External Services Scrutiny Committee

th Tuesday 15 July 2008 ...... 6.00 pm.* Committee Room 4, Civic Centre, Uxbridge

*NB: the Committee will break at 7pm. for 15 mins.

Committee Membership:

Councillors Mary O’Connor (Chairman) Peter Kemp Shirley Harper-O’Neill (Vice Chairman) Michael White Phoday Jarjussey

Contact Officer:

David Coombs Telephone: 01895 250 833 Democratic Services Facsimile: 01895 277 373 Civic Centre E-mail: [email protected] High Street Uxbridge, UB8 1UW ......

Members of the public are welcome to attend the meeting and listen to the discussion in Part 1 of the Agenda. This Agenda is available online at http://www.hillingdon.gov.uk/central/democracy/comm_reports/index.php

Please ensure that all mobile phones are switched off

DESPATCH DATE: 7th July 2008

Lloyd White Head of Democratic Services London Borough of Hillingdon, Civic Centre, High Street, Uxbridge, UB8 1UW www.hillingdon.gov.uk

External Scrutiny

About this Committee

This Committee will scrutinise services provided by non-Council organisations in the Borough including the public, private and voluntary sector.

This Committee will also undertake the health scrutiny role required by the Health & Social Care Act 2001.

This Committee will have the power to identify areas of concern to the community and instigate an appropriate review process.

It will report its findings to Cabinet, highlighting issues of concern for Hillingdon residents.

Lloyd White Head of Democratic Services London Borough of Hillingdon, Civic Centre, High Street, Uxbridge, UB8 1UW www.hillingdon.gov.uk EXTERNAL SERVICES SCRUTINY COMMITTEE

15.07.08 AGENDA

PART 1 – MEMBERS, PUBLIC AND PRESS

i.) Apologies for absence and to report the presence of any substitute members ii.) Declarations of Interest in matters coming before this meeting iii.) Notes of the previous meetings – 17th June 2008 iv.) Exclusion of Press and Public - To confirm that all items marked Part 1 will be considered in public and that any items marked Part 2 will be considered in private

1. Hillingdon PCT’s Provider Services Page 1

a) new governance arrangements b) proposed transfer of services to the Council’s Children’s Centres

At the end of item 1 at approximately 6.55 pm the Committee will break to enable the Chairman to present a report on the Healthcare for London Joint Overview & Scrutiny Committee (JOSC) to Cabinet. The Committee will reconvene for the remaining items at approximately 7.15 pm.

2. East & North Hertfordshire NHS Trust Page 4

Application for Foundation Trust status and the implications for Mount Vernon Cancer Centre

3. Work programme 2008/9 Page 6

PART 2 – PRIVATE, MEMBERS ONLY i.) Any Business transferred from Part 1

GLOSSARY

FT Foundation Trust JOSC Joint Overview & Scrutiny Committee PCT Primary Care Trust

Terms of Reference

1. To undertake the powers of health scrutiny conferred by the Health and Social Care Act 2001, including:

(a) scrutiny of local NHS organisations by calling the relevant Chief Executive(s) to account for the work of their organisation(s) and undertaking a review into issues of concern;

(b) consider NHS service reconfigurations which the Committee agree to be substantial, establishing a joint committee if the proposals affect more than one Overview and Scrutiny Committee area; and to refer contested major service configurations to the Independent Reconfiguration Panel (in accordance with the Health and Social Care Act);

(c) respond to any relevant NHS consultations.

2. To scrutinise the work of non-Hillingdon Council agencies whose actions affect residents of the London Borough of Hillingdon.

3. To identify areas of concern to the community within their remit and instigate an appropriate review process. External Services Scrutiny Committee

17th June 2008

Action Notes

Members present: Cllrs Mary O’Connor (Chairman), Shirley Harper-O’Neill, Phoday Jarjussey, Peter Kemp and Michael White.

Other Members present: Cllrs Philip Corthorne, Judith Cooper and John Major.

NHS officers/witnesses present: • Yi-Mien Koh: Chief Executive, Hillingdon PCT (items 1 & 2) • Kevin Mullins: Director, Out of Hospital Commissioning, Hillingdon PCT (items 1 & 2) • David Searle: Director of Corporate Development, Hillingdon Hospital (item 1 only) • Dr Mitch Garsin: Chair of the Hillingdon Local Medical Committee (item 1 only)

LB Hillingdon officer present: David Coombs Declarations of Interest – none

Notes of the meeting held on 22nd April 2008 - agreed as an accurate record

Exclusion of the press and public – it was agreed that all items of business were considered in public.

1. Developing a strategy for Hillingdon’s health services post Action by: Healthcare for London consultation

Yi-Mien Koh outlined the work the PCT is undertaking to develop a strategy for providing health services in Hillingdon. She said that the strategy will follow the themes of Lord Darzi’s Healthcare for London framework, in particular the mantras of ‘centralise where necessary, localise where possible’ and ‘prevention is better than cure’. The strategy will seek to: • Provide a greater proportion of health care in the community than at present. • Improve partnership working between the PCT and Council, both in terms of closer working between ‘health’ and ‘social’ care and on the wider ‘health and well-being’ agenda (i.e. encouraging people to lead healthier lifestyles). • Address health inequalities in the Borough and ensure services are focused on areas with greatest need.

- 1 -

In response, Dr Garsin said that GPs support many of these aims, including the greater integration of primary and secondary care, and the provision of more health care in the community. However, Action by: GPs have deep concerns about ‘polyclinics’.

Dr Garsin highlighted a recent survey undertaken by the Local Medical Committee (LMC) which demonstrates high public satisfaction (over 80%) with the service Hillingdon GPs currently provide. GPs believe these results question the public’s demand for longer GP opening hours. In addition, extending GP opening hours could encourage more people to visit thier GP instead of self-managing their condition as at present. This could place unaffordable pressures on primary care.

Dr Garsin added that the extent of public support for the BMA’s petition to oppose polyclinics provides a better indication of public opinion than the much smaller number of responses to the Healthcare for London consultation. Dr Garsin said that the public and GPs are worried that polyclinics could undermine the personal relationship with a ‘local’ GP, particularly if private sector organisations are awarded contracts to operate polyclinics.

Dr Garsin stated that there has been limited investment in Hillingdon’s GP surgeries in the last four years and expressed concern that GPs in ‘decaying’ surgeries could be pressured into moving to new polyclinics.

In response, Kevin Mullins stated that the PCT is sensitive to the views of GPs and key partners such as Hillingdon Hospital and the Council. He said that the PCT is committed to engaging stakeholders prior to a strategy being finalised for consultation.

The Chairman offered the opportunity for the representatives of Hillingdon Hospital and the Council to comment. David Searle said that the Hospital agrees with the PCT that patients must be treated in the most appropriate setting, and the Trust is already working with the PCT on a number of initiatives including the Urgent Care Centre and CATS. He added that any strategy for the future of Hillingdon’s health services must consider the implications for the whole Hillingdon health economy. Cllr Corthorne said that it is hard for the Council to comment until further detail is available but welcomed the opportunity to bring health and social care services closer together. He added that the PCT must engage elected Members in the process of developing the strategy.

Members supported the proposal to bring health and social care closer together and highlighted that in the past the Council or PCT had sometimes taken decisions in isolation.

- 2 -

Members highlighted that the public are supportive of their local GP services and any strategy for improving Hillingdon’s health services should focus on supporting existing good practice rather Action by: than starting from the opposite angle of imposing a set solution (polyclinics) that could undermine existing strengths.

Following Dr Garsin’s earlier comments, Members sought further information on the quality of GP surgeries in Hillingdon. Dr Garsin responded that approximately 5-10 surgeries are located in poor quality premises which cannot be modernised. However, he believes the remaining 80-90% of GP surgeries in Hillingdon could be retained and physically improved so that they are equipped to provide excellent services. Kevin Mullins added that the PCT will be examining the condition of GP surgeries in Hillingdon as part of the work to develop the healthcare strategy. Members reminded the PCT of the importance of ensuring primary care accommodation meets access requirements.

Members stated that it would be important to continue to monitor the quality of care provided across GP services in Hillingdon, particularly if a variety of organisations were to run polyclinics. It was noted that the PCT is continuing to develop methods for performance managing independent contractors, but services may differ slightly across the Borough in response to local need. Dr Garsin added that GPs working together under a federated model would be more preferable than polyclinics; closer working in a ‘federation’ would enable GPs to maintain links with the local community whilst reducing some of the concerns around the service provided by single-handed GPs.

Members noted that Healthcare for London is only a vision and proposals for developing health services in Hillingdon will need to consider where the capital and revenue funding to deliver new services will come from.

