Agenda item

10:30

In light of recent increases in emergency department waiting times, representatives from the Oxfordshire Clinical Commissioning Group (OCCG) will attend to explain the system-wide approach to managing pressures on urgent care. An urgent care update report is attached at JHO7.

Ian Davies addressed the meeting in relation to Agenda Item 9 also. He urged the Committee to look at services under threat at the Horton Hospital as a whole, and not as a two stage consultation process, adding his warning that there was a real possibility that Accident & Emergency and Paediatrics service would also be closed. He added his concern that the two stage process lacked clarity and caused a prolonged uncertainty for the public. He pointed out that there were several small birthing units in the country with fully integrated obstetric services made up of a large number of doctors and which fully satisfied their training needs. He urged strong challenge from the Committee and for these services to be reviewed as a matter of urgency.

Cllr Kieron Mallon urged the Committee to consider the ‘excessive’ travel time from Banbury to Oxford in the event of a need for obstetric care as a result of complications. To add to this, as had been extensively reported on local BBC news, the Committee should consider the lack of public transport to Oxford from the suburbs of Banbury should travel by car be not an option; the 90 minute to 2 hour travel time; and the need to allow up to 1 hour for parking at the John Radcliffe. He highlighted his concern for vulnerable mothers from the ethnic minority population in the Banbury area who had been cited in studies as more likely to suffer complications in pregnancy. He reminded members that areas of Banbury had been included in the top 20% of the most deprived households in England, pointing out there had been no evidence to suggest that Health had considered demographic evidence in detail. He added that the Brighter Futures Programme had documented the importance of a feeling of safety as a contribution to a state of well-being for the most disadvantaged. Cllr Mallon also cited the ‘misleading maternity information’ given to pregnant mothers that most of the young were a low risk. In conclusion, he asked, on behalf of Banbury Town Council, that the proposals be reviewed as a matter of urgency.

Eddie Reeves addressed the meeting as a local resident of Banbury Calthorpe ward. He stated that he often found it a chastening experience when, in his occupation as a local solicitor he drafted wills bequeathing monies to Horton General Hospital. He urged the Committee to ensure that it remained a General Hospital. He made reference to the written submission made to Committee Members from Cherwell District Council and to the fact that the local MP was collating journey times to the John Radcliffe Hospital made by her residents. Mr Reeves stated his view that there was a great need for a fully functioning Horton General Hospital in Banbury, in view of its growing size and stature and in its role as a strategic centre in the north of the County. He re-iterated Cllr Mallon’s belief that the two-stage consultation process was flawed and stated his concern that decisions had already been made ahead of the public consultation. Furthermore, these decisions were detrimental to both the residents of Banbury and those over the county border in South Northamptonshire who relied on the Horton’s services.

David Smith, Chief Executive of the Oxfordshire Clinical Commissioning Group (OCCG) and Diane Hedges, Chief Operating Officer and Deputy Chief Executive, OCCG attended. Diane Hedges introduced the report highlighting that the management of pressures on Urgent Care was a continual challenge due to a number of factors detailed in the paper, but Oxfordshire was performing well compared to other areas nationally. However there was no complacency and there was a recognised need to look at process at the front end, in particular, flow through the hospital.

Members of the Committee asked questions exploring a number of issues, including:

·         The recent alert status at the John Radcliffe Hospital, which resulted in some elective surgery being cancelled;

·         A complaint that an outpatient appointment was cancelled after the patient had started their journey to hospital;

·         The split between Adult Social Care and the Health Service in relation to the 122 Delayed Transfers of Care;

·         The length of time ambulances were waiting outside Accident & Emergency in order to discharge their patients;

·         Lack of promotion by OCCG of the GP Out of Hours service;

·         The relationship between discharge delays and the recent closure of beds across hospital sites and the possibility of some beds being re-commissioned;

·         Possible additional pressure on GP practices from the discharge of patients to their homes;

·         The new model of ‘ambulatory by default’ exposing issues in the post-acute sector.

