ADULT AND COMMUNITY SERVICES SELECT COMMITTEE – 26 OCTOBER
2004
UPDATE
ON THE ISLE OF WIGHT COUNCIL’S RESPONSE TO THE HEALTHCARE STRATEGY AND BEYOND
HEALTHFIT
REPORT OF COUNCILLOR IAN STEPHENS, CHAIRMAN, ADULT AND COMMUNITY SERVICES SELECT COMMITTEE
REASON FOR SELECT COMMITTEE CONSIDERATION
To
enable the Select Committee to be updated on progress with the, “Response to
the Local Isle of Wight Healthcare Strategy”, which was published in February
2004 by the Social Services, Housing and Benefits Select Committee as was (now
the Adult and Community Services Select Committee). The Strategy, published jointly by the Isle of Wight Healthcare
NHS Trust and the Isle of Wight Primary Care Trust, is the local plan in
response to the HealthFit initiative.
|
ACTION
REQUIRED BY THE SELECT COMMITTEE To consider the update on
the Select Committee’s recommendations contained within their, “Response to
the Local Healthcare Strategy”. The Select Committee continue to monitor progress made in respect of the themed topics and bring any concerns to the attention of the Hampshire, Southampton, Portsmouth and IW Health Scrutiny Joint Committee. The
Strategic Health Authority; IW Primary Care Trust, Healthcare NHS Trust and
the Council’s Adult and Community Services Directorate consider the
recommendations arising from this meeting and respond thereto within 28 days. |
BACKGROUND
This update constitutes the
Select Committee’s ongoing responsibility for the scrutiny of health. It builds upon the
previous update brought to the Committee on 15 April 2004, entitled, “Isle of
Wight Health Community: Local Healthcare Strategy Consultation Report”.
The appendices attached to this report are split into the 6 individual themes. These contain the recommendations, which are taken from the Social Services, Housing and Benefits Select Committee’s, “Response to the Isle Wight Healthcare Strategy” and have been endorsed by Full Council and the Joint Health Committee for Hampshire and the Isle of Wight. The Select Committee’s report was also recognised by South East Employers as being a useful guide to scrutiny.
Also shown is the response (including the “suggested way forward”) taken from the, “Isle of Wight Health Community: Local Healthcare Strategy Consultation Report”, which was presented by the Trust/PCT to the meeting of the Select Committee on the 15th April 2004.
Representatives from the PCT, Healthcare Trust and Strategic Health Authority, have been invited to this meeting so that Members can be fully advised of the action being taken, as a consequence of the recommendations put forward by the Select Committee, and other recent or future decisions that have impacted on themes within the Isle of Wight Healthcare Strategy.
RELEVANT PLANS, POLICIES, STRATEGIES AND PERFORMANCE INDICATORS
The
Scrutiny of Health is linked to the Isle of Wight Council’s aim of, “Improving
health and the quality of life for all”, contained within The Council’s
Corporate Plan.
CONSULTATION PROCESS
The
Select Committee carried out a consultation process involving a wide range of
stakeholders, which started in November 2003 and finishing in January 2004 and
involved the gathering of evidence from meetings and in written format. Each
meeting covered a particular theme from the Strategy with a Lead Member taking
responsibility for each of these themes.
The
Select Committee would like to thank all stakeholders, expert witnesses and
others who participated in the consultation process, whose views contributed to
the Select Committee’s final report.
The
NHS also carried out its own consultation in line with their duties under Section
11 of the Health and Social Care Act 2001.
FINANCIAL, LEGAL, CRIME AND DISORDER IMPLICATIONS
The Council’s responsibilities in relation to health scrutiny are contained within the Health and Social Care Act 2001, the Local Authority Overview and Scrutiny Committees Health Scrutiny Functions) Regulations 2002 and the Health and Social Care Act 2001, Directions to Local Authorities (Overview and Scrutiny Committees, Health Scrutiny Functions, 2003).
There are no direct financial or crime and disorder implications arising from this report.
APPENDICES ATTACHED
Appendix 1 – General Recommendations and areas of concern from the Adult and Community services Select Committee
Appendix 2 – Transfer of Care & Older People: recommendations from the Select Committee:
Appendix 3 – Surgery & Emergency Services: recommendations from the Select Committee:
Appendix 4 – Patient Travel & Transport: recommendations from the Select Committee
Appendix 5 – Maternity & Children’s Services: recommendations from the Select Committee:
Appendix 6 - Mental Health: recommendations from the Select Committee:
Appendix 7 - Primary Care & Dentistry: recommendations from the Select Committee:
BACKGROUND PAPERS USED IN THE PREPARATION OF THIS REPORT
Health and Social Care Act 200. HMSO, 2001
Isle of Wight Local Healthcare
Strategy. PCT / Healthcare NHS Trust, 2004
Response to the Isle of Wight
Local Healthcare strategy. Isle of Wight
Council, 2004
Isle of Wight Community: Local
Healthcare Strategy Consultation Report. Isle
of Wight Healthcare Trust / PCT, 2004.
