Mr Mazillius referred to the section on Transfer of Care and Older people contained in the Isle of Wight Local Healthcare Strategy. The following proposals were highlighted as being of particular interest to the Select Committee:

· The bed census undertaken at St Mary’s Hospital

· Evidence that discharge planning would be vital to ensure the reduction in the length of stay in hospital and the number of beds required.

· Proposals to reduce the number of beds by 56 by April 2004 and again by a further 60 - 80 by 2005

· Plans to increase the number of nursing home beds

· Proposals designed to achieve financial savings of £2.7 million

At a meeting held on the 14 October 2003 the Select Committee had made specific recommendations to the health bodies with regard to the above proposals. The recommendations arising from this meeting were as follows :

· To avoid bed blocking, bed closures should only be considered when all agencies were satisfied that the Transfer of Care Strategy had been successfully implemented.

· The Tansfer of Care Strategy should not result in increased pressures on local authority budgets

· Proposals to transfer more care provision into community settings can only be successful if well-trained healthcare staff are in place

· The proposed bed closures should not undermine the Hospitals plans with regard to winter pressures

· The recruitment and retention of care staff would also be fundamental to underpinning the proposals for Older People Services

Mr Mazillius invited the expert witnesses to briefly outline their views on the strategy

MR KEITH DE BELDER - ABBEYFIELD IW EXTRA CARE

Mr De Belder advised the meeting that Abbeyfield were in the process of developing a modern purpose built care facility. Its key principle would be to develop an integrated care scheme to allow for the progression of care within the same facility. The facility would incorporate a day care centre and would be made available to the local community. Training of staff would also be delivered. Mr Belder believed that the project would meet the needs of social change.

Mr De Belder indicated that it was essential to incorporate developments such as these into the strategy and that the Council’s Planning Department should include social change as part of the planning process.

MRS FELICITE BOOKER - AGE CONCERN

Transfer of Care

Mrs Booker referred to the two bed censuses undertaken by St Mary’s Hospital. The bed censuses had identified a number of patients that did not need to be in hospital. Mrs Booker considered that because the census had been carried out in the summer, these findings did not reflect the full pressures being placed on hospital beds as the results may have been different if undertaken during the winter months. This may have effected the decision taken on the number of bed closures.

Mrs Booker expressed concerns that the discharge planning proposals seemed to place an emphasis on removing the patient from hospital rather than involving family and friends. Mrs Booker considered that the Voluntary Sector should be more involved in active discharge planning.

Mrs Booker considered that the strategy had recognised the importance of the Voluntary Sector in implementing the proposals, however she believed it was essential that realistic investment in the Voluntary Sector be made. Organisations needed to be able to be able to plan for the future.

Mrs Booker referred to the proposed investment of £750,000 into a range of community services and initiatives commencing in 2004/5. She asked what would happen if the investment was not successful.

Mrs Booker sought confirmation that there would be on-going evaluation of intermediate care services during the delivery of the programme of bed closures and that this evidence be shared with all relevant stakeholders who had been engaged in the strategy.

Mrs Booker confirmed that she had received expressions of concern from both older people and carers with regard to the proposals.

Older People

Mrs Booker was unconvinced that adequate resources would be made available to provide support for all older people.

MRS FRANCES WRIGHT - CARERS UK

Transfer of care

Mrs Wright emphasised the importance of carers and advised the meeting that their work saved the community significant money, and was therefore disappointed that carers were not mentioned in the strategy.

Mrs Wright stated that Community Care was not a cheap option. The social and environmental needs of older people also required consideration. Mrs Wright indicated she considered the reduction in the number of beds optimistic. Mrs Wright asked whether the 20 new nursing home beds would be free for patients and what measures were being implemented to recruit care workers in the community.

Mrs Wright considered that the coordination of patients leaving hospital was improving. However improvements in the discharge planning procedure were still required. In particular, the need to involve both carers and families in the discharge planning process.

Older People Services

With regard to Older People Services, Mrs Wright considered that the Voluntary Sector and Care Providers were being heavily relied upon.

Mrs Wright advised the meeting that everyone spoke highly of the medical care and staff at both the PCT and Hospital but considered communication between departments to be poor.

Questions and Answers

With regard to the new 20 nursing home beds, Mr Conal Grier, Commissioning Manager, Older People Services, PCT advised the meeting that the discharge into these beds would be free for patients.

MRS RADCLIFFE - WIGHT HOME CARE

Mrs Radcliffe advised the meeting that Wight Home Care had 400 clients and 150 carers. The employment of carers was a huge issue for them and recruitment was key to maintaining and improving the service. The general level of care required had become higher. Additionally Wight Home Care suffered large training costs.

Serious concerns were raised regarding discharge planning. In particular ensuring patients had quality of care once discharged. Mrs Radcliffe considered their patients were often discharged too early in their recovery and were placing strain on the Wight Care out of hours service.

Questions and Answers

Mrs Radcliffe considered that agencies would have to grow to accommodate the needs of the strategy and she believed that this would have an adverse effect on the service. Mrs Radcliffe indicated that if the strategy resulted in additional demand for home care they would be unable to fulfill that need.

Mrs Jane Wilshaw, Deputy Chief Executive/Director of Operations IWHNHST clarified that the hospital did not operate an ageist policy. Questions relating to age were asked on admission partly to determine demographic details and to determine the level of care required.

Mr Mazillus asked Mr Dannatt from the Registered Nursing Home Association whether he considered that there were sufficient nursing home beds to meet the demands of the strategy. The strategy mentioned that there currently 247 nursing home beds, Mr Dannatt advised the meeting that there were in fact 307. In recent years a large number of beds had been closed and Mr Dannatt indicated that if this were to continue then the implementation of the strategy may have failed. However Mr Dannatt advised the meeting that nursing homes were extending to provide more beds. A perhaps greater problem would be recruiting and retaining staff. Mr Dannatt believed that in view of more beds being in the pipeline the strategy should be delivered successfully .

Mrs Drake from Older Voices referred to the shortage of carers. She considered the strategy relied upon carers which raised an urgent need to recruit and train staff before the strategy could be successfully implemented.

MR TED BERROW - CIVIL SERVICE PENSIONERS ALLOWANCE

Mr Berrow referred to the recent Panoram Programme regarding homecare. He indicated that this raised issues of adequate supervision of agencies delivering domiciliary care. Mr Berrow believed that effective delivery of care in the community could not be easily achieved and quality of care may suffer. Instead Mr Berrow suggested that patients should be offered a choice between domiciliary care and residential care.

Mr Mazillius advised the meeting that a Task Group had been established by the Social Services, Housing and Benefits Select Committee and was currently undertaking work regarding homecare.

GENERAL QUESTIONS AND ANSWERS

During questioning Mr Dannatt confirmed he had not experienced any problems with regard to patients being discharged too early into care placements.

Mr Flux, from the Registered Nursing Home Association referred to written evidence which raised concern regarding the level of training for staff. Mr Flux refuted this and considered his staff to be well trained. Mr Flux also referred to the Single Assessment Process which would be an important aid to ensure correct placement for individuals. In addition Mr Flux indicated that the extra demands placed on homes could be met, but with a caveat that the Local Authority support the strategy.

Mrs Radcliffe from Wight Home Care told the meeting that a great deal of time and resources were channeled into their staff, however employees could only obtain a certain level of qualification and highly trained staff were often lost to alternative employers offering career progression and an increased salary. Mrs Radcliffe believed that offering contracted hours and a salary would help stem the loss of staff.

Partnership working was discussed. Mr Dannatt considered that better marketing as employers was an area that could be improved. Mrs Wilshaw referred to the Statement of Intent signed by the Council, NHS Trust and PCT (which should now be extended to private sector) which indicated the need for a generic support care worker. Mrs Wilshaw also mentioned that work had been undertaken in schools to advertise care work as a career prospect.

