Agenda item

10:20

A statement from Oxford Health NHS FT on its proposals to progress a strategic development and quality improvement plan for its community services across Oxfordshire (including services at Wantage Community Hospital/OX12).

The Chairman stated that he would take the public speakers after the statement had been read out to give them an opportunity to comment on it.

Nick Broughton, Chief Executive of Oxford Health Foundation Trust, read a prepared statement.  He noted that for several years, there have been calls to refresh and update a county-wide approach to community-based care, in order to deliver a vision of more integrated care, closer to home, but, due to various circumstances, attempts to progress this work have been repeatedly frustrated. At the same time, locally-focused work intended to respond to healthcare challenges in parts of the county, such as the OX12 project, have also been delayed. These false starts and recurrent delays have resulted in damage to relationships and an understandable loss of trust from the public, which Oxford Health regrets.

The experience of responding to the COVID-19 pandemic has taught some useful lessons in how to improve services in an effective and timely way. Rather than spending a prolonged period on developing another transformation plan that is likely to fail to deliver, they propose to adopt a more rapid approach to service improvement, making small changes with involvement from patients and the public and refining them with ongoing feedback.  They have set themselves an ambitious target to have produced a strategic development and quality improvement plan for community services at the end of this year.

Dr Broughton, on behalf of the Trust, apologised for the delays in completing the long-overdue work to upgrade the plumbing systems at Wantage Community Hospital and expressed regret at the long period of time that it has taken to resolve the unsatisfactory situation with the inpatient ward that has been closed at Wantage since 2016.

He announced that services were able to restart, including maternity care from the midwife-led unit.  Deliveries will be re-starting in the unit from 1 October. Also a new, local podiatry clinic at the Hospital will open and the school nursing team are also working there, busily organising vaccinations for local school children.

However, looking at the output from the application of the health and care needs framework in OX12 and based on the bed occupancy rates in other hospitals, the Trust believes that re-opening the general inpatient ward at Wantage would not be a sustainable plan or the best way to use NHS resources at this time. Instead, they would like to progress new opportunities for developing a wider range of outpatient, community outreach and other daytime services at the Hospital which will be of greater benefit to local residents, such as  mental health services for children and younger people and new ways of providing care for those who are older and frail.

He recognised the need for the NHS family to follow a formal process involving local people to deliver this type of change and will work with the clinical commissioners to undertake this as soon as the current restrictions relating to the COVID-19 pandemic allow.

The Trust commits to working with local residents and other key partners to co-develop and pilot services in and around the Hospital that will provide benefits for the local community and are in line with the latest clinical recommendations and care pathways. Their aim is to see the Hospital thrive once again and enter a new chapter in its long and cherished history.

Julie Mabberley welcomed the news that the plumbing problem had been resolved.  She was very concerned at the proposed closure of the inpatient facilities and emphasised that a full consultation would be necessary to do that.  The issue had been addressed by the Committee 42 times since the closure of the beds was first considered but there has been no discussion as to whether the closure of the beds should take place or how they should be replaced by other services.  There is a need for rehabilitation services particularly in the wake of the Covid-19 pandemic.

Councillor Jane Hanna welcomed Dr Broughton’s recent meeting with the OX12 Task and Finish Group and his positive tone and intention.  However, she was shocked at the announcement of the closure of the inpatient beds, especially coming before he had met with the Wantage Town Council Health Committee or the stakeholder group that had worked so hard on the pilot framework.  She believed that Covid-19 had changed the situation.  There was a need for step-up and step-down beds.  The situation regarding public consultation under COVID-19 needed to be clarified urgently in order to protect the democratic process.  She asked that the OX12 report be thrown out as she believed it was no longer valid.

Councillor Jenny Hannaby stated that it appeared that a strategy for community hospitals may be finally coming about but there was still no solution for Wantage Community Hospital’s inpatient beds.  The OX12 report had been accepted despite all the requests from local people to reject it.  The population is likely to double and it is not clear how local health services will cope with that.  She believed that the origins of the problem could be traced back to the decision not to provide an extension for the GPs.  She noted that the funds for the refurbishment of the maternity unit had been raised by the local community.  Local people will be very disappointment at the decision on the inpatient beds.  She believed that democracy was seeping out of the system.

Dr Broughton responded by reiterating that it is their intention to set out a vibrant vision for the hospital in Wantage.  It will involve a wider range of services than it currently provides and an ability to meet increasing demand from an increasing population.  With regard to the inpatient beds, the statistics show that there are currently too many inpatient beds across the county and significant problems staffing the units.

Dr Ben Riley, Managing Director Primary and Community Services, Oxford Health, added that he was fully behind the vision.  He stressed that the decision had not been taken on inpatient beds but the demand was reducing.  With COVID-19, there was a greater emphasis on getting people home and home care services have been enhanced.  He fully accepted that there would have to be proper consultation on any decision to close the beds,

Councillor Hilary Hibbert-Biles asked for more information on the Rapid Access Care Unit.  Dr Riley responded that they would be providing the same services as before although the model may be slightly different.  It would be like a hybrid between hospital- and home-based care.  He did not want to be too prescriptive at this stage as there would be local engagement and co-design involved.

District Councillor Paul Barrow expressed concern that a full county-wide review would be very difficult to complete in three months.  He said that the Committee would like to be invited to become involved and asked would OX12 continue to be a pilot or would it be just another postcode in the overall review.

Dr Riley confirmed that they would like the Committee to be involved.  He stated that they were looking at a more rapid improvement cycle – making small changes and getting public feedback quickly, rather than waiting to have one master plan for the whole county.

Councillor Jeanette Matelot recounted the experience in Thame where they lost the inpatient beds but gained a lot more, for example consultant clinics where patients would otherwise have to travel to Oxford.  She believed that it now provided more services for more people than before.

Dr Alan Cohen asked if all of the service partners are as enthusiastic about this as Oxford Health.   Dr Broughton responded that they are all as one in terms of providing comprehensive out-of-hospital care across the county and making the most efficient use of assets such as community hospitals.

Councillor Alison Rooke asked, if there had been no problem with the plumbing and the hospital had been functioning for the last four years, would Oxford Health still be proposing the closure of the inpatient beds.  She also asked if public consultation on that point was going to make any difference or if the decision had already been made.

Dr Broughton stated that, as of now, they do not see that re-opening the beds is sustainable.  However, they would engage with the community before making a decision and that engagement would be meaningful.  Any formal consultation will follow the usual process.  They have to look at the best way to configure beds across the county and the smaller 12-bed facility at Wantage is suboptimal and more resource intensive.

Diane Hedges, Chief Operating Officer and Deputy Chief Executive, Oxfordshire Clinical Commissioning Group, confirmed that they were supportive of the proposed process of engagement and consultation.  She noted that she was receiving many requests for space at community hospitals for out-patient services and she was convinced that there was a vibrant future for those hospitals.

The Chairman welcomed the positive tone and what he believed was the first expression of regret for what had happened and an apology for the delays in correcting the plumbing problem at Wantage Hospital.  He thanked the representatives of Oxford Health for their time and their sentiments.