Agenda item

13:30

A presentation from Dr James Kent and Dr Nick Broughton.

The Committee had received a presentation and supporting document updating the Committee on work towards a Community Services Strategy.

The following speakers had been agreed:

Julie Mabberley stated that most of the proposals for Wantage Community Hospital in the update related to out-patient appointments but the hospital had very little parking.  Out-patient appointments would be much better placed at the Health Centre but all promises by the NHS to extend the building (first given in 2012) had, so far, come to nothing.

They had yet to see the metrics which showed that care at home (with current staffing levels) provided better patient outcomes for reablement than the community hospital used to.  It also used to provide palliative care and there was no mention of where or how this service was currently provided.

Based on current NHS plans, the in-patient facility was likely to remain temporarily closed for about 7 years.  She asked that it be reopened without further delay regardless of any strategies for future services in the community.

Councillor Jenny Hannaby recounted the history of the closure of in-patient beds at Wantage Hospital for new members of the Committee.  She blamed the closure in 2016 on a lack of maintenance by Oxford Health.  She praised the hard work of the local community in campaigning for the hospital and participating in the work of the stakeholder group.

Councillor Hannaby, as new Cabinet Member for Adult Social Care, stated that she was well aware of the excellent work supporting people in their homes but she believed that there was still a place for Community Hospitals and she asked that a strategy be implemented and not just talked about.

The Chair noted that the Committee had been unable to progress discussions on how the community services strategy would be scrutinised as it had been without a Chair since the election until this meeting.  She therefore proposed that the Committee should just note the reports and have an extra meeting to give the subject the detailed examination that she believed it deserved.

Dr James Kent, Chief Executive, Oxfordshire Clinical Commissioning Group (OCCG), introduced the item. He stated that the proposals built on the spirit of partnership across the system that had worked well in dealing with the pandemic.  It was anticipated that legislation would require more partnership working.  Both he and Dr Broughton had only taken up their positions last year. They were well aware of the history but were keen to look forward to what could be achieved.

It had been agreed to look at community services in the round and comprehensively.  Work had started in collecting information on what was currently available.  They were not proposing a strategy at this stage but a path towards a strategy.  It was expected to be an 18-month process but they had taken on board the need for more and earlier engagement.  The presentation outlined the fail-safes and checkpoints that the Committee had asked for.

Dr Nick Broughton, Chief Executive, Oxford Health NHS Foundation Trust (OHFT), stated that they had spent a lot of time looking at community services in the round but also at Wantage Community Hospital in isolation as they wanted it to thrive and continue to be an important component of community services.

The context had changed not least with the development of an Urgent Community Response Service and the procurement process for Home First Reablement.  Pilots of this had been successful.  OCCG continued to work closely with GPs and Primary Care Networks (PCNs) to help them recruit clinical pharmacists, paramedics and OHFT was supporting recruitment of mental health staff.  All partners need to work together to ensure integrated delivery.  There had also been a huge expansion of digital capacity as a result of the pandemic.

The Chair asked the Chief Executives to respond to the point made at the April meeting that keeping the in-patient beds closed for so long was essentially pre-determining a decision to close them permanently.

Dr Broughton accepted there it had been a long and painful journey but he assured the Committee that the future of the beds had not been pre-determined.  Dr Kent expressed the hope that the early engagement in the proposed process would help rebuild trust.

City Councillor Jabu Nala-Hartley asked if it was true that hospitals were having to buy beds from the private sector and if so, what the cost was and if it would not be better if that money was spent within the NHS.  She also asked if the Chief Executives were aware of private sector companies selling buildings to US companies in order to lease them back.

Dr Kent responded that he was not aware of any sale and lease back arrangements.  During the height of the pandemic it was necessary to purchase beds from the private sector in order to manage both Covid and non-Covid patients.  That was a national system in place and he was happy to provide the data on that.  They were not now purchasing a large number of additional beds.

Dr Broughton added that they did not purchase private beds for the community system.  There were a small number of places (15 to 20) purchased out-of-county for mental health patients.  The shortage of places in Oxfordshire had been compounded by the infection control procedures necessary due to the pandemic.

Dr Alan Cohen welcomed the provision of out-patient services at Wantage Community Hospital and the accompanying evaluation plan.  He noted that Stephen Chandler, OCC Corporate Director for Adult and Housing Services, at the previous week’s Health and Wellbeing Board meeting, suggested holding a seminar or workshop on community services.  Dr Cohen welcomed that and suggested that it should be a joint workshop between this Committee and the Board.  This was also welcomed by Dr Broughton.

The Chair also noted that she had received a response the previous day in relation to the proposal for an extension to the health centre at Mably Way, Wantage, that issues around the district valuer had been progressed and that a timescale of two years was likely.

Councillor Charlie Hicks asked how the system was being reorganised to lock in the learning from the pandemic experience of the importance of voluntary groups and social media for example.  He wanted to know what was being done to promote preventative services and tackle issues such as inactivity and if a population health management approach was being taken.  He also asked what accountability meant in the new context of the Integrated Care System (ICS).

Dr Broughton agreed that he wanted to see more upstream, preventive services.  He reiterated that they were working with Primary Care Networks to recruit a wider range of professionals including social prescribers.  The population health approach was what the ICS was all about.

Councillor Arash Fatemian referred to the feeling expressed by a number of Committee members at the April meeting that they were being asked to do the same thing as they had been asked to do 18 months earlier.  He welcomed the inclusion of fail-safes but believed that they needed to be more specific and detailed to ensure that we do not end up with the same situation in another 18 months.

Dr Broughton responded that nobody could change the past but he was happy to be held to account on the proposals for community services which were an absolute priority for Oxford Health.

The Chair asked for a more comprehensive response to the report from the OX12 Task and Finish Group than had been given for the April meeting.  Dr Kent agreed to review the previous response and respond again.

The Chair thanked the Chief Executives for coming to the meeting to take questions on the plan for developing a strategy.

Action: Dr Kent to respond again to the OX12 Task and Finish Group report.