Reference was made to whether the 20 intemidiate care beds would be staffed by PCT or Trust employees. Mr Grier advised the meeting that 2 teams were in place on the island to support these beds. These teams beneficially supplemented the range of care treatment therapy undertaken in nursing homes. With regard to promoting independence, Mr Grier also mentioned that there were a number of actions within the strategy to enable people to regain health in order to reduce pressures on resources. Mr Grier advised the meeting that the SHA were currently investigating generic workers which was often found to be an effective approach to care.

CLOSE OF MEETING

Mr Mazillius thanked everyone for their attendance and contributions

The next themed meeting would be considering Surgery and Emergency Services on 3 December 2003 at County Hall, Newport commencing at 6.00 pm.

Meeting closed at 8.04 pm

NOTES OF THE SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE HEALTH CONSULTATION MEETING CONSIDERING SURGERY AND EMERGENCY SERVICES HELD IN THE COUNCIL CHAMBER ON THURSDAY, 3 DECEMBER 2003 COMMENCING AT 6.00 PM

Members of the Select Committee Present :

Mr I R Stephens (Chairman), Mrs B D Clough, Mrs D Gardiner, Mr J F Howe, Mr R G Mazillius, Mr A J Mellor, Mr V J Morey, Mrs E Oulton, Mr D G Williams

Other Members Present :

Mr R C Richards

Expert Witnesses :

Mrs Joyce Mears Care Services Manager, Isle of Wight Housing Association,

Mrs Daphne Williams Diabetes UK

Mr Alan Horwell Manager, Earl Mountbatten Hospice,

Stakeholders :

Mrs Nancy Ellacott Secretary of the Civil Service Pensioners Alliance

Mrs Doreen Drake Older Voices

Mrs Winifred Hague Isle of Wight Physically Handicapped - West Wight Group

Social Services and Housing Directorate :

Mr Simon Smith Manager, Emergency Duty Service

Mrs Kathy Pevreall Senior Practioner, Duty Team

Health Representatives :

Mr Mark Price Director of Strategic Development, Isle of Wight Healthcare NHS Trust (IWHNHST) /PCT

Mr Tim Walsh Consultant Surgeon, IWHNHST

Dr R Beal A&E Consultant, IWHNHST

Ms Sheila Paul Associate director, Elective/Surgery Care Group, IWHNHST

Mr Malcolm Hunter Associate Director, Emergency/Medicine Care Group, IWHNHST

Ms Eleanor Green PCT

The Chairman welcomed all guests to the meeting, the second of six themed meetings which the Select Committee would be undertaking in its role of Health Scrutiny. The Chairman introduced Cllr David Willams as the Member Champion for this meeting: Surgery and Emergency Services.

SURGERY AND EMERGENCY SERVICES

Cllr Williams invited the expert witnesses to briefly outline their views on the Strategy:

MRS JOYCE MEARS – ISLE OF WIGHT HOUSING ASSOCIATION (IWHA)

The Isle of Wight Housing Association (IWHA) provided the largest Supporting People scheme. They provided 2 schemes through the National Care Standards Commission: one for people with learning disabilities and another for older people.

Mrs Mears commented that the ‘in hours’ service was fine. However, during ‘out of hours’ her staff had experienced problems when contacting NHS Direct. Long delays had been experienced before calls were answered and staff were spending a long time answering questions. One number for all out of hours calls would be helpful.

The new pre-operative assessments were welcomed by the IWHA, as this improved the experience for vulnerable patients.

Concern was expressed that if the number of surgical cases treated as day cases increased, the workload for staff would increase because people would require more care at home. Mrs Mears was also concerned that there may be an increase in the number of post–operative complications.

Mrs Mears commented that domiciliary carer’s pay was relatively low, resulting in problems in recruiting such staff.

Mrs Mears commented that at present many referrals for personal care were turned down as there were not enough staff. The number of referrals would double or treble if the proposals went ahead.

Mrs Mears noted that there needed to be a change in people’s attitudes. Patients may not think they were getting the care needed if this care was not delivered by staff who would traditionally undertake this work.

MRS DAPHNE WILLIAMS – DIABETES UK

The suggestion was made that information on discharge and community care be given to patients at the pre-operative assessment.

Mrs Williams commented that giving paramedics greater responsibility was a positive thing.

MR ALAN HORWELL – EARL MOUNTBATTEN HOSPICE

Mr Horwell detailed the operation and aims of the Hospice of which he was the manager. He had no concerns about the strategy.

MR SIMON SMITH – MANAGER OF THE OUT-OF-HOURS SERVICE, ISLE OF WIGHT SOCIAL SERVICES

Mr Smith mentioned that his team had many contacts with A&E and agreed with Mrs Mears that it would be helpful if discharge planning was included as part of the pre-operative assessment.

MRS KATHY PEVREALL – SENIOR PRACTITIONER, DUTY TEAM

Mrs Pevreall also highlighted that pre-operative assessment should include discharge planning and be linked in with care managers. Mrs Pevreall also mentioned that there were very few carers in the community.

QUESTIONS AND ANSWERS

With regard to domiciliary carer’s pay, Mrs Mears advised the meeting that a pay increase to £7.50 per hour would improve the service. Mrs Mears had requested a direct access number for the out of hours service but had been advised to go through 999. Mr Hunter, Associate Director, Emergency/Medicine Care Group, IWHNHST referred to the single point of access proposals in the strategy, although it was indicated that Housing Associations were slightly different and these views should be listened to.

Patient choice targets were on schedule, although it was noted that the choice would be limited to more local areas. Feedback on National consultation of Patient Choice was currently awaited.

The issue of managing patient expectations was raised. The meeting was advised that there was some evidence to suggest that the NHS Direct has had some success in this area. Although as providers of the services health representatives indicated that there had been some reservations about its impact. Although it was noted that NHS Direct had been successful in advising patients of other services available to them to receive appropriate care.

Members questioned whether a policy was in place for emergency planning. The meeting was advised that a mock accident had been successfully carried out with 20 patients in order to test the major incident plans. This incident had been monitored and had received a good report in terms of both how the Hospital and Ambulance Service had responded. It was asked that if there were only 20 patients used in the simulation, would there be enough beds in the event of a major incident. Dr Beal, A&E Consultant IWHNHST explained that the Hospitals Emergency Plan was comprehensive. In the event of an emergency bed space was less important because much of the care was provided at the scene of the accident. Mr Smith, Social Services Directorate explained that all agencies worked together closely on the Emergency Planning Group to ensure all plans are in place in the event of an incident.

With regard to the strategy’s proposals to increase the training of paramedics, it was considered that this would improve the outcome for patients and Islanders living in remote areas. Reference was made to the involvement of St Johns Ambulance in responding to emergency calls. It was explained that this was the first responder scheme, which was being set up across the country. It was noted that the Trust was currently in discussion with St Johns Ambulance, if implemented volunteers would be trained to carry out additional duties and to be first responders to emergencies. This would be in addition to the Ambulance Service, not as a replacement. It was noted that the Islands Ambulance Service was exceeding its response targets.

A question was asked regarding the impact of GPs opting out of the IDOC service and whether this would place more pressure on the out of hours services. Mr Price, Director of Strategic Development IWHNHST/PCT referred to the General Medical Service (GMS) Contract, which allowed GPs to opt out of providing the out of hours service. GPs views were currently being canvassed, but in view of how the GMS was written it was likely that local GPs would opt out of the service. The PCT still had a responsibility to provide an out of hours service once the GMS was implemented in April 2004. However there would be a period of grace between April 2004 and December 2004 to allow a new service to be implemented.

With regard to GPs carrying out more minor surgery it was explained that part of the new GP contract had specified minor surgery as an area that GPs might wish to specialise in this could be made part of the new GP contract. Mr Walsh, Consultant Surgeon IWHNHST explained that minor surgery was often straight forward and accepted that if the GPs were sufficiently trained it may be advantageous to patients and more cost effective, although it should not be particularly encouraged and definitely not enforced.

Concern was raised regarding specialist hospitals on the mainland having a lack of resources and potential communication problems with St Mary’s hospital and whether this was being resolved through the Strategic Health Authority (SHA). It was noted that the PCT would need to raise any complaints with mainland providers through the Service Level Agreement. In addition it was mentioned that communication with mainland hospitals can be difficult and when this arises issues need to be addressed with the provider.

