Agenda item

11:30

Diane Hedges, Chief Operating Officer and Deputy Chief Executive of OCCG will update the Committee on the development of system-wide Transformation Plans (TP), including a draft plan for consultation and engagement for consideration by the Committee (JHO8).

Ian Cave, Sustainability & Transformation Plan Programme (STP) Director will present an update on the Sustainability & Transformation Plan for Buckinghamshire, Oxfordshire and Berkshire (BOB) (JHO8).

Prior to discussion on the Oxfordshire Transformation Plan (OTP) and the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Sustainability & Transformation Plan (STP), the Committee was addressed by the following speakers:

Roseanne Edwards, speaking in the interests of electors in Banbury, put forward the view that the public did not want the BOB STP, adding that the BOB STP Plan ordered that at every stage, communications experts were to be employed ‘to dress up the bad news as deliriously good’.  She commented that the Trust had made temporary, changes at the Horton ‘to make the STP easier to push through’ which demonstrated ‘how damaging and dangerous the STP would be.’ She recounted some recent  stories reported to her in the last week which demonstrated to the Committee and NHS managers, who ultimately bore the responsibility, that the consequences of STP wold be ‘unjustified and completely unacceptable.’

She asked what about post STP? commenting that managers did not know as it was untried. She asked then ‘what about Plan B? and if there was a way back ‘when it proved unworkable.’  She urged the Committee to act in the interests of electors and refer any Horton Hospital downgrading to Jeremy Hunt, adding that the loss of the Horton’s maternity, acute medicine, paediatrics, trauma and Accident & Emergency would cause ‘utter chaos’. She also stated her view that the John Radcliffe could not cope at present, and it too would have to reduce beds under the Plan. She added that ‘as a foundation trust it would soon be offering 49% of beds to private patients’.

Dr Elizabeth Peretz stated her belief that the Committee would be asked to endorse ‘devastating’ cuts to the Health service, via the STP and OTP and emphasised that these plans must be made available to the public to comment on. Also that they should be presented as a whole system as there would be no other way to see if they were sustainable or not. She also asked that the Committee seek clarity and assurances about the finances, and in particular, the timetable for signing off contracts, to ensure that they do not sign off any binding contracts before the final consultation document is brought before the public. In conclusion she called for an NHS that is both fully funded and public.

Clive Hill urged members of the Committee to remember that the primary role of this Committee was to ‘strengthen the voice of local people’ and its job to challenge OCC and the OCCG. During the course of his address he related some of his concerns about the proposals to be contained in the STP and OTP to a number of measures taken by OCC and the OCCG to, in his view, ‘downgrade’ the Chipping Norton Hospital. He urged the Committee not to be railroaded and to study the situation at Chipping Norton. He also put forward the view that the Chipping Norton Hospital had all its needs on one site, ie. beds, consultants, clinics, physiotherapy, maternity, the GP Surgery and Pharmacy; adding that it did not require reinventing, but the beds needed to be reverted back to NHS beds.

Keith Strangwood urged the Committee to take action and use its power to refer to the Secretary of State any attempts to downgrade the Horton Hospital’s facilities once the final STP and OTP documents came before the Committee.

At the request of the Chairman, the Oxfordshire Transformation Plan (OTP) was taken first. Diane Hedges and Dr Joe McManners attended from the OCCG, Stuart Bell from Oxford Health (OH) and Andrew Stevens from the Oxford University Hospitals NHS Trust (OUH).

Diane Hedges introduced the paper (JHO8) which laid out plans to conduct two public consultations on OTP proposals. She emphasised that the purpose behind the OTP was to achieve more efficiency for the resources which were already in existence and not to make cuts. She reminded the Committee that people were living longer and, although resources were matching inflation, they were not matching the level of demand, which had increased considerably. She explained that the OCCG wanted to design services differently and, for example, use a different skill mix such as the emerging Advanced Senior Nurse Practitioners.

It was explained that the OCCG would be publishing a summary of the Plan before the end of the month, and the version of the full plan in early 2017. The reason for this was that the OCCG was currently going through a contracting round to agree funding over the next two years.

