ISLE OF WIGHT
HEALTH COMMUNITY
LOCAL
HEALTHCARE STRATEGY CONSULTATION REPORT
1. Introduction
The Strategic Health Authority Healthfit project required all parts of Hampshire and the Isle of Wight to produce locality strategies. At the end of October the PCT and Healthcare Trust Boards approved the Local Healthcare Strategy for submission for a period of 3 months public consultation. The period ran from 1 November 2003 to 31 January 2004 – most of the consultation events took place during this period and a few written responses came in immediately after this period, including, in agreement, the response from the Isle of Wight Council.
The purpose of this report is to summarise the process and outcome of the consultation period and to put forward recommendations on the way forward.
2. Process of consultation
Key stakeholders, including patient groups, voluntary organisations, staff representatives, the Local Authority and the Strategic Health Authority have been participating in the development of the Local Strategy since January 2003. Key events/briefings included:
§ 15 April: Locality workshop – including local authority members and officers, community health council, voluntary organisations, public, patient and staff representatives.
§ 18 June: Informal meeting with the Isle of Wight Council.
§ June/July: Workshops for services including stakeholders.
§ 8 July: Presentation to the Health Select Committee of the Isle of Wight Council.
§ August: Meetings with larger voluntary organisations (including the Rural Community Council).
§ September/October: Meetings on the draft strategy with the Health Select Committee, full Isle of Wight Council and local MP.
The development of the Local Strategy has been supported by a Local Strategy Patient and Public Involvement Group, comprising staff, Non-Executives, public relations and lay representation. The group has played an important role in determining how information has been communicated effectively to staff and the public. It also enabled lay involvement in the development of the Healthcare Strategy document.
A full chronology of key events leading up to and during the consultation period is presented as Appendix I. Events included:
§ Meetings with public and patient representatives.
§ Attendance at seven public meetings organised by the Isle of Wight Council Health Select Committee.
§ A voluntary services workshop.
§ Chief Executive “drop-in” sessions.
Our approach to the consultation period was underpinned by a communication strategy, led by the Trust communications team. This included liaison with the County Press to support them in producing weekly articles on different aspects of the strategy during much of the three month period, an article in the Wight Insight magazine in December 2003, participation in the Isle of Wight Radio phone-in programme and a successful poster campaign.
The process we have undertaken during this three month period represents the largest patient and public involvement exercise undertaken across Island health services. As well as representing a discrete exercise for the purposes of debating the future of healthcare for the Isle of Wight there are many lessons that we have learned and will be able to apply to our future patient and public involvement activities. This has been a valuable exercise locally and meets the Government requirements for the future planning of health services outlined in section 11 of the recent Health Act.
3. Outcome
The consultation process took place with a good level of awareness and engagement in the debate on the future of health services on the Isle of Wight because of the strong public reaction to the original SHA healthfit document (December 2002). During the three month consultation period it was evident that the strength of feeling has reduced as the proposals in the Local Healthcare Strategy were seen as less threatening to Island based services. The process outlined in section 1 above ensured a high level of patient and public engagement and it was evident from the responses that we received that there was a good level of understanding of the proposals. The reduction in the strength of feeling resulted in more passive involvement e.g. receiving and debating information through the media sources, than active involvement, e.g. attending the public events. However there were members of the public very actively involved, through attendance at the public meetings, the Chief Executive drop-in sessions and taking the time to submit a detailed written response. The time taken by senior staff to debate the issues raised on the future of Island healthcare was evidently appreciated by small groups of the general public.
A total of 63 written responses were received from members of the public, our staff, voluntary organisations and interested stakeholders. A summarised list of these responses is presented as Appendix II. The response was greatest on the transfer of care and patient travel cost sections, with dentistry and mental health also attracting a good response.
The voluntary services workshop on 11 December 2003 was evidently appreciated by the voluntary organisations who attended and in general the level of interest and engagement from the voluntary sector was strong. The level of engagement from the Isle of Wight Council Health Select Committee was very strong as they tackled their first major local issue since they took on their new responsibilities for scrutiny of the local NHS with great enthusiasm. Attendance by the general public at the Select Committee seven public meetings was poor, but the involvement of stakeholders and the voluntary services was much better. The Health Select Committee also ran their own consultation in parallel with ours, which has served to dilute the formal written response that we received.
4. Way
Forward
Following consideration of the consultation response I have detailed below some of the key points and a suggested way forward for each service:
Section 3 - Transfer of Care
§
Much agreement that, in theory, this is the right
direction.
§
Much concern about our ability to implement it in
practice, due to our ability to recruit and train staff, the fragile homecare
market, the availability of care home beds, and the capacity of community
services to cope.
§
Concern that further bed reductions at St Mary’s will
mean we have difficulty coping in peak demand situations.
§
A bed census should be conducted during the Winter
months.
Suggested way forward - Establish a joint PCT/Trust/Social Services group to
consider implementation issues. Bring forward detailed
proposals for further consideration and consultation.
Section 4.1 – 4.4 - Primary Care
§ Few comments on this section but some support for the vision for primary care.
§ Some concern at PCT leading out of hours services, GPs taking on work previously done by Consultants and recruitment position for GPs.
§ Detail of the new GP contract has emerged since the strategy was developed.
Suggested way forward - Progress to implementation.
§
Much concern at the lack of access to NHS dentistry.
§
Some responses urged that priority is given to
children’s dentistry.
§
Some responses indicated that more information is needed
for the public on what the PCT is doing to address the problem.
§
Our status at one of “most challenged areas” has been
confirmed since the strategy was developed and more national support is now
available.
Suggested way forward - The Dental Action Plan being developed with the national
team is implemented and publicised.
§ Few comments, but those were supportive.
