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Social Services, Housing and Benefits Select Committee

Isle of Wight Council

Response to the Isle of Wight Local Healthcare Strategy

 

 

 

 

 

 

 

 

 

 

 

 

February 2004

 

CONTENTS

 

 

 

 

Introduction                                     2

Context                                             2

Background                                     3

Consultation Process                       5

Summary of Evidence                      6

Conclusions                                      16

Recommendations                            17

References                                       21

Glossary                                           22

Appendices                                       24

 

 

 

APPENDICES

 

 

Appendix 1                                       Membership of the Social Services, Housing and Benefits Select Committee

 

Appendix 2                                       Schedule of Health Consultation meetings

 

Appendix 3                                       List of attendees, including expert witnesses

 

Appendix 4                                       List of all invitees

 

Appendix 5                                       Copy of invitation to all invitees

 

Appendix 6                                       Copy of invitation to expert witnesses

 

 

INTRODUCTION

 

  1. This report sets out the formal response of the Isle of Wight Council’s Social Services, Housing and Benefits Select Committee to the proposals contained in the Isle of Wight Local Healthcare Strategy.

 

CONTEXT

 

  1. The Isle of Wight (IW) is a predominantly rural area and the only island in the southeast region. With a year round population of 132,731 people, it covers 147 square miles and measures 23 miles by 13 miles. This population increases by an average of 115% during each of the summer months. In addition, 28.4% of the Island’s population is aged 60 and over, which is more than 7% higher than the national figure.  Furthermore, 3.2% of the total population is 85 and over1. 

 

  1. Indices for deprivation in 2000 show that out of its 48 wards the IW has 15 wards in the top 20% of those most deprived nationally.  It also has 5 wards that are in the worst 20% nationally for access to services, all of which are rural wards2.

 

  1. Unemployment on the Island is 2.6%, higher than Southeast average of 1.6%3 and wages are lower than the Southeast or United Kingdom national average.  Recent research from the Policy Studies Institute indicates that unemployment may exacerbate existing health problems or cause new ones4.

 

  1. The Isle of Wight Council (IWC) is a unitary authority with responsibility for delivering all statutory services. Politically, the Council consists of 48 Members, of whom 27 are Island First (a coalition of Liberal Democrats and Independents), 13 Conservative, 3 Labour and 5 others. The Council has an Executive of 10 members and its Overview and Scrutiny function is delivered through 6 Select Committees.

 

  1. Improving health, housing and the quality of life for all features as one of the Key Objectives in the Council’s Corporate Plan.

 

  1. Healthcare on the Island is provided through the following National Health Service (NHS) bodies:

·        The strategic delivery of the Island’s health services is provided by the Hampshire and Isle of Wight Strategic Health Authority (HIOWSHA). This also covers Hampshire and the unitary authorities of Portsmouth and Southampton.

·         

·      The Isle of Wight Primary Care Trust (PCT) is responsible for planning, commissioning, and securing local healthcare services, including district nursing and health visiting. In addition, the Primary Care Trust is also responsible for delivering public health services and managing local General Practitioner (GP) and NHS dental provision.

 

·        The Isle of Wight Healthcare NHS Trust (NHS Trust) is responsible for providing acute (medical and surgical) community, mental health and ambulance services.5

 

  1. The Island has one district general hospital, St. Mary’s, in Newport, the Island’s County Town. St. Mary’s provides medical and nursing services, including general surgery, and specialist services such as urology and orthopaedics. 

 

  1. The number of beds available at St. Mary’s is different depending upon the day and the time (for example some beds are open during the week and closed at weekends).  The figures available on 13th February 2004 were:6

 

·        341 (+ 8 day) acute and rehabilitation beds 

·        14 (+ 6 day) children’s beds

·        27 maternity beds (cots and Special Care Baby Unit)

·        40 mental health beds

·        10 learning disabilities beds

·        10 nursing home beds

 

  1. Visiting mainland consultants provide additional services in areas such as renal medicine and paediatric surgery. In addition, a number of health centres and clinics are located across the Island offering community based care7.

