Agenda item

10:45

There will be an oral update on the provision of intermediate care beds at Chipping Norton Community Hospital.

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

Clive Hill, Chipping Norton Hospital Steering Group

Clive Hill stated that last year the conclusion was, following the consultation which had begun in 2014, that the nurse provision was better provided by the NHS. The Chipping Norton community considered that the consultation process was binding and they were led to believe that the matter had been settled. He urged the Committee to conclude that the current decision to change NHS nurse provision to that of the Orders of St John Nursing provision was not viable on the basis that it had not been fully evaluated. He added that, given the rural setting of the town, there would be a need for fully trained, NHS nurses to ensure patient safety. Mr Hill urged the Committee to instruct OCC to extend the current arrangements to ensure that full evaluation of the consequences of employing Orders of St John nurses could be carried out, and if this was not done then to refer it to the Independent Reconfiguration Panel.

District Councillor Mike Tysoe, Mayor of Chipping Norton

Councillor Tysoe made the following factual observations which, in his view, would demonstrate that what was being planned was a significant change of service and not simply a change of management as currently claimed:

·         That the average length of in-patient stay under NHS management is 27 days. Over a comparable period under OSJ management, average stay is 40 days. This 13 day difference would represent a significant cost as it would cause bed blocking in the acute sector and also cause 50 fewer patients per annum to have access to the unit. This had not been factored in;

·         That under recent OSJ management, on average, active intervention and rehabilitation was delivered by physiotherapists for only 4 out of 14 patients at any given time. Currently, under the NHS management, an average of 10 out of 14 patients were receiving such care at a given time. This is a large difference and a completely different level of service.

·         That if part of the cost-cutting would mean fewer than two qualified nurses on duty during any shift, then that is a level of service which is below that which the NHS considers to be safe;

·         That currently, NHS management considers that a crash trolley on site should  be essential for safety, it was Cllr Tysoe’s view that this was not shared by the OSJ;

·         That he had been told that the training given to OSJ nursing staff did not compare with the NHS nursing and auxiliary staff training. This was a different level of service with whatever associated risks to patients.

Cllr Tysoe concluded by stating that all the above needed to be investigated further before any further decisions were made concerning the Chipping Norton Intermediate Care ward.

Councillor Hilary Hibbert-Biles – Local Member

Cllr Hibbert-Biles urged the Committee to ensure that there was a full public consultation on the issue of the perceived downgrading of beds from sub-acute intermediate care to intermediate care for the elderly; believing that an officer review was not sufficient.

She told the Committee that she had been involved in various discussions over the years since 2002 on the issue of nursing provision at the Hospital. The outcome of the first round was a contract which provided a staff level and expertise to enable the unit to admit patients of all ages who needed a hospital environment. It did not state that after three years it would revert to a lower level of care and the care would be for the elderly only.

Last year she had been involved in discussions with the County Council (OCC) and Oxford Health (OH). It had been agreed that the clinical management would lie with Oxford Health, who had more experience in this field and there would also be a modern matron on site who would take shifts. There would also be a band 7 staff nurse, together with other NHS nurse providers. OSJ had overall management of the building which also included maternity (OUHT) and the first aid unit (SCAS). This arrangement, in her view, had worked well.

She added that, in a letter to David Cameron MP from the CCG in January 2014 it was stated that there would be no change to the current service arrangement being proposed and that the specification and contractual arrangements would not change. It would follow then that these beds should be sub-acute, as per the contract. It also states that these beds are for all ages and yet every briefing only talked about older people and the Older People Joint Budget.

She pointed out that the contract specified that community based bedded care services support faster recovery from illness, prevent unnecessary acute hospital admissions or avoidable use of long term care, timely discharge and maximise independent living. She added that that was what was needed.

It was Cllr Biles’s view that Oxford Health still wished to take over the management of the nurses if a contract could be agreed. Furthermore, she believed that the beds could continue for a further four years, should the subsidy be given over to Oxford Health, who then could do the same as the OSJ had done. Cllr Biles also commented that until last year it had not generally been known that OCC had taken over the commissioning of the beds from the NHS and that she was concerned about this lack of transparency over the hospital.

She concluded by stating that these beds are the only intermediate care beds in the north of the county and a unit was needed that is expertly run by Oxford Health nurses to support the patient for a speedy return home – and also to stop bed blocking. This would also save money in the long run for both organisations.

David Cameron MP supports the nurses staying in the NHS and does not want the Unit to become more of a care home. To this end he was arranging a round table discussion with the appropriate parties. Until that meeting had taken place she believed that nothing could move forward unless there is a full consultation.