§ Integrated access proposals supported.
Suggested way forward - Progress to implementation.
§ Very few comments, but those were supportive.
§ Pre-operative assessment supported.
§
Visiting Specialist Consultants providing services at
St Mary’s supported.
Suggested way forward - Progress to implementation.
Section 7 - Maternity Services
§ Very few comments, but those were generally supportive.
§ Council supported our preferred medical staffing model for obstetrics.
§ Mixed response on proposal for Island-based termination of pregnancy services – main response came from staff in support.
Suggested way forward - Progress to implementation.
§ Majority of comments were made on the proposals for acute paediatrics, including the implications of reducing from two to one tier of medical staff.
§ Healthfit clinical lead for Children’s Services has expressed major concerns at the achievability and sustainability of the consultant –delivered model for the Isle of Wight. The Workforce Development Confederation express similar concerns. The Family and Child Health Care Group in the Trust recognise that a further review of the future possible staffing options is required.
§ Very few comments opposing the transfer of a small number of neonatal patients to Portsmouth. However the affordability of this proposal is under question following preliminary discussions between Portsmouth and Island representatives. Strategic Health Authority support with be sought.
§ A couple of comments were received expressing concern at the inadequacy of CAMHS provision and urging a speedy completion to the current CAMHS review.
Suggested way forward - A further review is undertaken on the future options for
paediatrics and neonatology.
§
Mixed response to the Mental Health proposals.
§
Some support for the Mental Health Access and Treatment
Team, but concern that the bed closures and estates changes were motivated too
much by the need for financial savings rather than service reasons.
§
Concern at the appropriateness of the design of Sevenacres
for mixing adult and older people with mental health problems.
§
Concern at potential termination of Healing Arts
projects funded non-recurrently.
§
Concern at potential termination of Surfwave user
involvement project.
§
Council suggested that mental health proposals are
delayed pending a review of service provision by a newly-appointed Mental
Health Co-ordinator.
Suggested way forward - Progress to implementation. Any changes proposed by the
Trust to the estates rationalisation plan would require further
joint consideration and consultation. Implementation plan
should take account of concerns raised in consultation and
ensure strong user and carer involvement.
§ Very few separate comments on proposals in this section – they were predominantly on the transfer of care strategy and how it would impact on older people.
§ Support for general direction outlined, including the health promotion and lifestyle initiatives.
Suggested way forward - Progress to more detailed proposals, but consider jointly
with the transfer of care proposals.
§ Majority of response was on patient travel costs (section 11.2).
§ Support for greater equity in our future policy and ‘pushing hard’ the ferry operators.
§ Some support for a fixed fee contribution, although there were more comments advocating no contribution and the PCT funding far more patient travel costs.
§ Strong lobby from cancer patients, their groups and the staff who work with them, to maintain current levels of reimbursement to them.
§ Voluntary workshop identified the need for greater co-ordination of current transport provision.
§ Discussions with the ferry companies have not resulted in any firm proposals, but are still ongoing.
§ Council rejected the options put forward in the strategy and also recommended that joint working with them and the voluntary sector be effected as a matter of priority.
§ On section 11.1 there was support for the jumbulance and for helicopter or fixed wing transport.
Suggested way forward - Postpone the introduction of a new scheme for
reimbursement of patient travel costs pending the proposed
joint discussions with Isle of Wight Council and voluntary
sector.
§ Few comments on this section.
§ Some expression of support for the development of cardiac services in Portsmouth and Southampton.
§ Suggestion that follow up appointments for cardiac surgery should be available at St Mary’s rather than Brighton as at present.
§ Concern that the extra responsibilities for prison healthcare will receive insufficient funding.
§ Some expression of support for the concept of joint commissioning.
Suggested way forward - Progress to implementation.
§
Concerns on the level of funding available and that the
size of the financial recovery plan would diminish the various plans for
services put forward in the strategy.
§
Some comments encouraging the PCT/Trust to continue to
press the argument for the ‘Island Premium’.
§
Some comments urging financial recovery to be targeted
at the functions and cost of managerial staff and ‘systems of administration’.
§ Since the strategy was developed we have a better understanding of resource levels available and cost pressures for 2004/5 and beyond. These are predicted to require a larger recovery plan than that described in the strategy.
Suggested way forward - The Island resource plan needs to be reviewed and updated
with some urgency.
5. Conclusion
Following the consultation period we have a better understanding of what the general public and stakeholders views are on the future of healthcare for the population of the Isle of Wight. “Keeping the NHS Local” (Department of Health, 2003) is particularly relevant to the Isle of Wight and there is acceptance and understanding that the direction is “redesign not relocate”. Maximum local service provision is a feature of the Local Healthcare Strategy, but also there was support and understanding that the more specialised services will be accessed from mainland centres, in particular for inpatient treatment.
Broadly the different sections of the strategy fall into 3 categories:
(i) Primary Care
Dentistry
Emergency Services Progressed
to implementation
Surgery
Maternity Services
Commissioning
(ii) Transfer
of Care General
direction is clear and accepted, but
Older People Services concerns raised on
implementation need to
Mental
Health Services be
addressed and further communication and consultation is required on the
implementation plan.
(iii) Children’s Services Following
consultation a further review and
Patient
Transport and Travel new proposals
are required.
I believe that we should take forward the
strategy section by section as outlined above.
A new resource plan will be developed jointly by the Trust and PCT and
any significant service changes, either in the services outlined above or other
services, as a result will require further development of our Local Healthcare
Strategy.
6. Recommendation
The Trust/PCT Board is recommended to approve the way forward for the Local Healthcare Strategy outlined in section 4 and 5 above.
MARK PRICE
DIRECTOR OF STRATEGIC
DEVELOPMENT