Mr Mazillius asked the NHS representatives if, in spite of the bed closures, the Trust would be able to cope with red alert situations (4 beds or less over a respective period). Mr Price stated that the Trust would need to look at management of peak situations

Mrs Drake from Older Voices highlighted that long waiting times for surgery was stressful for older people. The meeting was advised that a number of specialties at St Mary’s expected to exceed the waiting times target this year and would be at a 6 month waiting time from April 2004; including urology, surgery, gynecology and ophthalmology. However orthopaedics was not on target, due largely to the length of each operation and the age range of the Island population. The Audit commission had set a target of 83% usage of theatres which the hospital aimed to achieve by the end of February 2004.

Mrs Oulton asked Mr Walsh about the article in the County Press during which he discussed Day surgery. Mr Walsh replied that he had expressed concern as day surgery can be difficult for older people as it requires after-care in the community. He also mentioned that it would be difficult for the Trust to save the total amount of money required without a detrimental effect upon patient care. Providing healthcare on the Island is costly due to cross-Solent travel, a high population compared with the size of the hospital and the difficulties associated with employing enough medical staff to cover rotas. Additionally Mr Price added that attempting to save the total amount of money in 12 months would have an adverse effect on services however it should be remembered that these financial savings would be made over a number of years.

Finally concern was raised as to how the hospital would cope with the number of tourists visiting the Island each year. The meeting was advised that this could be covered in a separate discussion about the financial plan.

CLOSE OF MEETING

Cllr Williams thanked everyone for their attendance and contributions

The next themed meeting would consider Patient Travel and Transport on 9 December 2003, in County Hall, Newport commencing at 6.00 pm.

Meeting closed at 7.58 pm

NOTES OF THE SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE HEALTH CONSULTATION MEETING CONSIDERING PATIENT TRAVEL AND TRANSPORT HELD IN THE COUNCIL CHAMBER ON TUESDAY, 9 DECEMBER 2003 COMMENCING AT 6.00 PM

Members of the Select Committee Present :

Mr I R Stephens (Chairman), Mr J R Adams, Mrs B D Clough, Mr J F Howe, Mr R G Mazillius, Mr V J Morey, Mrs E Oulton, Mr D G Williams

Other Members Present :

Mr M J Cunningham, Mr R C Richards

Expert Witnesses :

Mrs Emma Shambrooke Project Development Officer, Rural Community Council (RCC)

Mrs Margaret Wilder Chairman of the Physically Handicapped Society, Newport Group

Mr Steve Porter Chairman, Quality Transport Partnership (QTP)

Stakeholders :

Mr David Phillips A member of the public interested in health issues

Mrs Kathy Snook IW Liaison Officer, Wessex Cancer Trust

Mr Paul Herrington Chief Executive, Wessex Cancer Trust

Mrs Sylvia Giblin Osteoporosis Society

Mrs Fay Miller Physically Handicapped Society, Newport Group

Health Representatives :

Mr Mark Price Director of Strategic Development, Isle of Wight Healthcare NHS Trust (IWHNHST) / Primary Care Trust (PCT)

Mr Dave Crawley Chief Executive, PCT

Mrs Helen Shield Director of Finance, PCT

Mrs Val Anderson Chairman, PCT

Mr Dave Arnold Director of Ambulance Services, IWHNHST

Social Services and Housing Directorate :

Mr Richard Webb Service Manager, Operational Support

Mrs Cathie Way Team Manager, Hospital Team

The Chairman welcomed all guests to the meeting, the third of six themed meetings, which the Select Committee would be undertaking for its role in Health Scrutiny. The Chairman introduced Cllr John Howe as the Member Champion for this meeting: Patient Travel and Transport.

PATIENT TRAVEL AND TRANSPORT

Mr Howe referred to the section of the Isle of Wight Local Healthcare Strategy, which detailed plans for Patient Travel and Transport. The following proposals were highlighted as being of particular interest to the Select Committee:

· The options for travel reimbursement, ranging from full reimbursement to no reimbursement, and the consequent cost implications.

· The possibility of obtaining a Medivac helicopter

· The Patient Choice initiative and the implications for Island patients travelling to other Health Authority areas.

At a meeting held on 14 October 2003 the Select Committee had made specific recommendations to the Health Bodies on the Island with regard to the above proposals:

· The redirection of services from St Mary’s Hospital to GP surgeries could be at risk if the recruitment of GPs is not addressed as a matter of priority.

· That wherever possible, care should be provided centrally at St. Mary’s Hospital by visiting specialists.

· Proposals to transfer more care provision into community settings can only be successful if well-trained healthcare staff are in place.

Mr Howe invited the expert witnesses to briefly outline their views on the strategy

MS EMMA SHAMBROOK – ISLE OF WIGHT RURAL COMMUNITY AND COUNCIL (RCC)

Ms Shambrook gave details about OPTIO (a community transport project), which operated a community car and bus scheme and services run through a help line. The community car scheme operated with 50 drivers making over 1,000 journeys each month. ‘Dial a bus’ was a scheme that operated for people with disability, mainly wheel chairs. This had wide implications. Many journeys were made for hospital and doctor appointments.

The presentation from the RCC concluded that the hospital care scheme was not flexible enough, but there were opportunities to expand this service and address some of the social inclusion issues on the island.

Questions and Answers

Mrs Shambrook advised the meeting that patients were taken to the Island Ferry ports not to mainland hospitals. It was estimated that one patient per fortnight/month was taken to a ferry port and 50/60 were taken to St Marys per week. In addition patients were taken to doctors appointments. It was estimated that the cost of transport was 40 pence per mile. The RCC were currently bidding to the community fund for a further £150,000 fuding for the next 3 years. The eligibility to use the transport was based on a medical need and on a GPs referral.

With regard to patients travelling alone, it was indicated that they would prefer company on these journeys

Mrs Shambrook indicated that there had been some joint working with the Hospital however there was more scope to improve this.

It was noted that the service required greater provision for wheelchairs and there was always a need for more drivers.

Following the discussion the Committee suggested that it would be beneficial if the possibility of joint working between the OPTIO and hospital car service was investigated.

MRS MARGARET WILDER – CHAIRMAN OF THE PHYSICALLY HANDICAPPED GROUP, NEWPORT

Mrs Wilder made a short presentation to Members about the voluntary work of her charity group. The Newport Group had 22 members who met fortnightly to assist their clients with transportation needs. All of the nine drivers were voluntary and the organisation hired a ‘Red Cross’ ambulance. It was noted that the use of taxis was too expensive. The number of clients who could be transported was limited and car drivers could only sometimes carry one passenger due to their disability.

Questions and Answers

The meeting was advised that other Physically Handicapped Groups on the Island included, Ryde (8 Members), West Wight (12 Members), Cowes (5 Members) and Ventnor (15 members). The Red Cross charged 60 pence per mile and the Newport Group did not receive discounted rates.

It was noted that they received no funding and instead raised money in other ways.

Mrs Wilder confirmed that if the cost of taxis was subsidised the Group would utilize them.

MR STEVE PORTER - CHAIRMAN OF THE ISLE OF WIGHT, QUALITY TRANSPORT PARTNERSHIP (QTP)

Mr Porter suggested more could be achieved by the pooling of resources.

Since some work had been done by the PCT regarding HealthFit proposals, it was suggested that Mr Porter discuss the issues with Mr Crawley, Chief Executive of the PCT. They would then approach the ferry companies about the increasing need and specialism for patients travelling to the mainland. In addition Mr Crawley indicated he would include in his discussions with the ferry companies the issue of allowing patients to stay in their cars

The Select Committee would also investigate, through the Isle of Wight Council’s Portfolio Holder for Transport, Cllr Ernie Fox, the possibility of convening a meeting of all transport providers on the Island. This should include the Quality Transport Partnership (QTP), the Isle of Wight Council, the RCC, the PCT, Healthcare Trust and Voluntary Sector.