 

  1. Many health services, particularly, specialist surgery, are commissioned off the Island from other NHS Trusts or specialised treatment centres. Services currently commissioned include cardiac surgery, which is provided by the Royal Sussex County Hospital in Brighton.

 

BACKGROUND

 

  1. The Local Government Act 2000 gave Local Authorities a wider role in health improvement within their local communities.  With effect from 1 January 2003 the Health and Social Care Act of 2001 has provided a more explicit power for local authorities that have a responsibility for Social Services to scrutinise health services within the authority’s area. Overview and Scrutiny committees (OSCs) with responsibility for health are now able to make recommendations and report on matters relating to the planning, provision and operation of health services local health service and can require local NHS representatives to attend meetings and answer questions8.

 

  1. Within the IWC the Social Services, Housing and Benefits Select Committee is the OSC with responsibility for health scrutiny. Membership of the Social Services, Housing and Benefits Select Committee is based on the political make-up of the Council. Details of the membership are attached at Appendix 1.

 

  1. The Health and Social Care Act 2001 also stipulates that NHS bodies have a statutory duty to provide information to OSCs and shall consult them on any proposals for a substantial redevelopment of services.  When dealing with proposals for a substantial development or variation by an NHS body, where more than one OSC has been consulted, a joint committee covering all the local authorities affected by the proposals must be formed for the purposes of consultation and providing a formal response.

 

  1. In December 2002 the HIOWSHA published a number of proposals for the development of a strategic framework for the future configuration of local health services entitled HealthFit.  This indicated that the need to develop new services had been forced by a number of factors including9:

 

·        The need for the NHS to live within its means.

 

·        The needs and expectations of local people.

 

·        New employment laws (for example the European Working Time Directive).

 

·        New developments in information technology.

 

·        Increased pressures to centralise some services, due to some technologies only being available in specific locations.

 

·        Increased pressures to localise those services where new technologies will allow patients to be diagnosed and treated closer to home.

 

·        New evidence on the best care and treatment of patients.

 

·        Growing evidence of inequalities in health care provision.

 

  1. In October 2003 the Isle of Wight Primary Care Trust and the Isle of Wight Healthcare NHS Trust published their local response to HealthFit - The Isle of Wight Local Healthcare Strategy.

 

  1. As the proposals set-out in HealthFit were deemed to be of a substantial nature and affected services across the Hampshire and Isle of Wight, the Select Committee agreed, in October 2003, to provide a response to these proposals for the HIOWSHA through the recently convened Hampshire and Isle of Wight Joint Health Scrutiny Committee.  However, due to the importance of the proposals contained in the Isle of Wight Local Healthcare Strategy, the Select Committee also agreed to provide a separate response on these both to the HIOWSHA and to local NHS health bodies.  For clarity, this report sets-out the Select Committee’s response to the Isle of Wight Local Healthcare Strategy (the Strategy). Please note, however, that this response does not contain full details of all the proposals contained in the Strategy.

 

CONSULTATION PROCESS

 

  1. In order to provide an evidence-based response to the Strategy the Select Committee agreed to undertake its own locally-based consultation. Contact was made on the Committee’s behalf with local health bodies to ensure that duplication with the NHS’s own consultation process was avoided at all times.  The Select Committee was determined to operate in an independent and transparent manner throughout the process.

 

  1. The Select Committee held six public meetings based upon the themes set-out in the Strategy. The schedule of themed meetings is attached at Appendix 2. The meetings were held in the evening at County Hall in Newport. The Select Committee took the view that the timing and location of the meetings was essential to provide every opportunity for all members of the community to contribute to the consultation process. Evening meetings were arranged to take account of those unable to attend the traditional day time Council meeting and County Hall at Newport was chosen as a venue due to its central location and it’s accessibility for the disabled.

