Health Overview and Scrutiny Panel

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					                  HEALTH OVERVIEW AND SCRUTINY PANEL

    MINUTES OF THE MEETING of the Health Overview and Scrutiny Panel held
    in Conference Room A, Civic Offices, Portsmouth on Thursday 5 February
    2009 at 2.00 pm.

                                       Present

                        Councillors David Stephen Butler (Chairman)
                                    Margaret Foster
                                    Jacqui Hancock
                                    David Horne
                                    Lee Mason

                                Co-opted Members

                        Councillors Peter Edgar
                                    Keith Evans
                                    Vicky Weston

                                Also in Attendance

                        Katie Benton, Scrutiny Support Officer,
                          Portsmouth City Council
                        Garry Campion, Solent Coastguard
                        John Coupe, Portland Coastguard
                        Glen Hewlett, Director of Development & Estates,
                          Portsmouth Hospitals Trust
                        Police Sergeant Andy McMahon, Sussex Police
                          Specialist Search Unit
                        Anthony Quinn, Senior Local Democracy Officer,
                          Portsmouth City Council

1   Apologies for Absence (AI 1)

    Councillor Eleanor Scott from Portsmouth and Councillors Gwen Blackett,
    Dorothy Denston and Dennis Wright sent their apologies.

2   Declarations of Interest (AI 2)

    Councillor Peter Edgar declared a personal, but non-prejudicial interest, as he
    is a shareholder in a local taxi company.

    Councillor Lee Mason declared a personal, but non-prejudicial interest, as he
    is a keen diver.




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    A warm welcome was then extended to all Members and Co-optees of the
    Panel, with special welcome given to Garry Campion, John Coupe, Glen
    Hewlett and Police Sergeant Andy McMahon. The Panel were informed that
    with the changes of the political balance of the Council came changes to
    membership of scrutiny panels, and this therefore meant that Councillor April
    Windebank would no longer be with the Panel, but Councillor Eleanor Scott
    would be replacing her. The Chairman expressed that Councillor Scott comes
    to the Panel with the experience of working with the local Primary Care Trust,
    which would no doubt be helpful to the Panel.

    RESOLVED that a letter is sent on behalf of the Health Overview and
    Scrutiny Panel to Councillor Windebank thanking her for her contribution
    and participation to the Health Overview and Scrutiny Panel for the last
    two municipal years.

3   Minutes of Meeting Held on 1 December 2008 (AI 3)

    RESOLVED that the minutes of the meeting of the Health Overview and
    Scrutiny Panel held on 1 December 2008 be confirmed as a correct
    record subject to the amendment of the name Anger Dryer to Angela
    Dryer at point 59.

4   Matters Arising from the Previous Minutes (AI 4)

    There were no matters arising from the previous minutes.

5   Review of the Closure of Hyperbaric Medicine Unit, Royal Hospital Haslar
    and Hyperbaric Medicine Unit, Queen Alexandra Hospital (AI 4)
    A brief summary of the witnesses and evidence being presented before the
    Panel was given to Members. Members also heard that QinetiQ, the private
    company responsible for running the two Hyperbaric Medicine Units, had
    declined to attend the meeting of the Health Overview and Scrutiny Panel, and
    that South Central Ambulance Service, who were asked for a witness
    statement, had not communicated with the Panel. In response to this
    information the Panel expressed its disappointment that one of the main
    stakeholders playing a part in this review had decided not to attend. Members
    felt that QinetiQ was not fulfilling its responsibility towards the people of
    Portsmouth to provide explanations as to why the Units are closing. The Panel
    also expressed its opinion that the HOSP is working towards positive
    outcomes for the city and is disappointed that QinetiQ does not wish to
    contribute towards this. Members questioned if either the Ministry of Defence
    or a National Health Service provider had put constraints on QinetiQ attending.

    RESOLVED (1) that a letter is sent to QinetiQ to convey the HOSP’s
    disappointment that they did not wish to attend the Health Overview and
    Scrutiny Panel review of the closure of the Hyperbaric Medicine Units.
                 (2) that a letter is sent to South Central Ambulance Service
    conveying the HOSP’s displeasure that inadequate communication has
    been received in regard to this scrutiny review.

    Glen Hewlett, Director of Development and Estates at Portsmouth Hospitals
    Trust, then outlined the Trust’s views on the closure of the Hyperbaric
    Medicine Units, and the reasons for there not being an agreement to place a

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permanent Unit placed at Queen Alexandra Hospital, Portsmouth.
The Panel heard:
•   That between 1996 - 1998 Portsmouth Hospitals Trust agreed to
    centralise their acute services from Queen Alexandra Hospital and
    St Mary’s Hospital, Portsmouth to a new hospital at Queen Alexandra
    Hospital;
•   That the Ministry of Defence announced the proposed closure of Royal
    Hospital Haslar, Gosport, in 1998, with 2001 given as a date for
    permanent closure;
•   That due to this announced closure Portsmouth Hospitals Trust
    re-evaluated their plans and incorporated some of the services due to
    leave Royal Hospital Haslar. In order to achieve this Portsmouth
    Hospitals Trust worked closely with QinetiQ and the Ministry of Defence to
    include a Hyperbaric Medicine Unit within their outline plans. In 2000 a
    Hyperbaric Chamber was moved from Aberdeen to Queen Alexandra
    Hospital, but this chamber was due only to be temporary;
•   That the current lease on the Hyperbaric Medicine Unit at Queen
    Alexandra Hospital runs out at the end of March, but an agreement has
    been reached with QinetiQ to keep it running it until the end of April. The
    unit must then close after this date, as the building it is contained within
    must be demolished to make way for the new hospital;
•   That in 2002 the Ministry of Defence instructed QinetiQ to withdraw their
    inclusion within the Queen Alexandra Hospital designs;
•   That the financial close for the Queen Alexandra Hospital plans was in
    December 2005;
•   That QinetiQ approached Portsmouth Hospitals Trust again in 2006
    asking to be re-included within the plans. Portsmouth Hospitals Trust re-
    included the Hyperbaric Medicine Unit but could not place it back within its
    original site. Therefore it was placed on the 3rd floor of the new hospital;
•   That around this time the Ministry of Defence and QinetiQ were reaching
    a strategic alliance for the signing of the new contract;
•   That in June 2007 QinetiQ again asked to be withdrawn from the Queen
    Alexandra Hospital plans;
•   That Portsmouth Hospitals Trust were disappointed with QinetiQ’s
    statement to the Health Overview and Scrutiny Panel, as they believe it to
    be factually incorrect. They believed the following points to be inaccurate:
          • That Portsmouth Hospitals Trust decided to close Royal Hospital
             Haslar – this was due to a Ministry of Defence as they wished to
             centralise their services to Birmingham;
          • That the National Health Service had a hand in closing the
             Hospital, rather than the Ministry of Defence;
          • That a Hyperbaric Unit wasn’t agreed for placement at Queen
             Alexandra Hospital - as Portsmouth Hospitals Trust did originally
             include the Hyperbaric Medicine Unit within their original plans in
             2001, and again in 2006, but this was not included within
             QinetiQ’s statements;
•   That Portsmouth Hospitals Trust and QinetiQ have always had a good,
    close working relationship and are concerned that QinetiQ stated
    inaccurate information relating to Portsmouth Hospitals Trust within their
    statement.




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In response to questions the Panel heard:
•    That although Portsmouth Hospitals Trust are aware of the elective
     patient therapies the Hyperbaric Medicine Unit can treat, it is not the Trust
     that provides funding for this, but rather Portsmouth City Teaching
     Primary Care Trust;
•    That although the Unit is transportable, Portsmouth Hospitals Trust have
     been unable to find another location for it other than on the 3rd floor of the
     new Hospital. This causes problems because the unit is very heavy and
     the floors will have to be reinforced. The Unit also has to be removed
     every 10 years to be water tested and this will mean that the area it is
     situated in will have to have removable walls;
•    That the Unit requires a back up generator (in case of power shortage) as
     it is a clinical facility, and that this would prove very expensive if it were to
     be placed in its own separate block, rather than within the main Hospital
     building;
•    That a crane is required to move the Unit and this would prove costly for
     QinetiQ if they wished to place it in another part of the hospital, provided a
     new location could be found;
•    That Portsmouth Hospitals Trust are not statutorily required to have a
     Hyperbaric Medicine Unit within the new Hospital;
•    That Portsmouth Hospitals Trust has not spoken to other suppliers of
     Hyperbaric Medicine Units. This is because they were originally
     approached by QinetiQ to site a Unit and were not actively looking to
     provide a Unit for the new Hospital themselves;
•    That QinetiQ have a licence from the Ministry of Defence to provide
     Hyperbaric therapies to their personnel, and therefore other companies
     would not be able to provide this service;
•    That as far as Portsmouth Hospitals Trust are aware QinetiQ have stated
     that it will take 4-6 months from the start of the build to get the new
     Hyperbaric Medicine Unit up and running at St Richards Hospital,
     Chichester. A provisional start time has been given of February 2010.
     This differs to QinetiQ’s proposed down time of 3 months;
•    That Portsmouth Hospitals Trust cannot comment on whether this move is
     financially driven by QinetiQ and the Ministry of Defence, but that it agrees
     the 2006 plans were more expensive that the original 2001 plans;
•    That Portsmouth Hospitals Trust cannot give a reason for QinetiQ pulling
     out of the original plans;
•    That Portsmouth Hospitals Trust has approached QinetiQ about providing
     a Category 4 Monoplace Chamber within the Hospital, but unfortunately
     QinetiQ have not yet responded to this request.

The Panel then heard from Garry Campion, Solent Coastguard and John
Coupe, Portland Coastguard.
                               (TAKE IN REPORT)
The Panel were informed:
•   That Solent Coastguard is concerned at both the Hyperbaric Medicine
    Units at Queen Alexandra Hospital and Royal Haslar Hospital closing;
•   That since they were informed of these plans they have put into place
    contingencies;
•   That the south coast is an area of interest for divers with larger numbers
    visiting the area in the summer months;



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•    That for the period the two Hyperbaric Medicine Units are out of use HM
     Solent Coastguard will have to use either the Poole Hyperbaric Chamber,
     located in Dorset, or the Whipps Cross Hyperbaric Chamber, located in
     London;
•    That the suggested move to St Richards Hospital is in HM Solent’s favour,
     as it is more central in the district and has two landing sites for the
     service’s helicopters;
•    That the only constraint of the Hyperbaric Medicine Unit moving to
     St Richard’s Hospital is if the helicopter is coming from the west, as the
     flying time to the east will be a few minutes extra;
•    That all possible eventualities have been covered in the contingency
     plans. Poole Hyperbaric Chamber is taking on extra staff for the period
     that the Hyperbaric Medicine Unit will be out of operation in the central
     southern area;
•    That South West Ambulance Service are aware of the closure of the Units
     and will be able to take extra casualties if needed;
•    That Plymouth Hyperbaric Chamber are also aware of the situation and
     are on alert to take casualties;

In response to questions the Panel heard:
•    That on average, the time taken to fly to/from a mid channel diving
     incident to a Unit at St Richard’s would be around 20 minutes, an extra 10
     minutes on journeys taken currently;
•    That there are two helicopter landing sites at St Richard’s Hospital, one of
     which is next to the Accident & Emergency department, the second of
     which is in a college field which is a walkable distance to the Accident &
     Emergency Department, but will need an ambulance transfer;
•    That for diving incidents in the far east of the region it will take around an
     extra eight minutes for the helicopter to reach Poole Hyperbaric Medicine
     Unit;
•    That Poole has only reached capacity two times within the last five years
     and HM Coastguard have contingency plans should this happen again;
•    That Whipps Cross is around an extra 70 miles away from the current
     Hyperbaric Medicine Unit sites, but with HM Coastguard helicopters
     travelling at speeds of 120 knots plus this will not take much time to travel;
•    That helicopters are not always used in diving incidents. HM Coastguard
     take the lead from the duty diving doctor on whether or not a helicopter
     needs to be launched using a connect call procedure, where the doctor
     provides expert advice on treatment for the patient;
•    That ambulances are not necessarily used in the transportation of patients
     experiencing Decompression Illness or Air/Gas Embolisms. It is preferred
     that patients are not transported in this way due to speed issues;
•    That Decompression Illness is not always fatal. It depends on what type it
     is. If the air bubbles are in the joints it can be very painful for the patient
     but generally not fatal, whereas if these bubbles start to move into the
     bloodstream and into major arteries/organs then this can start to cause
     permanent damage, and in some cases, death;
•    That the Poole Hyperbaric Chamber has two separate chambers. One is
     a 6-man twin chamber, which can take four and two patients respectively.
     The second of which is a smaller Chamber, which is two-man. Therefore
     Poole can take eight patients at any one time, which is more than the
     Hyperbaric Medicine Unit due to be moved to St Richard’s Hospital;


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•   That the Royal Navy do not tend to use the Hyperbaric Medicine Units
    operated within a local area and do not use HM Coastguards for
    assistance. The Navy manages any incidents in-house. The Navy do
    have one Hyperbaric Chamber on Horsea Island, but this is strictly only
    for Army and Navy use. This facility has no accident and emergency and
    is therefore a Category 2 facility.

The Panel then heard from Police Sergeant Andy McMahon on behalf of Lorna
Dennison Wilkins for Sussex Police Specialist Search Unit.
The Panel was informed:
•   That there are eight police divers based at Shoreham-by-Sea in West
    Sussex. The counties of Kent, Surrey and Hampshire do not have their
    own specialist search units so the West Sussex unit covers all of these
    areas;
•   That Police diving can be very hazardous. Some operations have been
    known to search under ships for drugs, and have dived to deep depths;
•   The Police Specialist Search Unit always carry out casualty evacuations
    and risk assessments before doing a dive. As part of this they will ring or
    contact the nearest local Hyperbaric Chamber (currently Royal Hospital
    Haslar) in order to make sure that the Chamber is online for the day. If
    not, the next nearest chambers are contacted;
•   That the Specialist Search Unit have medics who are able to treat the
    early symptoms of Decompression Illness, but if there is ever a major
    incident the Police diver would have to transported to a Hyperbaric
    Medicine Unit. This is why close liaison are always kept with the next
    Hyperbaric Chamber;
•   That if the Hyperbaric Medicine Unit does move to St Richard’s Hospital it
    will work within Sussex Police’s favour as it will be more central for them;
•   That the two landing sites at St Richard’s Hospital can be difficult to
    access by helicopter: the site next to Accident & Emergency is dependent
    upon westerly winds for landing and the second site is only transportable
    for patients by ambulance. This could cause problems if there any
    casualties suffering from DCI heading to the chamber at St Richard’s;
•   That an incident involving a Sussex police diver has not yet happened, but
    a diver in Avon and Somerset area recently had to be rushed to a
    Decompression Unit suffering from vesicular bends. This diver had spent
    18 minutes at 27 metres, which is not particularly deep. This shows that
    Decompression Illness can happen suddenly and at shallow waters;
•   That the closure of the Hyperbaric Medicine Unit for the possible nine
    months listed may have an effect on Police diving, as particularly deep or
    hazardous dives will have to be rigorously risk assessed to ensure Police
    divers are not at risk. Sussex Police will continue to assess all dives.

The Panel then heard from Katie Benton, Scrutiny Support Officer, who
detailed the key points QinetiQ’s written statement.
                              (TAKE IN REPORT)
The Panel was informed:




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    •   That QinetiQ states that the main operational reason for the running of the
        Hyperbaric Medicine Unit is to train the Ministry of Defence’s Medical
        Officers in diving medicine, and to provide support for diving training and
        operations. However, without a steady flow of both elective and
        emergency patients, QinetiQ would not be able to run the Hyperbaric
        Medicine facility (and maintain staff skill, currency and competence).
        Therefore the unit must be dependent on patients from outside the
        Portsmouth area, as Portsmouth City Teaching Primary Care Trust does
        not approve funding for treatments other than Decompression Illness and
        Air/Gas embolisms.
    •   That QinetiQ only provides two paragraphs in relation to the reprovision of
        the Hyperbaric Medicine Unit service. In these, QinetiQ explain that it was
        a coincidence of time and budget constraints on the Ministry of Defence
        and the Portsmouth Hospitals Trust development programme that meant
        a decision to relocate the HMU at Queen Alexandra Hospital could not be
        agreed. It then states that it is cheaper for the taxpayer to move the
        Chamber to St Richard’s Hospital in Chichester;
    •   That there is still a question over fit for the future or the possible merger of
        Royal West Sussex NHS Trust and Worthing and Southlands NHS Trust
        and whether this possibly affects the move of the Hyperbaric Medicine
        Unit to King Richard’s Hospital.

6   Date of Next Meeting

    The date of the next meeting of the Health Overview & Scrutiny Panel is
    Wednesday 4th March 2009 at 2.00 pm in Conference Room B.

    The meeting closed at 15.25 pm.




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