The Select Committee were informed that 500 patients per week were currently crossing the Solent. The PCT contributed £53K per year towards the cost of these journeys, with those in receipt of benefits receiving the majority. However, the PCT indicated that the situation was inequitable and they were seeking views to address this. The Select Committee expressed concern that the PCT should review its eligibility for cross-Solent travel reimbursements.

The meeting noted that the PCT received no additional funding to provide patient travel and transport, unlike some other Islands, therefore any funding used to provide this service was unfortunately taken from the health care budget.

It was considered that the PCT, the Acute Trust and the Isle of Wight Council should meet to discuss in greater detail.

MR PAUL HERRINGTON - WESSEX CANCER TRUST

Mr Herrington advised Members of the NHS Cancer Plan, which specified that specialist treatments should be as good as our European partners. Specialist Treatment Centres were located on the mainland and due to clients on the Isle of Wight being older, it followed that more older people in the lower-income bracket had to travel to the mainland.

For those receiving cancer treatments, visits were often several times each week for 6 to 8 weeks. This could lead to people suffering from personal cash flow problems. The Wessex Cancer Trust had purchased a mini bus for mainland-side journeys to the hospital or the Manor House, but this was not possible on the Island side. There was a need to co-ordinate travel for patients on the Island. A bid had been made for funds, which failed, but the Trust had not heard of OPTIO prior to this meeting.

The Portfolio Holder informed the meeting that a Community Transport Officer was in post and hopefully information could be shared and assistance provided.

The Select Committee suggested that the Isle of Wight Community Transport Officer be asked to work with other transport officers and charitable organisations, to assist with the co-ordination of patients and carers travel arrangements on the Island.

ADDITIONAL QUESTIONS AND INFORMATION

The meeting was informed that a bid had been submitted to the Single Regeneration Budget (SRB) at Ryde for a ‘vehicle co-ordinator’. The budget of £55K was raised and Members’ considered this to be an insufficient amount. If the allotted budget were used up during part of the year, difficult choices would have to be made about cutting other services.

Members also questioned the meaning of ‘free medical care’ and were informed that the Audit Commission paper contained specific criteria for free services across the Island. The Select Committee suggested that the PCT could review the size of the patient travel budget in line with anticipated demand.

CLOSE OF MEETING

Mr Howe thanked everyone for their attendance and contributions

The next themed meeting would be considering Maternity and Children’s Services on 15 December 2003 at County Hall, Newport commencing at 6.00 pm.

Meeting closed at 7.55 pm

NOTES OF THE SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE HEALTH CONSULTATION MEETING CONSIDERING MATERNITY AND CHILDRENS SERVICES HELD IN THE COUNCIL CHAMBER ON MONDAY, 15 DECEMBER 2003 COMMENCING AT 6.00 PM

Members of the Select Committee Present :

Mr R G Mazillius (Vice Chairman), Mrs B D Clough, Mrs E Oulton, Mr R C Richards (deputizing for Mr J F Howe), Mr D G Williams

Other Members Present :

Mr M J Cunningham

Expert Witnesses :

Mr Dave Chapman Chairman of Maternity Liaison Services

Mrs Kate Attrill Connexions midwife

Stakeholders :

Mrs Marion East L.E.A Project

Mrs Shaheeda Nehorai Co-ordinator, Home Start

Mrs Sue Erridge Sure Start, Ryde Programme Manager

Social Services and Housing Directorate :

Mrs Prue Grimshaw Services Manager for Family Services

Health Representatives :

Mr Mark Price Director of Strategic Development, Isle of Wight Healthcare NHS Trust (IWHNHST)/PCT

Dr Piers Rowlandson Clinical Director, Family and Primary Care, IWHNHST

Mrs Jane Dowdell Associate Director, Family and Primary Care IWHNHST

Mrs Gill Kennett Maternity Services Manager, IWHNHST

The Chairman welcomed all guests to the meeting, the fourth of six themed meetings which the Select Committee would be undertaking in its role of Health Scrutiny. The Chairman introduced Cllr Barbara Clough the Member Champion for this meeting: Maternity and Childrens Services

MATERNITY AND CHILDRENS SERVICES

Mrs Clough invited the expert witnesses to outline their views on the strategy

MR CHAPMAN – REPRESENTING THE NATIONAL CHILDBIRTH TRUST AND MATERNITY SERVICES LIAISON COMMITTEE

Maternity Liaison Committee

Mr Chapman briefly outlined the membership of the Committee, which included Health representatives, Maternity Service Manager, Midwives, Lay representatives, Consultants and Health visitors.

The strategy outlined 2 options, the Maternity Liaison Committee favoured option 1.

Option 1 was based upon current staffing levels of 3 consultants, 1 Associate Specialist, 2 Specialist Registrars, 1 Senior House Officer and 3 Staff Grades, plus 1 additional consultant post. Consultant cover would be provided 24 hours 7 days a week.

Mr Chapman considered that there was a strong suggestion of moving towards midwife led care in option 1. The fundamental difficulty of option 2, the consultant led option, was the issue of recruitment and retention of staff.

Mr Chapman commented that option 1 was viewed positively and that he considered that the service could be moved forward in sensible manner.

National Childbirth Trust (NCT)

Mr Chapman indicated that the NCT also favoured option 1.

Important areas for consideration were as follows:

Pre birth – midwife led care, continuity of care and antenatal education

Birth – Increasing the number of ‘normal’ births, continuity of care, facilities for mothers and families

Post birth – continuity of care

Mr Chapman emphasized that the continuity of care was an area of concern

MRS KATE ATTRILL - CONNEXIONS MIDWIFE

Mrs Attrill explained that prior to her appointment to Connexions a year ago the needs of young mothers were not being met. Since her appointment Mrs Attrill had focused on areas of weakness in the services provided for young mothers. It was emphasised that often young mothers found it difficult to access services. Mrs Attrill had found there had been inequalities for accessing health for young people, Mrs Attrill considered young people required specialised services. Housing had been identified as one of the major needs for young mothers, some progress had been made in this area by way of streamlining services through the Social Services Directorate. With regard to education, work had been done to look any barriers that were preventing young mothers accessing education following pregnancy. Mrs Attrill explained that she provided an individualised service for young mothers and provided help and support at all levels. The services had received 108 referrals this year.

Mrs Attrill outlined a number of cultural reasons that contributed to young people becoming pregnant. These included bullying, to keep boyfriends and to gain housing. Bullying was a particularly common reason and needed addressing. Information had been compiled on a relatively small sample of mothers, however a years audit would be produced in the near future which would illustrate the current gaps in the service.

MS LISA DIDIER-CARTER – TEENAGE PREGNANCY COORDINATOR

Mrs Didier-Carter explained that they were currently working towards a Government initiative/target to half the rate of under 18 year old conceptions by 2010 and to also establish a downward trend for girls under 16 years old. The National Strategy for young people had been localised to best suit the needs of the Island. The Local Strategy was being used by many agencies and in particular was focusing on improving the following areas:

Improved advise on contraception

Sex and relationship education

Advertising services available to users

QUESTIONS AND ANSWERS

During discussion it was considered that the integration of services was paramount to ensure continuity of care.

Mrs Kennett, Maternity Services Manager, IWHNHST advised the meeting that there were currently four midwife community teams on the Island. It was indicated that the health service would consider case loading, which would mean each midwife would have a case load of approximately 25 patients per year, and would deliver the full range of care in partnership with another mid wife. However due to the geography of the Island and its separation from the mainland services, there would always need to be some link with medical aid.

Currently the termination service was subcontracted to the BPAS in Bournemouth, however the strategy recognised the need to have some localised service. The Maternity Services Manager was currently waiting for a costing from the BPAS to provide this service locally however expected it to be costly. It had been recognised that the after-care following terminations was a weakness of the service.

Some steps had been taken for the midwifery service to work with the Education Service. The South Wight Service regularly accessed some high schools, however capacity was a problem together with timetabling with the High Schools curriculum. In addition Mrs Erridge stated that Surestart were developing a family centre and crèche at Ryde High School working with both pupils and young parents.

Mrs Dowdel was confident that the strategy supported continuity of care.

