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Agenda item

Community Services Strategy

12:00

 

An update on the Community Services Strategy.

 

Minutes:

Before receiving the presentation, the Committee heard from the following three speakers:

 

Julie Mabberley welcomed the document but noted that the timetable and actions looked very similar to those outlined at HOSC in September 2018.  She asked if the governance was now in place and if resources had been made available.  The Oxfordshire A&E Delivery Board urgent care work, due to be completed by the end of April, needed to be set alongside this to ensure completeness.

 

She noted that the timetable showed a period of 17 months and hoped that they would not have to wait that long for services to be brought to OX12.  She described the role that the community hospital had played before closure in helping patients through the transition from acute hospital to home.  In looking forward to the community involvement in this strategy, she reported that members of the stakeholder group would be happy to be involved.

 

Bill Falkenau, Clerk of Wantage Town Council, reminded the Committee that he had previously spoken at the Committee meeting in February 2020 and had asked on behalf of Wantage Town and Grove Parish Councils that the OX12 Report be withdrawn and that the beds temporarily closed at Wantage Community Hospital be reopened.  The concerns expressed at the time had been fully justified by the report of the Task and Finish Group that was considered under Agenda Item 9.

 

He believed that the Community Services Strategy paper had merit but appeared to have the effect of kicking the issue of the inpatient beds in Wantage further into the “long grass” for a prolonged period which was unacceptable.  The Legionella risk had been dealt with since last September and he believed that there was now no legal justification for the beds to remain closed.  He called for the reopening of the beds prior to work on the Community Services Strategy proceeding.

 

Councillor Jenny Hannaby referred to Page 5 of the presentation in Addenda 2:  where it recognised that OX12 residents needed to have confidence in their access to effective rehabilitation whether in hospital or at home.  She said that the question was “what hospital?” – Wantage or having to travel across the county?

 

Councillor Hannaby asked for the evidence that safe services can be provided long-term at home, free at the point of need.  She noted that during the pandemic, patients who were not yet well enough to go home were put in a hotel with agency staff when they could have been looked after in Wantage Community Hospital.

 

Councillor Hannaby asked how much developer funding had been drawn down since OCCG took over primary care commissioning.  She believed that there was £1.2m currently held by planners and suggested that some of that could be used to fund the proposed strategy.

 

Councillor Mike Fox-Davies noted that the strategy appeared to be very similar to one which was presented to a meeting in Didcot in late 2018.  He drew attention to Page 6 of the presentation which was headed “Why different this time? Why will it deliver?”  This was where he believed the focus needed to be.

 

Dr Ben Riley, Managing Director of Community Services, Oxford Health, introduced the presentation which outlined the proposed strategy.  He acknowledged the length of time that had elapsed since the closure of the inpatient beds at Wantage hospital and reiterated the apology given by his Chief Executive, Dr Nick Broughton.  They were committed to proceeding as fast as the pandemic would allow.

 

The strategy had been supported by the Health and Wellbeing Board at its meeting in March.  It had the support of all the Oxfordshire councils as well as the CCG and the hospital trusts.

 

Stephen Chandler, Corporate Director for Adult and Housing Services, described the evidence available to show the benefits of reducing time spent in hospital beds in favour of more care being delivered in the home.  The response to the pandemic had shown how a strong partnership across the system could change the way health and social care were managed.  He agreed with other speakers that the challenge was in delivering this change.

 

Dr Riley added that work was ongoing in developing an evidence pack which they should be able to share within a couple of weeks.  Oxford Health had just published a more detailed Strategic Development Framework on its website.  The presentation pack brought in points from the OX12 report – particularly on innovation and workforce planning.  There was a dedicated email address available to start taking feedback as part of a wider engagement.

 

Dr Riley had met twice with the Wantage Town Council Health Committee and assured them that the needs of the population would be at the forefront.  He gave an example of a pilot for urgent community nursing and therapy services in the Wantage area.  Data from that will inform the strategy going forward.

