Agenda item

Daniel Leveson (BOB ICB Place Director, Oxfordshire); Lucy Fenton (Transformation Lead – Primary, Community & Dental Care

Oxford Health NHS Foundation Trust); Susannah Butt (Transformation Director-Primary, Community and Dental Care, Oxford Health NHS Foundation Trust); Dr Ben Riley (Executive Managing Director- Primary, Community and Dental Care, Oxford Health NHS Foundation Trust); have been invited to present the final co-produced report providing details on both the outcomes of the Public Engagement Exercise around Wantage Community Hospital, as well as on the final offer as to which specific services will be provided at the Hospital following the closure of the in-patient beds in 2016.

 

Based on the feedback of the HOSC Substantial Change Working Group (to be provided verbally during the meeting on January 16^th), the Committee will be required to AGREE on:

 

1.    Whether or not to declare the closure of beds at Wantage Community Hospital as a Substantial Change, and,

 

2.    Whether or not to refer to the Secretary of State for Health and Social Care the matter of the closure of beds at Wantage Community Hospital.

 

PLEASE NOTE the following:

 

The Committee’s Substantial Change Working Group will be meeting on Friday 12th January, where it will be making its final decision on what it will be recommending to the wider HOSC on 16th January. The reasoning behind the Working Group meeting being scheduled at a date that is close to the formal HOSC meeting on the 16th is due to the fact that it is pivotal that the Working Group and the wider HOSC take the outcomes of the Wantage Town Council Health Committee Public Meeting on 11^th January into account prior to making a formal decision on whether or not to; refer this matter to the secretary of state and as to whether or not to declare the closure of the in-patient beds at Wantage Community Hospital as a Substantial Change.

 

The following documents are attached to this item:

 

1.    A report by the Health Scrutiny Officer, outlining the context and explanations as to what it is the Committee will be required to decide on during this item.

 

2.    The final co-produced report on Wantage Community Hospital outlining the outcome of the Public Engagement Exercise and the next steps and recommendations.

 

3.    A list of appendices including; a list of outpatient services delivered at Wantage Community Hospital, the HOSC History of the hospital, a Map of Community hospital inpatient locations, and a statement of support from Oxfordshire County Council on the recommendations being proposed as to how to configure the future services at Wantage Community Hospital.

 

4.    A report by Verve, the independent facilitator used for supporting the Public Engagement Exercise.

 

5.    A letter of support from the Chief Executive of Oxford University Hospitals NHS Foundation Trust on the recommendations being proposed as to how to configure the future services at Wantage Community Hospital.

 

Daniel Leveson (BOB ICB Place Director, Oxfordshire); Lucy Fenton (Transformation Lead – Primary, Community & Dental Care, Oxford Health NHS Foundation Trust); Susannah Butt (Transformation Director-Primary, Community and Dental Care, Oxford Health NHS Foundation Trust); Dr Ben Riley (Executive Managing Director- Primary, Community and Dental Care, Oxford Health NHS Foundation Trust); had been invited to present the final co-produced report providing details on both the outcomes of the Public Engagement Exercise around Wantage Community Hospital, as well as on the final offer as to which specific services would be provided at the Hospital following the closure of the in-patient beds in 2016.

 

It was highlighted that the Committee had received a written report from the Health Scrutiny Officer, which provided some context as well as clarity over the process around the decision that the Committee were required to make during this item.

 

The Committee Chair explained that the members of the Substantial Change Working Group (Cllr Hanna, Cllr Barrow, Cllr Champken-Woods, and Cllr Hayward) had considerations as well as provisional recommendations which were to be shared verbally with the Committee by herself.

 

The Chair reminded the Committee that 31 January 2024 was the date that formal powers of referral to the Secretary of State by HOSCs were to be removed by the government, and that this had influenced the necessary timing of this extra meeting and the intensity of work; including the public meetings that had been held in the lead up to the HOSC meeting. 

 

The Oxford Health (OH) Executive Director of Primary Care and Community Services explained that the Public Engagement Exercise had represented an intense piece of work over the last 6 months, and it presented a fantastic opportunity to engage with local representatives and members of the stakeholder group to determine a secure future for Wantage Community Hospital. It was explained to the committee that the coproduction with the local stakeholder reference group had shared various different sources of information and types of data available on the health needs of the population (including the Joint Strategic Needs Assessment as well as service data) that supported the findings in the report.