01983
823803 or [email protected]
COUNCILLOR IAN STEPHENS
CHAIRMAN, ADULT AND COMMUNITY SERVICES SELECT COMMITTEE
APPENDIX 1
GENERAL RECOMMENDATIONS AND AREAS OF CONCERN FROM THE ADULT AND COMMUNITY SERVICES SELECT COMMITTEE
1.
Before making their
recommendations the Select Committee expressed 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, and the later
submission of ‘Beyond Healthfit’. The
Select Committee was concerned that the Strategic Framework contained new
proposals on areas of health provision that were not able to be addressed by
the local Strategy. The Select Committee was particularly concerned that the
new Strategic Framework made a number of proposals for cancer services,
including palliative care, which were not referred to in the Local Healthcare
Strategy.
2.
The Select Committee
expressed grave concern over the lack of detailed financial information
supplied in the Strategy, both in terms of current and future spending.
3.
The Select Committee also
strongly considered that the successful recruitment and retention of healthcare
staff would be essential in ensuring the successful delivery of all the
proposals in the Strategy. In noting this, the Select Committee had also
expressed concerns regarding the management capacity of the local health bodies
throughout the implementation period of the Strategy.
4.
The Select Committee had
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:
Appendix 2
LEAD MEMBER – COUNCILLOR ROGER MAZILLIUS
Recommendations
and response so far from the NHS
Transfer of Care & 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.
2.
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.
3.
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.
4.
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.
5.
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.
6.
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.
7.
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.
8.
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.
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.
Recommendations:
§
In order to avoid bed
blocking, phased bed closures must not be considered until both the NHS and the
Council’s Social Services Directorate are satisfied that the transfer of care
strategy has been successfully implemented.
§
The transfer of care strategy
must not result in increased pressure on local authority Social Services
budgets or staffing.
§
A bed census should be
carried-out during the winter months to ensure that proposed bed closures are
realistic.
§
The proposed bed closures
must not undermine the Hospital’s plans with regard to winter pressures or any
other contingency plan.
§
Every trust patient should
have a complete patient plan covering discharge planning and post-hospital
care.
§
Patient discharge planning
should continue to ensure the inclusion of carers as an integral part of the
process.
§
The IWC, voluntary sector and
independent carer providers continue to cooperate to improve the recruitment,
retention and work conditions of carers.
§
Improvements to pay,
conditions and training for carers be considered a priority to ensure that
sufficiently qualified staff are available to deliver, develop and maintain the
health and social care needs of elderly Isle of Wight residents in the future.
§
A dedicated nursing team be
established by the NHS Trust to ensure that the proposals for transfer of care
can be implemented.
Trust/PCT Response as at 15
April 2004
1.
Transfer of care
§
Much agreement that, in theory, this is the right
direction.
§
Much concern about our ability to implement it in
practice, due to our ability to recruit and train staff, the fragile homecare
market, the availability of care home beds, and the capacity of community
services to cope.
§
Concern that further bed reductions at St Mary’s will
mean we have difficulty coping in peak demand situations.
§
A bed census should be conducted during the Winter
months.
Suggested
way forward:
Ø
To Establish a joint
PCT/Trust/Social Services group to consider implementation issues.
Ø Bring forward detailed proposals for further consideration
and consultation.
2.
Older People’s Services
§ Very few separate comments on proposals in this section – they were predominantly on the transfer of care strategy and how it would impact on older people.
§ Support for general direction outlined, including the health promotion and lifestyle initiatives.
Ø Progress
to more detailed proposals, but consider jointly with the transfer of care
proposals.
APPENDIX 3
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 was
answered and staff spent a long time answering questions.
2.
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.
3.
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.
4.
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.
5.
The increased role of
paramedics was supported by those present at the meeting.
6.
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.
·
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
§ Few comments, but those were supportive.
§ Integrated access proposals supported.
Suggested way forward:
Ø Progress to implementation.
§ Very few comments, but those were supportive.
§ Pre-operative assessment supported.