With regard to Maternity Services an additional 2 consultants would be employed. The interviews for these posts would be in January 2004. Although with regard to the termination service, all consultants had a choice as to whether they perform this procedure and therefore the effect of this increased staffing would not yet be known

With regard to Children’s Services the Healthcare Trust did not believe a 2-tier system could be maintained and that the service would need to be consultant delivered within 4-5 years. The Trust did recognise that training needs for staff would need to be addressed.

Concern was raised regarding the recruitment and training needs of Maternity Services Staff and pediatricians. It was considered that this area needed to be addressed before the strategy could be successfully implemented. The meeting was advised that both Portsmouth and the Island were pooling resources to address this weakness.

CLOSE OF MEETING

Cllr Clough thanked everyone for their attendance and contributions.

The next themed meeting would be considering Mental Health on 6 January 2004 at County Hall, Newport commencing at 6.00 pm.

Meeting closed at 7.25 pm.

NOTES OF THE SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE HEALTH CONSULTATION MEETING CONSIDERING MENTAL HEALTH HELD IN COMMITTEE ROOM ONE ON TUESDAY, 6 JANUARY 2004 COMMENCING 6:00 PM

Members of Select Committee Present :

Mr R G Mazillius (Vice Chairman), Mr J R Adams, Mrs D Gardiner, Mr J F Howe, Mrs Erica Oulton, Mr D Williams

Expert Witnesses :

Mr Mike Hallisey Alzheimer’s Society

Mr Mike Shaw Advocacy 101%

Mr Robin Ford Advocacy 101%

Mrs Etty McKinley People Off the Streets

Mr Keith Gwilym Learning Disability Homes Association

Social Service and Housing Directorate :

Mr Martin Henson Social Services Manager

Mr Daron Perkins Learning Disabilities Team Manager

Health Representatives :

Mr Mark Price Director of Strategic Development, Isle of Wight Healthcare NHS Trust (IWHNHST)/PCT

Dr Mark Denman-Johnson Professional Executive Committee, PCT

Mrs Sue Stoneman Associate Director, Mental Health and Learning Disabilities, IWHNHST

Mrs Tina Harris Deputy Associate Director, Mental Health and Learning Disabilities, IWHNHST

Stakeholders :

Mrs Gill Ashley Women’s Institute

Mrs Joyce Mears Isle of Wight Housing Association

Mr David Baker Beulah Church, Seaview

Mrs Mandy Sellers IW PCT

Mr Louis Brand IWC Social Services & Housing

Ms Anne Robinson Carers UK/Gurnard Parish Council

Mrs Jill Mazillius

J Imrie

Mr Roger Fordham MIND

Mrs Doreen Drake Older Voices

Mr Rodney Ireland IW Healthcare Trust

Mr Graham Elderfield IW Healthcare Trust

Mrs Marion Prowse RRC

Mr Peter Foster Nursing Bank

Cllr M Cunningham IW Council

Ms Ros Patey Not Just Enterprise

Mrs Elizabeth Martin Riverside Centre/DIAL

Mrs Sue Bennett Mental Health Carers Support Service

Mrs Ruth Daniell PCT

Mr Guy Eades Healing Arts

The Vice-Chairman, Cllr Roger Mazillius, welcomed all guests to the meeting, the fifth of six themed Meetings which the Select Committee would be undertaking in its role of Health Scrutiny. The Chairman introduced Cllr Erica Oulton as the Member Champion for this meeting: Mental Health.

MENTAL HEALTH

Cllr Oulton invited the expert witnesses to briefly outline their views on the strategy.

MR MIKE HALLISEY – ALZHEIMER’S SOCIETY

Mr Hallisey expressed his apprehension on the changes to services outlined in the strategy, in particular those that would affect Shackleton House. Mr Hallisey questioned whether the changes would benefit patients. Some of the existing buildings were purpose built for their current use, whereas a hospital ward would not be. He was also concerned that if there was a need for extra beds in some facilities how this would be handled and was uncertain that the indicated changes would benefit patients. Mr Hallisey ask that it be noted that Memory and Recall Clubs were over subscribed at the moment and there was concern that if the changes made to Mental Health Services resulted in the need for more places in these clubs, where would they go? Also there was an issue regarding security and external space needed at any replacement for Shackleton House.

Questions and Answers

Mrs Stoneman, Associate Director, Mental Health and Learning Disabilities, IWHNHST commented that there were problems with the physiotherapy provision at Shackleton House but there would be no bed reductions. The provision at St Mary’s would overcome lack of physiotherapy. Mrs Stoneman indicated that any replacement to the existing facilities would not make things worse and that the need for space, single rooms and external space was fully understood. There was a need to look at the estate implications. It was indicated that by the end of 2004 the Trust would need to clear on which wards would change. Mr Price, Director of Strategic Development IWHNHST explained that a piece of work needed to be done following this consultation to look at the whole estate implication, particularly at St Mary’s if the Transfer of Care Strategy was implemented and there were further acute bed closures, it would provide opportunity to look at the sites again. Although Mr Price was confident that the St Mary’s site would continue to be the hub of health services on the Island, the location of these services still required some examination and this was why the strategy had not specified the changes.

MR ROBIN FORD – ADVOCACY 101%

Concerns were raised regarding outside services (care in the community) it was noted that they were bound by legislation, do different jobs, have different resource issues and have good methods of treatment. There was a concern regarding the effect of the ‘Home Assessment’ and that carers and patients needed to know more. There were also concerns regarding the reduction of beds, the funding for outside services and the retention of carers. Mr Ford stressed the need for a professionally paid person to disseminate information to service users. Although the services of the Riverside Centre were good, Mr Ford stressed the need for the work of Healing Arts to continue and explained the positive impact this had on service users. There was a plea from outside services for funding to be maintained.

MR MIKE SHAW – ADVOCACY 101%

Mr Shaw broadly welcomed the strategy but had some reservations. His main concern was that mental health was given the priority it deserves, as it effects 1 in 4 people at some point in their lives and because of its links with physical health. Mr Shaw believed greater investment should be made in mental health. The Island had one of the highest suicide rates in the country and high hospital re-admission rates. Mr Shaw believed there were hidden dangers in reducing beds at Seven Acres, The two year funding had now expired and there was no further funding for a co-ordinator.

There was a need for a person and/or a group to do the coordination for service users and carer involvement. Mr Shaw considered that mental health users should be involved in re-drafing this section and propose a way forward.

Questions and Answers

Mr Shaw indicated that Service users were involved in the development of the Isle of Wight Health Improvement and Modernisation Improvement Plan which was launched in February 2003.

Concerns were raised regarding the lack of funding for a mental health co-ordinator and the stress this would place on existing staff. The meeting was advised that the funding was provided by the PCT and Social Services, health representatives were unable to provide details however understood the necessity to review what happened next.

Mrs Bennett from the Mental Health Carers Support Service (MHCS) outlined a number of issues that had arisen following its launch in October 2003, these included :

Carers were concerned regarding the proposed reduction of beds and resulting increase in workload.

A need to prioritise alternative respite services and make it a wider care service in conjunction with Social Services

MHCS wish to be involved in the development of respite care and were impressed by the support given by Practitioners and the PCT.

It was noted that the issues outlined by Mrs Bennett had been under discussion over the last year The range of respite services required work between the Trust and the Council’s Social Services Directorate. There was a common thread of concern regarding the shift of services from hospital to community care and these proposals were constantly reviewed. It was noted that difficulties in recruitment had caused delay. Mrs Harris, Deputy Associate Director, Mental Health and Learning Disability IWHNHST was keen to keep the involvement of services users views and support. Carer services now have dedicated funds secured, it is important to identify carers and their needs.

It was considered that good progress had been made over the last 3 years regarding the transition of Psychiatric Nurses working closely with Social Workers. There was evidence of a new breed of mental health worker emerging.

The difficulties in finding funding and gaining the support of charities was expressed.

The Select Committee were assured that Assessments and Care Plans were being produced and records kept. Performance targets were being met.

It was questioned why there had been a delay in the reduction of beds at Seven Acres. It was explained that the timing of and the number of reduction of beds was determined and influenced by all partners and users of the service. The reduction in beds had been delayed until November 2003 at which point it was planned that there would be a phased reduction of 2 beds on alternate months over a period of 12 months. Since the 2 bed closures in November 2003, there would be no further reductions until April 2004. This would allow some time for issues of recruitment to be addressed. By November 2004 Home Treatment Service would be in place with the same services as if the patient was in a hospital bed. The reduction in beds was planned to take place once support services in the community were operating. It was indicated that Health representatives were confident that the targets in bed reductions at Seven Acres would be met by November 2004. The possibility of moving the Halberry unit to Seven Acres was still being investigated.

It was asked how would the Mental Health Service be monitored after the changes within the strategy had taken place, and what would happen if it failed. It was explained that work would continue with service users to monitor success and the Steering Group would be constantly monitoring changes.

Questions were asked in relation to the proposals involving a mix of patients, both young and old and how this would work in relation to Occupational Therapy (OT). The OT service would offer options for the elderly and young to chose within which area they received therapy, these changes may not be in place by September 2004. Issues of privacy and dignity had been considered in these developments.

MRS ETTY MCKINLEY – PEOPLE OFF THE STREETS

Mrs Mckinley expressed concern for the number of mental health patients with dual and multiple diagnoses who were unable to access services and could not determine how the proposed changes would help. In addition moving people around and into the community raised security issues and raised the risk of discharged people who had nowhere to go falling back into drugs. There was a need to raise funding nationally. How do we reach people ‘at home’ if they have no home to go to? Mrs Mckinley asked would there be a loss of staff relating to the reduction in beds. Mrs Mckinley believed that mental health sufferers were treated as second rate citizens. There was a need to feed information to service users. The carer needs to be taken into account when dealing with mental health.

Questions and Answers

Mrs Harris told the meeting that part of the strategy’s remit was to support discharged patients but this was dependent on adequate funding. The Community Mental Health Teams were stretched, but new funds were in the development plans. The Outreach Team was well resourced and there was no plan to put pressure on them. It was planned that Access and Treatment services would support people in a crisis. Health representatives recognised that it was commonly viewed that the only existing safety net was Seven Acres but others were being put into place. The work of the Mental Health Carers Support Service would be a great help in this area. The Trust recognised the need to identify carers and meet their needs. Mrs Harris indicated that she would like to meet with Mrs Mckinley to discuss this issue.

Reference was made to the Health Improvement and Modernisation Programme target to reduce suicide mortality by 20% by 2010 and whether the Trust would meet this target. Mrs Stoneman, Associate Director, Mental Health and Learning Disabilities, IWHNHST highlighted this was a National Target. Mrs Stoneman also referred to shortfalls and the need to bridge this gap, stating that this would need a transitional period. An audit on training and skills deficiencies had been carried out and treatment training would be implemented however it would take time to develop these skills in the workforce. The Trust’s target for April 2004 would not be met and investment was needed for which a bid had been made.

A question was asked as to whether the Trust was short on Psychiatric Medical staff and whether money from the sale of properties was ring fenced to Mental Health. Mrs Stoneman replied that Locum coverage had been good and two posts had been filled one more would be in place by February 2004 and the last post had been appointed.

MR KEITH GWILYM – LEARNING DISABILITY HOMES ASSOCIATION (LDHA)

Mr Gwilym commented that the Learning Disability Service had small mention in the strategy and would welcome closer working with both Health and Social Services. With regard to specialist services the Community Learning Disability Nursing Service was invaluable with regard to advise and expertise and any reduction would cause great difficulty. The LDHA had been without the use a psychologist, however a part time service had not been provided but Mr Gwilym would like this expanded. The Learning Disability Service welcomes the move from Residential Care to Supportive Living.

Mrs Mears, Isle of Wight Housing Association raised concern that the strategy did not refer to supportive housing which often filled the gap between discharge from hospital to home. It was indicated that the supportive housing area required expansion.

Mrs Stoneham advised the meeting that there was a directive to look at Learning Disability Nurses integration. It was recognised that mental illness needed to be identified earlier in patients which would reduce the requirement for beds and reduce the numbers of suicide. Preventing the deterioration of patients was also an area that required improvement.

GENERAL QUESTIONS

During questioning a Health Representative clearly stated that alternative service provision for mental health patients was to be welcomed.

Stakeholders raised a number of concerns regarding the need to ensure that proper care was available following the transfer of patients from the hospital into the community. It was explained that the need to ensure that these facilities were available was one of the reasons that there had been delays in bed closures.

Concern was expressed regarding the continuation of care when both carers and GP’s were unavailable. It was explained that with the new integration of services there was no longer confined to accepting referrals only from the GP or carer and there was now a single point of access.

Stakeholders asked how respite places would be replaced when a patient’s carer was no longer available? It was replied the respite and crisis team would decide with the carer on how to support the patient.

CLOSE OF MEETING

Cllr Oulton thanked everyone for their attendance and contributions.

The final themed Consultation Session is on Primary Care and Dentistry on 14 January, 6.00 PM, County Hall, and over all Consultation Session will be at Medina Theatre on 21 January at 6.00 PM

Meeting Closed at 8:25 pm

NOTES OF THE SOCIAL SERICES, HOUSING AND BENEFITS SELECT COMMITTEE HEALTH CONSULTATION MEETING CONSIDERING PRIMARY CARE AND DENTISTRY HELD IN COMMITTEE ROOM ONE ON TUESDAY, 14 JANUARY 2004 COMMENCING 6.00 PM

Members of Select Committee Present

Mr I R Stephens (Chairman), Mr J R Adams, Mrs D Gardiner, Mr J F Howe, Mr R G Mazillius, Mr V J Morey, Mrs E Oulton, Mr D G Williams,

Expert Witnesses

Mr Jimmy Spence Dental Surgeon, Ryde

Mrs Val Black Director of Community Education, Hampshire and Isle of Wight NHS Workforce Development Confederation

Mrs Pat Hurley/Mrs Sheila Tweedie Parkinson’s Disease Society, IW Branch

Social Service and Housing Directorate

Mrs Dawn Berryman Acting Service Manager, Social Services

Mr Keith Mitchell Manager, Older Persons Team

Health Representatives

Mr Mark Price Director of Strategic Development Isle of Wight Healthcare NHSTrust (IWHNHST) /PCT

Mr David Crawley Chief Executive PCT

Dr Peter Randall GP, Sandown Medical Centre

Mrs Camilla Lambert Director of Primary Care, PCT

Mrs Val Anderson PCT

Dr George Thompson GP, Brookside Health Centre, Freshwater

Stakeholders

Mrs Gill Ashley Women’s Institute

Mrs Jill Mazillius Women’s Institute

Mrs Nancy Ellacott CSPA/PCT Forum

Mrs Sheila Wight Public

Mr Bruce Claxton IWC Standards Committee

Mrs Felicity Booker Age Concern IW

Mr David Farmer IW PCT NED

Mr Mark Rarp Young Arthritis Support IW

Mrs Erica Myers Sure Start/Children’s Fund PCT

The Chairman, Cllr Ian Stephens, welcomed guests to the sixth and final themed meeting which the Select Committee had been undertaking in its role of Health Scrutiny. The Chairman introduced Cllr Deborah Gardiner as the Member Champion for this meeting: Primary Care and Dentistry.

Cllr Gardiner invited the expert witnesses to briefly outline their views on the strategy.

MR JIMMY SPENCE – DENTAL SURGEON, RYDE (also speaking on behalf of Liz Lammiman, Orthodontist who’s paper was submitted)

Mr Spence advised the meeting that he had little confidence in the new dental contract. The problems that had been in evidence since 1990 indicated that changes must be made. Over the past 10 years prices had fallen which made it difficult to pay technicians. Dentists were pulling out of NHS Dentistry and becoming self employed. It has been rumoured that Dentists who were 100% committed to the Health Service and who felt pressurised by the strategy would leave the NHS. There was a shortage of dentists and this had been exacerbated by the difficulties in recruiting from outside the UK because of EU Regulations and the closure of local Dental Schools. It was noted that the waiting time for children’s dental surgery in Portsmouth Hospital was significantly lower than the Isle of Wight. Mr Spence stated that he had no faith that the proposals contained in the strategy would improve dentistry.