 

The Committee were informed of the importance of the local community’s engagement in the exercise and its stakeholder engagement events, and how the NHS had taken the views of the local community seriously and that these had influenced the recommendations.

 

The OH Executive Director of Primary Care and community Services also reiterated the three scenarios as to how the hospital’s future ground floor services that were presented to the community during the engagement exercise, and explained that there were some key principles that would be used to guide the decision as to the future services. Such principles included a consideration that the community wanted clarity about a secure future for the community Hospital and that it was imperative for there to be sustainability around the future services that would be agreed and delivered.

 

It was explained to the Committee that the recommendation that was ultimately proposed in the co-produced report was that the closure of the inpatient beds would become permanent, and for the redevelopment of the ground floor of the hospital into a clinic-based facility.

 

The OH Executive Director of Primary Care and Community Services stated that the Trust would progress an application for Community Infrastructure Levy (CIL) funding to support the refurbishment of the hospital’s ground floor, but that the application would only proceed depending on the decisions of HOSC on the report.

 

The Committee were informed that letters of support had also been obtained from key stakeholders, who were supportive of the recommendations outlined in the co-produced report. These included letters of support from Oxford University Hospitals NHS Foundation Trust as well as Oxfordshire County Council.

 

The BOB Integrated Care Board (ICB) Place Director for Oxfordshire also expressed thanks to Wantage Town Council and the stakeholders who participated in the Public Engagement Exercise; and explained that upon assuming his post as ICB Director of Place he had heard two things. Firstly, that the community wished to reengage with the NHS; and secondly, that they wished to resolve a secure future for Wantage Community Hospital. The Place Director thanked the Town Council and Stakeholder reference group for engaging in the process which had planned outcomes.

 

Cllr Hannaby, Chair of the Wantage Town Council Health Committee, was invited by the Chair to read out the motion that was passed unanimously:

 

“The Council notes that the co-production exercise had determined that:

 

1.    On average 1361 OX12 residents per year currently access the Minor Injuries Units elsewhere in the County – predominantly in Abingdon. It’s estimated that this will grow to 1745 visits per year with the forecast population growth.

2.    Approximately 60 OX12 residents through the year are placed in In-patient Community Hospital beds elsewhere in the County (5 per month with a 34 day average stay). This number is not expected to grow due to the changes in alternative health and care pathways.

3.    Currently, 1445 OX12 residents per year have used the ophthalmology outpatient appointments pilot at Wantage Community Hospital. The ICB have indicated that approximately 21,168 OX12 residents per year would benefit from expanded outpatient services if additional clinic space was made available (30,240 visits in total).

4.    Within the hospital building there is insufficient space to provide more than one of the options of inpatient beds or expanded outpatient clinic offering.

5.    The capital cost of providing a MIU in Wantage would be in excess of £3 million given the need for it to include comprehensive X Ray facilities to be fully viable.

Given the above the Council is minded to support the recommendations of the co-produced report. Namely the permanent retention of existing outpatient pilot clinics and additional outpatient services which would be facilitated by accessing approximately £600,000 of CIL funding to carry out necessary refurbishments and other capital expenditure.

 

In agreeing to the above the Council also:

 

1.    Welcomes the commitment by the ICB to bring forward plans to source palliative care beds in the local community but also will continue, through discussions with Health partners including OCC Social Services, to seek ways by which early discharge and inpatient rehabilitation can be provided locally – for example within local nursing home settings.

2.    Appreciates the engagement with health partners so far and wishes to continue this to identify means by which services provided by a Minor Injuries Unit or First Aid Unit could be sourced locally. For example, we note that GP led Urgent Treatment Centres are provided in some communities and would, inter alia, wish to explore if this is a facility that could be provided at Mably Way.” 

Cllr Hannaby added her own observation that she hoped that in the future there could be local availability of national capital funds for much needed local health resource. However, Cllr Hannaby emphasised that Wantage Community Hospital needed to have a permanent future as local councillors had been active in pressing for this as far back as 2006 when plans for the closure were made public. The plan, funded by CIL capital and existing revenue, would give the hospital this security and additional much needed hospital services. Working on the plan would mean continued trust in the NHS and a leap of faith, but she welcomed co-production and thanked the BOB ICB Director of Place for his offer to meet with the public again in June to share progress. 

