Agenda and minutes

Apologies were received from District Cllr Susanna Pressel and Dr Keith Ruddle.

District Cllr Ian Corkin attended and took part in the Committee as a representative from Cherwell District Council but not in a voting capacity, as the vacancy had not been filled formally as yet.

There were no declarations of interest.

The Chairman had agreed to the following speakers, all of whom would make their address at the start of Agenda Item 4:

-       Valerie Ingram  - Administrator of ‘Save our Horton’ Facebook page

-       Keith Strangwood – Chairman, ‘Keep the Horton General’ Group

-       Dr Peter Fisher FRCP – Member of the Public and retired consultant in General Medicine at the Horton Hospital

-       Sarah Ayre – retired midwife

10:05

At the request of the Committee, Paul Brennan, Director of Clinical Services, Oxford University Hospitals Foundation Trust (OUH) and Andrew Stevens, Director of Planning and Information, OUH, will attend to answer further questions on the contingency Plan for Maternity and Neonatal services at the Horton Hospital. The purpose of this is so that the Committee can be assured that there are satisfactory reasons for invoking emergency measures to temporarily close the Obstetrics Unit at the Horton General Hospital.

This will include evidence of efforts made by the Trust to maintain a consultant-led maternity service at the Horton and discussion about the risks and impacts of closing the Obstetrics Unit.

The OUH report on its contingency plans which was first published for the Committee’s 15 September 2016 meeting is attached for reference, together with various background information (JHO4).

Prior to consideration of this item the Committee was addressed by the following speakers:

Valerie Ingram

Valerie Ingram informed the Committee that she was the administrator of the Facebook page ‘Save our Horton’ and communicated with just over 16,000 members on a daily basis. It was her view that Banbury and the catchment area was growing at an unprecedented level and key to the Core Strategy was sustainability, adding that to allow the maternity unit to be downgraded even temporarily was contrary to those principles.

She stated that Oxford was not close to Banbury and very difficult and expensive to get to. She added that in 2008, the Independent Reconfiguration Panel had deemed that the distance between Banbury and the JR was too far and not safe, stating that this was as relevant today as it was then and in fact transport had worsened nowadays making it even more difficult to access services.

She informed the Committee that a recent FOI request made in June had revealed that a blue light run from Banbury to the JR revealed an average time of 43 minutes, which did not take into account loading times at either end. Furthermore that an emergency C Section, category 1, was recommended to take place within 30 minutes; and the clock did not begin ticking until the doctor had agreed the procedure, adding additional time to be factored in, but which was not included in the Trust’s contingency plan. She added, moreover, Chipping Norton Midwife –Led Unit (MLU), when in difficulties, tended to send their patients to the Horton as it was easier to access. The outcome of this would be that this option would be removed, thus increasing the risk to patients, and overloading the JR. She further stated that the JR had been on divert on two occasions the previous week and Warwick had the week before, thus highlighting existing pressure. She added her view that GPs and ambulance staff in the Banbury area were not happy with the proposals.

Valerie Ingram also suggested that downgrading to an MLU would possibly see the removal of the on call 24 hour House Consultant anaesthetist, thus bringing into jeopardy the Children’s ward and Accident & Emergency. The Trust has made no guarantees that this position would remain and FOI requests had gone unanswered.

She stated that, in her view, recruitment had been ‘lack lustre and appalling’ and it had taken letters from Facebook members to get the adverts back onto the system.

She referred to a proposal that had been made to the Trust which would utilise existing facilities, retain staff and utilise the services already in Banbury, which had been refused. At the Trust’s recent AGM the Trust had commented that agency staff would be employed if staff did not wish to be moved to Oxford. She commented that the same should then happen for the doctors, that locums could be employed in Banbury in the interim period until doctors could be found. She concluded by stating  ...  view the full minutes text for item 59/16

11:30

At the request of the Committee at its last meeting, Paul Brennan, Director of Clinical Services, Oxford University Hospitals Foundation Trust (OUH) will attend to answer more detailed questions on proposals to further develop an outpatient (ambulatory) model of care across the Trust.

The Committee will determine whether it considers the proposal to be a substantial service variation requiring consultation.

The impact of the proposal on patients, staff and partners will be explored in greater detail, including the impact of reducing the number of beds across several of the Trust’s hospitals.

The OUH reports on the proposal, which were first published for the Committee’s 15 September 2016 meeting, are attached again for reference (JHO5).

Prior to consideration of this item the Committee received advice from Nick Graham, Chief Solicitor, OCC. He advised the Committee to determine the question of whether the closure of the beds amounted to a substantial change in service, and to try as far as possible to reach agreement with the Trust. If this was not possible then it had recourse to refer the matter to the Secretary of State.

The following representatives attended for this item:

-        Lily O’Connor – Division Nurse, Medicine, Rehabilitation and Cardiac Division, OUH

-       Paul Roblin  - Chief Executive, Local Medical Council

-       James Price – Consultant Gerontologist & Divisional Director for Acute Medical, Rehabilitation & Cardiology

-       David Smith – Chief Executive, OCCG

-       Stuart Bell – Chief Executive, Oxford Health

-       Andrew Stevens – Director of Planning & Information, OUH

-       Cllr Mrs Judith Heathcoat – Cabinet member for Adult Social Services, OCC

-       Seona Douglas – Deputy Director for Adult Social Services, OCC

Paul Brennan began by stating his reasons for the proposal not being a substantial change in service. Firstly, the Trust was investing £4m in services to enable Health to support patients in their own home. Secondly, there would be no change in access to services and no change in services provided. Thirdly, integration of non-bed services provided by Oxford Health and by OCCG would continue in order to make services more responsive to patients in the right environment. Finally patients could be managed in the most suitable environment to get the best care needed.

Mr Brennan clarified at the request of the Committee that the original plan in relation to DTOC (Delayed Transfers of Care) was, via the work of the Liaison Hub, to get to 150 beds, 137 was then reached, and it was then agreed to drop down to 55 beds, which took place in July.

Mr Brennan was asked if the Hub had managed to maintain the flow of patients through the system. He responded that this had happened, and more had been done due to investments made in hospital integrated services. The OUH had invested £1.2m jointly with Oxford Health (OH) and the OCCG to keep the Liaison Hub. £1.6m had also been invested in additional nursing and medical staff to run the community services. The Hospital Discharge Team was seeing more patients managed on a non-bed pathway despite rising demand (6 – 8% increase in emergency attendance). He added that taking forward stage 2 had not led to any additional cost to Social Care – there had been no evidence provided of this. He reminded the Committee that phase 2 of the programme had started 4 months ago and half of it had already been implemented, with no additional charge on Social Care.

A member asked about how this wider remit with the Liaison Hub was working out with Adult Social Care (ASC). Lily O’Connor responded that alongside the 55 beds already highlighted, there were 49 intermediate care beds at Chipping Norton, Isis and Watlington, working  ...  view the full minutes text for item 60/16