In response to the issues raised above, Yi-Mien Koh said that the concept of polyclinics is not new: there are already health centres in Hillingdon which house a number of GPs and provide a range of additional primary care services. The proposal referred to as polyclinics involves building on the strengths of such health centres, specifically to provide longer opening hours and potentially include social care services. Yi-Mien Koh said that GPs would remain the core tenants of any polyclinic in Hillingdon. She added that the PCT would seek to build on existing good relationships with GPs in Hillingdon, and any proposals for Hillingdon’s primary care services will aim to maintain the existing GP-patient link.

- 3 - Finally, Members questioned the PCT on their plans for developing and then undertaking consultation on the proposed strategy. In particular, the Committee and Cllr Corthorne highlighted the importance of local Councillors being able to contribute to the Action by: emerging strategy prior to formal consultation.

Yi-Mien Koh confirmed that the PCT is proposing to formally consult local residents on the strategy in September 2008, and agreed that it is vital to ensure the Council and stakeholders are able to contribute prior to formal consultation.

Agreed –

• That the Committee thank the witnesses for attending. • That the Committee note the information provided, in particular that (i) the PCT is proposing to undertake public consultation on a strategy for health services in September 2008, and (ii) the Committee will need to respond to the consultation as part of its health scrutiny role.

• That the Committee ask officers to organise a workshop/event to enable Councillors to contribute to the development of the strategy prior to the formal consultation, in particular to Democratic examine the implications of the PCT’s proposals on the Services Council’s social care services and the voluntary sector.

2. Joint overview & scrutiny committee (JOSC) on service Action by: provision for tier 4 personality disorders including the Henderson Hospital

The Committee noted the background information provided with their agenda and the additional information circulated prior to the meeting. Members noted the information provided by South West London & St George’s Mental Health Trust which highlighted that the Henderson Hospital has treated approximately two Hillingdon residents per annum in recent years.

Members therefore sought to establish the impact on Hillingdon residents of the hospital remaining closed. Hillingdon PCT acknowledged that the PCT has used the Henderson in the past, but highlighted that many of these patients had discharged themselves before treatment had finished. The PCT indicated that this may suggest community services could be a more appropriate form of treatment.

Members questioned the PCT on how they are proposing to commission tier 4 personality disorder services if the Henderson remains closed. Building on the earlier point, the PCT said that they were working with Central & North West London NHS

- 4 - Foundation Trust (the local mental health trust) to develop community services for such conditions.

In response, Members highlighted that community services may Action by: not be appropriate for all Hillingdon residents with tier 4 personality disorders, and asked from where the PCT would purchase services for those people who required in-patient treatment. The PCT said that they are already working to identify new providers including one in London and another in Nottingham. Members expressed deep concern about the proposal to commission hospital services in Nottingham and highlighted that this would make it very difficult for families and relatives to visit. Members urged the PCT to purchase the most local service possible, and highlighted that the Cassel Centre in Richmond may be able to provide some of the services previously delivered at the Henderson.

Agreed –

• That based on the information provided by the PCT, the

Committee’s recommendation to Council is that Hillingdon

should not participate in the proposed JOSC on the closure of

the Henderson Hospital. In making this decision, the

Committee note the PCT’s commitment that it will:

o Work with CNWL to develop community based services for tier 4 personality disorders; o Continue to commission in-patient services if these are clinically required, and where in-patient services are required then the PCT will seek to commission the most local service that meets the patient’s need (i.e. that the Cassel Centre will be used where appropriate). David • That the Committee remain briefed on main developments with Coombs the proposed JOSC. Hillingdon • That the Committee receive an update from the PCT in 6-12 PCT months on how it is commissioning tier 4 personality disorders.

3. Work programme 2008/9 Action by:

Members discussed topics for scrutiny in 2008/9 and suggested that the following issues are incorporated into the Committee’s work programme:

• Community cohesion – preferably in April 2009 to update on

previous reviews on hate crime and tension monitoring

• The London Ambulance Service (LAS) – in particular the impact of the Healthcare for London proposals

• The PCT’s services for treating diabetes and Parkinson’s

- 5 - Disease (following suggestions from the public)

Agreed – • That the Committee ask the Chairman and Scrutiny Advisor to David finalise the work programme incorporating the comments Coombs above.

• That the work programme takes account of the Committee’s role in responding to likely forthcoming consultations on specific proposals resulting from Healthcare for London (e.g. on stroke, maternity and trauma care).

4. Submission for evidence in response to a DH and DCSF ‘call Action by: for evidence’ on child and adult mental health services

The Committee’s working group into the transition from child to adult mental health services is proposing to submit evidence to a government review on the same topic. The Committee supported this proposal and congratulated the Working Group on their work so far. Members also thanked Maureen Colledge for all of her work in supporting the review.

Agreed – David • That the Committee endorse the proposed submission. Coombs

Meeting closed at 7.40pm

Next meeting: 15th July – 6pm

This is a summary of the External Services Scrutiny Committee proceedings. If you wish for more detailed information on any of the resolutions please contact David Coombs on 01895 250833.

Circulation of these action notes is to Members of the External Services Scrutiny Committee, relevant Cabinet Portfolio Holders, Leaders, Whips and appropriate officers.

- 6 - ITEM 1

Hillingdon PCT’s provider services

Contact Officer: David Coombs Telephone: 01895 250833

REASON FOR ITEM

To enable the Committee to examine two significant developments to Hillingdon PCT’s provider services, namely (a) reforms to the governance structure for provider services, and (b) the proposed transfer of certain child health services to the Council’s new Children’s Centres.

OPTIONS AVAILABLE TO THE COMMITTEE

1. Receive the presentations from the witnesses

2. Question the witnesses on their presentations

3. Make recommendations as appropriate

4. Decide what further action is required

INFORMATION

Background

1. Primary Care Trusts (PCTs) are at the centre of the NHS and control approximately 80% of the NHS budget. PCTs spend this money in two ways. Firstly, they commission services for their local residents (e.g. from hospital and mental health trusts), and secondly, provide a range of healthcare services themselves. These are known as ‘provider services’ and include services usually provided in the community such as community nursing, health visitors, and podiatry.

2. The Committee have generally focused on the issues surrounding the PCT’s commissioning of services from other providers (e.g. Hillingdon Hospital and Central & North West London NHS Foundation Trust). This meeting seeks to provide the opportunity for Members to examine significant developments within the other area of Hillingdon PCT’s spending – the services provided by the PCT itself.

New governance arrangements for provider services

3. Recent Government policy has sought to refocus the role of PCTs onto the commissioning of services from other providers and move away from providing services themselves. Back in 2005 the Government indicated its view that PCTs should divest themselves of provider services and only commission services. This was controversial

External Services Scrutiny Committee – 15th July 2008 Page 1 PART 1 – MEMBERS, PUBLIC & PRESS

and the requirement has changed so that at the very least, PCTs must create new governance arrangements for their provider services that maintain an internal separation from the commissioning function.

4. Hillingdon PCT is therefore in the process of reforming its governance structure for provider services in order to meet Government requirements. Senior officers from the PCT will be attending the meeting to outline progress to the Committee. Members may wish to examine: • What has been the impact of the reforms on staff? • What is the impact of the governance changes on the services provided to Hillingdon residents? • Is the PCT proposing to divest itself of its provider services? If not, what governance structure is the PCT adopting? • How do the changes to the governance of provider services affect relationships with the Council’s social care services? • How is the PCT proposing to develop its provider services? Are these services likely to grow in scope and provide an expanded range of services in Hillingdon and beyond? Will these services be competing against a greater range of providers within Hillingdon?

Proposed reforms to child health services

5. In addition to considering the development of the governance of the PCT’s provider services, this meeting is also examining a proposed development to the services provided ‘on the ground’.

6. Members are likely to be aware of the Council’s current work to establish a network of Children’s Centres across the Borough. Cabinet considered a report on this issue in December 2007 which outlined that Hillingdon has a target to develop 12 Children’s Centres in 2006-08 in addition to Nestles Avenue, which was developed in 2004-06. Children’s Centres aim to improve outcomes for young children and their families by providing a holistic range of integrated services. The Centres are financed by a ring- fenced Government Grant and contribute to meeting the Council’s statutory obligations under the Childcare Act 2006.

7. The report to Cabinet stated that Children’s Centres will bring together multi-disciplinary teams of professionals from different agencies and voluntary groups to work together in a single community-based setting. It said that this will enable a skilled, holistic and responsive service to all families with young children. Partnership working is therefore central to Children’s Centres.