 

  1. The Select Committee agreed that independent witnesses should be invited to each themed meeting to give expert evidence to Members on the proposals contained in the Strategy. In addition, a wide range of stakeholders, patients’ representatives and representatives of other interested bodies were invited to contribute to all, or any, of the meetings, either orally or in writing. In addition, a final meeting to provide feedback on the consultation process was held at the end of January. Details of the attendees at each meeting, including expert witnesses, are listed at Appendix 3 and a list of all invitees is given at Appendix 4.

 

  1. All the expert witnesses were contacted by Select Committee Support staff first by letter and then by telephone to provide background information on the consultation process and to offer advice with regard to the proposed structure and content of each themed meeting. A copy of the letter of invitation sent to all invitees is attached as Appendix 5 and a copy of the letter sent to each expert witness is attached as Appendix 6.

 

  1. In addition, representatives from both the Council’s Social Services and Housing Directorate and the Island’s health bodies were invited to all the meetings. The Select Committee would like to thank these representatives for their contributions to the consultation process.
  2. Three advertisements providing details of how to become involved in the consultation process were placed in the Island’s principle local newspaper, the Isle of Wight County Press, and a dedicated web page, with links to the relevant NHS web pages was set-up on the Council’s website, Iwight.com. Articles on the consultation process were included in the December editions of the Council’s magazines, Wight Insight and some Members’ local newsletters.  Wight Insight is distributed to over 86% of Island households10.

 

  1. Throughout the consultation process provision was made for feedback on the proposals to be made either by telephone, in writing or by e-mail. Arrangements were also in place to make all documentation available in Braille, on tape or in community languages. The Select Committee would like to thank the assistance received from the Council’s Communications and Public Relations Team and the Council’s Software Development Team on this part of the consultation process.

 

  1. A member of the Select Committee was nominated to champion each of the themed consultation meetings. The member champion, together with the Chairman and Vice Chairman of the Select Committee, received an in-depth briefing from Select Committee support staff prior to each meeting. Details of the member champions are included at Appendix 3.

 

SUMMARY OF EVIDENCE

 

26.  The Select Committee’s response will include a summary of the oral and written evidence received as a result of each of the following themed meetings:

 

Meeting

Date

Venue

Transfer of Care and Older People

 

27 November 2003

County Hall, Newport

Surgery and Emergency Services

 

3 December 2003

County Hall, Newport

Patient Travel and Transport

 

9 December 2003

County Hall, Newport

Maternity and Children’s Services

 

15 December 2003

County Hall, Newport

Mental Health

6 January 2004

County Hall, Newport

Primary Care and Dentistry

 

14 January 2004

County Hall, Newport

Consultation Feedback Session

27 January 2004

Medina Theatre, Newport

Transfer of Care and Older People

 

  1. The Select Committee were keen to hear evidence on the following aspects of the proposals for Transfer of Care and Older People:

 

Key issues:

 

·        The timing of the bed census undertaken at St Mary’s Hospital.

 

·        The role of discharge planning in ensuring the reduction in the length of stay in hospital, increasing the number of patients treated and reducing the number of beds required.

 

·        Proposals to withdraw 56 beds at St. Mary’s by April 2004 and a further 60 - 80 by 2005.

 

·        Plans to purchase 20 intermediate care beds in nursing homes

 

·        Proposals designed to achieve financial savings from the bed closures of 2.7 million by 2005/06

 

  1. During the public meeting on Transfer of Care and Older People concern was expressed by a representative from the voluntary sector over the timing of the bed census. It was felt that having been based on summer figures the findings did not reflect the pressures that can be placed on hospital beds during the winter months. Whilst the representative welcomed the recognition that the Strategy had given to the voluntary sector, they felt that realistic investment in this sector would also be necessary to underpin delivery of the proposals.

