APPENDIX II
HEALTHCARE STRATEGY FOR THE ISLE OF WIGHT
RESPONSES FROM CONSULTATION
NUMBER	NAME	TYPE OF	ACTION	COMMENT
		RESPONSE
1	Anonymous	Staff comment form		Various comments on transfer of care, patient travel, bed reduction,
				dentistry, mental health, financial recovery and prisons.
2	Anonymous	Letter		Compliments "good ideas" of developing community services and
				employing more NHS dentists. Complaint about nursing staff.
3	Anonymous	Pink form		"Macmillan Nurses should be available at weekends to retain
				patient continuity".
4	Anonymous	Pink form		Various points, including concern at closure of beds and transfer
				of care strategy, also dental health of young people due to current
				lack of access.
5	Anonymous	Pink form		Concern on how additional staff would be recruited and additional
				responsibilities "thrown back" to GPs or Social Services. Concern
				that language in the consultation document was unclear and that
				more should have been done to consult with the general public.
6	Member of the public	Pink form		?
7	Mental Health Carers Support Team	Email/Letter	Copied to	Response only on mental health. Concern at the reduction in
			Mandy Sellers	inpatient beds, that the proposals are wholly driven by financial
				pressures and will put additional pressure on carers. Asks for
				additional carer involvement in future consultation, compliments
				support from managers and clinicians to date.
8	Member of the public	Letter	Acknowledgement Letter	Comments on most parts of the strategy (a 12 page letter).
				Opposed to the transfer of care strategy, considers the dentistry
				situation to be a "national disgrace" and considers that all patient
				travel should be funded in full.
9	Member of the public	Email submitted to		Submitted to Select Committee meeting on patient travel and
		Select Committee		transport. Some patients have to travel in extreme discomfort.
				Travelling whilst ill is dangerous.
10	Staff department within the Trust	Staff comment form	Acknowledgement Email	3 points - practical support suggested for patients travelling for care
				to mainland, good communication essential for patients
				transferring between care sectors and comments on new build
				facility for prisoners.
11	Macmillan Cancer Relief	Telephone Call		Request that the Macmillan nurse service become a 24 hour 7 day
				a week service.
12	Member of the public	Pink form	Acknowledgement Letter	Supports refunding of patient travel costs. Concern at access to
				local dentistry, in the Cowes area.
13	Member of the public	Email and hard copy		Various comments on all parts of the strategy.
14	Member of the public	Pink form		Urges local NHS to have BASICS (British Association in Immediate
				Care) doctors.
15	Member of the public	Pink form		Comments on bed management, dentistry and patient travel costs.
				Supports reimbursement for patient travel costs.
16	Member of the public	Pink form		Bring back Hospital matrons. Suggest an NHS lottery to help fund
				travel costs to the mainland.
17	Footprint Trust	Letter	Acknowledgement Letter	Footprint Trust is a "not for profit company who's objective is to
				inform and educate as widely as possible about the ecological
				footprint of the Isle of Wight and beyond". Encourages promotion
				of healthy lifestyles, formal and informal recreation. Support for
				primary care mental health team, local day treatment centres for
				mental health and "Walking for Health". Comments on 3 sections -
				primary care, mental health and older people services.
18	Member of the public and Mental	Letter	Acknowledgement Letter	Compliments for the voluntary services workshop. Concerned that
	Health Service user			funding for surfwave, service user involvement project, terminates on
				31 March 2004. Concerned that certain Healing Arts projects have
				time limited funding which may not continue.
19	Member of the public	Pink form		No comments.
20	Member of Trust staff and member	Letter	Acknowledgement Letter	Response only on patient transport and travel. Concerned that
	of Cancer User Group			some options in this section could require cancer patients,
				currently reimbursed their fares, to meet their own travel costs.
				Describes the whole experience of travelling for cancer treatment.
21	Member of Trust staff	Letter	Acknowledgement Email	Response only on children's services. Supports development of
				a training and skills programme for nursing and multi-disciplinary
				specialist roles. Paediatric Oncology Shared Care Unit standards
				require a resident middle grade doctor who needs to be available
				at all times, so concerns expressed on whether there will be
				sufficient medical cover.
22	Carers Liaison Group	Pink form	Acknowledgement Letter	Comments on many sections of the strategy. Complimentary of
				IDOC, the practise based diabetes service, the parkinsons
				specialist nurse and the "crossroads" scheme for older people.
				Recommends a winter bed census, more mention in the
				document requested for carers and supports the principle that
				reimbursement of patient travel costs should go to frequent
				travellers, not just the current renal and cancer patients. States
				that great care will be needed in planning the design and
				environment for the elderly mental health units which will replace
				Shackleton and Halberry.
23	Member of the public (also a	Pink form	Acknowledgement Email	General response on the contribution that complimentary therapies
	complimentary therapist)			can make e.g. in primary care and chronic disease management.