8. In line with this, the PCT are now proposing to move certain child health services from existing health clinics and into the new Children’s Centres. Given this Committee’s role

External Services Scrutiny Committee – 15th July 2008 Page 2 PART 1 – MEMBERS, PUBLIC & PRESS

in examining proposed developments to health services, PCT officers are attending the meeting to provide further information.

9. In considering this issue, Members may wish to note the findings of the Joint Overview & Scrutiny Committee (JOSC) to review the Healthcare for London proposals. The Committee took evidence from the Royal College of Paediatrics and Child Health and noted the importance of treating children in the environments to which they are exposed in their daily lives. The Committee heard that there is a need to move away from traditional settings when caring for children and to integrate services into daily lives.

10. The JOSC therefore made the following recommendation:

As with adults, hospital treatment should be a last resort for children, and non-NHS community facilities should be used to promote good physical and mental health.

We recommend that the NHS works with local authorities to ensure that Children’s Centres and Extended Schools are equipped and resourced to provide community health services for our young residents.

11. The PCT’s proposals are therefore in line with the recommendations of the JOSC, however Members are likely to wish to seek further information from the PCT on the specific detail. Potential issues to consider include: • What services are being moved into Children’s Centres? • How does this affect the level and quality of service provided? • Will people have to travel further to access these services? • What will happen to the premises that no longer provide these services?

Witnesses

12. Senior officers from Hillingdon PCT will be attending and are likely to include: • Yi Mien Koh: Chief Executive • Maria O’Brien: Managing Director, Provider Services • Caroline Shermer: Head of Children and Families, Provider Services

SUGGESTED SCRUTINY ACTIVITY

Members question Hillingdon PCT on the developments to provider services and decide whether to take any further action.

BACKGROUND REPORT

Hillingdon Children’s Centre development – report to 13th December 2007 Cabinet

External Services Scrutiny Committee – 15th July 2008 Page 3 PART 1 – MEMBERS, PUBLIC & PRESS

ITEM 2

East & North Hertfordshire NHS Trust: application for Foundation Trust status and the implications for Mount Vernon Cancer Centre

Contact Officer: David Coombs Telephone: 01895 250833

REASON FOR ITEM

To update the Committee on East & North Hertfordshire NHS Trust’s application for Foundation Trust status, in particular (a) the Trust’s response to the Committee’s submission to the consultation, and (b) the role of Mount Vernon Cancer Centre within the Trust’s business plans.

OPTIONS AVAILABLE TO THE COMMITTEE

1. Receive the presentation from the Trust

2. Question the Trust on the key issues

3. Make recommendations as appropriate

4. Decide what further action is required

INFORMATION

1. East & North Hertfordshire NHS Trust was established in April 2006 and provides hospital services on four sites: • Lister hospital in Stevenage • Queen Elizabeth II (QEII) hospital in Welwyn Garden City • Hertford County hospital in Hertford • The Mount Vernon Cancer Centre in Northwood, Hillingdon

2. The Trust is currently applying for Foundation Trust (FT) status and undertook a 12 week consultation on its proposals between 3rd March and 30th May 2008.

3. The Trust’s consultation document is attached to this report and outlines the structure under which the Trust would operate as an FT.

4. The Committee is interested in the Trust in relation to its management of the Mount Vernon Cancer Centre in the north of the Borough. The Committee responded to the consultation to highlight local concerns about the proposed constituencies for electing the FT Council of Governors. Specifically, the Committee suggested that the Trust could slightly modify the proposed governor constituencies to ensure that the communities

External Services Scrutiny Committee – 15th July 2008 Page 4 PART 1 – MEMBERS, PUBLIC & PRESS

local to Mount Vernon are represented in the Council of Governors. Members may wish to question the Trust on whether it is likely to support this proposal.

5. A successful application for FT status also requires Trusts to have a robust business plan and Members may wish to ask the Trust for further information on how Mount Vernon fits within its strategic plans. Members are aware that the cancer services at Mount Vernon have been subject to recent review, and previous reports by various NHS organisations have recommended the closure of these services. When questioning the Trust, Members will need to bear in mind that the future of Mount Vernon Cancer Centre will be depend on the commissioning intentions of the Primary Care Trusts (PCTs) who purchase cancer services for their populations. As such, the Trust (which provides the services in response to the commissioning intentions of PCTs) may be limited in the information it can provide to this meeting.

Witnesses

6. Nick Carver, Chief Executive of East & North Hertfordshire NHS Trust is attending the meeting.

SUGGESTED SCRUTINY ACTIVITY

Members question the Chief Executive of East & North Herts NHS Trust on the issues outlined in this covering report. Key issues for consideration include: • What is the status of the Trust’s application for FT status? • How did the Trust modify its proposals in response to this Committee’s and other submissions? • How will the Trust ensure that the local communities surrounding Mount Vernon are able to benefit from FT status? • How does the Mount Vernon Cancer Centre feature in the Trust’s strategic business plans?

APPENDICES TO THIS REPORT (ATTACHED)

1. East & North Hertfordshire NHS Trust Foundation Trust status consultation document

2. LB Hillingdon External Services Scrutiny Committee submission to the consultation

External Services Scrutiny Committee – 15th July 2008 Page 5 PART 1 – MEMBERS, PUBLIC & PRESS

Foundation Trust Status Consultation Document

Your hospital, your care, your voice Details of our application to become a NHS Foundation Trust Are you interested in local 2 health services? Help us shape our future.

Contents

Section Title Page No. This document sets out our plans to strengthen our links with No. our community and our staff by becoming a NHS foundation trust. This is a relatively new type of NHS organisation that is owned by and accountable to its community. For us to be a 1 About the East and North 5 successful NHS foundation trust, we need everyone in our Hertfordshire NHS Trust community who is interested in the Trust to become a member of the Trust to help shape our future. 2 NHS foundation trusts 9 We are proud of both the high quality clinical care we provide 3 How will the proposed East 10 and the levels of involvement and interest that our community and North Hertfordshire takes in our services and in our future. However, we want to Foundation Trust be run? increase this involvement and the best way to do so is by becoming a NHS foundation trust. 4 Next steps 18 In becoming a NHS foundation trust we will remain very much part of the NHS family. We will uphold the founding values and 5 How to get involved 19 principles of the health service – providing high quality clinical services free to all entitled to its care, based on need and not on 6 Additional information 21 ability to pay. Our vision will remain to be “trusted by the community” and our values will be to put our patients first, to work as a team, to value everybody, to be honest and open and to value diversity.

So what are the key differences between a NHS trust (as we are now) and becoming a NHS foundation trust? Put simply, they are that we would be:

 Answerable to and governed by our community through a system of local accountability to members and elected governors, with the latter being elected by the membership

 Authorised and regulated by an independent regulator known as Monitor

 Able to have greater financial freedoms to support the delivery and development of our services

 Able to have greater freedom, working with our community, to decide how we develop our services. Chairman and chief executive’s 3 joint foreword

Becoming a NHS foundation trust will offer new Please read through this document carefully and ask opportunities and benefits to those of you who decide us as many questions as you want, either directly or to become a member of the Trust – which we very by filling out the consultation questionnaire and much hope you will do. You will be able to elect membership forms attached. governors to be your representatives on the Council of Governors and you will be able to receive The consultation, which started on 3 March, ends on discounted goods and services via the NHS Discount 30 May 2008. You have until then to give us your views Scheme. on our proposals. There is no closing date to becoming a member of our proposed NHS foundation In this document we set out our proposed vision, trust and we very much hope that you sign up to that strategic aims and governance arrangements, asking too. you several questions about how we should organise ourselves when we become a NHS foundation trust.

We want to hear your views on these questions before we submit our application to become a NHS Richard Beazley Nick Carver foundation trust to the Department of Health. We also Chairman Chief Executive want to encourage you to become a member or even to consider putting yourself forward for election as a governor. Have your say 4 Your views matter to us – you will influence the future of the proposed East and North Hertfordshire NHS Foundation Trust.

The consultation will run for 12 weeks from 3 You can do this by: March until 30 May 2008, which is the final date we  Filling in the response form on our website: can accept responses. www.enherts-tr.org  Inviting us to come and talk to your team, group or Our application to become a NHS foundation trust will organisation about our proposals be shaped by the feedback we receive. Subject to a  Attending a consultation road show event to find out satisfactory application, we expect to become an NHS more (see page 16 for dates and venues) foundation trust in autumn of 2008.  E-mailing your comments to us at ftconsult.enh- [email protected] Please take the time to read this document which is  Filling in the response form in this document and available in other formats and languages on request. returning it using the Freepost address (no stamp We want you to talk to us about our proposals and tell needed): FREEPOST RRBA-KEKX-BLHH us what you think. East and North Hertfordshire NHS Trust Lister Hospital (L69) Coreys Mill Lane STEVENAGE SG1 4AB

 Writing to us - your comments should be sent to :

Sarah Brierley Deputy Director Strategic Development Lister Hospital (L69) Coreys Mill Lane Stevenage Hertfordshire SG1 4AB Section 1: About the East and North Hertfordshire NHS Trust 5

1.1 Our Trust

The Trust was established in April 2000 following the merger of the previous East Hertfordshire and North Hertfordshire NHS Trusts. As a result of our staff’s hard work and commitment, we have succeeded in developing a shared organisational culture, characterised by strong clinical and managerial leadership.

