Agenda item

12:30

The reinstatement of routine referrals to OUH services following the COVID-19 lockdown. Including:

·         Overview of the approach to re-starting referrals

·         Information on specialties where patients are being seen and treated elsewhere and how this is being communicated to GPs and patients

·         When OUH expect to be able to accept referrals for these specialities

·         LMC representative to attend to share views from primary care.

Dr Raman Nijjar, Chairman of the Oxfordshire Local Medical Committee shared the views from GPs on the restart and recovery of routine appointments at Oxford University Hospitals (OUH).  He noted that NHSE had asked, about five months ago, that all services be reinstated but this had not happened in Oxfordshire.  Patient care was deteriorating as a result of routine referrals not taking place.  He believed that patients were not being prioritised as they were in neighbouring counties.

Dr Nijjar had raised it with OCCG and had a meeting with them but OUH were unable to attend.  At that meeting he said that services needed to resume by the end of July or mid-August but seeing no movement on this, he decided to go to the press.  He was aware of a number of case studies of appalling care.  GPs were doing their best with limited tools but they could not refer to a number of services.

Lisa Glynn, Interim Director of Clinical Services, OUH, stated that referrals were open for cancer and other services had started to reopen but capacity was restricted.  Unfortunately for a number of services this had been particularly problematic.  They were monitoring the volume of patients and the timeline from referral to booking and when that goes below 12 weeks they could look at reopening the waiting list.  This would be expected to happen between now and February/March.  They were working across BOB (Bucks, Oxon, Berks West) to improve availability and working with the independent sector too.  Urgent patients were being prioritised.

Dr Bruno Holthof, Chief Executive, OUH, added that they were serving patients across the Thames Valley area with a population of 3 million.  Patients who were clinically urgent could always be referred.  If there was a second wave of COVID-19, he did not expect that services would close but they would have to readjust.

Barbara Shaw stated that, even pre-COVID, women had to go out of county for routine gynaecological referrals.  She understood there were recruitment issues and asked if this was expected to continue.  The report suggested that some patients were having to wait 52 weeks.

Lisa Glynn responded that there was a community service in place now with patients requiring acute services being referred to OUH.  They restarted a few weeks ago.  There had been improvements in recruitment and some short term support had been provided.  In the gynaecologic oncology sub-specialty there had been recruitment advances as well as partnering with private general gynaecologist services in Berkshire which had brought about improvement.

Dr Alan Cohen asked if the capacity was restricted by space or personnel and if local sites could be used.  Lisa Glynn replied that both were an issue.  They were using space from local providers but there were a limited number of consultants and they needed to use them most efficiently. They were looking at using weekends and evenings to reduce the backlog.

Dr Holthof stated that they were having a lot of non-attenders.  There was good uptake of digital consultation and they were using community centres.

Dr Nijjar stated that the numbers waiting for referrals were not small.  ENT (Ear, Nose, Throat), for example, had issues pre-COVID.  It was estimated that 7,000 patients may be waiting.  GPs were open but secondary care was not happening for many.  He said that he had not heard why Oxfordshire was different from other areas.

Barbara Shaw asked about dealing with the backlog when waiting lists reopen.  Diane Hedges agreed that nobody was very happy with the situation. For example, triage was being developed for ENT which already had long waiting times pre-COVID.  They were looking at alternative providers but it may mean people having to travel further.  In BOB they were examining a possible cataract service.  She AGREED to share the waiting times with the Committee.

The Chairman expressed concern that the real scale of the problem was not known because the waiting lists were closed and also that looking at out-of-county solutions might not be impactful as many people will have difficulty travelling.

Barbara Shaw agreed that it was necessary to know the real scale of the problem and asked what the medium term plan was to deal with the backlog and the long term plan for reinstatement of normal services.  Jean Bradlow asked if it was possible to contract in consultants rather than sending patients out of county.

David Walliker, Chief Digital and Partnership Officer, OUH, stated that the waiting time for ophthalmology was 32 weeks.  When they stopped taking referrals there were 1500 on the list.  If they had continued taking referrals the list would have increased by 335% assuming previous rates of referral.

The problem for ophthalmology was that it was not easy to set up alternative centres because of the diagnostic equipment required which was based in the John Radcliffe Hospital.  Safe waiting areas had to be set up, mindful that most people come with a partner or helper.  They were working hard with partners to put a sustainable system in place.

City Councillor Nadine Bely-Summers stated that it was disappointing that a relatively rich county like Oxfordshire should have so many enormous waiting lists.  She noted that there had not been any COVID-19 admissions to the JR since June so it was very disconcerting that so many services appear to be overwhelmed.

Dr Nijjar commented that it seemed to him that figures were regarded as more important than people.  He could not fathom why there was a refusal to put people on the waiting list.  He was also concerned that there was no quality data – only taking historical pre-COVID data which may not be relevant anymore.

The Chairman AGREED to write to OUH and OCCG asking for more information on the points raised in the discussion.  He hoped that it would be possible to deal with this further between Committee meetings because there were long-term implications for people’s health and the health system.