Agenda item

14:20

At the last Meeting, the Joint Committee asked Oxfordshire Clinical Commissioning Group (OCCG) and the Oxford University Hospitals Foundation Trust  (OUHFT) to report back, in line with their timetable on the progress with the following information for consideration at this Meeting:

(a)      Report on the survey conducted (independent consultant, Pragma to present);

(b)      Workforce Analysis;

(c)       Financial Analysis;

(d)      Options Appraisal and Outcome;

(e)      Review of small units;

(f)        Next steps

The reports are attached at HHOSC7

At the last Meeting, the Joint Committee asked Oxfordshire Clinical Commissioning Group (OCCG) and the Oxford University Hospitals Foundation Trust  (OUHFT) to report back, in line with their timetable on the progress with the following information for consideration at this Meeting:

(a)      Report on the survey conducted (independent consultant, Pragma to present);

(b)      Workforce Analysis;

(c)       Financial Analysis;

(d)      Options Appraisal and Outcome;

(e)      Review of small units;

(f)        Next steps

The following attendees were present: Anna Hargrave, South Northants CCG; Rosalie Wright; Lou Patten, CCG; Catherine Mountford, CCG; Ally Green, CCG; Veronica Miller, OUH; Kathy Hall, OUH; Sarah Breton, CCG; Helen Mills, Pragma and a further representative of Pragma.

(a) Helen Mills introduced the report on the survey detailing the methodology used in the research.

Ally Green highlighted comparisons and detailed the statistics within the paper setting out the conclusions drawn. Ms Mills added that overall anxiety for mothers to be peaked during labour and giving birth. Reference was made to the 2016 Review and the hierarchy of improvements that matched their own work. The priorities matched the improvements suggested by the focus groups and interviews. Issues around parking were coming through strongly.

Ms Mills went on to refer to the position with regard to The Horton. Before the changes locally it had been the default choice. The closure had increased anxiety with families weighing up the fact of the Midwife Led Unit at The Horton against the distance to the John Radcliffe Hospital.

Representatives responded to questions from Members:

·         The quantitative data presented was truly robust. Where qualitative data was included the quotes were chosen to represent the points made. Referring to the word bubbles on page 30 of the report Members noted that the word ‘Care’ could be taken in two ways. It was accepted that some interpretation of the qualitative data was necessary.

·         Responding to points that the vast majority of women in the local area would choose The Horton if there was an obstetrics unit available Ms Mountford caveated the information available. It was true for certain areas and when breaking it down it was necessary to be cautious as the numbers may be at low levels.

·         Asked to distil their perspective on the work done Ms Mountford stated that the maternity experience was very individual. The changes at The Horton had impacted differently at different stages of pregnancy. Decision-making was impacted. Anxiety around the decision-making had increased.

·         The research was a unique opportunity to be able to survey people following the changes but before the final decision was made. It would be helpful going forward.

·         Asked about the impact of mother’s anxiety on the unborn child members were advised that the issue of anxiety was taken very seriously, and the Trust was supportive.

During discussion members considered the information provided and expressed concern at the spikes in anxiety levels for pregnant women evidenced in the research. The Chairman in noting the anxiety levels stated that the Committee remained to be convinced that outcomes could be used as a measure of success.

(b) Veronica Miller and Rosalie Wright introduced the paper setting out the workforce analysis.

Representatives responded to questions:

·         OUH offered rotations to staff and considered where staff wanted to work. There were some keen to work at The Horton. At the moment there were less opportunities to work in the North of the County due to the lower number of births.

·         Asked about their response to the offer from Cherwell District Council (CDC) to discuss key worker housing Ms Hall stated that they were willing ready and open to working with CDC. T was a question of waiting for planned developments to take place.

·         Ms Mountford explained that in terms of staffing numbers they had taken the best model for Option Ob9. This was a delivery model option rather than straight staffing.

·         Responding to the query from Jenny Jones that KTHG be invited to the RCOG event Kathy Hall indicated that it was not in their gift but that they would ask on their behalf.

·         A member sought assurances that the very best processes to secure successful recruitment were being employed including the use of professional consultancy where appropriate. He referred to a successful NHS Conference in Manchester with several consultancies. The Committee was advised of the range of approaches being used. It was suggested by the Chairman that the member share with Sam Shepherd the details of the successful recruitements

As a result of questions on what additional staffing would be needed for the hybrid model there was a short adjournment for more detailed information to be provided. It was stressed that this detailed information was publicly available and the paper to the Committee had sought to draw out the main points.

During discussion of the additional information Veronica Miller advised that more staff were needed to run a rota across two sites in an integrated staffing model than was needed to run two sites independently of one another. Kathy Hall added that a rota which just works for the smaller unit was better than using a rota across the trust as a whole. After lengthy discussion of the numbers involved Lou Patten recognising that the method of displaying the information was currently not clear undertook to make the information clearer and to circulate it between meetings.

(d) Catherine Mountford introduced the Options Appraisal and Outcome paper highlighting the 2 options that they saw as being better than any others and worth taking forward.

During discussion the Chairman suggested that the top 4 were worth taking forward. The Chairman expressed disappointment that the Committee had not been included in the weighting process as had been agreed. He further expressed disappointment that it had been agreed to keep them blind but to share them with Nick Graham, as the County Council’s Monitoring Officer. This was not done before the scoring and did not encourage a feeling that there was transparency or engender trust. The Chairman was not suggesting that they had been changed and Catherine Mountford apologised that they had been sent late but that they had not seen them until after the event. Ms Mountford added that two units and options 11 and 10 were not mutually exclusive.

(e) Sarah Breton introduced the work on small units. Ms Breton highlighted that where there were successful small units there were two small units in an area. Oxfordshire was very different having one unit having a very large number of births and any second unit having possibly a very small number of births. They had made contact with Furness with a view to a visit. The Chairman suggested that if the decision was taken to fully back two units then the smaller unit would be able to broaden its catchment and be not so small.

(c) Ms Mountford presented the contents of the finance paper. The Chairman queried whether it was possible to index the figures given the birth rate changes. Ms Mountford replied that there had been massive changes I the way figures were collated. The Chairman stressed that that proportionality was not sufficient, and he would like to see like for like figures to be able to understand the potential loss of income. Ninety-seven percent of mother to be in South Northants would have chosen The Horton and that would bring in income. Lou Patten undertook to see what it was possible to do.

Following consideration of each of the papers the Committee considered next steps. It was AGREED:

(a)  To note the work completed and the outcome of the option appraisal process;

(b)  Note that OCCG and OUH will be working on pulling together the findings from the Horton HOSC workstreams and any additional information into papers for the CCG meeting in September

(c)that the Horton HOSC arrange a date significantly in advance of the CCG Board paper

(d)  that representatives of other small obstetric units be invited to attend the Committee, to give evidence of how they work to achieve their aims and retain their training accreditation, at a date to be arranged but in sufficient time for any findings to be considered as part of the OCCG meeting.