Currently the Trust provides a wide range of At the end of that consultation, it was decided that hospital services on four sites: inpatient, surgical and emergency services for people with serious or complex conditions will in  Lister hospital in Stevenage the future be moved from the QEII hospital in Welwyn Garden City to the Lister hospital in  Queen Elizabeth II (QEII) hospital in Welwyn Stevenage. This will require an investment of over Garden City £100 million.

 Hertford County hospital in Hertford However, this is not the whole story. Consolidation of acute hospital services on the Lister site will  The Mount Vernon Cancer Centre, based on the provide the platform to strengthen and develop Mount Vernon hospital site in Northwood, our services further. Within this context, we need Middlesex to identify and agree, with the help of our staff, community and partners, priority areas for Over the last two years, we have worked with developing our services in future. colleagues in the Hertfordshire primary care trusts to complete an extensive analysis of our future The Lister, QEII and Hertford County hospitals serve requirements and options. This analysis was a population of approximately 500,000 people. Just complemented by widespread discussion and over 4,500 staff help to provide our services on debate about our future, which culminated in the these three sites. There are 880 inpatient beds split Delivering quality health care for Hertfordshire between the Lister and QEll. The Trust has an consultation. This proposed major change to the annual turnover of some £270 million. configuration of healthcare services in Hertfordshire by 2014, including new and different Our fourth site is the specialist regional cancer futures for the Lister and QEII hospitals. centre at Mount Vernon where we have just under 500 staff. We are very proud that it is one of the These changes were proposed in order to ensure country's top five cancer treatment centres, that we continue to be able to provide high quality, providing a specialist tertiary chemotherapy and sustainable services for our community so that radiotherapy service, and serving a population of healthcare in Hertfordshire is as good as, if not some two million people, including those living in better than, that available outside the county. Hertfordshire, Bedfordshire, northwest London and parts of the Thames Valley. 1.2 Our vision and values 6 Our approach to providing and developing our services is guided by a clear vision and a set of clearly defined and meaningful values.

Our vision

The East and North Hertfordshire NHS Trust is committed to being trusted by the community it serves to provide a comprehensive range of modern, convenient, high quality and caring acute hospital services. Our values

 We put our patients first  We work as a team  We value everybody  We are honest and open  Consultation We value diversity question 1: Do you agree with our vision for the future of the Trust as a NHS Foundation Trust? 1.3 Our achievements

Recent service developments at the Trust include: 7

The opening of the Vicki Adkins Breast Unit at In addition to these service developments, we are the QEII hospital – providing ultra modern and very proud of our staff and their clinical holistic services for women with suspected or achievements which include: diagnosed breast cancer – a service developed hand-in-hand with our patients and the  A 37% reduction in MRSA bacteraemia between community April 2007 and January 2008

 The development of high tech interventional  A 41% reduction in Clostridium difficilebetween cardiology services (angioplasty and pace- April 2007 and January 2008 making) – improving the quality of life and survival rates for people suffering or at risk of  Being selected as the single specialist surgical heart attacks centre across Hertfordshire and south Bedfordshire for complex urology cancers  The opening of new, state of the art radiotherapy facilities at the Mount Vernon  Being awarded one of the top ranking standards Cancer Centre, supporting faster and more available to all NHS trusts for clinical risk effective cancer treatment management of both general acute and maternity services - level two compliance with the NHS Litigation Authority

1.4 Continuing our improvements

However, whilst we recognise our achievements we are not complacent – we know that we need to continue to actively work with, and listen to, our staff, patients and the community if we are to continue to improve all our services, right across the Trust.

Ultimately we want to where we invest our time and funds, whether it provide services that meet be in developing our maternity services, and surpass the needs of our improving our medical records service or patients and our staff. NHS developing more car parking spaces – foundation trust status will members and governors will be key to enable us to make more informing these decisions in the future. decisions locally about how and 1.5 Our strategic aims 8 With the help of our staff, community and partners, we will build on our strengths and achievements to provide responsive, convenient, modern, caring and high quality hospital services that meet the needs of the communities we serve.

Discussions held over the last year with patient  Working with colleagues in primary care to representatives and senior clinical staff have expand local access to specialist acute identified particular priority areas that we wish to services – we want to expand the provision of focus on over the next few years. These include: specialist services locally by working with GPs and other clinicians to offer a range of  Consolidating acute services for complex or outpatient-based services in local and serious conditions onto a single site – community hospitals including in the new £30 enabling us to move ahead in providing high million local general hospital that will be built quality, attractive and sustainable acute in Welwyn Garden City services for the benefit of our community on the Lister hospital site in Stevenage  Undertaking more cancer care locally – expanding the amount of cancer care provided locally in east and north Hertfordshire by working with commissioners and cancer specialists to ensure that as many patients as possible can benefit from high quality cancer care as close to home as possible. “Right now, we are investing in new facilities to bring together our emergency services for children and young people. We know that this will be better for children and their families who need our help quickly; it also puts us on track to rival the best service available anywhere in the country. Dr Andy Raffles, consultant paediatrician and clinical director” for children’s services “At the Lister we have a very successful cardiac laboratory, which means that far fewer people need to travel outside the county for their care. We are now looking to future development that will allow us to help far more patients – including those suffering heart attacks – every minute of every day. Dr Mike Dubowitz, consultant cardiologist and deputy clinical” director specialist medicine Consultation question 2: Do you agree with our strategic aims? Section 2: NHS foundation trusts

9 2.1 What are NHS foundation trusts?

NHS foundation trusts:  Are still very much part of the health service,  Are subject to the same forms of inspection and operating in line with core NHS values and performance rating as the rest of the NHS principles There are currently over 85 NHS foundation trusts  Have greater freedom to determine and invest in England. Over the next couple of years all NHS in local service priorities trusts are expected to achieve NHS foundation trust status.  Are required to provide services that, as a minimum, meet National Health Service targets applying to all NHS acute trusts

2.2 How will becoming a NHS foundation trust help us to achieve our vision?

We want to become a NHS foundation trust because:  We will have stronger links with both our invested directly into our local services, such as staff and our local communities – which providing more midwives to support one-to- means that we will be able to make more one care during labour or in improving hospital decisions about local priorities car parking facilities

 Our staff, community and partners will be  We will be able to raise revenue and access able to share responsibility with us for capital funding in new ways – this means that making decisions – this means greater local we will be able to develop and improve our involvement in how our hospitals are run and services faster than we can today what priorities we set for the future Taken together, these benefits underline that  We will have greater financial freedom – this becoming a NHS foundation trust means that we means that any surpluses we create will belong will be able to be more responsive to local to the Trust in the future rather than belonging priorities and have greater freedom to make to the broader NHS. Once we are a NHS decisions locally. foundation trust our surpluses will be re-

“While we will see the Lister becoming the centre for acute hospital services in east and north Hertfordshire, we are also committed to Consultation providing routine care – such as outpatient services and diagnostic tests – in the question 3: community through a network of local hospitals. What actions should we take to Mr James Quinn,” consultant ear, nose and throat surgeon and build an organisation that is more medical director patient-focused? Section 3: How will the proposed East 10 and North Hertfordshire NHS Foundation Trust be run?

The proposed East and North Hertfordshire NHS Foundation Trust will be governed by a partnership between local communities, staff, partner organisations, the Council of Governors and the Board of Directors. This relationship is summarised below.

Summary governance structure

3.1 Membership

NHS foundation trusts strengthen local ownership of, and responsibility for, services provided by hospitals. Residents, patients and carers in areas served by the Trust, together with our staff, can register as members of the new NHS foundation trust by applying to join the constituency most appropriate to their circumstances. This is explained further in section 3.1.3. 3.1.1 So what are the benefits of becoming a member? 11 Membership of the proposed East and North We recognise the need to make membership Hertfordshire NHS Foundation Trust will be attractive and worthwhile. Our membership designed to encourage widespread and proposals are designed, therefore, to support representative engagement. widespread and representative engagement with our staff, community and partners. We expect our The Trust will not, and cannot be, one size fits all – members to be able to reap the benefits set out in we will work with our members in ways that are the table below. sensitive to their lifestyle, time availability and areas of interest.