 

Another pilot in mental health services was aimed to start in October and they were developing plans with Oxford University Hospitals to provide consultant outpatient clinics at Wantage Hospital.  It was not a case of waiting 17 months before putting services into the hospital.

 

Diane Hedges, Deputy Chief Executive, Oxfordshire Clinical Commissioning Group, addressed the timetable for development and implementation.  Extra capacity had already been created through stronger partnership working.  The commitment was there to provide the resources.  If at the end of the whole process it was decided that the inpatient beds at Wantage were not part of the plan that would be a consultation issue.

 

At the June Health and Wellbeing Board it will be outlined how the project deliverables will be arrived at and the way in which people can engage.  The points made by the Task and Finish Group about evaluation will be taken on board and this can come back to the next HOSC meeting if that is desired.

 

The table on Page 8 listed programme actions but most of these could only be progressed when the country gets to COVID Level 2.  Changes that require a consultation process will be identified but that will not stop progress in other areas.  Diane Hedges concluded by agreeing with the Task and Finish Group that there was a need to have the difficult conversations about the options.

 

Councillor Jane Hanna stated that there had yet to be a proper discussion on Wantage Hospital.  Other smaller towns had inpatient beds.  COVID had changed the situation and there was a need to see the data around that.  She also asked if the extension to the GP practice was going to be built this year.

 

Diane Hedges responded that the crux of the debate was around whether it was better to be local or to receive specialised services.  She agreed to share the evaluation approach with members of the Committee before the next meeting.

 

Barbara Shaw expressed concern that services around sight and hearing loss were particularly affected by COVID and these had an impact on isolation especially for older people.  Diane Hedges responded that GPs can refer to audiology for hearing aids but, in regard to ear wax removal, people were being asked to self-care.  She agreed the connection was an important one to make in regard to isolation.

 

Dr Alan Cohen welcomed the pilot projects but asked that their criteria for success be outlined so that they can be evaluated properly.  He also noted that the next update on the strategy was going to the Health and Wellbeing Board for agreement before HOSC will see it so they would have no opportunity to scrutinise it.

 

Councillor Jane Hanna suggested that the order of the meetings of the Board and OJHOSC be reversed so that members of the Health and Wellbeing Board would have an opportunity to be informed of the views of OJHOSC.  Councillor Fatemian said that the committee would be able to send its representations to the Health and Wellbeing Board before it met.

 

Dr Riley responded that they were working with NHS benchmarking on this and that defining the criteria up front was part of the plan.  Diane Hedges added that down the line detailed criteria will be needed on how to decide between options of the beds and these criteria would be developed in an engaged way as had been done for maternity.

 

The Chairman cited an example where the Committee previously agreed with a proposal to move stroke services from the Horton Hospital in Banbury to the JR in Oxford, accepting the argument in that case that it was more important to be safe than local.

 

The Chairman asked for a weekly update on developments and anything published on the strategy, as the Committee already receives from OUH and the Horton Hospital.

 

He read from the minutes of a Committee meeting held in Didcot in November 2018 at which very similar proposals were put to those presented today.  He said that this process would have to be scrutinised closely to ensure that progress was made this time.

 

The Chairman asked that the next stage of the strategy be circulated to members of the Committee in good time for them to give feedback that will be presented to the Health and Wellbeing Board.

 

The Chairman also stated that the issue will be discussed offline as to whether it was best for the full Committee to monitor progress or have a Task and Finish Group in order to avoid the timing of Committee meetings causing any delays to the process, with a proposal to be brought to the June meeting.

 

The Chairman proposed the following:

·         That Dr James Kent, Chief Executive, OCCG, come to the June Committee meeting to discuss if the timeline can be shortened to something more similar to that for Horton which took 12 months.

·         That fail-safes be discussed to deal with any delays in the strategy – particularly any that affect Wantage.

·         That Drs Broughton and Riley of Oxford Health address the issue that keeping the inpatient beds in Wantage Community Hospital closed for so long was essentially predetermining their future.

 

The proposals were seconded by District Councillor Paul Barrow and were agreed.

 

Supporting documents: