PAPER A1

NOTES OF EVIDENCE

Meeting	Policy Commission for Care Trust Delivery and Health Scrutiny
Ref	He.PC.16/08/05
Date	16 August 2005
Time	18.00hrs
Place	Council Chamber, County Hall, Newport
Purpose of meeting	Formal public meeting
Attendance	Commission	Cllrs Erica Oulton (Commissioner), Geoff Lumley, Roger Mazillius, Win McRobert, Margaret Webster, Colin West, David Whittaker Co-opted Members Ms Nancy Ellacott – Chairman, Primary Care Patient and Public Involvement Forum (PPIF) Mr Peter Pugh – Chairman, Healthcare PPIF
	Cabinet	Cllr Dawn Cousins – Cabinet Member for Care, health and Housing Cllr Andy Sutton – Leader of the Council Cllr Ian Ward – Cabinet Member for Environment, Transport and Planning
	Secretariat	Cllr David Pugh
	Officers	Ms Louise Biggs – Overview & Scrutiny Team Mr Andrew Shorkey – O&S Team Ms Sandy Weller - Acting Director of Social Services / Associate Director Adult and Community Services Ms April West – O&S Team
	NHS Officers	Mr Graham Elderfield – Joint Chief Executive, Isle of Wight Primary Care Trust (IWPCT) and Isle of Wight NHS Healthcare Trust (IWNHSHT) Ms Lynda Blue – Joint Director of Finance, PCT / IWHNHST Ms Helen Shields – Director of Commissioning, IWHNHST / IWPCT
	Stake holders	Mr Andrew Cole – Older Persons Mental Health Team Leader Mr Kevin Dannatt – Registered Nursing home Association Mr Daniel Harwood – Consultant, Older Persons Mental Health, IWHNHST Ms Fay Miller – IW Physically handicapped society Ms Kathy Snook – Wessex Cancer Trust Ms Eileen Weeks – Age Concern Ms Margaret Wilder – IW Physically handicapped society
	Apologies	None
Agenda Items
1. To receive evidence from Mr Graham Elderfield, Ms Helen Shields and Ms Lynda Blue	Mr Elderfield gave a presentation setting the context of the recent proposals as part of the HealthFit initiative and resulting Healthcare strategy produced by the two local NHS trusts published in 2003. The presentation contained the following key points: 1. The recovery planning had been running for three years – this being year 3. 2. The PCT and IWHNHST were aiming to be debt-free by next year. 3. The recovery plan came with risks, such as: retention and recruitment of staff, although this had been somewhat alleviated by overseas recruitment, challenging performance targets from central government, implementing new staff contract, including the agenda for change programme for non-clinical staff, prescription guidelines and National Institute for Clinical Excellence (NICE) guidelines and Patient Choice. 4. Most of the savings in the past had been non-recurrent savings but a financial balance on a recurrent basis must be found. 5. The link between financial control and star ratings was highlighted. The need for a debt free health economy was also cited as being important prior to any formation of an integrated organisation to provide health and social care. 6. The financial recovery plan covered six main themes: system reform, system redesign, changes to service provision, redundancies, estate rationalisation and corporate efficiency savings. 7. The plan for redundancies was to make vacant posts redundant and to redeploy existing staff. 8. The Joint Investment Budget would finish once the schemes which were currently funded had come to an end. This would save around £250,000 9. Patient travel reimbursements for renal and cancer patients would cease in April 2006. It was considered inequitable to provide only two patient groups with travel costs. A question over the legality of paying for travel costs was also raised. Savings from patient travel would be around £90,000. 10. Accommodation and care for cancer patients travelling from the Island would no longer be provided by Manor House. Less expensive alternatives were being investigated. The predicted saving from this was £234,000. 11. The service currently being provided by Shackleton House would move to Halberry Lodge and the services currently provided at Halberry Lodge would be provided on St Catherine’s Ward on the St Mary’s site. Client groups requiring different levels of care would not be mixed under this arrangement. Savings were predicted at around £500,000. 12. An increase in budget for community mental health services would assist in reducing the need for acute mental health services. Questions were then asked by members of the Commission, other members of the Council and members of the public. The following evidence was received: 13. The bed occupancy figure of 98% was questioned in relation to safety. It was considered safe although the most efficient level would be around 85%. 14. A question as to whether the proposals would impact negatively on patients was asked. The response given was that the choices were difficult but finances were finite. 15. It was indicated that the quality of some services would be reduced but would remain within the standards set out by Government. 16. Corporate efficiencies would contribute to the savings and are included within the Cash Releasing Efficiency Savings (CRES) and redundancy figures. 17. The notice for Manor House had not yet been given and was awaiting a detailed review of the contract with Southampton University Hospital Trust who provided the service through Manor House. A request was made on behalf of users of this service to include them in planning the changes. There were also plans for Wessex Cancer Trust to fund chemotherapy facilitates on the Island, which would reduce the need for travel. 18. The Leader of the Isle of Wight Council pledged to look into the delivery of a patient travel scheme within the lifetime of the administration, subject to receipt of figures for the number of patients travelling to mainland appointments. 19. Some travel under Patient Choice was previously provided by the Department of Health. Funding for patient travel was no longer available under the Patient Choice scheme. 20. A question was asked in relation to staff morale and sickness levels relating to the proposed changes. Sickness levels were considered low and it was planned that ongoing discussions would be held with staff about the changes. 21. A contingency plan, should any further slippage occur in relation to the financial recovery plan, would be to look at other proposals including the use of some capital monies. This contingency plan was not favoured by the management. 22. The Patient Choice scheme could result in a loss of services if patients choose to receive health services elsewhere. There were plans to develop niche markets within the Healthcare Trust to keep island patients and attract mainland patients. 23. There will be £15 million additional funding to develop services next year. 24. The consultation process with the public and partner organisations for future changes within the health services was raised. The NHS would consult with the Isle of Wight council on future changes. It was highlighted by Members of the Policy commission that it was essential for the local NHS to take the public, patients and partners with them when proposing changes to health services. 25. The issue of whether the Island’s healthcare economy was funded sufficiently was raised and whether the cost of treating patients on the Island was higher than on the mainland. It was considered that the new national tariffs being introduced under the Payment By Results policy would help to identify this ‘Island premium’. 26. The services provided by the Kestrels would continue in another building, which would be fitter for purpose. Information on the level of savings provided by this move would be forwarded to the Policy Commission Members. 27. There were question relating to the urgent nature of these recovery measures. The response given was that these plans were part of the HealthFit and Local Healthcare Strategy. 28. A question was asked in relation to whether it would be more cost effective in the long run to retain land rather than sell it off. It was considered that whilst some land would be sold off for savings, the majority of land would be retained by the Healthcare Trust.
Actions	1. A letter from the Policy Commission, containing recommendations and any further questions, to be sent to Mr Elderfield 2. Patient Transport arrangements to be considered by the Isle of Wight Council after receipt of figures for the number of patients travelling to the mainland.	Policy commission for Care Trust Delivery and Health Scrutiny / Overview and Scrutiny Team To be confirmed