Key benefits of becoming a member

Aspect of membership Benefit

Decision-making To put yourself forward for election or nominate others to stand for (governance) election as a governor of the NHS foundation trust (governors take part in decision-making as a member of the Council of Governors)

Influence Influencing plans and decisions taken by the Trust by taking part in membership surveys or workshops

Inform Getting involved in or providing views on projects related to areas of personal interest to help improve our services

Awareness Receive regular newsletters and access to a members-only area on the Trust’s website to receive information and news from the Trust on health issues. Participate in members’ meetings, events and webchats

Discounted goods and Receive discounts on a wide range of goods and services, services including holidays via the NHS Discount Scheme which is available for members to join

Consultation question 4: How can we best communicate with our members? Consultation question 5: How can we ensure that our membership is not over representative or under representative of those who live in our community?

12 3.1.2 Who can become a member? Public membership will be open to anyone living within the We want as many people as possible to join us and help shape proposed membership area. The map below shows the areas and the future of hospital services in east and north Hertfordshire, as electoral wards included in the proposed membership area. well as through the Mount Vernon Cancer Centre. Staff membership is open to all who work for us, as we want We will make every effort to ensure that the NHS foundation them to be involved fully in our NHS foundation trust. We want trust’s public membership is representative of those eligible to to maximise the involvement of our staff and have agreed with become a member. To achieve this we are committed to working trade union representatives that every employee will become a actively with the community and its representatives to promote, member of the Foundation Trust automatically. Those who wish secure and support a membership that is truly representative in to, can opt out of membership. terms of age, gender, ethnicity and socio-economic group. Staff membership will be open to all working at the Trust who You do not need any special skills, qualifications or experience to meet at least one of the following criteria: be a member – you just need to have an interest in your local hospital or cancer centre.  They are employed by the Trust under a contract of employment with no fixed term Membership will be open to two main groups (called  They are employed by the Trust under a contract of constituencies): employment with a fixed term of at least 12 months  Public (including patients, carers and volunteers)  They are employed through, for example, recruitment  Staff who work in our hospitals agencies and sub-contractors  They have exercised functions for the purposes of the trust continuously for at least 12 months (this excludes those offering services on a voluntary basis who may become members of the public constituency

Figure 2: Representation of public constituencies 3.1.3 Key membership features 13 We wish to encourage the widest possible involvement from local communities in our NHS foundation trust. There will therefore be no limit on the number of people who can become members as long as they meet the eligibility criteria.

Key conditions of membership will include: Being a member will not:

 Individuals must be 14 years of age or older – we  Cost you anything are keen to encourage membership from a  Require you to attend meetings (unless you wish broad spectrum of the community and wish to to attend meetings of the Council of Governors, ensure that young people’s views are tapped in which will be held in public) to – both as patients (potential and future) or  Enable you to receive preferential NHS clinical staff treatment over non-members  Members of the public (including patients) must complete an application form to become a . 3.1.4 How can you become a member? member  Staff members will not be required to complete You can register to become a member from the age an application form as the Trust proposes to use of 14 years. To do so, you just need to complete a automatic membership by default in respect of short membership application form that you can the staff constituency – essentially staff will find at the end of this document. Alternatively you automatically become members with an option can register online at our website: to opt out of membership www.enherts-tr.org

“As a local councillor, I can see that a foundation trust with thousands of members gives local people a voice that up to now may have been hard for the NHS to hear. It’s a very exciting development for the health service locally. Cllr Andrew Canter, Welwyn Hatfield borough ” council and member of the Trust’s involvement committee Consultation question 6: Do you agree with the proposal for the minimum age of members to be 14? 3.2 The Council of Governors 14 The Council of Governors will be fundamental to the way the NHS foundation trust works. While governors are not involved in the day-to-day running of the Trust, the Council of Governors will work alongside the Board of Directors. Their role will include:

 Representing the views and interests of local  Acting as guardians, ensuring how the Trust communities to make sure that the Board of operates in line with its terms of authorisation Directors takes into account the needs of these  Setting the remuneration, expenses and other communities and upholds the principles and terms and conditions of office of the chair and values of the NHS non-executive directors  Influencing decisions about spending and  Appointing, or removing, the Trust’s auditors priorities for investment and service  Receiving and considering the annual report development and annual accounts  Appointing and removing the Trust’s chair and  Being consulted by the Board of Directors on non-executive directors the forward plans of the Trust  Approving the appointment of the Trust’s chief executive  Sharing local responsibility for the success of the Trust

3.2.1 What are the benefits of becoming a governor?

Because of the nature of their role in how the Trust is run, governors will receive further benefits in addition to those enjoyed by members outlined in section 3.1.1.

Key benefits of becoming a governor

Aspect of membership Benefit

Priority/agenda setting Informing the overall strategic direction of the Trust. Major decisions and areas of managerial and clinical focus can be influenced and set by the active participation of governors

Inform and influence Acting as a channel between members and the Trust

Personal development Participate in the Trust’s Governor Development Programme, which will develop knowledge and skills to support individuals fulfil the role of governor

Awareness Attend governor briefings, events and meetings on health and governance issues 3.2.2 Proposed composition of the Council of Governors 15 As an NHS foundation trust, we must have a body Public governors that is representative of our membership In recognition of the wide geographical areas constituencies and our relationships with our covered by the Trust and its four hospitals, we are partners, local communities and other proposing to divide the public constituency on a stakeholders. Our proposals have been developed geographical basis. This will help to ensure that the both in response to our local context and as a result public membership and the Council of Governors of learning from the experiences of existing NHS reflect the views of the different localities and foundation trusts. communities served by the Trust.

We propose that our Council of Governors consist We are not proposing to divide the public of 38 governors made up of: constituency in a way that distinguishes between patients, carers and other members of the public.  20 public governors While we recognise that many will have received  5 staff governors care from our hospitals, equally all members of the  13 governors appointed by partner community are potential future patients. organisations Members of the Trust’s public membership The majority of the members of the Council of constituency will elect public governors. Governors will be individuals who are elected from the public membership constituency. What that Staff governors means is that you can be elected to sit on the Members of the Trust’s staff constituency will elect Council of Governors only if you are already a staff governors. In order to ensure that staff member of the NHS foundation trust. governors are representative of those we employ, we propose to have staff governors elected from We are proposing that governors will be elected to different groups across the Trust. serve on the Council of Governors for up to three years in the first instance. Please see section 3.3.1 Partner governors for further detail on this issue. NHS foundation trusts have a statutory duty to include a number of appointed governors, The exact make-up and numbers of the Council of including representatives from Primary Care Trusts Governors will be decided following consultation (PCTs) and local authorities. – which is why we very much want to take the views of our staff, local communities and partners We also propose to have additional governor into account. representatives from other stakeholder groups, including the voluntary sector. Partner governors Our proposals are summarised in the table of the will be appointed by their organisation and will be proposed Council of Governors on page 16. invited on to the Council of Governors, rather than going through an election process.

Partner governors will be expected to represent not just the interests of their organisation, but also those of other similar bodies connected to the Trust. Consultation question 7: Do you think our proposed arrangements for the Council of Governors will ensure that it is representative of our community and that our proposed governance arrangements are comprehensive, practical and reasonable? Proposed Council of Governors

STAFF 16 Consultants and doctors (1)

Nurses and midwives (1) Elected by staff members Other clinical staff (1) Non-clinical staff (2)

PRIMARY CARE TRUSTS

East and North Hertfordshire Primary Care Trust (1) PUBLIC Bedfordshire Primary Care Trust (1) (INCLUDING PATIENTS)

Elected by North Hertfordshire (4) LOCAL AUTHORITIES public Welwyn Hatfield (4) East Hertfordshire (1) North Hertfordshire District Council(1) members Stevenage (4) St Albans (1) Welwyn Hatfield Borough Council (1) South Bedfordshire (1) Mid Bedfordshire (1) East Hertfordshire District Council (1) Other (4) (Covers remaining Stevenage Borough Council (1) NHS foundation catchment including Mount Trust decides Vernon Cancer Centre areas. St Albans City and District Council (1) with partners See Appendix 1 for full list) Bedfordshire County Council (1) Hertfordshire County Council (1)

OTHER ORGANISATIONS

Hertfordshire Chamber of Commerce representative (1) POhWER representative (1) Hertfordshire Black and Minority Ethnic (BME) Partnership representative (1) University of Hertfordshire representative (1))

TOTAL TOTAL 20 18

3.3 Proposals for the Board of Directors

The Board of Directors will manage the proposed NHS foundation trust, which will be accountable to patients, staff and the local public. The Board of Directors will work in partnership with the Council of Governors, from which it will receive advice and support.

