led initiative and plan, where current infrastructure is no longer fit for purpose.  A lot has been learned from previous endeavours and with the integration of health and social care the collaboration and partnership has deepened.  Rethinking delivery of all services within the accelerated  ...  view the full minutes text for item 205

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Monitoring

a.    Orthopaedic Trauma Modernization Pilot (Hampshire Hospitals Foundation Trust)

b.    Spinal Surgery Service Implementation Update (University Hospital Southampton)

Items for Monitoring 

a. Orthopaedic Trauma Modernization Pilot (Hampshire Hospitals Foundation Trust) 

Representatives from Hampshire Hospitals Foundation Trust confirmed that the pilot is 12 weeks into the changes and reported on progress to date from the 2 December reconfiguration due to end in March 2020.  

Members heard:

The Trust is working closely with South Central Ambulance Service (SCAS) for transporting patients safely to sites.  

There have been changes to processes and pathways to cope with additional demand and capacity.  Models have been successful in predicting bed capacity.  

Consultation exercises with staff highlighted concerns such as disruptions or changes to work location which have been addressed.  The feedback now is positive with good working conditions, as well as supervision and training opportunities for junior work force.  Successful recruiting of new staff has led to the highest staff in post for trauma staff.  

A comprehensive dedicated system with specialist nurses, Hampshire County Council community partners, and Integrated Intermediate Care services has allowed for moving patients who need supported discharge and improvements have been noticeable.  

The general election purdah effect was taken into consideration during the consultation.  Outcomes of further consultation and engagement surveys will continue to be considered alongside collaboration with Healthwatch.

Transport was a concern and actions taken on that front, making sure up to date information is available to patients, carers, and families regarding changes in travel between Winchester and Basingstoke with clear signposting and robust ambulance coverage. 

Previously, the quality of trauma and orthopaedic care and fatality rate was higher than the national average.  There were long wait time issues, longer stays in hospitals, and cancellations during winter pressure periods.

Centralization was undertaken to address these issues.  People can be treated quickly with access to the right surgeon for the right, timely treatment with better outcomes.  A dedicated rehabilitation unit provides further benefits returning patients to pre-trauma condition with reduced time in hospital. 

Those in pain have not had planned operations cancelled as those beds have been ring-fenced.  Emergency departments continue to carry on and only a small number of people need to be moved.  

Looking at patient outcomes, times, and quality of care, data for the test period has been collated and reviewed with partners.  The Trust is grateful for the support of patients, staff, and partner organizations.   

RESOLVED -

That the Health and Adult Social Care Select Committee:

a.    Noted the implementation update, engagement data, and current challenges as well as any recorded issues addressed and/or resolved 

b.    Requested a further update on outcomes in September 2020

b. Spinal Surgery Service Implementation Update (University Hospital Southampton)

Representatives from University Hospital Southampton provided an update on the transfer of elective spinal services from Portsmouth Hospital Trust in December 2018 and changes in the pathway.  

In response to questions, Members heard:

Access to operation theatres remain a problem and one additional theatre has been added to manage the volume.  Trauma has doubled since December and affects getting elective cases into the theatre.  More work remains to be done.  ...  view the full minutes text for item 196

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Monitoring

a.    Integrated Primary Care Access Service Update

b.    Andover Hospital Minor Injuries Unit Update

c.    Out of Area Beds and Divisional Bed Management System

Items for Monitoring

a. Integrated Primary Care Access Service Update 

Representatives from the Southern Hampshire Primary Care Alliance and Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups provided an update on Integrated Primary Care Access Service.  The hub offers GP (General Practitioner) out of office service and is part of a national pilot for evening and weekend appointments, routine and urgent, when GP surgeries are closed.  Members heard:

Seven months of running services has highlighted stresses and operational delivery issues, as set out in the paper.  Public engagement has shown how people use the service and the ease of access to full medical records.  However, the services moving from place to place have been complicated for bookings and 111 responders, in an already confusing landscape.

Geographical challenges, inadequate GP recruitment, and service challenges if GPs are absent have been significant hurdles leading to system pressures and challenges, reliability of service provision, and missed appointments.  Winter pressures are building up and changes are being considered to increase capacity to meet demand. 

In response to questions, Members heard:

While there have been accessibility and transportation issues, the provision of transportation and video consultations (especially for mental health appointments) are being considered as a long-term solution.  Manual recording of where people are coming from have been used to assess needs and challenges.  The current provision allows for home visits when patients are unable to come in (scheduling may vary depending on pressures) and one such visit has taken place in the last month.

Traditional GP practices are not commissioned to provide mandated out of hours services.  While 92 doctors have been signed up and are part of the rota capacity, they may also have other commitments and barriers to working.  There has been a shift from locum to the contract model to meet provisions, and consideration of employment model changes and necessary consultations.  There is also a missed opportunity for doctors who are wanting to shift how they work to a portfolio way.

Out of hours practice names and changes, varying locations and times can continue to cause confusion, distance challenges, appointment cancellations, difficulty filling GP shifts, etc. which can result in more 111 calls and emergency hospital visits.  The fundamental aim is to consolidate services and meet needs as best possible within current geographical restraints.

With GP availability and recruitment challenges, traditional models are not sustainable in the short or long term, but having consolidated practices are the way forwards to allow clinics to continue to run.  For indemnity purposes and transformation change, a doctor has to be on the premises for prescription checks, limiting the authority of advanced nurse practitioners and paramedics.

Communication strategies are also in place to provide support and education on self-care, services available at chemists, home remedies, when to ring 111 or A&E (Accidents and Emergency) etc. to better care for oneself.  In addition to ongoing campaigns in communities, school training for new generations are helping with both self-care and mental health concerns.  Attitudes  ...  view the full minutes text for item 183