24	Heart Care Club	Letter	Acknowledgement Letter	Concerns at the cost of travel to Brighton for cardiac patients.
				Requested that follow-up appointments to cardiac surgery take
				place on the Island. Welcomes the future developments in
				Portsmouth and Southampton for cardiac patients. Records
				concerns that proposals may put enormous pressure on the
				district nursing service.
25	Wessex Cancer Trust	Letter	Acknowledgement Email	Describes it as "excellent consultation document". In our future
				proposals on patient travel costs urges that "particular financial
				concerns of a vulnerable section of (this) community is taken into
				careful consideration".
26	Member of PCT staff	Staff comment form		Suggestion is put forward of a public event similar to the one held
				at the Riverside Centre in December for voluntary agencies, is
				held to engage the public in discussion of the dentistry problem.
27	Earl Mountbatten Hospice	Letter	Acknowledgement Letter	Describes the current travel issues for Hospice patients so that
				"they can be taken into account when we consider the transportation
				needs of patients on the Island".
28	Earl Mountbatten Hospice	Letter	Acknowledgement Letter	Seeks an assurance from the Trust that the proposed changes to
				the services provided from Halberry Lodge will not in anyway disrupt
				the quiet tranquil environment of the Hospice.
29	Member of the public	Letter	Acknowledgement Letter	Response on various parts of the strategy. Comments on the
				bed closures, the bed census, discharge planning, dentistry and
				patient travel costs. Complimentary on the diabetes expert patient
				programme. Expresses "serious doubts that the work of
				consultants can be carried out effectively by all Island GP practices".
30	Member of the public	Pink form		Response only on older peoples service/transfer of care. Expresses
				a number of concerns on the transfer of care strategy, including
				insufficient residential beds in the community and that many elderly
				people do not wish to be looked after in their own homes.
31	Member of the public	Pink form		No comment.
32	Member of Trust staff	Staff comment form	Acknowledgement Email	Two points raised:
				1) Concerns being expressed about "the ability of services in the
				community to deal with what is expected of them".
				2) Concern at funding available for the Island health economy and
				that efforts will continue to be made to encourage the Government
				to treat the Island and its unique issues in a proper manner.
33	Member of the public	Letter	Acknowledgement Letter	The document offers "nothing but a third rate service". It is
				everything to do with saving money". Opposes the bed closures,
				reduction in posts. Questions the degree of priority given to
				establishing an Island based TOP service. Concerned that more
				patients maybe sent to the mainland for treatment.
34	Member of the public	Pink form/Letter	Acknowledgement Letter	Comments about her treatment.
35	Member of Trust staff	Staff comment form	Acknowledgement Email	Comments only on patient travel costs. Describes the economic
				and psychological impact upon cancer patients travelling to
				Southampton for treatment. Concerned if reimbursement for
				cancer patients is reduced.
36	Member of Trust staff	Pink form	Acknowledgement Email	Supports Island based TOP service and "expanded" primary care
				strategy. Supports reimbursement of travel costs for parents
				of neonatal patients to be seen on mainland in the future. CAMHS
				provision currently inadequate.
37	Member of the public	Letter	Acknowledgement Letter	Supports jobs for all Island based trainee nurses. Describes how
				nursing used to work in the "old days". Cleanliness and hygiene
				need to be a priority.
38	Member of the public	Pink form		Concerned at safety and care of vulnerable people if there are not
				enough carers. Urges that financial recovery should be targeted
				at "systems of administration".
39	Rural Community Council	Letter	Acknowledgement Letter	Comments on three sections - mental health, patient travel and
				transport and the transfer of care/older people. On mental health
				concern that hospital beds would be reduced before community
				services were in place, concern at the short term funding of the
				Surfwave service user project and a suggestion that the voluntary
				sector could work more with the NHS in giving support to carers.
				Provides useful information on community transport projects
				currently running and urges closer integration of transport with the
				planning and delivery of healthcare services. On transfer of care/
				older people concerned that the community services need to be up
				and running and proved that they are working before any further
				hospital bed closures. Suggests a winter bed census.
40	Member of the public and the	Letter	Acknowledgement Letter	Comments only on patient travel section. Describes difficulties
	Cancer User Group			of travelling for cancer patients. Concerned at any reduction in
				reimbursement for cancer patients.
41	General Practitioner	Letter	Acknowledgement Letter	Two issues raised:
			Response sent	1) Bed management and validity of bed census.
				2) Investment and workload in primary care.
42	Trust Staff Side Representatives	Email	Acknowledgement Email	Comprehensive response covering many aspects of the strategy.
	(composite response)		Copied to Trust Execs	Expresses support for the potential of integrated working, the
				clinical decisions unit, proposed medical staffing model in