Health representatives responded with the following:

·         There was a period 2 weeks ago when 7 elective operations were cancelled but, in the main all the doors were open. Members of the public were being reminded to use their local GP or local pharmacy where appropriate;

·         The cancelled outpatient appointment was unfortunate and an apology was given. This was not normal action to take and indicative of the pressure the hospital was under;

·         The reasons for delayed transfers could be due to a number reasons affecting health care and social care. Management initiatives, such as the reablement contract were often multi-disciplinary and couldn’t be singled out;

·         There was not a major ambulance queuing issue currently compared to 2/3 years ago - Performance figures would be sent to the Policy Officer. Oxfordshire was performing better than many other Health authorities in the southern region;

·         There were some staffing pressures for the Out of Hours service over this year’s winter period but it has seen 6,000+ patients which was 20% more than in previous years. There had also been 30% more home visits than in the previous year. Thus, to some extent, the service was being successful at keeping patients in their own home;

·         Approximately 146 beds have been closed and 164 patients had become medically fit for discharge from the JR and the Horton hospitals. The major issue was about the support given to patients when they leave hospital, not the beds;

·         The Liaison Hubs were the right place to assess patients leaving hospital if they had any needs upon discharge. All patients then had the opportunity of reablement services. The intention was not to put pressure on GPs and the OCCG was mindful of getting the balance right;

·         The current initiative of carrying out ambulatory care by bringing the GP Out of Hours service into the JR, had not proved as successful as was hoped because the current premises were not suitable. The OCCG was constantly seeking other ways of ‘breaking the cycle’.

At this point with regard to the management of pressures on urgent care in maternity at the Horton General Hospital, the Chairman then invited local member, Cllr Arash Fatemian to speak about the continued temporary closure of the Obstetrics Unit and the proposals contained within Phase 1 of the Oxfordshire Transformation Plan. He stated that the latest update on the position (dated 23 December 2016) on the recruitment of Obstetric doctors by Oxford University Hospitals NHS Foundation Trust (OUH) which had stated that:

‘The OUH Trust Board made a decision on 31August 2016 that obstetric-led maternity services at the Horton could not safely be maintained. They (the Board) required the decision to be reviewed so that if enough doctors were recruited to run the service it could be reinstated.

The service was initially temporarily suspended with effect from 3 October 2016 with the hope that if enough doctors were able to be appointed in the meantime, then the service could reopen in January. This decision was reviewed at the end of October, and it was clear that there would only be three doctors in post in January out of the 9 needed. Therefore the suspension was extended again until March and it was decided to review the situation again in December after the next round of recruitment and advertising.

That situation was reviewed again this week and unfortunately, the current number of obstetric doctors remains at 3 and the maximum number of doctors likely to be in post by March is 5, which is not enough to reinstate the service at that point.’

Cllr Fatemian referred to this Committee’s decision at the 30 September meeting, when it decided not to refer this matter to the Secretary of State, on the evidence that it was satisfied that OUH had adequate reasons for acting without consultation on the basis of urgency relating to the safety or welfare of patients or staff. The Committee agreed to monitor the temporary closure and the recruitment plan which was in place to increase staffing levels. The Trust’s update on performance of maternity services at the Horton, dated 23 December 2016, stated that they would not have enough experienced and skilled medical staff in post to reopen the unit in March 2017 as planned.

At the request of the Committee, Nick Graham, Director of Law & Governance advised that the grounds for referral to the Secretary of State were limited to circumstances where the Committee did not believe the reasons given for closure of the Obstetrics Unit to be adequate. In terms of procedure, if the Committee would have to demonstrate that it had taken steps to agree a local resolution with the Trust and there had been a lack of resolution.

David Smith confirmed that the OUH was still in a position that there were insufficient doctors to run the service. In response to concerns raised by the speakers that the two-phase OTP consultation was flawed, he stated that the OCCG was consulting in this manner as previously agreed with the Committee on 30 September.

On the conclusion of the discussion it was AGREED

(a)  to thank the OCCG for the update on the management of pressures on urgent care;

(b)  (on a motion by Cllr Fatemian, seconded by Cllr Bulmer and carried unanimously), that, without prejudice, to refer the temporary closure of the consultant- led obstetrics unit at the Horton General Hospital to the Secretary of State for Health under Regulation 23(9)(b) of the 2013 Regulations, for consideration on the following grounds:

(1)  that the Committee believed that the material grounds for not referring the matter had changed, ie. the Trust’s recruitment plan had failed and the closure would now be longer than envisaged; and

(2)  it considered that nothing could be gained by further discussion at a local level with the Trust.