Questions and Answers

Mention was made that hygienists had not been referred to. Mr Spence advised the meeting that nationally there were 20,000 Dentists in the UK and 3,000 Hygienists. Mr Crawley, Chief Executive, PCT mentioned that some of the issues mentioned by Mr Spence such as the closure of dental schools were outside the scope of responsibility of the PCT and were Government Policy.

Mr Spence outlined the need to recruit more dentists. However, this had been made difficult due to EU regulations. The number of patients registered with Mr Spence’s practice was 800 children and 200 adults, which was just above average, in addition some work was undertaken in the Prison Service. A scheme had been put to the PCT to take on 1,000 more patients over 18 months. Dentists were worried about the contract and what would happen after three years. They had no faith in continued funding.

Mr Spence made reference to children’s dental waiting times. It was asked how confident were the PCT that the details outlined in the draft strategy would have a practical effect. Mr Crawley explained that a meeting had been scheduled with Mr Spence on 24 January 2004 to discuss this. In addition Mr Crawley stated that the PCT had inherited a position without the tools for change. A local liaison group has been set up to feed back from the dentist’s position. Mr Crawley indicated the key to success was working together, breaking down barriers between independent and NHS dentistry, reviewing the services in place and to develop an action plan. Problems had built up over a number of years and they would not be resolved quickly but by staged improvements. There was a need to look at recruitment and retention.

Concern was raised regarding waiting lists for children who required general anaesthetic . It was stated that Portsmouth had a waiting list of one week, however it was 12 months on the Island. Mr Price, Director of Strategic Development Healthcare IWHNHST clarified that 12 months was the maximum waiting time and he would suspect that the average time was less however these statistics were surprising and could be investigated. Mr Spence advised the meeting that Portsmouth had a specialist unit for this service which may positively effect the statistics for that area. However Mr Spence considered the Island to have one of the best weekend emergency service supported by both Dentists and the PCT

Mrs Lambert, Director of the PCT advised the meeting that the Dental Access Team were to work with the PCT on dental problems and plans for the future and it was expected that more resources would become available to help with recruitment. Mrs Lambert was confident that a difference could be made to the dental service over a period of time. With regard to children’s services, some capital finding had been forthcoming and it was envisaged that there should be some improvement from summer 2004. Members were reminded that the PCT had not had sight of the dentists contract either.

The Select Committee were advised that a meeting had been held on 13 January 2004 and it was confirmed that the Chief Dental Officer was aware of the problems with international recruitment and work was being done to address this. With regard to funding Mr Crawley indicated that the problem was nationwide. It was hoped that funding would be based on need and not population, the delegation of funding would determine what improvements could be made.

A general discussion was held on the size of the problem/shortage of skills of dentists and hygienists at national and local level.

MRS VAL BLACK – DIRECTOR OF COMMUNITY EDUCATION, HAMPSHIRE AND ISLE OF WIGHT NHS WORKFORCE DEVELOPMENT CONFEDERATION

Mrs Black outlined the new course now available at Portsmouth University for Dental Nurses on which 24 Dental Therapy places had been filled. Portsmouth University had obtained European funding for this course and the support students in training. Links were already in place with other Universities in respect of the placement of undergraduates.

Questions and Answers

Discussion ensued regarding the loss of trained NHS dental staff to private practices. It was indicated that career and further training opportunities must be available for the first 24 students and that student numbers would increase. In addition contracts for NHS Dentists were for a period of 3 years.

The meeting was advised that scoping was required on placement capacity within Community Dental Practices and the position may change. This was a project management issue as there was a need to move quickly on this work. Talks were continuing with other Universities regarding undergraduate placements in Hampshire and the Isle of Wight. The PCT would be working with Portsmouth University to firm up placements on the Island.

MRS PAT HURLEY – PARKINSON’S DISEASE SOCIETY IW (PDS)

Mrs Hurley gave background information on the work of the Parkinson’s Disease Society (PDS) on the Island. Eight years ago the PDS fundraised for a Parkinson’s Nurse for the Island and raised £100,000. The funds for the Nurse ran out at the end of January 2004 and the PCT had taken up the option to continue its funding. The PDS were pleased with the proposals for treating people in the community and would like to see people with Parkinson’s being referred to the Parkinson’s Nurse by their GPs. The Society asked that it be noted that there were difficulties with travel expenses for patients and carers when they are referred to Southampton Hospital. There is now a Community Support Worker to visit patients in the community to advise on the availability of Benefits and she would tie in with the Parkinson’s Nurse. Lottery funding had been obtained to set up exercise classes at the Riverside Centre and it was hoped that this could continue. The Society would like to see more Hydrotherapy available to Parkinson’s patients and were prepared to put moneys towards this, both in respect of capital funding and running costs. There had been a positive response from patients on the Island regarding the Parkinson’s Nurse.

Questions and Answers

Mr Mazillius thanked Mrs Hurley for her positive presentation. Mrs Hurley advised the meeting that there were approximately 360+ Parkinson sufferers on the Island. Although Mrs Hurley was unable to identify the number of sufferers prior to the Nurse, there were not many provisions on the Island. The Parkinson’s Nurse was now going on a prescribing course, which would enable her to prescribe drugs to patients. The Nurse was also working in parallel with the Neurologist at the Hospital. Mr Crawley advised members that the services provided by the Parkinson’s Nurse were stemming costs of Neurology however there would be no cost savings.

It was considered that over time there would be a greater demand for services. Mr Price advised the Select Committee that a meeting had taken place to discuss travel costs and reminded the meeting that no specific funding was provided for this service. The Hydrotherapy service was under review and it was suggested that Mrs Hurley write to the Trust with the offer to contribute monies towards this.

Currently the Neurologist visited the Island on a weekly basis, Mr Crawley recognised that this was not sufficient and the PCT would like to see this service increased. However Neurology tended to be planned on a larger population than the Island. The Island had been covered well by consultants, but in a case of emergency patients were transferred to the mainland. Dr Frankel, the Neurologist for the Island, deals with chronic cases and graded the seriousness of each case to determine how quickly patients needed to be seen. He also would visit hospital wards.

With regard to waiting times it was noted that a routine appointment was currently a maximum of 21 weeks reducing to17 weeks by the 31 of March 2004 and it was hoped this would continue to decrease.

It was noted that GPs were asked to work to put facilities in place to attract funding. The tests for good practice were strict and the higher the good practice facility, the higher the funding for doctors. Within the Medical Service Contract there were processes for identifying the targets that must be reached to obtain funding.

With regard to promoting a healthy life style, Mrs Ashley from the Women’s Institute (WI) suggested that more effort should be made and a higher profile be given to promoting changes to lifestyle and diet. Dr Randall, Sandown Medical Centre explained that work was being carried out on Dietetic Services in conjunction with Portsmouth, however there was a lack of Dieticians. There was work being done with local groups e.g. Sports Centres and the existence of groups such as Weight Watchers were a great help in promoting healthy eating. The PCT would welcome the WI’s support. The PCT employed two dieticians. It was noted that obesity was seen as a priority issue and talks were taking place with the LEA in respect of education.

With regard to physiotherapy and chiropody services there would be expansions in the transfer of care into the community with investment in other areas such as district nursing.

Representatives from the PCT were asked whether they believed the strategy would work with regard to chronic diseases, they believed it would.

The Isle of Wight Council’s Social Services were asked whether the strategy would work with regard to services for older people. The Social Services Directorate advised the meeting that they were already working closely with the community workers and that joint working was good. Although there was not enough home care and the services budget was under stress. Difficulties were being experienced delivering care in the community due to recruitment and retention of staff and resource issues

Members referred to contingency planning with regard to the possibility of GP’s opting out of the IDOC service, the meeting was advised that positive negotiations ware taking place with GPs and IDOC on providing this service. At a local level it was believed that the running of an out of hours service could be achieved. From 1 April 2004 Doctors could choose to work out of hours, opening up the opportunity to select to work out of hours only or within normal working hours. There were difficulties when trying to do both. It was noted that IDOC was established ten years ago, one of only 5% in the country and had received an overwhelmingly good response.