				obstetrics, enhancement of midwifery roles and a local TOP
				service. Expresses concern at the funding available for Island
				healthcare, the achievability of a consultant delivered model in
				paediatrics, the capacity of diagnostic and support services to
				support some of the proposed changes and the need to handle
				sensitively the transfer of staff between hospital and community
				services.
43	Member of the public	Pink form		Two points raised:
				1) Difficulty for "hard to reach" groups accessing services.
				2) Urgent that dentistry becomes available to all children with
				no cost at point of delivery.
44	Member of the public	Pink form/Letter	Acknowledgement Letter	Urges the Trust to work with Portsmouth Hospitals Trust to improve
				the physical accommodation for the renal dialysis unit on the St
				Mary's site.
45	Two members of Trust staff	Pink form	Acknowledgement Email	Concerned that health visiting service is not mentioned in the
				report (NB just one reference is made in section 3.4 on transfer of
				care).
46	Member of the public	Pink form	Acknowledgement Letter	Request that district nursing help out with her individual health
				needs (Pat McCamley actioned this).
47	Dr Roger Walters, Healthfit Clinical	Email		Dr Walters is the Healthfit Clinical Lead for children's services. A
	Lead for Children's Services			two page email was submitted that expresses concern on the
				viability and sustainability of the proposed "consultant delivered"
				service for acute paediatrics.
48	Member of the public	Letter	Acknowledgement Letter	Describes this proposal as a "cost cutting exercise". Concerned
			Copied to Peter Randall	at bed closures, the need for patients visitors costs to be met for
				mainland travel and difficulties in accessing GP appointments at
				Sandown Medical Centre.
49	Member of Trust staff	Email	Acknowledgement Email	Supports the concept of a consultant led service in paediatrics,
				but concerned that a paediatrician must be immediately available
				on a 24 hour basis for resuscitation and other relevant emergencies.
50	Healing Arts	Letter	Acknowledgement Email	Comprehensive 13 page response on many aspects of the strategy.
				Complimentary on the philosophy and principles underlying the
				proposals which "chart a wise and achievable future for Island
				health services". Document is strong in the detailed proposals for
				secondary healthcare, but only on the vision, rather than the
				detailed proposals, for primary care. Urges greater involvement with
				wider partners - healing arts, healthy living programme, users and
				carers groups etc.
51	Consultant within the Trust	Email	Acknowledgement Email	Various comments on the reference to "greater availability of
				diagnostic services" (page 21).
52	Member of the public	Letter		Complimentary about personal experience of services - care in the
				community, elderly mental health services and care in a nursing
				home.
53	Healthy Living Programme	Letter	Acknowledgement Letter	Promotes the work of the Healthy Living Programme in developing
				community services, which are consistent with the direction
				outlined in our Healthcare Strategy. "States that the strategy sets
				out a model of working that would benefit both the patient and the
				health service". Concerned at the general lack of funding, and the
				nature of short term funding, of many of the community projects
				outlined by HLP in their response.
54	Staff within the Trust Mental Health	Email		Describes response of Sevenacres management administration
	Services			team when considering the document at a meeting. Concerned
				that mental health estate rationalisation plans only provide a
				one-off benefit and recurrent savings will still need to be found.
55	Member of staff in Mental Health	Email (staff)	Acknowledgement Email	Comments only on the mental health section. Urges consideration
	Services			of a day treatment facility.
56	Member of the public	Pink comment form	Acknowledgement Letter	Praises the County Press articles and recommends that we
				should do more of this. Comments on dentistry, more staff in
				community services and services for people with drug and alcohol
				problems.
57	Anonymous	Pink comment form		Short comments on transfer of care, primary care, children's
				services and mental health services.
58	Member of PCT staff	Staff comment form		Comments only on the transfer of care section. Stresses
				importance of preparation and development of community services
				before any further bed closures.
59	Member of PCT staff	Pink comment form		Comments on the transfer of care strategy and the development of
				community nursing.
60	Member of PCT staff	Pink comment form		Queries whether additional community staff will be in place to
				receive the extra patients.
61	Ryde Community Forum	Letter		Four page response on various issues raised at a public meeting
				organised by Ryde Community Forum, including transfer of care,
				transport and travel, services in Ryde and concern on resources.
62	Isle of Wight Council Health	Letter/Report		Comprehensive 20 page report on all aspects of the strategy.
	Scrutiny Committee			Recommendations attached.
63	Hampshire and Isle of Wight	Email	Acknowledgement Email	Composite response from the WDC on workforce issues throughout
	Workforce Development Confederation			the strategy. They comment upon infrastructure to support workforce development, clinical networks, intermediate care, critical care review, working time directive compliance and resources/support.