 

The NHS were asked for their response to the Wantage Town Council motion, and the BOB ICB Director of Place welcomed the motion and thanked the Town Council and the stakeholder reference group. The Place Director explained that the NHS would clarify that the 3 million costing for a walk-in Xray is for capital and revenue costs and that the palliative care commitment was to continue to work with stakeholders so that Wantage would be included as a local area for additional services. 

The HOSC Substantial Change Working Group welcomed the good understanding that had been achieved and that once delivered, the plan would give Wantage Community Hospital a sustainable future and would provide a growing population with a foundation of increased hospital services for the community for the next few years, and that this could be built on as and when the context of financial, estate, and workforce constraints improved.  

The Chair highlighted that the Substantial Change Working Group had considered the co-produced report, and through scrutiny of the NHS engagement with the community and in agreeing to the recommendation NOT to refer this matter to the Secretary of State for Health and Social Care, had taken the following key points into consideration:  

1.     There was evidence of an intensive and good engagement process over six months: The Working Group considered that this had been a much improved experience for the stakeholder reference group and Wantage Town Council Health Committee. The HOSC Working Group and officer worked intensively since the February HOSC meeting through to now with direct scrutiny and weekly engagement. The Working Group expressed thanks to the NHS partners, the Wantage Town Council Health Committee, and the stakeholder reference group which included the previously worked with community on the OX12 who had been involved throughout. The wider Committee also thanked the public who participated in public meetings as well as the survey.  

 

2.     The Working Group noted that the report presented included a time-tabled plan to modernise the hospital, confirm temporary specialist clinics, and to open new hospital services. This differed from the experience of the community and HOSC of the OX12 project which, after a lengthy process, resulted in a report in January 2020 that recommended the hospital inpatient beds, subject to further work to confirm, should permanently close without any proposed plan for improved hospital services or a timetable. 

 

3.     The NHS had also agreed to both the size of the population currently at 33,179 rising to 41,000 by 2030, as well as the history of the community hospital with the stakeholder reference group with the assistance of HOSC research. The NHS offer contained in the report, once delivered, would provide expanded community-based specialist clinic provision at a time of growing need and integration across the NHS to better join up as well as increase provision.

 

4.     The likely loss of the benefit to Wantage Community Hospital and the area’s residents of CIL (Community Infrastructure Levy held for NHS health improvements in the Vale of White Horse) funding for the refurbishment of the hospital, and the likely loss of benefit of securing the future of the hospital for hospital specialist services was also taken into account. The Committee had heard from clinicians who had led the existing temporary hospital clinics that they wanted their clinic to be confirmed rather than being temporary in nature. The Working Group (and wider Committee) also heard from the public, who did not wish to lose the ophthalmology and other temporary clinics at the hospital.

 

5.     The stakeholder group had agreed that the plan proposed had to be sustainable to avoid the loss of services. Working up a plan had to take account of the enablers and constraints, as this would be crucial for sustainability of the plan as well as hospital-like services more broadly. The key enablers and constraints were shared with a Stakeholder reference group workshop and meetings, and were also subsequently shared with the public. These included:

 

(i)             Constraints of the estate available for hospital services in the community. Additional space had been a matter of liaison by the NHS with regard to whether estate was available at Mably Way Primary Care Network, although there was no available space at this time. 

 

(ii)            The national context regarding capital available for local infrastructure improvements meant that the only funding available were CIL funds held for health at the Vale of the White Horse. This was the funding available if made a priority by the NHS. This would happen if the HOSC supported the proposed recommendations in the co-produced report, with ongoing local scrutiny. A referral to the Secretary of State would have resulted in a delay to this funding.

 

(iii)          There were also constraints related to workforce. Dr Ben Riley had explained to the public that there were serious shortages of workforce in some areas such as radiography for X-ray services. However, other areas of the workforce were well provided for such as community nursing.

 

6.     The Working Group were pleased to see the letters of support and assurances that were provided with the co-produced report. It was reassuring to see the expressions of support for the proposed recommendations in the co-produced report from both Oxford University Hospitals NHS Foundation Trust as well as Oxfordshire County Council.

