Agenda item

12:15

To consider a report (JHO9) from the Clinical Commissioning Group and the Oxford Health Foundation Trust giving an outline framework for working with local communities to review local health needs, current and projected demographics and local assets, to inform service change.

The report includes a timeframe and consultation plan for developing options for the local area that includes Wantage Community Hospital. Please note there will be a number of A3 copies of the Annexes supplied at the meeting for ease of reference.

13:15 - LUNCH

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

Julie Mabberly, speaking on behalf of the Wantage Hospital Campaign Group stated that when she previously addressed the Committee prior to the temporary closure of the hospital in 2016, it had been understood that this closure was subject to statutory consultation. This had not taken place adding that an engagement exercise was not the same as one of consultation. She pointed out:

-       that 650 new homes had been planned for the Wantage area, now the figure stood at 1,000;

-       there was a significant percentage of people aged 65 and over and the local NHS was not making the most of the family and friends asset and resources;

-       the difference in care in community hospitals to that of acute hospitals was that patients were encouraged to leave their beds;

-       it was not understood where the required 142 beds would be situated.

Cllr Hannaby, local member for Wantage, spoke of the ‘invisibility’ of Wantage Hospital stating her view that the ‘new plan’ presented to Committee would not be implemented quickly. She called for a comprehensive online consultation plan to which the public could give their comments. It was her view that, had legionella not broken out, the situation would not be as it was currently. She stated her belief that the OCCG had taken this as an opportunity to close the hospital, commenting that Wantage Hospital was a vibrant hospital which had served the community well. The Hospital also gave employment to a large number of people in the area. She urged the Committee to help the people of Wantage in their campaign to keep it open until such time as the health provision was decided for the area. She asked for equal treatment with other towns in Oxfordshire, expressing her fear that this kind of proposed engagement for the county would begin to split communities and one town against the other. Furthermore, it was her belief that the Hospital needed to be open to assist with the winter pressures. She concluded by stating that if the consultation was not open and transparent, it would be unsuccessful.

Joan Stewart, speaking on behalf of ‘Keep our NHS P,ublic’ campaign commented that at first glance, the framework suggested a gentle move towards approval. However, it was her view that beyond the window dressing, the intention was still the same which was to mask underfunding and the provision of few hospital beds. She added that in the past there would have been a consultation, but this review was not in the same vein. She asked if the proposed options would be deliverable. She pointed out that an audit of the community hospitals had already been carried out in 2016, and, in her view, the primary care locality plans were already in motion and underway. She asked where was the interconnection of the community hospitals, warning that a domino effect could ensue alongside greater fragmentation, with a potential for localities to be pitched against locality. She asked where in the paper was the evidence of greater integration of health and social care, despite the much publicised systemic delivery. She warned that in her view this paper was premature and there was a need to reconsideration.

Louise Patten and Dr Collison (OCCG) and Pete McGrane (OH) attended for this item. Louise Patten stated that phase 2 had been suspended and it had been decided not to consult until the needs of the local population was known. After that, a dialogue would be conducted with the public. Until then plans for a formal consultation could not be developed. Moreover, there had been much talk about how committed each organisation was to working as a system and about the need for discussion with the planners. The NHS, the community and the County Council were going to work together looking at the wellbeing of the people of Oxford. It was also about working together with the voluntary sector to deliver this. She pointed out that the Health & Wellbeing Board owned this paper and this process. What was being presented here was a draft to glean the comments of the Committee on whether the system leaders had got the process right and whether it was sufficiently clear.

She continued that the frustrations voiced by the public had been heard, ie. the lack of transparency, lack of trust and their wish to be involved. There was a need to conduct intelligent conversations with the public, setting out to everybody what the needs were, and then armed with that information, state what the process would be. This would be conducted with a shared understanding of working together to develop that solution.  She added that certain services would have to be provided at scale as the costs would be too high to provide for a small number of people coming through the door. Certain services would need to be provided in towns and there would be a joining up of towns and localities. This was about having an honest conversation. With regard to the consultation process, the OCCG would take on board the wishes of the public, for instance, not to hold forums or public meetings when mothers and children could not attend. It had been understood that online, ongoing engagement was the favoured approach.

She added that the review would look at the health and care needs of the local population and what would be needed in the future, whilst taking into account housing growth. Moreover, the review of services and assets would need to describe services in local towns, for example, looking at GP practices and how to co-locate services there. Dr Collison added that the OCCG would try to ask the question about whether it made sense clinically and was it evidence based? The OCCG had some evidence of growth and size of the population in an area, and, for example, the growing numbers of older people in an area, but more knowledge was needed. With the huge advances in technology the OCCG needed to ask itself whether it should operate within the current system or did it need to do more. She explained that there were three principles of emerging good practice. These were:

-       integration of health and social care;

-       delivery of more care closer to home; and

-       not keeping patients in bed for too long.