 

  1. Many witnesses at the meeting who expressed a view on discharge planning considered that improvements in this area were still required and that the proposals should be revised to address these concerns. In particular, one voluntary sector representative felt that the proposals seemed to place an emphasis on removing the patient from hospital rather than involving carers, family and friends in the planning process. It was also felt that it could be of benefit to involve voluntary sector organisations in the discharge planning process.  Furthermore, one witness raised concerns about patients being discharged too early. This was however, disputed by representatives from both the NHS Trust and the private care home sector.  Speakers from across all the sectors of care provision agreed that post-hospital care was vital to underpin successful discharge planning.

 

  1. A private sector representative explained that the successful employment of carers was a key issue for them and that recruitment in this area was vital to maintain and improve services.

 

  1. Many of the witnesses referred to the need for adequate resourcing to be made available to provide support for all older people. Reference was made to the importance of community care not being seen ‘as a cheap option’. Many speakers agreed that the recruitment and retention of care staff was vital to underpin the proposals for transfer of care.

 

  1. One voluntary sector representative believed that the effective delivery of care in the community may not be easily achieved and quality of care may suffer as a result.  It was suggested that patients should be offered a choice between domiciliary care and residential care. A representative from health indicated that the Transfer of Care Strategy is all about promoting independence away from the hospital setting. It was also confirmed that £750,000 had already been committed to delivering these proposals.

 

  1. Following questioning from Members a private sector representative expressed the view that in order to fully implement the Strategy more nursing and residential care beds would be needed. He did, however, indicate that in his view the shortfall in beds was now being addressed.

 

  1. Written evidence was also received for the meeting on Transfer of Care and Older People. These respondents raised similar concerns over the recruitment and retention of staff required to deliver the proposals.  Particular support was given by one respondent to increasing the pay of those working in the care sector.

 

  1. One respondent expressed deep concern that the Strategy appeared to suggest that a decision had already been taken with regard to future bed closures. They felt that that this was a statement of intent rather than a proposal to be consulted on. The respondent also questioned the timing of the bed census.

 

  1. In receiving evidence on the proposals for Transfer of Care and Older People the Select Committee has recognised that services in this area of healthcare must be developed in line with the National Service Framework for Older People.

 

Surgery and Emergency Services

 

  1. The Select Committee were keen to hear evidence on the following aspects of the proposals for Surgery and Emergency Services:

 

Key issues:

 

·        Proposals for cancer services, preoperative assessments and specialty triage clinics

 

·        Plans to redirect some services from St Mary’s Hospital to GP surgeries

 

·        The impact that the Government’s commitment to Patient Choice could have on the proposals for Surgery and Emergency Services (by the summer of 2004 all patients waiting 6 months for surgery should be offered the choice to move to another hospital or provider. From December 2005 patients who may require planned surgery will be offered a choice of hospitals)

 

·        Proposals for changing the way in which emergency care on the Island is organised.

 

  1. During the public meeting on Surgery and Emergency Services one voluntary sector organisation reported that their staff had experienced problems when contacting NHS Direct.  There had been long delays before a call is answered and staff spent a long time answering questions. 

 

  1. The proposals for pre-operative assessments were generally welcomed by all the expert witnesses as it was hoped that these would improve the hospital experience for vulnerable patients. It was suggested that the assessment could also be used to provide patients with information both on discharge procedures and the options available for community care.  This latter suggestion was supported by a representative from the Council’s Social Services Directorate.

 

  1. Questions were raised by one attendee regarding proposals for increasing the use of day surgery as it was felt that this might result in an increase in the workload for carers.  In addition, it was felt that increasing the number of procedures carried-out in day surgery might also lead to an increase in the number of post–operative complications being experienced by patients. 

 

  1. When questioned about the effect that government plans for GPs could have on the out of hours service a health service representative indicated that whilst discussions with Island GPs were ongoing it was likely that many will opt out of this.  They confirmed that the responsibility for providing an out of hours service now lies with the PCT.

