Agenda item

10:20

David Smith, Chief Executive of the Oxfordshire Clinical Commissioning Group (OCCG) will present a report on the proposed changes to the service model for the new Townlands Hospital that is being built in Henley.

The report includes initial feedback from the public consultation which closed on 15 June and sets out the proposed decision making process.

The Committee is RECOMMENDED to note the report and request a further report with proposals for the future of the Townlands Hospital to the meeting in September.

Prior to the start of the discussion the Committee heard the following addresses:

Cllr Ian Reissman – Chair, Townlands Hospital Steering Group

Cllr Reissman urged the Committee to instruct the CCG to devote more time to informing the community of the detail in relation to the new model such as information on the care available at the hospital, numbers of patients it was envisaged coming through the hospital, and how this would be monitored. In his view there were significant risks to the new model given the insufficiency of evidence available. He added that GPs in Henley did not appear to be supporting the plans and CCG representatives in neighbouring Berkshire had not commented.

Councillor David Nimmo-Smith

Cllr Nimmo-Smith, speaking as local member for Henley, expressed concern about the alteration to the model, which, at the start of the consultation period included Emergency Medical Units (EMU) and at the end had introduced Rapid Access Care Units (RACU). He reported concern that the consultation process had left their questions unanswered and he asked for reassurance that their medical needs would be fully addressed in the new model.

He added that the Henley and District community felt that the consultation was therefore incomplete and flawed and that the rush to get the building up and running as soon as it had been completed was at the expense of a robust plan and appropriate consultation. He added that it appeared that neither of the senior partners of the two Henley GP practices had endorsed the model.

Notwithstanding the above, Cllr Nimmo-Smith  felt that there was much that was good in the model and welcomed the facilities to be provided, such as more consultants and day care and an increasing outreach service from the Royal Berkshire Hospital in Reading. However, the community, who were the users of the facilities offered, had not bought into the new model. He urged the Committee therefore to ask why the CCG had structured the questions in a way that it made it easy to agree with all that they were proposing, why information had gradually trickled out which had changed the consultation; and why they had put to one side the comments made at the public meetings and in the Henley press.

David Smith, Chief Executive, OCCG gave a presentation on the model of care. He stressed that the hospital was due to be handed over to the NHS in November of this year and there had been an increase of £900k lease cost to bear thus making it very important that the best possible use of the facilities were made in the long term. He added that no decision had yet been made by the CCG and they planned to return to the 17 September meeting of this Committee in order to take any comments on board.

Andrew Burnett (OCCG) and Pete McGrane, Oxford Health, attended to explain the changes from the current model to the enhanced model. Andrew Burnett pointed out the expansion to outpatient unit which offered a rapid access clinical unit and Pete McGrane highlighted the growing body of clinical evidence which showed that patients often did not do well in hospital and the need therefore to use the rapidly expanding diagnostic technology in order to enable patients to be supported at home for a speedier recovery. Andrew Burnett added that there would still be a need for bed-based care and this would be provided by the Orders of St John at a home adjacent to the hospital. It had been identified that there was a need for 5 – 8 beds for the local population, some of which would be used for stepping up care, and some for stepping down care.

John Jackson stated that he had attended four public meetings in Henley to speak about the implications of the new model of care for social care. He added that a large amount of information had been provided by the County Council from March detailing the increasing provision of social care to be provided in the future to reflect the projected increase in the elderly population and the need to support patients to keep them out of acute care and looked after in the community.

In response to a question from a member about the issue of the number of beds to be offered at the hospital, David Smith commented that currently, a great number of this population had to go to Reading or elsewhere for their healthcare. This was a real opportunity, in a state of the art building, to provide real care for local people. He reiterated that bed care for those who needed it would still be provided in a building situated adjacent to, and on the same site. John Jackson also commented that the support of informal family carers was essential and the County Council was working very closely with the CCG to ensure the best possible support would be available to patients.  This model would help to return patients to the best possible state so that they could live independently and not rely on additional support. He added that the new Care Act would be providing limited additional resources to pay for support to carers. It was thought that large numbers of family carers were not known and a strategy was underway to maximise the numbers of carers. Progress had been made in the last few years and targets had been included in the Health & Wellbeing Strategy to increase numbers.