A member expressed concern about the decision to separate the consultation into two phases, particularly as the battle against changes to community services would be prolonged. The preventative work that OCC’s Social Care were having to do due to cuts in local government provision was highlighted and concern expressed that local authorities were starting to drop out of the picture.

The Committee wanted to ensure that communities were made aware of the impact the proposals would have on them. Diane Hedges responded that the CCG would have wanted to address all the proposals in January, but a broader picture was required that would identify the future shape of services in each locality and the OCCG needed time to prepare this. She added that splitting the consultation would mean areas of greatest concern regarding patient safety could be covered in January.

A Committee member responded that there was a need to challenge the NHS to be more realistic about prospective time periods for consultation. She cited the temporary closure of Wantage Hospital, which remained closed whilst consultation periods were deferred, and the temporary closure of the obstetric-led service at the Horton Hospital, pointing out that the NHS was asking a lot of communities given the scale of public passion for local services. Stuart Bell commented that the Midwifery and Physiotherapy Units at the Horton Hospital, and all community hospitals, would be continued.

A member stated his concern about the ‘decoupling’ of the OTP consultation emphasising the need to rebuild trust amongst the public in the north of the county and for them to be given the opportunity to respond to the proposals via a focussed consultation.  He also commented that there were areas where better care outcomes could be delivered, for example in critical care. It was his view that the OCCG could explore ways of giving GPs more experience in other areas, as a means of attracting more to the profession.

Stuart Bell emphasised the importance of doing more work in the primary care arena, meaning longer engagement was needed, to make it more resilient. . He reminded the Committee of its requirement at the last meeting that there be a consultation on proposals to reconfigure acute beds in January, whatever the situation was with the OTP. Furthermore, he gave his reassurance that the NHS was acutely aware of the impact of social care on Health.

A member of the Committee expressed her concern about whether there would be sufficient funds to provide the extra staff needed. Diane Hedges stated that this information would be in the consultation paper and would be made clear.

Diane Hedges was asked when the GPs would be consulted on the Plans in view of how much they were expected to be involved. She explained that a representative from each locality was on the OCCG Board and each locality was conducting discussions with GPs about the implications and impact of the proposals on their patch.

Members expressed concern about the absence of primary care proposals in the plans for consultation and the apparent lack of join up with GPs. Dr McManners stated that primary care was being viewed as an enabling work stream and therefore  it was essential to try to sustain models already in place and not to have new structures. He added it was about trying to include capacity, stating that the OCCG would have a primary care strategy very soon  to discuss with GPs. Stuart Bell confirmed that proposals in phase 2 of the consultation would focus on services that link the most with primary care.

In response to fears from a  Committee member that a decision had been taken already to remove all services from the Horton Hospital, Andrew Stevens referred to the paper presented stating that splitting the consultation would enable a greater public focus on OUT’s proposals. He reassured the Committee that no decision had been made on any of the options for acute services as yet.

Members of the Committee then, in discussion with Diane Hedges and Andrew Stevens AGREED to approve the consultation Plan as presented and to AGREE that the OCCG should proceed with phase 1 of the consultation in January and requested that:

·         With regard to options relating to obstetric/midwife-led units in the north of the county – if any proposal impacts on any surrounding services, then information on this should be included in the consultation;

·         Options around the closure of any other service at the Horton Hospital be included and considered together, for example emergency abdominal, viability of paediatric care, Accident & Emergency – and if they are not included in the first phase, then nothing in the first phase would prejudice the second phase;

·         Proposed delivery of planned care at the Horton would be included in the consultation paper and the impact of changes in GP delivery would be made clear;

·         That the geographical detail be easily identifiable so that the public can be clear about proposed changes to be made to services in their locality; and

·         Clarity on the meaning of ‘ambulatory’ care.

The Committee was then given a presentation by Ian Cave, Sustainability & Transformation Plan Programme Director, updating members on the latest situation with the STP in which he emphasised again that it was not about cuts, but about being more efficient. He reported that a summary of the Plan would be published in early 2017 – and explained that the aim of the recent contracting round was to engender a clearer position. Ian Cave was joined by Gary Ford, Chairman of the STP Oversight Committee and Diane Hedges, Chief Operating Officer & Deputy Chief Executive, OCCG.