 

  1. The increased role of paramedics was supported by those present at the meeting.

 

  1. A written submission received for the meeting questioned the proposal that GPs will in future undertake more minor surgical procedures. Concern was expressed that this might lead to a further downgrading of St Mary’s and it was suggested that this proposal had been developed to save money. Another written submission expressed concern that a reduction in surgery and emergency service provision might result in a greater number of elderly people having to travel to the mainland for treatment.

 

Patient Travel and Transport

 

  1. The Select Committee were keen to hear evidence on the following aspects of the proposals for Patient Travel and Transport:

 

Key issues:

 

·        The perceived inequality of the current arrangements for travel cost reimbursement and the viability of each of the options presented to resolve this.

 

·        The possibility of obtaining a Medivac helicopter for use by Island patients.

 

·        Availability and co-ordination of transport schemes for patients.

 

·        The impact that the Government’s commitment to the Patient Choice initiative will have on the proposals for Patient Travel and Transport (an explanation of Patient Choice is provided in paragraph 37)

 

  1. During the public meeting on Patient Travel and Transport evidence was heard from voluntary sector providers that many journeys undertaken under local community transport schemes are made for hospital and doctor appointments and that demand for these journeys is increasing. A representative from this sector suggested that the current car scheme at St. Mary’s is not flexible enough to meet all patients’ needs, but they felt that there are opportunities to expand this service and also address some of the social inclusion issues on the Island.

 

  1. A representative of a voluntary sector group providing transport on the mainland for Island residents expressed the view that there is a need for greater co-ordination of transport on the Island. 

 

  1. Health Service representatives informed the Select Committee that 500 patients per week are currently crossing the Solent.  They explained that the PCT contributed £53,000 in 2002/03 towards the cost of these journeys. This included paying the transport costs for those in receipt of benefits and for patients requiring treatment for renal conditions or cancer.  Many present at the meeting felt that this situation was inequitable as the current budget does not seem to fully reflect the needs of all patients crossing the Solent.

 

  1. Having heard the evidence, and taking the view that proper scrutiny of the proposals for Patient Travel and Transport is vital to achieve the best outcomes for Islanders, the Select Committee has agreed that it would like to make a number of general observations about the proposals contained in this section of the Strategy

 

  1. First, members of the Select Committee have suggested that joint working between the IWC, health bodies, the voluntary sector and transport providers on patient travel and transport should be immediately effected. The Select Committee has taken the view that this work should take place at the same time as a reinvestigation by the NHS of the proposals for patient travel and transport.

 

  1. Secondly, the Select Committee also notes that a study into subsidised cross-Solent travel11 for health related reasons was jointly undertaken in 2001 by the IWC, local health bodies and the Isle of Wight Partnership. The findings from this study resulted in recommendations for a consolidated travel scheme, essentially providing transport from one or several central points on the Island to mainland hospitals. The Select Committee considers that any future joint working on health related travel should take into account the findings from this study.

 

  1. Thirdly, the Committee is concerned that that there may be a lack of transport available for those patients wishing to access primary care services that have been moved from the hospital setting into the community. In support of this the Committee would like the Island’s health bodies to be aware of a recent report from the Social Exclusion Unit (part of the Office of the Deputy Prime Minister) that states that, “changes will be made to specialist travel to healthcare services so that it is organised around the patient”, and also that the Government will “promote accessibility consideration in decisions on healthcare infrastructure”12.

 

  1. Finally, the Select Committee considers that the recently introduced Patient Choice initiative may have an impact upon the distances that Island patients may in future be asked to travel for treatment.  This is because the scheme will allow patients who have been waiting longest the opportunity to receive treatment at hospital outside of their immediate locality. Again, the Committee would like the Island’s health bodies to note that Guidance13 issued by the DoH to PCTs, NHS Trusts and Strategic Health Authorities on Patient Choice has suggested that patients:

 

 

 

In light of this the Select Committee therefore considers that the possible implications for the Island of the Patient Choice initiative have not been fully addressed by the Strategy.

 

  1. In making these observations the Select Committee has noted that, ‘health treatment should be free at the point of delivery’14

 

Maternity and Children’s Services

 

  1. The Select Committee were keen to hear evidence on the following aspects of the proposals for Maternity and Children’s Services:

 

Key issues:

 

·        The two options for the future staffing of the maternity unit, option 1 being the preferred choice of the NHS.

 

·        The proposal for the introduction of a ‘consultant-led service’ in the Children’s Unit.

 

·        The recruitment and retention of maternity and children’s services staff

 

  1. During the public meeting on Maternity and Childrens’ Services the consensus of views expressed, including a spokesperson for organisations representing expectant mothers and their families, supported option 1.

 

  1. Many present stressed the importance of ensuring the continuity of care between the antenatal and the post-natal period. Similarly, it was felt that integration of services was key to maintaining continuity of care.

 

  1. One attendee expressed concern that some young women can find it difficult to access services.

 

  1. A written submission received from a charity working with young people indicated that they would like to see provision of an Island facility for the care of chronically sick children. In addition, the same organisation expressed concerns over the increase in childhood obesity.

 

  1. Following the meeting, a member of the public expressed concern that the proposals for the Child and Adolescent Mental Health Services (CAMHS) do not take account of the transition period experienced by patients moving from the children’s’ support service to adult mental health services. It was felt that better liaison between the two service areas was necessary to underpin such a transition period. In receiving this evidence the Select Committee notes that this section of the Strategy makes scant reference to the future funding of this area of healthcare provision.

 

  1. The Select Committee welcomes the emphasis that the Strategy has placed on the enhancement of career prospects for maternity and children’s services staff and supports the concept of a maternity clinical network.

 

  1. The Select Committee welcomes the PCT’s commitment to working with the Council on the development of community-based services in children’s centres.

 

  1. In receiving evidence on the proposals for Children’s Services the Select Committee has recognised that services in this area of healthcare must be developed in line with the National Service Framework for Children.

 

Mental Health

 

  1. The Select Committee were keen to hear evidence on the following aspects of the proposals for Mental Health:

 

Key issues:

 

·        Proposals that Adult Mental Health in-patient facilities should be rationalised and community services should be enhanced. 

 

·        Proposals to develop alternatives to in-patient admission.

 

·        Plans to relocate the Halberry unit to Sevenacres.

 

·        Plans to relocate the Shackleton unit to St Mary’s.

 

·        Plans to relocate the Kestrels unit to Halbery.

 

·        The proposed sale of 3 freehold properties

 

·        Concerns that bed closures could precede improvements in community care.

 

  1. During the public meeting on Mental Health concern was expressed by many of the expert witnesses present about plans to reduce overall mental health bed provision before community services are up and running. A representative from the voluntary sector expressed particular apprehension about the proposals for Shackleton House. It was explained that some of the existing buildings at Shackleton House were purpose built for their current use, whereas a hospital ward would not be. Similarly, another speaker suggested that it might be dangerous to reduce bed availability at Sevenacres.  It was noted that the Island has one of the highest suicide rates in the country, and a high hospital readmission rate.

 

  1. Another expert witness explained that users of mental health services can have great difficulty in accessing those services and they could not see how any of the proposals contained in the Strategy would make this any easier. Other speakers indicated that increasing the care that mental health patients receive in the community would not work for those people who do not have permanent homes.

 

  1. Many of the representatives of organisations working with mental health patients commented that the proposals for increasing the care of mental health patients in the community could be successfully delivered if funding were securely in place.

 

  1. One attendee considered that changing the age mix of patients at Sevenacres might reduce patient integration thus how the facility will work and function.   Therefore it was felt that any proposals on how the building will be organised in future should take account of this.