RECOMMENDATIONS

1. Before making their recommendations the Select Committee would like to express their concern at the publication of the Healthfit Strategic Framework prior to the end of the local consultation process on the Isle of Wight Local Healthcare Strategy. The Select Committee understands that the Strategic Framework is intended to build on the work begun in December 2002 under the umbrella of Healthfit but is concerned that the Strategic Framework contains new proposals on areas of health provision that were not able to be addressed by the local Strategy. The Select Committee is particularly concerned that the new Strategic Framework makes a number of proposals for cancer services, including palliative care, which are not referred to in the Local Healthcare Strategy. The Committee has therefore agreed to continue with their scrutiny of the Healthfit Strategic Framework and make appropriate representations.

2. The Select Committee has also expressed grave concern over the lack of detailed financial information supplied in the Strategy, both in terms of current and future spending. The Strategy indicates that altogether there is a need across the Island health community to seek savings totalling £32 million by 2006 _15. The Committee believes that such savings could undermine the successful delivery of the proposals contained in the Strategy. Further, such savings seem counter to the monies allocated to future services under the NHS Plan in 2000_9.

3. The Select Committee also strongly considers that the successful recruitment and retention of healthcare staff will be essential in ensuring the successful delivery of all the proposals in the Strategy. In noting this the Select Committee has also expressed concerns regarding the management capacity of the local health bodies throughout the implementation period of the Strategy.

4. The Social Services, Housing and Benefits Select Committee has agreed to make the following general recommendations to the Isle of Wight Primary Care Trust, the Isle of Wight Healthcare NHS Trust and the Hampshire and Isle of Wight Strategic Health Authority:

· That, in line with the Joint Statement of Intent signed by the NHS and the Council, the joint commissioning of services that improve the health of Islanders should be effected wherever possible.

· That the clinical capacity of hospital trusts in the rest of the HIOWSHA region is reviewed in order to ensure the future care of Island patients.

· That no hospital services on the Island are reduced or withdrawn before the community service is fully funded, manned, trained and resourced.

· That all nurses trained at St Mary’s are given the opportunity to work on the Island, either in the hospital or in the wider community in future.

· That none of the proposals contained in the Strategy be implemented before the necessary staff have been recruited.