CLOSE OF MEETING

Cllr Stephens thanked everyone for their attendance and contributions.

An over all Consultation Session will be held at Medina Theatre on 27 January at 6:00 PM and all are welcome to attend.

He thanked Health representatives, the Social Services Directorate and the Select Committee and Best Value Support department for their help with the consultation sessions.

Meeting closed at 8.00 pm

NOTES OF THE SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE HEALTH CONSULTATION MEETING HELD AT MEDINA THEATRE ON TUESDAY, 27 JANUARY 2004 COMMENCING AT 6.00 PM

Members of the Select Committee Present :

Mr I R Stephens (Chairman), Mr J R Adams, Mrs B D Clough, Mrs D Gardiner, Mr J F Howe, Mr R G Mazillius, Mrs E Oulton, Mr D G Williams

The Chairman welcomed members of the public and interested stakeholders to the meeting.

BACKGROUND

The Strategic Health Authority (SHA) published its HealthFit proposals in December 2002 and the NHS Trust/ Primary Care Trust had produced the Healthcare Strategy for the Isle of Wight: a response to Healthfit (the Strategy) in November 2003.

The Select Committee had been given the power of Health Scrutiny in January 2003. This power was aimed at improving the health and well being of Island residents and allowed the Select Committee to make recommendations to the NHS on any proposals to substantially vary a service.

As proposals in the strategy had been considered a substantial variation, the Select Committee decided to conduct its own consultation in order to form a response to the local NHS Trusts. Following the Select Committees meeting on 14 October 2003 at which the Committee had scrutinised the Draft Isle of Wight Healthcare Strategy, the Select Committee had agreed to undertake its own consultation with stakeholders, patient’s representatives and members of the public.

The Committee had held 6 themed meetings on:

Transfer of care and Older People 27 November 2003

Surgery and Emergency Services 3 December 2003

Patient travel and transport 9 December 2003

Maternity and Children’s services 15 December 2003

Mental health 6 January 2004

Primary care and dentistry 14 January 2004

Each themed meeting had been chaired by a ‘Member Champion’. This final meeting had been convened to provide feedback on the main findings and provide members of the public with another opportunity to voice any concerns. Each member champion discussed their individual consultation meeting, listing the main proposals from the strategy and the findings of the committee.

TRANSFER OF CARE AND OLDER PEOPLE – CLLR ROGER MAZILLIUS

Cllr Mazillius mentioned the importance of ”Improving health, Housing and Quality of Life for all” and listed the main proposals from the presentation. These were: to reduce beds by 56 by April 2004 and by 60-80 by 2005, to increase nursing home beds, proposals to improve discharge planning and more care within the community.

Cllr Mazillius highlighted the fact that the Social Services department could be fined if discharge planning was inadequate. Also, that the Island has the best record on discharge planning in the South East.

It was explained that the main findings of the Select Committee were that there was great concern over bed closures and that care in the community should be set up before any bed closures are implemented. The problem of recruiting carers was also highlighted. He also raised the fact that the value of voluntary carers is equal to the budget of the NHS. The Select Committee had found that there was significant concern amongst Members and representatives from the voluntary sector that recruitment problems may undermine any beneficial effects of the Strategy.

Questions

There were no questions.

SURGERY AND EMERGENCY SERVICES – CLLR DAVID WILLIAMS

Cllr Williams listed the main proposals from the strategy as: all specialties to introduce pre-operative assessment by 2004, GPs to carry out more surgery, there will be more visiting consultants and the role of the paramedics will be increased.

The main findings of the Select Committee were that the preoperative assessments were welcomed, but it would be helpful if additional information about discharge planning was included in this assessment. There had been concern raised at the meeting on the 3 December that more day surgery could lead to increased workload for carers. Some concern was also expressed at that meeting on the proposals for GPS to carry out more minor surgery. The increased role of paramedics had been broadly welcomed.

Cllr Williams also added that that Emergency Services on the Isle of Wight were currently working very well.

Questions

There were no questions.

PATIENT TRAVEL AND TRANSPORT – CLLR JOHN HOWE

The main issues from the Strategy were listed as being the fact that currently £53,000 is spent on travel reimbursements by the PCT. The options for reimbursement are listed in the strategy and Cllr Howe suggested that people should make their views on which option is best direct to the PCT/ NHS Trust. The possibility of obtaining a Medivac helicopter was referred to and also the effect that Patient Choice will have upon the distances which people are expected to travel in the future.

The main findings of the Select Committee were listed as: the need for greater co-ordination of transport on the Island, the increasing demand for on-island transport to hospital and GP surgeries, the need for more equitable reimbursement s and the fact that the budget does not adequately reflect the islands situation with regard to travel costs. The fact that the money for travel reimbursements currently came out of the PCT’s budget, rather than being separate funding passed on from the Department of Health was raised. Mention was given to the fact that Island operators had been invited to attend the meeting on the 9 December 2003, but had declined.

Questions

Cllr Harry Rees spoke on his ongoing drive to gain special recognition from Government with regard to the Island’s situation, including the cost of travelling to mainland hospitals. He considered that the Strategy was fundamentally flawed due to lack of funding and that there was a strong need to lobby Government to increase the NHS budget for the Island.

A member of the public mentioned an individual who lived in his local area who had died during a cross-Solent transportation, which had been delayed, and that obtaining the Medivac helicopter was essential for the health of Islanders.

Cllr Ernie Fox raised the point that recommendations in the final report must be specific and practical. He thought that there was a strong need to work with other organisations on the Island to facilitate a better coordinated transport system and mentioned the need for the community to put pressure on the Island’s ferry companies.

Cllr Ian Stephens added that the recommendations involving travel for the Select Committee’s final report will involve working with many other interested parties, including the, Social Services, the Voluntary sector, Rural Community Council, NHS bodies and Island residents. He added that moving things forward in a cohesive manner was the only to ensure access to services for Islanders.

MATERNITY AND CHILDREN’S SERVICES – CLLR BARBARA CLOUGH

Cllr Clough considered that most of the initial fears about maternity services moving to the mainland hospitals had been allayed.

Cllr Clough ran through the main proposals and findings from the strategy: option one was favoured with regard to changing maternity services. Cllr Clough expressed that services users had been appreciative of the service but had also looked forward to further developments, including an extended post-natal service. The problem of recruiting and retaining staff to work within Children’s services was highlighted. Also, the fact that some younger mothers have trouble accessing services due to poverty. Overall the stakeholders had expressed the importance of maintaining choice for mothers during pregnancy. Childhood obesity was also mentioned as an increasing problem for the Island.

Questions

A point was raised that the disturbed adolescents unit had not been mentioned in the strategy.

MENTAL HEALTH – CLLR ERICA OULTON

Cllr Oulton listed the main proposals from the strategy as: adult mental health in-patient facilities to be rationalised, community services to be enhanced and older people’s mental health to be moved to St Mary’s hospital. Cllr Oulton explained that many stakeholders and Members considered that the community care must precede any bed closures and also that homelessness must be a top priority.

Cllr Oulton added that she hoped that the NHS would take the considerations of the Select Committee on board.

Questions

There were no Questions

PRIMARY CARE AND DENTISTRY – CLLR DEBORAH GARDINER

Cllr Gardiner explained that the implications of the strategy for Primary care were significant. Chronic disease management was to be increasingly dealt with by primary care. Cllr Gardiner mentioned that the new school of therapists complementary to dentistry would alleviate some of the recruitment problems.

Questions

A member of the public asked a question in relation to recruitment, referring to the fact that it had been tried before and not worked, so why should it work this time.

CONCLUSIONS

Cllr Stephens concluded the meeting by adding that anyone was free to contact either himself or Select Committee Support with any further comments. He considered the on going monitoring of the strategy to be essential and hoped that the meetings had been a good opportunity for everyone to have their say. The Select Committees final response to the Isle of Wight Local Healthcare Strategy would be available from mid to late February 2004.