 

  1. When questioned by Members a health service representative clearly stated that alternative service provision for mental health patients was to be welcomed.

 

  1. Many of those who spoke at the meeting strongly supported the creation of a dedicated Mental Health Co-ordinator post.

 

  1. A voluntary sector representative who submitted written evidence after the public meeting suggested that mental health service user involvement on the Island was in crisis.  Further, the Select Committee was informed that many local projects that promote greater user involvement are due to come to an end with, as yet, no possibility of future funding. The same representative also felt that users should be invited to assist health bodies with redrafting the proposals for mental health. They also noted, however, that if patients were unable to become involved due to the nature of their illness, their views should be represented by an independent non-user advocate. 

 

  1. A further written submission received after the meeting echoed many of the concerns expressed above. It suggested that the proposals for mental health services may have been developed in response to financial pressures rather than with the aim of bringing about positive service developments. It was felt that if this were the case increased pressures would be placed on those caring for mental health patients.

 

  1. In receiving evidence on the proposals for Mental Health the Select Committee has recognised that services in this area of healthcare must be developed in line with the National Service Framework for Mental Health.

 

Dentistry and Primary Care

 

  1. The Select Committee were keen to hear evidence on the proposals for the future delivery of dentistry and primary care services:

 

Key issues:

 

·        How dentistry services will work under the proposed new contracts.

 

·        The shortage of NHS dentistry provision on the Island, particularly children’s dentistry.

 

·        How plans to address recruitment, retention and placements of dentists and hygienists will be effected

 

·        The issue of the reimbursement of travel costs for patients and carers crossing the Solent.

 

·        The continued provision of the GP Out of Hours service.DENTISt???

 

·        Proposals for the development of community services, e.g. physiotherapy and chiropody.

 

  1. During the public meeting on Primary Care and Dentistry a dental surgeon practicing on the Island suggested that although NHS dentists have not yet seen the contracts, they were already concerned about them.  He felt that nationally and locally, due to funding shortages, more dentists would leave the NHS to become self-employed.

 

  1. A Health Service representative informed the Select Committee that new training courses and places were now available at Portsmouth University for therapists complementary to dentistry.  The courses were supported by new European funding and had links to other local universities.  The PCT confirmed that it would be working with Portsmouth University to ensure that some undergraduate placements were made on the Island.  

 

  1. One voluntary sector representative indicated that their organisation supported the proposals in the Strategy for increasing the treatment of chronically ill patients in the community.  The same organisation was, however, also concerned about travel costs for patients and carers when a referral was made to a mainland hospital.   The PCT expressed their confidence in the proposals for the future management of chronic diseases. 

 

  1. Questions were asked about the new out of hours GP service.  A GP present at the meeting indicated that he believed that the out of hours service would continue to be provided in the future.

 

Consultation Feedback Session at Medina Theatre

 

  1. The final meeting at Medina Theatre was arranged to enable the Select Committee to share the main issues raised by witnesses, stakeholders and others throughout the consultation process with the general public. Feedback on a theme by theme basis was provided by each of the Member Champions and all attendees were invited to contribute to the discussion.

 

  1. Members of the public again expressed concern about the adequacy and fairness of the patient travel budget.  With large numbers of patients and carers crossing the Solent on a daily basis, it was felt that these expenses were already costly and unfair to Island families, and that the proposals for patient travel would only serve to worsen the situation.

 

CONCLUSIONS

 

  1. Since January 2003, powers to undertake health scrutiny have fallen within the remit of the Isle of Wight Council’s Social Services, Housing and Benefits Select Committee.  This response will therefore be presented to the Select Committee meeting scheduled for 19 February 2004.

 

  1. The Select Committee will also send their final response to the Hampshire and Isle of Wight Joint Health Scrutiny Committee, which is currently undertaking a consultation process on the Healthfit Strategic Framework.  It is hoped that the views of the Isle of Wight Social Services, Housing and Benefits Select Committee on local issues will assist the members of the Joint Committee with their examination of the health service throughout the whole region.  A final response from the Joint Committee to the HIOWSHA and local NHS health bodies is expected by the end of this year.