We propose that the Board of Directors will include The role of the Board of Directors will include: a non-executive chairman and other non-executive  Providing strategic direction and leadership to directors, who will be in the majority on the Board. the Trust The executive members will be in the minority and  Overseeing the operation of the hospital must include the chief executive, finance director services a registered medical practitioner or dentist and a  Exercising the legal powers of the NHS registered nurse or midwife. foundation trust’s  Monitoring the Trust’s performance against objectives and targets  Ensuring that high standards of clinical and corporate governance are maintained 17

3.3.1 Transitional arrangements

We recognise the need to ensure a smooth and  Stagger the initial terms of office for governors effective transition of governance arrangements in for reasons of business continuity – this will line with becoming an NHS foundation trust. To mean that 50% of governors will be elected for support this development we propose to: a period of eighteen months and 50% for a period of three years on the following basis. The  Transform the Trust Board into the Board of number of votes received will determine the Directors for the NHS foundation trust, with the initial terms of office – candidates attracting the chair and chief executive continuing in their lowest number of votes will serve for an initial roles eighteen month term

 Allow current non-executive directors to  Commission the Council of Governors to complete their appointed term of office or establish a representative appointments remain in post for a period of 12 months, committee to select and approve new non- whichever is the longer executive directors against an agreed person specification  Develop an aspirant governor programme to inform and support members who may wish to stand for election to the Council of Governors

Consultation question 8: Do you agree with the proposed arrangements to support our transition to a foundation trust?

“Having been involved in the work of the Trust as a lay representative over a number of years, I know that it is committed to involving local people in shaping future hospital services. Our challenge is to get involved and ensure that the Trust acts on what people want. Elisabeth Conder,” chair of the Trust’s Patients' Panel Section 4: Next steps 18

4.1 Timetable for NHS foundation trust development and approval

Indicative dates, which will be confirmed during the course of the Trust’s application to become an NHS foundation trust, are as follows:

Milestone by

Consultation begins 3 March 2008

Consultation ends 30 May 2008

Trust submits formal application to Department of June 2008 Health

Trust reports outcome of consultation June 2008

Department of Health makes recommendation to June 2008 Secretary of State for Health

Secretary of State approval to proceed to Monitor June 2008 assessment phase

Council of Governors elections begin July 2008

Statement of outcome of elections September 2008

Trust Board meet with Monitor Board September 2008 (Final assessment)

Earliest possible authorisation date Autumn 2008 Section 5: How to get involved 19

5.1 How to have your say

We hope that you have found this document interesting and informative. This is your opportunity to have a say in the future of the Trust.

All comments, views and discussions will be taken contact details if you would like your response into account. They will help us in developing our acknowledged or wish to receive feedback about application to become an NHS foundation trust. We the outcome of this consultation. intend to submit our application to the Secretary of State for Health in June 2008. There are a number of ways in which you can find out more about the consultation and its proposals. A range of material and activities has been A range of meetings will be held during the developed to support this consultation, including consultation period and we would welcome an full and summary consultation documents. These opportunity to come and talk to you. can be made available in large print, as well as other languages and formats, on request. We will also be holding a series of NHS foundation trust road shows during the consultation period, There are a variety of ways in which you can feed where people can drop in, talk to hospital back to us: representatives and find out more both about our proposals and what becoming a member offers.  In paper form (using the consultation questionnaire attached on page 27) Key dates for consultation events are shown on  As a letter to the Trust’s dedicated consultation page 20. For a full list, please contact the office consultation office or check the dedicated website.  Electronically via the consultation website (www.enherts-tr.org)  Emailing our dedicated consultation email address - [email protected]

You do not need to provide your name and address when responding, unless you wish to do so or would also like to become a member of the NHS foundation trust. You should also provide your

Please let us have your feedback by 30th May 2008 at the latest NHS foundation trust consultation public meetings and road shows: 20 Constituency Date/venue/time (area/s)

Welwyn Hatfield 28/4/08, 5.30pm-9.30pm Campus West, Welwyn Garden City

Stevenage 24/4/08, 5.30pm-9.30pm Stevenage Leisure Centre

East Hertfordshire 16/4/08, 5.30pm-9.30pm Rhodes Centre, Bishops Stortford

North Hertfordshire 10/4/08, 5.30pm-9.30pm Spirella Ballroom, Letchworth Garden City

St Albans 3/4/08, 5.30pm-9.30pm St Albans Civic Centre

South Bedfordshire & 30/4/08, 5.30pm-9.30pm Mid Bedfordshire The Weatherley Centre, Biggleswade

Other 17/03/08 5.30pm-9.30pm Post Graduate Centre, Mount Vernon

Further information or help can be obtained from the consultation office on request or via the consultation web page on the Trust’s website.

Consultation contact details are listed below:

Contact options: Details

Telephone 01438 781797

Log onto the Trust website www.enherts-tr.org

Email [email protected]

Write to us FREEPOST RRBA-KEKX-BLHH East and North Hertfordshire NHS Trust Lister Hospital (L69) Coreys Mill Lane STEVENAGE SG1 4AB 6.1 Glossary 21 As much as we have tried to make this document easy to understand, we have inevitably had to use some terms that are particular to the NHS. We hope this glossary will help you to understand their meaning.

Acute Services Commissioning Hospital services offering interventions or The system used in the NHS whereby treatments for planned episodes of care or for commissioning bodies – called primary care trusts emergency medical conditions. or PCTs – plan and review health care services, as well as purchase them on behalf of their local Ambulatory communities within the resources made available Health care that is provided in a way which through the Department of Health. Services are enables patients (especially children and young purchased from what are called provider people) to remain at home rather than be organisations – such as NHS Trusts and other admitted to hospital either overnight or for more health care organisations – to meet patient needs than a few hours. This can be one-off care for an and ensure the delivery of national and local emergency condition or ongoing care where standards and priorities. longer term treatment is required. Department of Health Board of Directors The Department of Health’s role is to help improve Consists of executive and non-executive directors. the health and well-being of the population of The executive directors are senior employees of England. It provides strategic leadership to the the Trust. The non-executive directors – and the NHS and social care organisations. The chair – will be appointed by the Council of Department has overall responsibility for: setting Governors. The Board of Directors has decision- the direction of health and social care services; making powers and a defined set of setting and monitoring standards for health and responsibilities for the day-to-day running of the social care services; ensuring NHS and social care organisation. organisations have the resources they need; and ensuring that patients and the public can make C-Diff choices about the health and social care service Clostridium difficile – a gram-positive anaerobic they use. NHS foundation trust status means that bacteria which forms spores. the Trust is no longer directly accountable to the Department of Health, although it remains firmly Capital spending part of the health service. Spending on the acquisition of land, premises, as well as on the provision, adaptation, renewal, replacement or demolition of buildings, equipment and/or vehicles. Executive directors Primary care 22 These are senior employees of the trust who sit on The patient’s first point of contact with health the Board of Directors. They include the chief services is normally through a primary care health executive and finance director, as well as the professional – typically a GP, practice nurse, dentist, medical and nursing directors. Executive directors optician or pharmacist. have decision-making powers and a defined set of responsibilities. They play a key role in the day-to- Primary care trusts (PCTs) day running of the organisation. These are NHS organisations that allocate the money given to them by the Government to health Governance care providers (NHS Trusts, NHS foundation trusts A framework through which organisations are and others) in line with local delivery of plans and accountable for improving the quality of their priorities. Some PCTs also provide primary and services and safeguarding high standards of care community health care services. by creating an environment in which excellence in clinical care will flourish. Governance Radiotherapy arrangements must reflect relevant national Treatment of a disease by means of ionising guidance, standards and laws. radiation

Interventional cardiology services Remuneration Cardiology services offering surgical procedures Pay or recompense that can be used to treat blocked arteries. Revenue funding Members NHS expenditure other than capital. Individuals with an interest in the development and well-being of an NHS foundation trust who Stakeholders register as members of the organisation. Any individual or organisation with an interest in the affairs of the trust. Monitor This national body is responsible for regulating Surplus(es) NHS foundation trusts. Its role is to ensure they are The difference between income and expenditure legally constituted, well managed and financially robust, so they can deliver high standards of health care for patients. Monitor acts independently from the Department of Health and is accountable to Parliament.

MRSA /bactermia Meticillin Resistant Staphylococcus Aureus. The presence of viable bacteria circulating in the bloodstream.

NHS foundation trust A public benefit corporation, which is authorised by Monitor under the NHS Act 2006 to provide goods and services for the purposes of the NHS in England. 6.2 Cabinet Office Code of Practice for Consultations 23

This consultation has been designed to reflect the Cabinet Office Six Consultation Criteria published in June 2006. These are:

1. Consult widely throughout the process, 4. Give feedback regarding the responses allowing a minimum of 12 weeks for written received and how the consultation process consultation at least once during the influenced the policy. development of the policy.

2. Be clear about what your proposals are, who 5. Monitor your department's effectiveness at may be affected, what questions are being consultation, including through the use of a asked and the timescale for responses. designated consultation coordinator.

3. Ensure that your consultation is clear, concise 6. Ensure your consultation follows better and widely accessible. regulation best practice, including carrying out a regulatory impact assessment if appropriate.

6.3 Further information and reading

The following documents may be of interest. More information about the East and North Hertfordshire NHS Trust is available on our website at www.enherts-tr.nhs.uk or from the consultation office on request. Our website includes a section dedicated to our plans and proposals to become a NHS foundation trust.  National Health Service Act 2006 http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/DH_064103

 Applying for NHS Foundation Trust Status: Guide for Applicants (February 2007) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073630

 Monitor Code of Governance www.monitor-nhsft.gov.uk

 East & North Hertfordshire NHS Trust Annual Report 2006/7 (www.enherts-tr.nhs.uk) Appendix 1

FOUNDATION ENCOMPASSING THE FOUNDATION ENCOMPASSING THE TRUST FOLLOWING ELECTORAL TRUST FOLLOWING ELECTORAL CONSTITUENCY WARDS CONSTITUENCY WARDS 24

North Hertfordshire Arbury East Hertfordshire Bishop’s Stortford All Saints (All wards) Baldock East (All wards) Bishop’s Stortford Central Baldock Town Bishop’s Stortford Meads Cadwell Bishop’s Stortford Silverleys Chesfield Bishop’s Stortford South Codicote Braughing Ermine Buntingford Hitchin Bearton Datchworth & Aston Hitchin Highbury Great Amwell Hitchin Oughton Hertford Bengeo Hitchin Priory Hertford Castle Hitchin Walsworth Hertford Heath Hitchwood, Offa & Hoo Hertford Kingsmead Kimpton Hertford Rural North Knebworth Hertford Rural South Letchworth East Hertford Sele Letchworth Grange Hunsdon Letchworth South East Little Hadham Letchworth South West Much Hadham Letchworth Wilbury Puckeridge Royston Heath Sawbridgeworth Royston Meridan Stanstead Abbots Royston Palace The Mundens Weston and Sandon Thundridge & Standon Walkern Ware Chadwell Ware Christchurch Welwyn Hatfield Welwyn East Ward Ware St Mary’s (All wards) Welwyn West Ward Ware Trinity Sherrards Ward Watton-at-Stone Haldens Ward Panshanger Ward Peartree Ward Stevenage (All wards) Bandley Hill Handside Ward Bedwell Hollybush Ward Chells Howlands Ward Longmeadow Hatfield Villages Ward Manor Hatfield Central Ward Martins Wood Hatfield West Ward Old Town Hatfield South Ward Pin Green Hatfield East Ward Roebuck Welham Green Ward St Nicolas Brookmans Park and Little Shephall Heath Ward Symonds Green Northaw & Cuffley Ward Woodfield FOUNDATION ENCOMPASSING THE FOUNDATION ENCOMPASSING THE TRUST FOLLOWING ELECTORAL TRUST FOLLOWING ELECTORAL CONSTITUENCY WARDS CONSTITUENCY WARDS 25

St Albans (All wards) Batchwood South Bedfordshire Barton-Le-Clay St Peters (Selected wards) Streatley Verulam Toddington Sopwell Caddington Cunningham Dunstable Central Ashley Eaton Bray Clarence Houghton Central Marshalswick South Houghton East Colney Heath Houghton South London Colney Icknield Sandridge Kensworth Marshalswick North Northfields Park Street Priory St. Stephen Watling Wheathampstead Slip End Redbourn Studham Harpenden North Totternhoe Harpenden East Harpenden South Harpenden West

Mid Bedfordshire Arlesey (Selected wards) Biggleswade Holme Biggleswade Ivel Biggleswade Stratton Clifton and Meppershall Harlington Houghton, Haynes, Southill and Old Warden Langford and Henlow Village Maulden and Clophill Northill and Blunham Potton and Wensley Sandy Ivel Sandy Pinnacle Shefford, Campton and Gravenhurst Shillington, Stondon and Henlow Camp Silsoe Stotfold FOUNDATION ENCOMPASSING THE FOUNDATION ENCOMPASSING THE TRUST FOLLOWING ELECTORAL TRUST FOLLOWING ELECTORAL CONSTITUENCY WARDS CONSTITUENCY WARDS 26

Other (Selected Three Rivers (All Abbots Langley wards including wards) Ashridge those covering Bedmond & Primrose Hill Mount Vernon Carpenders Park cancer centre) Chorleywood west Croxley Green Croxley Green North Croxley Green South Watford (All wards) Callowland Hayling Central Langleybury Holywell Leavesden Leggatts Maple Cross and Mill End Meriden Moor Park and Eastbury Nascot Northwick Oxhey Oxhey Hall Park Sarratt Stanborough Tudor Vicarage Hillingdon (Selected Northwood Woodside wards) Northwood Hills Hillingdon East Harefield Northolt West End Dacorum (All wards) Watling Ward West Ruislip Woodhall Farm Ward Eastcote & East Ruislip Grove Hill & Piccotts End Cavendish Ward Manor Adeyfield East Ward Ickenham Adeyfield West Ward South Ruislip Highfield Ward Uxbridge North Hemel Central Ward Uxbridge South Boxmoor Ward Brunel Gadebridge Ward Charville Chaulden & Warners End Barnhill Ward Yeading Aspley & Corner Hall Ward Townfield Bennetts End Ward Botwell Nash Mills Ward Yiewsley Leverstock Green Ward West Drayton Kings Langley Ward Pinkwell Ashridge Ward Heathrow Villages Berhamsted Castle Ward Berhamsted East Ward Berhamsted West Ward Barnet (Selected High Barnet Bovingdon, Flaunden & wards) East Barnet Chipperfield Ward Underhill Northchurch Ward Edgware Aldbury & Wiggington Ward Hale Tring East Ward Mill Hill Tring Central Ward Burnt Oak Colindale FOUNDATION ENCOMPASSING THE FOUNDATION ENCOMPASSING THE TRUST FOLLOWING ELECTORAL TRUST FOLLOWING ELECTORAL CONSTITUENCY WARDS CONSTITUENCY WARDS 27

Milton Keynes Danesborough Broxbourne Broxbourne (Selected ward) (All wards) Bury Green Cheshunt Central Cheshunt North Brent (Selected Queensbury Flamstead End wards) Fryent Goffs Oak Welsh Harp Hoddesdon Hoddesdon North Rosedale Harrow Pinner Rye (Selected wards) Hatch End Theobalds Harrow Weald Waltham Cross Stanmore Park Wormley/Turnford Canons Headstone North & South Wealdstone South Bassingbourn Belmont Cambridgeshire Gamlingay Edgware (Selected wards) Melbourn Queensbury The Mordens Kenton West & East Marlborough Greenhill West Harrow Harrow on the Hill Roxeth Roxbourne Rayners Lane Pinner South

Luton (All wards) Barnfield Biscot Bramingham Challney Crawley Dallow Farley Hightown Icknield Leagrave Lewsey Limbury Northwell Round Green Saints South Stopsley Sundon Park Wigmore Questionnaire Have your say and become a member

Part A NHS Foundation Trust status consultation Consultation question 6: Do you agree with the proposals for the minimum age of questionnaire: to be returned by 30 May 2008 members to be 14 (section 3.1.4)?

Please feedback your views to us and give reasons for your Yes No choice or alternatives where you do not agree.

Consultation question 1: Do you agree with our vision for the future of the Trust as a NHS foundation trust (section 1.2)? Consultation question 7: Yes No Do you think our proposals for the Council of Governors will ensure that it is representative of our community and that our proposed governance arrangements are comprehensive, practical and reasonable (section 3.2.2)?

Yes No Consultation question 2: Do you agree with our strategic aims (section 1.5)?

Yes No

Consultation question 8: Do you agree with the proposed arrangements to support our transition to becoming a NHS foundation trust (section 3.3.1)? Consultation question 3: What action should we take to build an organisation that is Yes No more patient-focused? For example, how can we ensure that patients, staff and the community feel more able to influence and inform the work of the Trust? Did you find this consultation document clear and easy to understand? (please tick)

Yes No

Consultation question 4: How can we best communicate with our members? Please Your name and address, or e-mail address (optional - this will tick all that apply. be used for consultation purposes only)

Email Post Website Please let us have any suggestions about how we could Please suggest any other methods have improved the content or style of this consultation document

Consultation question 5: How can we ensure that our membership is not over representative or under representative of those who live in our community (section 3.1.2)?