On the conclusion of the addresses, the Director of Adult Social Care, John Jackson, and Cllr Mrs Judith Heathcoat, Cabinet Member for Adult Social Care came up to the table. John Jackson read out the following statement:

‘We recently announced our intention to appoint the Orders of St John Care Trust as the provider of intermediate health care in Chipping Norton, replacing Oxford Health NHS Foundation Trust.

Since 2011 the 14 bed intermediate care unit at the Henry Cornish Care Centre on the Chipping Norton War Memorial hospital site has been run, first by the Orders of St John Care Trust with nurses seconded from Oxford Health Foundation NHS Trust and since last year by Oxford Health Foundation NHS Trust in a partnership with the Orders of St. John Care Trust.

It has been decided to revert to the original proposal that the intermediate care beds are run by the Orders of St. John Care Trust as it has proved impossible to make the system work as it involves two sets of management arrangements.

In addition it is because intermediate care provided by NHS nurses cannot be provided within the available budgets.

This was intended as a straightforward reversion of provider with no anticipated change to the level or quality of service, so it was initially felt there was no need for public consultation.

However our proposals have clearly caused concern amongst some people in Chipping Norton to the extent that unjustified and unsubstantiated attacks have been made on the Orders of St John Care Trust and the services they provide.

The Orders of St John Care Trust have responded to this by saying they would only be prepared to continue to provide intermediate care if there is broad community support.

We therefore feel clear that there should be a public consultation about the choice facing the people of Chipping Norton: either they support intermediate care provided by the Orders of St John Care Trust or there will be no intermediate care in Chipping Norton.

If the local community do not wish the Orders of St John Care Trust to provide intermediate care, or in the face of lack of local support the Orders of St John Care Trust decide not to provide intermediate care, then none will be available in the town.  If adult social services decide to commission other providers of intermediate care then this would almost certainly be much closer to Banbury to provide more equitable provision for the north of the county as a whole.’

John Jackson and Cllr Mrs Judith Heathcoat made themselves available to respond to questions from the Committee.

They were asked by the Committee what had triggered the statement. John Jackson responded that the starting point had been the managerial challenges. Both Oxford Health and the OSJ had worked very hard to make the original arrangement work. Originally, at the time of signing, possible risks had been mooted, and the issue had remained unresolved about who would be responsible in circumstances when there was a major failing. A further difficulty seen was that Oxford Health was providing a service which was effectively a care home. The collective view was that this arrangement would not work in light of the costs (set out in the note on the Addenda), and the fact that staffing costs of the current model were more expensive than the costs of providing intermediate care delivered by OSJ. He added also that no additional CCG resource could be made available and asked if it was appropriate to proceed with an expensive arrangement when an alternative care arrangement was available of equivalent quality. He stated that in his view there should be a public consultation based on what was realistic and based on what could be offered.

John Jackson also commented in response to critics that OSJ could provide good quality Intermediate care as demonstrated at the Isis in Oxford. He recommended that the Committee should visit Isis to view it at first hand. The Chairman accepted his offer.

A member of the Committee commented that the costs charged by OSJ appeared to be even higher than those of Oxford Health. John Jackson responded that the costs of the care home would be paid for by OSJ on the basis of a return to them on the costs of the building. He accepted that the figures had not been scrutinised in detail, but it did not alter the fact that the offer on the table would be significantly more than the budget available and significantly more than buying intermediate care beds elsewhere in Oxford.

A Committee member asked, as far as the patients were concerned, would the standards of care stay the same with 14 intermediate care beds. Cllr Mrs Heathcoat confirmed that the14 intermediate care beds would remain if the terms of the statement were agreed to.

John Jackson stated that Intermediate Care was not usually provided by the NHS nationally and confirmed that the OSJ were registered with the Care Quality Commission to deliver this service and met all training requirements.

John Jackson explained that his intention was to consult on the two options as soon as possible. This would be concluded in early September and the outcome would come back to this Committee in September. The staff consultation was to begin in the near future and they would be given the choice of whether to transfer to OSJ or to be redeployed in Oxford Health. He informed the Committee that the statement had been agreed beforehand with Oxford Health and the OSJ following a meeting with the 3 parties when it had become clear that the current situation was untenable.

The Committee thanked Cllr Mrs Heathcoat and John Jackson for their attendance and noted the report on Chipping Norton Hospital and expected further reports on the full consultation at its 17 September meeting.