 

  1. The Social Services, Housing and Benefits Select Committee will also present its final report to a full meeting of the Isle of Wight Council on 23 February 2004.

 

  1. To ensure that a wide cross section of the community had the opportunity to express their views throughout the consultation process, thematic meetings with health professionals, other professionals and voluntary groups, stakeholders, carers and patients have been conducted over a two-month period. The Select Committee has put the views of patients and carers at the centre of its deliberations in order to provide an evidence-based response.  This process has enabled the Select Committee to draw up a number of recommendations that emphasise the importance of putting the patient and local health service provision first, whilst recognising the need to modernise health services available to Island residents.

 

  1. Throughout the consultation process, the Select Committee has been determined to ensure that despite the pressures on local health services to reconfigure their service delivery, provision for Island patients can be maintained and improved by making use of new technologies, adequately funded community services and improved staff training.

 

RECOMMENDATIONS

 

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

 

  1. The Select Committee has also expressed grave concern over the lack of detailed financial information supplied in the Strategy, both in terms of current and future spending. The Strategy indicates that altogether there is a need across the Island health community to seek savings totalling £32 million by 2006 15. The Committee believes that such savings could undermine the successful delivery of the proposals contained in the Strategy. Further, such savings seem counter to the monies allocated to future services under the NHS Plan in 20009. 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

·        The proposals for pre-operative assessments be supported

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

REFERENCES

 

1.       Census 2000. 2000. National Office for Statistics. London, HMSO http://neighbourhood.statistics.gov.uk

 

2.       Homelessness Strategy 2005 – 2008. 2003. Isle of Wight Council. p 10

 

3.       Unemployment. 2003. Local Learning and Skills Council for Hampshire and the Isle of Wight http://www.hampshire-iow-lsc.org.uk

 

4.       Press Release: Jobless young risk downward spiral of poor health and unemployment. 2001. Policy Studies Institute. http://www.psi.org.uk/news/

 

5.       Isle of Wight Healthcare NHS Trust website: http://www.iowht.org.uk/Trust/Index.asp

 

6.       Information supplied by The Isle of Wight Healthcare NHS Trust, as of 12/02/04

 

7.       Isle of Wight Healthcare NHS Trust website:http://www.iowht.org.uk/Trust/Index.asp

 

8.       The Local Authority (Overview and Scrutiny Committees Health Scrutiny Functions) Regulations 2002 SI 2002/3048. London, HMSO  

 

9.       Resource Pack to support Phase 3 of HealthFit Hampshire and Isle of Wight Section 1: Introduction. 2003. Hampshire and Isle of Wight Strategic Health Authority.   

 

10.   In August 2002, the Island’s Citizens Panel was asked if they had seen a copy of Wight Insight within the past year.  86% of this sample answered that they had.

 

11.   Isle of Wight: Cross Solent Travel Study. 2001. Peter Brett Associates (commissioned by Isle of Wight Partnership, Isle of Wight Health Authority and Isle of Wight Council)  

 

12.   Making the Connections: Final Report on Transport and Social Exclusion. 2003. Social Exclusion Unit, Office of the Deputy Prime Minister. C 12, p 7 and p 111

 

13.   Choice of Hospitals: Guidance for PCTs, NHS Trusts and SHAs on offering patients choice of where they are treated. 2003. Department of Health. London, HMSO. p 6

http://www.doh.gov.uk/choice/policyguidance.pdf

 

14.   NHS Plan: A plan for investment, a plan for reform. 2000. Department of Health. London, HMSO. p 12

 

15.   Healthcare Strategy for the Isle of Wight: A response to HealthFit. 2003. Isle of Wight Healthcare NHS Trust/ Isle of Wight Primary Care Trust.