Agenda item

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

 

• Hampshire Hospitals: Outpatient, X-ray and community midwifery services in Whitehill & Bordon: Reprovision of services from alternative locations or by an alternative provider
• Southern Health: Plans to develop Secure Forensic Mental Health and Learning Disabilities Services

 

Items for Monitoring

 

·      North Hampshire CCG and West Hampshire CCGG: Transforming Care Services in North and Mid Hampshire

 

Hampshire Hospitals NHS Foundation Trust: Outpatient, X-Ray and Community Midwifery Services in Whitehill and Bordon:  Re-provision of Services from alternative locations or by an alternative provider

 

The Chief Executive of Hampshire Hospitals NHS Foundation Trust appeared alongside a representative from Hampshire CCG Partnership in order to speak to a report on service in Chase Hospital, Whitehill and Bordon (see report, Item 6 in the Minute Book).

 

Members heard that the Trust had chosen to appear before the Committee at this early stage, as the proposals had caused some concerns locally, and it was important to outline the reasons for proposing the withdrawal of some services from Chase Hospital.  The report considered these reasons in detail, but primarily they related to a reduction in the use of Hampshire Hospitals by those in the Whitehill and Bordon area as their preferred provider of acute secondary care services, which had reduced the number of outpatient and other specialty appointments being attended.  Most of the population in this area chose instead to receive services from the Royal Surrey, Frimley Park or Portsmouth.  The report covered travel times to these hospitals, showing that these services tended to be chosen because the acute services were closer to home than those offered by Hampshire Hospitals in Winchester and Basingstoke.

 

The reduction in the number of referrals was leading to reduced efficiency in clinical staff time, since they needed to travel from acute service sites in order to attend clinics in Chase.  The report showed that approximately 1.5 hours per session were lost through clinician travel, which could better be used at other sites to tackle rising waiting times and an increasing number of patients.  The Chase Hospital had a number of different providers operating from the same building, duplicating the same services, which was also inefficient; further thought needed to be given by the CCG, working in conjunction with providers, to see how the mix of providers could be adjusted to reduce these inefficiencies.  It was too early at this stage to report on whether any of the services that Hampshire Hospitals proposed to withdraw from the Chase could be replicated by another provider.

 

In relation to maternity appointments, expectant mothers were currently receiving antenatal appointments from Hampshire Hospitals midwives but choosing to have their babies at an alternative provider.  It was proposed that as most of these individuals were choosing to give birth in Royal Surrey County Hospital, it would make clinical sense for their maternity appointments to be supported by the Royal Surrey’s midwives.

 

The Chief Executive of the Trust noted the five tests of service change that the HASC needed to consider in coming to a view on the nature of a service change, and accepted that in relation to GP support, engagement and patient choice more work needed to be completed before the full picture was available.  It was also recognised that transport options from Bordon to Alton were limited and further work would need to take place around this.

 

The CCG and Hampshire Hospital’s clinical staff had been supportive in drawing the proposals together, and more work would need to be completed before the final impact of the proposals were known.  It was highlighted that the services impacted were a very small percentage of those offered by Hampshire Hospitals, and 13% of those available at the Chase Hospital. 

 

The CCG provided a brief overview of the longer-term plans for the future of services in Whitehill and Bordon, and noted that it was not possible to provide all specialties and outpatient services in each town across Hampshire given the finite resources and funding available for NHS services, but the commitment of commissioners was to provide as many services locally as it was viable and affordable to do.  Chase Hospital was not a natural satellite location for providers, so securing specialist consultant time was difficult, but discussions were ongoing and could be reported to a future meeting.  It was also reported that services in Haslemere were changing and some services from there may move back to the Chase, such as physiotherapy, speech and language therapy and podiatry.

 

In response to questions, Members heard:

·      That the midwifery proposals would see Royal Surrey community midwives continuing antenatal clinics at Chase.  All expectant mothers who were on a maternity pathway would continue to receive a service from the Trust.

·      That modelling around Whitehill and Bordon’s future health needs had been undertaken, being mindful of future housing developments, which might make increased outpatient provision in Chase more appealing to Royal Surrey Hospitals. 

·      Engagement with GPs had shown that they understood the rationale for withdrawing from Chase but wished to see a range of health services in the town.  They were working closely with the CCG to look at the future options for Chase, and the future direction on health services in the town.

·      There were three elements to patient transport; those who self fund their transport, those who are eligible for patient transport, and those who use  the voluntary network of drivers.  As part of patient and stakeholder engagement, the CCG would need to understand what sort of transport people would need should they be required to travel farther to access secondary care.

·      If analysis work were to show a travel time impact, then this is something the Trust and CCG will need to engage on, in order to understand how to minimise impact.  However, it may be that CCG discussions will result in the same services being provided but by a different provider, which would have less impact. 

·      That the CCG have been working on services in the Chase site for a number of years, working to align the right local health and wellbeing services.  The CCG were mindful of the housing being built locally, but this would be closer to the centre and is likely to make the Chase site unviable, as health services will likely need to be built where the majority of the population reside.  Work on this was progressing, with a business case for a future health hub due to be submitted in July.

·      Part of the rationale for the proposals was to increase the amount of consultant time in other locations by decreasing the travel time needed to access satellite clinics.  This would be part of the plan to tackle waiting times; it was much more efficient to provide clinics in larger sites with higher patient numbers.

·      Of those accessing the Chase site for outpatient appointments, 75% already use Royal Surrey, and 25% use Hampshire Hospitals.  Most of these individuals already access outpatient appointments elsewhere in Hampshire, with approximately 1% of these being provided in Whitehill and Bordon.

·      That once the CCG had completed work to see what services could be re-provided in Chase, the next steps would be to review any subsequent impact on other providers in terms of absorbing additional activity, but this was thought to be minimal given the small number of services being discussed.

 

The Chairman read out a short statement from Councillor Adam Carew, a Member of the HASC and local member for Whitehill, Bordon and Lindford, who was not able to attend the meeting.  In this statement, Cllr Carew outlined his opposition to the withdrawal of some services from Chase Hospital.

 

The Chairman moved to debate, where Members noted their concerns about the lack of engagement and the additional work that would need to take place before a view could be taken by the Committee on the nature of the service change.  Some Members raised concerns about the range of services that would be left in Whitehill and Bordon.  Discussion was also held on the need for the NHS to work smarter, and that should the data show that services are underutilised, and that resources are not being used in the most efficient way, that proposals should be brought forward that considered these issues.  It was agreed that whilst it was helpful to have early notice of the Trust’s proposals, they were not yet developed enough for Members to take a view on them.

 

RESOLVED

 

That Members agreed:

 

a.  That as the proposals for community midwifery services at Chase Hospital would see no change to how expectant mothers will access and attend services, that the HASC agrees that this area does not constitute a substantial change in service.

 

b.  To defer making a decision on whether the remaining proposals constitute a substantial change in service and would be in the interest of the service users affected, until the July meeting of the Committee.

 

c.  That the Trust and CCGs undertake a period of engagement on the proposals and bring the outcomes of this work to the next meeting of the Committee.  That such engagement does not take place until the CCG is clear on what the future of services provided from the Chase Hospital site would look like, should the Trust withdraw from this site.

 

d.  To request the following additional information as part of the July report on this issue to the Committee:

·      The outcomes of the CCG’s discussions with alternative providers.

·      The views of local GP referrers.

·      The outcomes of engagement work.

·      Travel times, public transport options and the cost of these, as well as support available to vulnerable service users.

·      Further analysis of the impact of the service change on patients once it is clear what services will be based in Chase Hospital in future.

 

The Chairman agreed to take the agenda out of order.

 

NHS North Hampshire Clinical Commissioning Group and NHS West Hampshire Clinical Commissioning Group: Transforming Care Services in North and Mid Hampshire

 

Representatives of North Hampshire and West Hampshire CCG’s attended alongside the Chief Executive of Hampshire Hospitals NHS Foundation Trust in order to update Members on the Transforming Care Service in North and Mid Hampshire (see report and presentation, Item 6 in the Minute Book).

 

Members considered the presentation, noting the progress made in relation to this work stream since the Committee last considered the topic in January 2018.  The integrated care model previously outlined had five key components which centred on:

·      Supporting people to stay well

·      Improved access to care when needed

·      Proactive joined-up support for those with on-going or complex needs

·      Better access to specialist care

·      Effective step up / step down care, nursing and residential care

 

Progress had been made against all of the five components, including:

·      Work with GPs across the geography to review patient cohorts and to bring primary care together to provide more joined-up services.

·      Rolling out extended hours across GP surgeries.

·      Redesigning the 111 service to reduce unnecessary attendances to urgent care.

·      Reviewing care pathways to ensure that they meet best practice and are accessible to patients.