Gary Ford stated that, as a clinician, he was keen on establishing a prevention programme and achieving better collaborative working across services in the Thames Valley region where this would add value.

Dr McWilliam clarified that confusion had occurred with regard to the role of Oxfordshire local authorities in the whole process. As statutory bodies, local authorities in Oxfordshire and this Committee were not part of the STP process, nor signatories to the OTP. However, officers working across the system were continuing to work with colleagues in Health for the good of patient care. This did not presuppose any position of local authorities as independent statutory consultees on these Plans.

In response to a question about what ambulatory care meant, Dr McManners explained that currently GPs could assume a stay in hospital for their patients which would be a few days whilst tests and treatments were completed. The Plans worked on the premise that all assessments would be completed quickly to enable patients to go home more quickly.

A member asked where public engagement would be on the STP, particularly in light of the statement ‘public consultation where required’. Stuart Bell explained that there was little in the forthcoming Plan that had not been discussed in this Committee over the last year. He was pleased that now there was an opportunity for people to realise that.

A Committee member asked why there had to be an STP and why couldn’t Oxfordshire continue to work with partners in spite of an STP? Gary Ford responded that the aim was not to increase bureaucracy, but that collaboration should already be taking place and the STP would clearly capture the benefits of working together. Mr Bell commented that the STP had no formal status and that it was a process to which a number of national bodies were accountable to the Government. It required the NHS to both describe and give a good case for how challenges were approached, such as how to put a limit on resources. If the STP was not to be rolled out, then the ability to access a fund would be declined. He added that given the circumstances the NHS faced, it was important to take a planned and integrative approach. The Chairman felt it important that the Committee spent some time to establish how it all fitted together in a special meeting.

A member commented that it would be excellent to utilise the very good skills staff at the Horton Hospital possessed in Trauma Treatment and the 111 service. Diane Hedges responded that the STP was indeed about prevention, including linkage with the 111 service. She explained that the NHS would continue to meet the care needs of patients, but how they were met would change. Efficiencies did not mean cuts, ie. a withdrawal of service.

A Committee member asked if areas within the Buckinghamshire, Oxfordshire and Berkshire West (BOB) footprint had large debt and whether under the STP this would make Oxfordshire liable for such debts. Stuart Bell responded that the STP was relatively positive in this county. There was a need to look at how some issues were addressed locally. Other areas, such as workforce development, would be addressed across the piece. He confirmed that the 2% efficiencies each year expected from the NHS would continue throughout implementation of the STP.

A member commented that diagnostic services at Hubs needed to be underpinned by access to acute services and this was proportionate to the level of deprivation in a community. If most of the acute activity was to be centralised in Oxford, he asked what about the needs of the most deprived areas in Oxfordshire as a whole?  Diane Hedges agreed that there were greater needs found in areas which would be best addressed targeted investment in community services. She added that there was a need to consider the outcomes of the Health Inequalities Commission.

In response to comments from Committee about the problems of accessing care centrally from Oxford for some patients, Gary Ford commented that a much better patient experience could be had for certain groups of patients from the EMU’s in Abingdon and Witney, for example. Moreover, pharmacies could be used more frequently than they were. It was about having the right quality of care in the right place. Diane Hedges stated that more links were needed with local communities.

A member asked if it was considered in the NHS that public consultation was required on the STP and what engagement with Adult Social Care had there been in relation to the STP. Diane Hedges responded that public consultation would be required for the OTP, but with regard to the STP there was an uncertainty. Gary Ford responded that some of the general elements of planning contained in the STP had already been repeated at meetings, but there was a need to look at what the focus was and its key areas of benefit.

Dr McWilliam responded that OCC, as a formal consultee, would be responding with regard to the broader issues of the proposals for Adult Social Care. He confirmed that implications for pooled budgets and any other aspects of Adult Social Care would be discussed over the coming months. The Chairman added that this was an area that the Committee needed additional information on.

The Chairman thanked all for attending and suggested that a special meeting be held to look at the STP document, which it was understood, was now in the public domain.