  

7.     The Working Group were pleased to see that there was a commitment to ongoing co-production with the community as part of the project delivery plan for reconfiguring the services to be provided on the ground floor of the hospital and wider integration. It was also positive to see that the offer was being made to meet with the public to report progress against the project in June.

The Committee were informed that 2022 marked the reopening of live births following OUH and HOSC liaison and the Wantage Stakeholder reference group; and the NHS had decided it would not be of interest to reopen this discussion as this service was confirmed. Options for the use of the ground floor were tested in respect of an inpatient hospital unit or repurposing the clinical space for a mix of specialist outpatient clinics with a mixture of preventative and urgent care. A data pack as well as the outcome of public engagement had been shared with the stakeholder reference group at a workshop on the 4 December 2023. Oxford Health would prioritise confirming the temporary clinics with Oxford University Hospitals and would close the beds permanently so that the exact mix of additional specialist clinics could be worked up.

In terms of alternatives to in-patient beds, it was welcomed that the report recognised that the contributions from lived experience of being sent home from hospital were mixed and that improvements to the service had been introduced in December, and there was a commitment to learn from the contributions of the Wantage public through the Wantage public engagement exercise.  

In terms of how and when CIL funding would be secured, the BOB ICB Director of Place reported that there had been communication with the CEO of the Vale District Council already. It was also the Substantial Change Working Group’s understanding that provisional holdings of CIL funding with an estimate of the finance required could be made easily pending any formal application for funds. It was clarified that it would be Oxford Health NHS Foundation Trust that would make formal decisions concerning the hospital and make the application with system support for the funding. The committee was strongly of the view that a provisional holding of £600,000 be made by the NHS as soon as possible after the meeting.

In response to a query from the Committee regarding the assurances that Oxford University Hospitals could provide, the Trust’s Director of Strategy and Partnerships

gave assurance that she had attended the Wantage Community Hospital workshops. The Trust had a proven track-record of bringing out specialist clinics to Wantage Community Hospital. Hospital specialists liked coming to Wantage Community Hospital and the provision of additional clinics in community settings was very much part of the OUH strategy. The Director confirmed the commitment of existing clinical leads for their existing clinics as well as for working with partners to match the needs of the community with what additional hospital services OUH could deliver. 

 

Moreover, the Committee also sought reassurances as to the liaison with Wantage Primary Care Network (PCN) for the proposed recommendations in the co-produced report. Oxford Health reported that liaison with the Primary Care Network with Dr Brammell had been effective. Dr Brammell had attended workshops also. There was a timings issue regarding receiving a communication from the PCN as the lead for the project was on maternity leave. Oxford Health had liaised with Dr Elaine Barber, the new clinical lead to ensure that the clinical lead received the report. Oxford Health were confident the PCN would be supportive of the plans, and that Dr Barber specified that she would have expected that if there were any concerns at all, that these would have been communicated. 

 

It was emphasised by the Committee that ongoing scrutiny was essential going forward on both the process as well as the outcomes around the key stages outlined in the proposed project delivery plan. The assurance of coproduction was important as the exact outcomes would depend on each additional service and could include research as well as performance outcomes for the population.

 

The Committee AGREED to the following recommendation made by the HOSC Substantial Change Working Group:

 

1.    That the matter of the closure of inpatient beds at Wantage Community Hospital is NOT referred to the Secretary of State for Health and Social Care.

 

The Committee also AGREED to issue the following recommendations to the NHS:

 

1.    That there is no undue delay in securing the CIL funding available in full for the purposes of providing the additional proposed clinical services on the ground floor of Wantage Community Hospital given the removal of the in-patient beds since 2016. It is recommended that there is a maximisation of the ground floor of the hospital for the purposes of expanding these specialist services.

 

2.    That the Project Delivery Plan for the future of the hospital’s ground floor services is delivered on schedule as much as possible, and that there is ongoing scrutiny over the process of delivering the plan and its outcomes for the local population.

 

3.    For a meeting to be convened as early as possible between identified leads within BOB ICB, Wantage PCN, Oxford University Hospitals, Oxford Health, Oxfordshire County Council, Wantage Town Council, and HOSC; with a view to plan for continued momentum on co-production and agreed scrutiny moving forward.