§
Visiting Specialist Consultants providing services at
St Mary’s supported.
Suggested way forward:
Ø Progress
to implementation.
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.
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.
2.
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.
3.
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.
4.
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.
5.
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.
6.
Secondly, the Select
Committee also notes that a study into subsidised cross-Solent travel 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.
7.
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”.
8.
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 Guidance issued by the DoH to PCTs, NHS Trusts and Strategic
Health Authorities on Patient Choice has suggested that:
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.
9.
In making these observations
the Select Committee has noted that, ‘health treatment should be free at the
point of delivery’
·
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 takes
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
Suggested way forward:
Ø Postpone
the introduction of a new scheme for reimbursement of patient travel costs
pending the proposed joint discussions with Isle of Wight Council and voluntary
sector.
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.
2.
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.
3.
One attendee expressed
concern that some young women can find it difficult to access services.
4.
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.
5.
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 sufficient 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.
6.
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.
7.
The Select Committee welcomes
the PCT’s commitment to working with the Council on the development of
community-based services in Children’s Centres.
8.
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.
·
The
Select Committee supports the introduction of Option 1 for the future staffing
of the maternity unit (please refer to the Isle of Wight Local Healthcare
Strategy).
·
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.
§ Very few comments, but those were generally supportive.
§ Council supported our preferred medical staffing model for obstetrics.
§ Mixed response on proposal for Island-based termination of pregnancy services – main response came from staff in support.
Suggested way forward:
Ø Progress to implementation.
§ Majority of comments were made on the proposals for acute paediatrics, including the implications of reducing from two to one tier of medical staff.
§ Healthfit clinical lead for Children’s Services has expressed major concerns at the achievability and sustainability of the consultant –delivered model for the Isle of Wight. The Workforce Development Confederation express similar concerns. The Family and Child Health Care Group in the Trust recognise that a further review of the future possible staffing options is required.
§ Very few comments opposing the transfer of a small number of neonatal patients to Portsmouth. However the affordability of this proposal is under question following preliminary discussions between Portsmouth and Island representatives. Strategic Health Authority support with be sought.
§ A couple of comments were received expressing concern at the inadequacy of CAMHS provision and urging a speedy completion to the current CAMHS review.
Suggested way forward:
Ø A further review is undertaken on the future options for paediatrics and neonatology.
LEAD MEMBER –
COUNCILLOR ERICA OULTON
Recommendations
and response so far from the NHS
Key issues:
·
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.
2.
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.
3.
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.
4.
One attendee considered that
changing the age mix of patients at Sevenacres might reduce patient integration
thus affecting 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.
5.
When questioned by Members a
health service representative clearly stated that alternative service provision
for mental health patients was to be welcomed.
6.
Many of those who spoke at
the meeting strongly supported the creation of a dedicated Mental Health
Co-ordinator post.
7.
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.
8.
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.
9.
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.
Recommendations:
·
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.
§
Mixed response to the Mental Health proposals.
§
Some support for the Mental Health Access and Treatment
Team, but concern that the bed closures and estates changes were motivated too
much by the need for financial savings rather than service reasons.
§
Concern at the appropriateness of the design of
Sevenacres for mixing adult and older people with mental health problems.
§
Concern at potential termination of Healing Arts projects
funded non-recurrently.
§
Concern at potential termination of Surfwave user
involvement project.
§
Council suggested that mental health proposals are
delayed pending a review of service provision by a newly appointed Mental
Health Co-coordinator.
Suggested way forward:
Ø Progress to implementation. Any changes proposed by the Trust to the estates rationalisation plan would require further joint consideration and consultation. Implementation plan should take account of concerns raised in consultation and ensure strong user and carer involvement.
Recommendations and response so far from the NHS
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.
·
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.
2.
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.
3.
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.
4.
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.
Trust/PCT Response as at 15
April 2004
1. Primary
Care
§ Few comments on this section but some support for the vision for primary care.
§ Some concern at PCT leading out of hours services, GPs taking on work previously done by Consultants and recruitment position for GPs.
§ Detail of the new GP contract has emerged since the strategy was developed.
Ø Progress to implementation.
§
Much concern at the lack of access to NHS dentistry.
§
Some responses urged that priority is given to
children’s dentistry.
§
Some responses indicated that more information is
needed for the public on what the PCT is doing to address the problem.
§
Our status at one of “most challenged areas” has been
confirmed since the strategy was developed and more national support is now
available.
Suggested way forward:
Ø The Dental Action Plan being developed with the national team is implemented and publicised.