HERTFORDSHIRE COUNTY COUNCIL

HEALTH SCRUTINY COMMITTEE

WEDNESDAY 17 MAY 2006 AT 1.00 PM

PROPOSED MENTAL HEALTH SERVICES CHANGES 2006/7

CONSULTATION OUTCOMES

Report of the Head of Scrutiny

Author: David MosesTel: 01992 555300

Executive Member: David Lloyd

  1. Purpose of report

To outline the responsibilities of and the options facing the Committee in respect of proposed reductions in mental health services and submissions received from those opposed to the changes.

  1. Summary

2.1The report outlines the responsibilities of the Committee in holding the health services to local democratic accountability and its power of referral to the Secretary of State for Health.

2.2Attached to this report is a paper detailing the proposals placed before the Hertfordshire Joint Commissioning Partnership Board (JCPB) on Thursday 11 May 2006 on behalf of the Hertfordshire Primary Care Trusts (PCT) in respect of service changes by the Hertfordshire Partnership Trust. It has twelve appendices.

2.3The PCT paper outlines the consultation process and responses received in respect of:

i)General issues

ii)St. Julian’s Ward at St AlbansHospital

iii)Direct Access Psychological Services

iv)Day Services

v)Early Intervention in psychosis

vi)Community Mental Health Teams (CMHT) staff reductions

vii)Closure of the Lister Hospital Assessment & Day Treatment Unit (ADTU)

ix)Reduction of Alcohol Services

x)Seward Lodge Day Service closure

xi)Conduct Disorder service reduction

xii)Learning Disabilities Therapy staff reductions

2.4There have been five requests from representative agencies who wish to present the Committee with oral evidence. A timetable has been developed to assist the due process of the meeting.

2.5A further 10 written responses have been received from representative organisations or members of the public.

3.Conclusion

3.1The Committee will consider whether to endorse all or some of the proposals, or to exercise its powers of referral to the Secretary of State for Health on the basis that those aspects of the proposals are not in the best interests of the delivery of a health service across Hertfordshire.

3.2In deciding whether to exercise their powers of referral, the Committee will need to take account of the fact that any delays in their implementation will result in further reductions of service either within Mental Health Services or other parts of the Hertfordshire Health Economy.

4.Responsibilities of the Committee

4.1The main responsibility of the Committee is to hold the Hertfordshire Health Services to local democratic account. These proposals have however already been subject to democratic accountability and endorsed by a majority of the elected members who sit on the Joint Commissioning Partnership Board.

4.2The Health Committee is also responsible for holding the HCC Executive Member for Adult Care, Community Safety & Health Services to account. Whilst Hertfordshire County Council forms part of the JCPB it is worth noting that the proposals under consideration are required due to savings targets required by the PCTs and not HCC Adult Care Services.

4.3Scrutiny Legislation empowers the Committee to refer the proposals to the Secretary of State for Health on the basis that either:

  • the consultation process was inadequate
  • the decision is not in the best interests of the delivery of a health service across Hertfordshire

4.4The Committee is not responsible for deciding on the overall level of service reductions required by the Hertfordshire Health Economy or for establishing the level of funding required to provide an acceptable level of health provision. It has however previously made representation to the Secretary of State for Health in respect of the national funding formula.

5.Papers attached

5.1The main paper with its twelve appendices has been prepared by the Hertfordshire PCTs following the decision by the JCPB at its meeting on the 11 May 2006.

5.2Annex A contains the following papers submitted by some of the organisations that have requested an opportunity to present oral evidence to the Committee:

1.Carers in Herts

2.AMICUS

5.3Annex B contains written submissions from organisations and members of the public:

1.Louise Denham

2.Watford & 3 Rivers PPIF (Patient & Public Involvement Forum)

3.HPTWatford Assessment & Therapy Team

4.St. AlbansCity & District Council

5.Beds & Herts Local Medical Committee

6.Greg Laing (de-personalise?)

7.Anonymous member of the public (name & address supplied)

8.Jacqualine Deacon

9.Sian Fellows

10.Berry & Keane Partnership

11.Carol Jeavons

A further paper was prepared by Chris Reynolds (Vice-chairman of the Hertfordshire Partnership Trust PPIF) and circulated directly to members of the Committee.

6.Timetable

6.1To assist the smooth running of this agenda item a timetable has been prepared for the meeting with the following approximate times allocated for this agenda item:

14.00Introduction by the Head of Scrutiny

1410Presentation on behalf of the Hertfordshire PCTs

1430Questions on matters of fact by members of the committee

1445Break for 15 minutes

*1500Sue Reeves - Chief Executive of Carers in Hertfordshire

*1515Simon De Forges – Viewpoint

*1530Heather Straughan – West Herts Manic Depression Fellowship Group

*1545POhWER

*1600Elaine LLjon Foreman – AMICUS

* each presentation to last 7mins followed by questions on matters of fact by members of the committee

1615Questions by members of the Committee to the PCT and HPT representatives in respect of issues raised by the presentations

1640Discussion and decision(s)

1700Summary by Head of Scrutiny

6.2A petition will be presented to the committee as part of the Viewpoint presentation.

6.3The Executive Member and representatives from Children Schools & Families and Adult Care & Community Services will be present to answer questions in respect of any impact on HCC’s social care services.

7.Issues for consideration

7.1When deciding whether to endorse or to refer all or some of the proposals to the Secretary of State for Health the Committee may wish to consider:

7.1.1Is the requirement for a 5% reduction in mental health services as opposed to the additional reductions elsewhere in the health service equitable bearing in mind the circumstances outlined in paragraphs 2.1 and 2.2 of the PCT report:

  • Initial targets were arbitrarily set by the Strategic Health Authority (SHA) and PCTs as 5% for all services
  • Mental Health Services have not been asked to make any of the additional savings required by the worsening financial situation
  • Mental Health Services are not part of the 6 national priorities

7.1.2Have the right options been identified for reductions in Mental health Services? The Committee may wish to consider:

  • Whether any of the options in table C on page 10 of the PCT report preferable to those proposed
  • Views of witnesses in respect of alternative ways of achieving the requisite savings

7.1.3Bearing in mind the additional savings that would be required either by mental health services or elsewhere within the Hertfordshire Health Economy, whether any substantial evidence has emerged to justify revoking the Committee’s previous decision to endorse the shortened consultation process.

At its meeting on the 25 April 2006 the Committee requested that the PCTs review the responses at the end of that week and to consider whether to target individual patients by letter. The Committee may wish to seek assurances that the appropriate action was taken.

7.1.5Concerns over individual proposals, in particular;

  • Whether the proposal conflicts with or places the Investing In Your Mental Health (IIYMH) strategy at risk
  • Whether risks have been adequately identified and/or addressed
  • The Impact on other parts of the health or social care services
  • Whether the concerns addressed in responses to the consultation process have been adequately addressed during the decision making process

8.Possible reasons for referral to the Secretary of State for Health

8.1The consultation was inadequate – see 7.1.3 above.

8.2The requirement to make a 5% reduction within the services provide by HPT has not been adequately justified by the SHA and/or the PCTs.

8.3Concerns expressed during the consultation process were inadequately addressed during the decision making process.

8.4The options selected by the HPT are not justified

8.5The proposals conflict with or place the IIYMH strategy at risk

8.5In respect of an individual proposal(s), either risks or implications have not been adequately addressed

agenda item 2 17 may 06

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