A member asked if there would be a capability to spot - purchase beds from OSJ and did they have proof that services from the Integrated Locality Teams (ILT) would be available and at the right time. John Jackson responded that OSJ were, in principle, supportive, but detailed contractual conversations with OSJ had not started. Pete McGrane responded that information was available on the ambulatory care model and it was anticipated that there would be significant demand for these community based teams. The ILT’s would see patients earlier thus reducing the potential for deterioration, as seen in a bedded setting, to be headed off. He added that the Trust was not seeing this in isolation from the significant changes in primary care services ie. in confederated care. The Locality Teams needed to be in situ to support patients and this had to be hand in hand with families and their carers’.

A member asked if the CCG was certain that it had received all responses to the consultation, particularly those made online. David Smith undertook to check this.

Some members commented on the rushed nature of the consultation and perceived failure of the CCG to take the public with them. David Smith responded that clearly there had been some opposition to the proposals and a petition had been submitted, the terms of which were purely focused on the beds. He added however that the support for the alternative model had got lost, that from a clinical point of view, it was believed this to be the right model of care for Oxfordshire. He stressed that the bed-based care would still be provided on the same site, but not within the hospital building, which was originally proposed. He also pointed out that the current building would have to be demolished at the point at which the building would be handed over. Should there be a delay there would be substantial problems.

A member asked if nursing staff would be conversant with the ambulatory care model. Pete McGrane explained that for the new model the Trust would want to use trained staff who would reach out into the community; and in the care home, there would be trained staff who would support patients back into the community. He added that colleagues in the Royal Berkshire Hospital were also very supportive of the aim to have in-reach geratology support to get patients back into the community.

A member asked if the staff would be NHS trained or would there be a different provider. John Jackson responded that the expectation would be that OSJ would employ the appropriately trained staff to meet patients’ needs. He pointed out that this model was used for the 20 beds at the Isis Home in Oxford. He offered to arrange a visit for committee members.

David Smith was asked if the new model of care would put the CCG in a better position to accommodate the costs of running the building and would  suitable transition arrangements be put in place to cope with winter pressures. He stated that members of staff were still working through the running costs but there was no doubt that costs would increase for the CCG. He confirmed that winter pressures plans were in place for when the building was taken over.

In response to reassurance sought from a member that facilities would be in place on patient discharge and that sufficient liaison would be made with Reading, Andrew Burnett stated that discharge plans were now much more refined. There was daily contact between clinicians and social services in place. However, there were still cross – border issues to be ironed out.

When asked why the change from the proposed Emergency Multidisciplinary Unit (EMU) to a Rapid Access Clinical Unit (RACU), Andrew Burnett explained that there was insufficient clinical throughput in the surrounding area to make running an EMU for 7 days per week worthwhile. The RACU could offer integrated staff presence, an x ray function and clinical availability for patients feeling unwell that day – with diagnostic facilities to enable people to remain in their own home if sufficiently stable to get through to the next day, rather than being taken into acute care.

A member asked if local GPs were signed up to the new model of care. Andrew Burnett responded that they were happy with the proposed model but were anxious that more work would fall on them if more patients were managed at home. John Jackson said that he and Pete McGrane had given some thought to this and had found that there had not been any more demand for GP care and community services arising from the operation of the EMU in Abingdon. It was more likely that they were anxious about the possibility of losing the beds.

On conclusion of the discussion the Committee thanked Andrew Burnett, Pete McGrane and John Jackson for their presentation and agreed to note the report on the consultation; and AGREED (unanimously) to the Chairman’s specific question that it was an ‘adequate’ consultation. The Committee noted the intention of the CCG to return to the Committee on 17 September to discuss the final decision of the CCG Board at the end of July.