Tick this box if you would like to receive an acknowledgement and feedback on the outcome of this consultation. Please note that acknowledgements and feedback can only be sent if you have provided your name and address. Take part in surveys on the Trust’s services and proposed Part B developments Your application to become a member of the proposed East and North Hertfordshire NHS Foundation Trust Take part in workshops looking at the Trust’s services Please note that trust staff do not need to register, you will automatically become a member unless you wish to opt out. Join working groups taking forward specific projects

Take part in road shows where the Trust talks to other I apply to be a member of the proposed NHS foundation trust. If members and/or the public about the work it does the trust application to become an NHS foundation trust is successful, I will automatically become a member of the new In considering the above categories, it would be helpful if you organisation. I consent to the processing of my personal could describe those services in which you have most interest information for the purposes of my potential membership by the (e.g. cancer care, stroke services, care of the elderly, etc.). Please East and North Hertfordshire NHS Trust. specify your preferences below if you have any

If you would like to register to become a member of the proposed East and North Hertfordshire NHS Foundation Trust, please complete and return this form. Following receipt of your application, we will confirm your membership. There is no deadline to return membership application forms.

I would like to become a member of the proposed How would you best like us to contact you? East and North Hertfordshire NHS Foundation Trust (tick all that apply) E-mail Post Telephone I am interested in standing for election to the Council of Governors. Are you a member of an organisation or group that you feel would like more information about the work of the Trust? Mr Mrs Ms Miss Dr Other Yes No

(please specify) If yes, then would you mind giving us the name of the organisation or group and who the best person to contact is First name please? Surname Organisation/group name Organisation name (if appropriate)

Contact person

Full address How to contact them

I do not want my name to appear on the public register Postcode (please provide your full postcode) of members

To become a member you need to be aged 14 or over. Telephone Please confirm your date of birth below. E-mail Date of Birth (Day/Month/Year) Are you or have you been: (please tick those that apply) Signed A patient or carer at any of Hertford County, Lister or QEII Date hospitals? If you prefer, you can download an application form at A patient or carer at the Mount Vernon Cancer Centre? www.enherts-tr.org.

How would you like to be involved with the Trust? (Please The data you supply will be used by East & North Hertfordshire tick all that apply) NHS Trust to contact you about Trust membership and other Be invited to annual general meetings related issues and will be stored and processed in accordance with the Data Protection Act. Full details are available on request. Receive regular newsletters/updates 13. How did you hear about becoming a member of the Part C East & North Hertfordshire NHS Foundation The following questions are optional Trust? (please tick all that apply) However this information will help us to determine the extent to which our membership and consultation responses are By letter representative and diverse. Your feedback on this consultation From other people /word of mouth document will also help us develop and improve future Newspaper information we may produce. Radio At the hospital 5. Are you? Other (please state) Male Female

6. How old are you? (please tick)

Under 16 17 – 24 25 – 40 41 – 60 60 - 75 75+

7. Are you a resident of east and north Hertfordshire? Yes No

8. What is the first part of your postcode? (e.g. SG2 or HP4)

9. Are you? (please tick most appropriate one)

a. A member of the public b. A member of staff employed by East and North Hertfordshire NHS Trust c. A NHS staff member not employed by East and North Hertfordshire NHS Trust d. A member of a voluntary or community group e. Other (please specify)

10. Ethnic origin. Are you? (please tick)

White Mixed Black Asian Chinese Black African Other If other please give details

11. Are you a member of a health related group or organisation? Yes No Thank you for responding to our consultation. If yes please give name of group or organisation Please return this form to:

12. If you consider yourself to have a disability please tick Freepost RRBA-KEKX-BLHH those that apply. East and North Hertfordshire NHS Trust Lister Hospital (L69) Sensory disability Physical disability Coreys Mill Lane Learning disability Another special need STEVENAGE (please specify) SG1 4AB

Nick Carver Chief Executive East & North Hertfordshire NHS Trust Lister Hospital Coreys Mill Lane Stevenage SG1 4AB

4th June 2008

Dear Mr Carver

Thank you for inviting the London Borough of Hillingdon to comment on your proposals to become a foundation trust. I write on behalf of the External Services Scrutiny Committee which holds the Council’s health scrutiny powers. I apologise that due to the annual cycle of Council meetings we were unable to comment during the consultation period and are grateful that you will consider this late response.

Overall, the Committee have generally supported applications from local NHS trusts for foundation trust status as this should enable Hillingdon residents to become involved in the management of their valued health services and increase local accountability.

East & North Herts Trust manages four hospitals and it is essential that the people living near and using each of these hospitals benefit from the increased local accountability offered by foundation trust status. However, we are concerned whether the proposals will offer these benefits in relation to Mount Vernon Hospital.

As you are aware, the Mount Vernon Cancer Centre is located in Hillingdon and receives much support from the local community. We are concerned by the proposals to include Hillingdon in the ‘other’ constituency for public governors along with a geographically diverse range of locations, for we feel that this may lead to the specific issues and local concerns around Mount Vernon not being given appropriate weight in discussions around the Trust’s future.

CLLR MARY O’CONNOR T.01895 250316 F.01895 250765 mo’[email protected] www.hillingdon.gov.uk London Borough of Hillingdon, Conservative Group Office, Civic Centre, High Street, Uxbridge, UB8 1UW

We therefore suggest a minor amendment to your proposals: that the number of public governors in the ‘other’ constituency is reduced to three, and a new constituency is created for Hillingdon and the other local authorities close to Mount Vernon.

This would not affect the overall size and balance of the Council of Governors. Crucially however, it would ensure the local community and users of Mount Vernon are represented in meetings of the Council of Governors and receive the same benefits from foundation trust status as those who live in the areas surrounding the Trust’s other hospitals. We understand that other consultation responses have highlighted this as an issue and we look forward to hearing your response.

Yours sincerely

Cllr Mary O’Connor Chairman External Services Scrutiny Committee

Cc: Cllr Ray Puddifoot: Leader of the Council, London Borough of Hillingdon

Cllr Philip Corthorne: Cabinet Member for Social Services, Health and Housing, London Borough of Hillingdon

Yi-Mien Koh: Chief Executive, Hillingdon PCT

2 ITEM 3

Work programme 2008/9 Contact Officer: David Coombs Telephone: 01895 250833

REASON FOR ITEM

To present a draft work programme to the Committee for the current Council year.

OPTIONS OPEN TO THE COMMITTEE

1. Note the draft work programme

2. Agree the draft work programme subject to any amendments

INFORMATION

1. At the last meeting of the Committee (the first of the 2008/9 Council year), Members considered potential topics for the year ahead. Members made a series of suggestions and asked for these to be incorporated into a draft work programme.

2. A draft work programme is attached and is presented to the Committee for comment. As agreed, two meetings are unallocated in order to allow time for considering potential proposed reforms to the NHS arising from Healthcare for London.

SUGGESTED SCRUTINY ACTIVITY

Members note the draft work programme and make any amendments as appropriate

External Services Scrutiny Committee – 15th July 2008 Page 6 PART 1 – MEMBERS, PUBLIC & PRESS

EXTERNAL SERVICES SCRUTINY COMMITTEE

2008/9 WORK PROGRAMME

Meeting Date Meeting theme and issues

17th June 2008 Developing a strategy for Hillingdon’s health services, including: • PCT response to Healthcare for London JOSC • PCT/Social Services joint working on the strategy

15th July 2008 Hillingdon PCT provider services, including: • Proposals to provide PCT services in the Council’s children’s centres • New governance structure for PCT provider services

24th September 2008 The Hillingdon Local Involvement Network (LINk), including: • Scrutiny of Health Advocacy Partnership’s (HAP) proposals to deliver the Hillingdon LINk

30th October 2008 Metropolitan Police, including: • Schools officers • Update on Safer Transport Teams

26th November 2008 Hillingdon PCT’s consultation on a primary and community services strategy

13th January 2009

25th February 2009

1st April 2009 Commentary on Healthcare Commission annual health checks for local NHS Trusts: • Hillingdon PCT • Hillingdon Hospital • Royal Brompton & Harefield • Central & North West London Mental Health Trust

28th April 2009 Community cohesion • Work of the Council’s partners to promote a cohesive Hillingdon

External Services Scrutiny Committee – 15th July 2008 Page 7 PART 1 – MEMBERS, PUBLIC & PRESS