She informed the Committee that Dr Ian Sturgess, Director of Improved Healthcare, had been invited to Oxford to advise on how to design models, encourage integration etc. It had been found that there was much potential going forward and good examples both around the country and locally, for example, the integrated delivery teams close to EMUs (Abingdon) and RACUs (Horton) could assess and treat patients. Another example given was around diabetes care/prevention which could be conducted by specialist nurses within communities rather than in hospitals. This was evidence of an up-to-date method of working out people’s needs and a good way of delivering care. The OCCG was looking forward to working with the public on the development of pilot services, which could lead to full consultation on any service change.

Questions from members of the Committee were as follows:

Louise Patten was asked whether capacity would make it necessary to run the consultation at one locality at a time, or concurrently. If it was the former, she was asked if it might prove to be ‘an eternity of engagement’? She responded that she did not know at this stage but to conduct it properly would take a lot of time. Dr Collison also spoke of a wish to set up a framework which would be applicable to anywhere in the county which would begin with what was needed, and then looking at what could be done at local level on a smaller scale and then what would be required at a county level.

Cllr Monica Lovatt, the Vale of White Horse District Council representative on the Committee, expressed her pleasure at the plan to engage locally with the people of Wantage and asked what was going to happen and how long it would take. She also commented that she was aware of the OCCG’s engagement on planning matters. She asked if they would consider starting with Wantage as it was a very rural area and was growing fast. Louise Patten responded that the OCCG had tried to set out a timescale for the Wantage gateway. She added that all of this process was not new, it was how Health planned, but it would be a much more integrated approach with other services and communities. A lot of data was already being gathered in local plans. By December, the OCCG would try to identify gaps in services in this area and if some services could be provided locally in Wantage. She added that by March the OCCG would be looking at service solutions and there would be clarity on the needs of the locality, the dialogue with the planners having been completed. She added that there were two aspects to the work, one of which was those services which could be looked at as a focused piece of work, not necessarily linked to overnight beds. The decision had been taken with Thame Community Hospital not to go to overnight community beds and to look at the different services being provided in the hospital. She gave the example of the rehabilitation services being provided at Townlands Hospital, Henley, where patients did not stay overnight and transport was available. She reiterated that service gaps did not mean overnight stays. Cllr Lovatt responded that the residents of Wantage and its surrounds were looking for modern, up to date facilities and quality care.

Louise Patten was asked if the consultation would begin by February or March 2019, as, by then the OCCG would be clearer on the design of services. She reported that the OCCG would first decide on services and buildings and it was envisaged that consultation could be more fluid. If, however, there was a significant service change, such as a reduction in service, then consultation would be more formal. A member asked if consultation had already taken place in relation to some services and whether engagement would be putting more water between the original reductions in service and the revised models; adding that it was important that this was clarified for meaningful public scrutiny purposes. Otherwise it would make it increasingly difficult for the Committee to scrutinise. She added that a significant engagement exercise would be required and, in her view, it needed to be looked at as a whole. Louise Patten responded that it would be undertaken locality by locality, so enriching an understanding of what people wanted for their area. However, many services would require a look at all localities together before deciding the best way forward. This would be linked to usage of services. Wantage Hospital, for example, would require a formal consultation process because it would have to be wider than the needs of Wantage itself, as the beds were part of a larger network. She gave the example of Townlands Hospital in Henley as an example of an area where hospital based services were looked at together with local services and then tuned with those facilities which were loved by the public.

Louise Patten was asked when the point of full consultation would take place, to which she responded April/May 2019, as there was a need to look at the wider localities across Oxfordshire to do so. It would be linked to a sustainable future, but not linked to beds.

With regard to Wantage Hospital, members asked how long would it be before formal consultation, as a significant time had gone by since its closure. Louise Patten responded that all services were linked to community hospitals. If sufficient local engagement was not to take place then a legal process would ensue and all would be back at the beginning. She assured the Committee that the OCCG could develop a vibrant future for the buildings which could help to cement this local asset into the community. On the future of Wantage Community Hospital, the conversation had not yet taken place about what could be provided in Wantage.

Members joined in expressing concern for the residents of Wantage at the lengthy term of temporary closure of the Hospital beds. At the time the temporary closure had been predicated on formal consultation within 6 months. The Committee now understood that funds to treat the legionella had been set asiide. Pete McGrane reported that the money had been set aside based on the assumption that there was a need for long term planning for the site. He added that it would also give an opportunity to look at services for a much broader spectrum of the population, such as services for mental health, diabetes, respiratory diseases etc.

Following further discussion, it was AGREED (unanimously) to:

(a)  thank all for their attendance and inform the OCCG that this Committee had taken on board the comments made about the outline framework of planning for the future population needs of the county and generally recognised the good work that was in progress, together with the need for wider consultation on some services;

(b)  urge Oxford Health to release and spend the capital sums invested in relation to Wantage Hospital in this financial year, in order to make good the fabric of the building where necessary; and

(c)  RECOMMEND the OCCG to accelerate this action so that by the next meeting of this Committee on 29 November 2018, it would be in a position to move forward with concrete proposals for Wantage Hospital which would include either the resumption of some services or a public consultation on the future of the Hospital.