 

Options for the centralisation of acute services were still being considered, and these were due to report later in the year once clinicians had completed their appraisal of the different potential pathways, including the potential impact on other acute hospitals.  The aim of these work streams would be to increase the sustainability of services in the longer term, and therefore the Trust and CCGs were keen not to rush this work, as it was important to get it right, and there were no safety concerns in providing services in the short term.  The Trust were also progressing cancer care and hospice discussions.

 

Since the last meeting, the Hampshire Hospitals estate survey had now been completed, which highlighted a c£100m need for capital funding to improve the estate across the three hospital sites.  The next step would be to draft this work into a business case for the funding required, which would be entered as a bid into the next wave of capital fund allocations.

 

In response to questions, Members heard:

·      That once the acute services reconfiguration work had been completed it would be important to test this with partners and the public, in order to measure the impact such proposals could have if implemented, and to understand the public’s support for proposed changes.

·      There was a finite amount of capital funding available nationally, which was significantly less than the demand across the country.  There was a growing recognition that backlog maintenance is a significant issue.  The CCG was working closely with the Trust to prioritise building works and identify those areas that would have the highest impact through improvements to the estate or make available estate that was fit for the future.  The next bidding round would be in July.

·      That extended hours for primary care didn’t necessarily mean longer working hours for GPs.  The focus was on providing a range of specialties based on the new model of primary care, such as physiotherapy, mental health workers, and community pharmacists.   For example, GP signposting had already freed up 5% of GP time to spend on clinical work.  The use of e-consult as a tool for patients to connect with their GP or health professional had also had a significant impact for those surgeries who had rolled out this way of working; the future of primary care would focus more on how technology can assist individuals to both better manage their own health, and to access health services.

·      Significant progress had been made in the Trust’s aspiration to open a hospice in Winchester, and it was hoped that the remaining capital funds would be raised within the next 12 months.  This service would have 10 beds serving the wider North and Mid Hampshire population, but also providing a range of outreach services in a range of settings.

 

RESOLVED

 

That Members agreed:

 

a.  To note the progress on developing the agreed options for ‘transforming care services in North and Mid Hampshire’.

 

b.To request a further update in the autumn once the proposals for the future of acute reconfiguration are available to be consulted upon.

 

Councillor Mike Thornton left at this point in the meeting.

 

Southern Health NHS Foundation Trust: Plans to develop Secure Forensic Mental Health and Learning Disabilities Services

 

Representatives from Southern Health NHS Foundation Trust presented a report on the plans to develop a secure forensic mental health service, and associated proposals relating to learning disabilities services (see report, Item 6 in the Minute Book).

 

The programme manager leading the project provided Members with an overview of the proposals, noting that the learning disability service building plans had been co-designed by a group of engineers and architects, with input from service users, in order to ensure that the purpose-built unit met the needs of those using them.  In particular, service users had been involved in the interior design of the building, with elements of their art work being incorporated in to decorations and the functional design of the building, following the suggestion of ‘must haves’ and ‘nice to haves’ by this group and their carers/families.

 

In relation to the forensic mental health unit for young people, this Trust were leading on work to modernise these pathways, providing places in Hampshire so that the number of out-of-area placements could be reduced.

 

In response to questions, Members heard:

·         That the capital funding for the projects had been secured, and the Trust had allocated the remaining funding for the building works internally.

·         By the time the building works begin, three patients are expected to be affected by the temporary move of the learning disabilities service from Woodhaven to Ravenswood.  These service users and their families have been involved in the plans and had been shown pictures of the temporary accommodation and of the designs for the final building on the Tatchbury Mount site.  Service users and their families were excited by the new building and were therefore satisfied with the temporary move whilst the new accommodation was being built.  All staff who worked with this cohort of service users would also temporarily relocate to Ravenswood, so there would be no change in the personnel supporting these individuals.

·         The same range of therapies and services would be available in Ravenswood.  As the temporary accommodation was medium secure, rather than low secure, some additional safeguards would be put in place, including an increased staffing model.

·         The representatives felt that the Trust were now better at engaging, involving and working closely with service users and their families.  The Trust had been open about the plans from an early stage, and this had enabled  real and early engagement.

·         A public meeting had been held to discuss all of the proposals, and a Facebook page also existed to engage with local stakeholders on the works.

 

RESOLVED

 

That Members agreed:

 

a.  That the proposal does not constitute a substantial change in service.

 

b.  That the proposals would have a positive impact on service provision and were therefore in the interest of the patient groups affected.

 

c.  To request:

·      The outcomes of service user and family engagement.

·      An interim update on the building works.

·      An update once the works have completed.