· That service users, relevant voluntary and patient’s organisations must be fully consulted throughout the implementation period of the Strategy

· That the Island’s health bodies be requested to provide feedback to the Select Committee on all the recommendations contained in this response in accordance with statutory requirements

5. In addition, the Select Committee has agreed to make the following specific recommendations to the Isle of Wight Primary Care Trust and the Isle of Wight Healthcare NHS Trust.

6. That, in respect of the proposals for Transfer of Care and Older People:

· In order to avoid bed blocking, phased bed closures must not be considered until both the NHS and the Council’s Social Services Directorate are satisfied that the transfer of care strategy has been successfully implemented.

· The transfer of care strategy must not result in increased pressure on local authority Social Services budgets or staffing.

· A bed census should be carried-out during the winter months to ensure that proposed bed closures are realistic.

· The proposed bed closures must not undermine the Hospital’s plans with regard to winter pressures or any other contingency plan.

· Every trust patient should have a complete patient plan covering discharge planning and post-hospital care.

· Patient discharge planning should continue to ensure the inclusion of carers as an integral part of the process.

· The IWC, voluntary sector and independent carer providers continue to cooperate to improve the recruitment, retention and work conditions of carers.

· Improvements to pay, conditions and training for carers be considered a priority to ensure that sufficiently qualified staff are available to deliver, develop and maintain the health and social care needs of elderly Isle of Wight residents in the future.

· A dedicated nursing team be established by the NHS Trust to ensure that the proposals for transfer of care can be implemented.

7. That, in respect of the proposals for Surgery and Emergency Services:

· Wherever possible, surgical care should continue to be provided centrally at St. Mary’s Hospital by visiting specialists.

· The increased role of fully trained paramedics in the Ambulance Service be supported.

· The retention of a full emergency services unit at St Mary’s hospital be strongly supported and that any future plans for a virtual single access point to these services are Island-based.

· The proposals for pre-operative assessments be supported

8. That, in respect of the proposals for Patient Travel and Transport:

· The PCT does not adopt any of the Strategy’s options for the future funding of cross-Solent travel

· The PCT reinvestigate the proposals for the future funding of cross-Solent travel and ensure that both the issue of social exclusion and the current inequities being experienced by those patients are addressed.

· The reinvestigation also strongly considers increasing the existing budget provision for cross Solent travel

· The reinvestigation take account of the findings of the 2001 Isle of Wight Cross Solent Travel Study.

· Joint working between local health bodies, the IWC, the voluntary sector and transport providers on all matters relating to patient travel and transport is effected as a matter of priority

· The PCT immediately make available a pre-payment voucher for patients with mainland hospital appointments and consideration be given to the timing of such appointments and the distance of travel.

· The PCT continue to negotiate with travel companies for volume-related concessions

· The development of helicopter and fixed wing transport for health related purposes continues to be pursued as a matter of urgency

9. That, in respect of the proposals for Maternity and Children’s Services:

· The Select Committee supports the introduction of Option 1 for the future staffing of the maternity unit.

· The recruitment and retention of maternity and children’s services staff continues to be a priority.

· The proposed consultant provided service for acute paediatrics should only be introduced when the necessary staff have been successfully recruited

10. That, in respect of the proposals for Mental Health:

· Consideration should be given to the appointment of a Mental Health Co-ordinator and that the proposals for Mental Health Services be delayed until the Coordinator has had an opportunity to evaluate service provision

· Full and ongoing consultation with mental health service users and representatives should take place before any of the proposals are implemented.

· Well-trained healthcare staff must be in place before any proposals to transfer more care provision into community settings are implemented.

11. That, in respect of the proposals for Primary Care and Dentistry:

· Priority should be given by the PCT to ensuring that all children on the Island have the opportunity receive NHS dentistry, including orthodontistry, and that local health bodies should continue to address the current deficit in service provision at a national level.

· The PCT develop a Project Management Plan for the scoping of placements and the increase of placements for NHS Dentistry for the Isle of Wight and that progress on this be reported back to the Select Committee in 9 months.

· The recruitment of GPs be addressed as a matter of priority in order to ensure the successful redirection of services from St Mary’s Hospital to GP surgeries and that progress on this aspect of the Strategy be reported back to the Select Committee in six months.