Members of the public who wish to speak at this meeting can attend the meeting in person or ‘virtually’ through an online connection.
To facilitate ‘hybrid’ meetings we are asking that requests to speak or present a petition are submitted by no later than 9am four working days before the meeting i.e., 9am on Wednesday 10th January. Requests to speak should be sent to scrutiny@oxfordshire.gov.uk
If you are speaking ‘virtually’, you may submit a written statement of your presentation to ensure that your views are taken into account. A written copy of your statement can be provided no later than 9am 2 working days before the meeting. Written submissions should be no longer than 1 A4 sheet.
Minutes:
The Chair invited the registered speakers to address the Committee.
1. Statement by Cllr Stefan Gawrysiak
Cllr Gawrysiak urged the Committee to ensure that the topic of Short Stay Hub Beds in Henley was not lost, and that strong answers needed to be provided to these questions. Accountability was imperative given the lack of consultation regarding this matter.
Cllr Gawrysiak made the following points:
1. In 2016 the Henley Step Down beds were NHS beds to relieve pressure on the Royal Berks. These were provided by the Oxfordshire Clinical Commissioning Group (OCCG) and were designated as permanent beds replacing the Peppard Ward Beds. The reference for this would be David Smith OCCG and John Howell MP.
2. In 2021 they were still permanent NHS Beds because a consultation was had by Kate Teroni (OCCG Chief Executive) to remove the 4 RACU beds.
3. Why had these permanent NHS Chiltern Court Beds been removed without consultation with GP's, patient Groups, RBH, Henley Town Council, Townlands Steering Group, and himself as County Councillor?
4. If their status had changed from being NHS beds, then it needed to be clarified when this change occurred as well as what consultation took place; including Minutes and Agendas?
5. These beds had been reduced from 125 to 63 and shortly to 40. Why had this process occurred without consultation and without having a geographical element?
6. Why was it that South Oxfordshire, Thame, Henley, Wallingford, had no beds at all?
8. How could it be right to place a vulnerable elderly patient in Banbury some 45 Miles away? Was it expected for elderly family members to catch a bus to see their loved ones?
9. Cllr Gawrysiak asked for the evidence that the reduction of these beds had been through the proper due process.
Cllr Gawrysiak emphasised that how could it be right to have a policy that stated that SSHB provision could or should not be predicated on some form of Geography, such that it left South Oxfordshire with no beds. Cllr Gawrysiak questioned as to how it was right to provide beds in Banbury, Chipping Norton, Oxford and Abingdon and not Henley/Thame/Wallingford/South Oxfordshire.
2. Statement by Janet Waters:
Janet explained that she was chair of the Bell Surgery PPG, and that she also represented the PPGs from the HenleySonNet PCN representing Bell, Hart, Sonning Common and Nettlebed Surgeries. Janet outlined that she was well aware of the history of the provision of Short Stay Hub Beds (SSHBs), having been a member of the Townlands Stakeholder Reference Group which gathered data and information concerning the use of the original 11 beds allocated to the Chiltern Court Care Home.
Janet stated that as representatives of patients in this PCN area, they objected to the closure of the 7 SSHBs provided in Chiltern Court Henley. There had been no communication or consultation before the final decision was taken. They were presented with a final decision that would impact patients in South Oxfordshire adversely. There may had been no legal requirement to consult; however, the lack of engagement and communication led them to have a negative view of the ICB and its provision of services. The target to reduce SSHBs by 50% in Oxfordshire was inequitable, as it left South Oxfordshire with no provision at all.
Janet stated that she was aware of the national targets regarding patients being discharged from acute settings to return home. The 95 % national target was not focussed specifically on the frail and elderly and meeting their medical and care needs. Care at home was indeed best, but only when the facilities were in place and if patients could cope in this setting. Driving decisions around the SSHBs to meet a national target was unacceptable to the local population that were benefiting from the supporting step between hospital and home or another setting.
It was understood that the target of 24-48 hours discharges from RBH or OUH was not being met. There was a problem with discharge and the provision of care at home. There had been a pilot, however, the evidence of success had not been made known and patients who were frail and elderly could not be at home for 3 days prior to assessment of their needs. However, Janet explained that from first hand experience, it took 3 weeks and 5 phone calls to get a coordinator to visit her 97-year-old mother at home after discharge from RBH after a hip operation last April. Janet was informed by the Home First team that they could not meet the targets due to staffing issues and there were too many demands on their services. The additional care hours that were provided was welcomed. However, there was no evidence that the removal of the SSHBs was safe and that it did not disadvantage patients.
The GPs supporting patients at Chiltern Court advised that there was a high occupancy in those beds and that there was a requirement for such a facility.
Other initiatives such as Hospital at Home were welcomed. However, these new services did not replace the need for patients to leave acute settings as soon as possible and be helped to take the next step in their recovery through a SSHB for a few weeks if required. This arrangement was still in place in other ICB areas and offered comfort, support and recovery to the patient and their family and friends. Why was Oxfordshire removing this important facility from so many in South Oxfordshire?
Another issue was the provision of SSHBs procured through ‘market factors’. This seemed like cost cutting and the decision to take no account of area led to inequality of provision and unacceptable levels of travel. The travel times by car, train and bus for families, friends and carers to these locations were unacceptable to their PCN area. Why was location not taken into account in the decision? How could these travel times be ignored in the Impact assessments? A two-tier system existed, consisting of those that could afford to pay post-acute discharge into a care facility to get back on their feet and those that cannot pay. Patients were paying £10000 for two weeks care and enablement post hip replacement as there was no one to care for them at home. This is unfair if only those more affluent patients will be afforded this facility.
Janet concluded by asking for a reconsideration of the decision to close the beds and to review the location of future provision. There was a great strength of feeling of injustice in her PCN area as to how their patients would be supported post-acute hospital discharge. No evidence had been seen that the resources and provision will live up to the rhetoric.
3. Statement by Robert Aitken:
Robert Aitken introduced himself as a resident of South Oxfordshire living in Bix & Assendon, and as former Vice Chair of Bix & Assendon Parish Council. He explained that he had a long participation with the Townlands Steering Group, and was a trustee of the League of Friends of Townlands Hospital as well as an Ambulance Service Community Responder for nearly 10 years.
Robert objected to the proposed closure of the SSHBs in Henley and fully supported Councillor Gawrysiack’s efforts to have this decision deferred to allow proper consultation. This decision was taken without any communication, let alone consultation, with local interest groups, the community, or even GP surgeries. The existing bed hub had been well used and was valued by local GPs. The argument put forward against consultation was that it was not needed as the beds’ contract was with Oxfordshire County Council, so not NHS beds. The beds were a direct replacement for NHS beds in the old Townlands Hospital under an NHS contract; if that was subsequently switched, that too was without communication or consultation; and the beds continued to function as step down NHS beds.
The sole justification appeared to be to fulfil a national target, effectively that no more than 5% of hospital discharges be to bed hubs or equivalent. This was an arbitrary nationwide target, and may or may not had been right as such, but for it to be a prescriptive local requirement irrespective of clinical need was inappropriate.
Furthermore, the implication that a small minority would require a step-down bed was not being respected for this large area of South Oxfordshire, as it would have zero beds. There was no guarantee of space in alternatives which were getting squeezed too. In any event they were not close enough for family participation in the recovery.
Robert understood that the enhanced Care in the Home Service to support this was not fully in place, let alone trialled, when this decision was taken. Since then, Government decisions to increase the minimum wage, resulting in further unfunded pressure on local authorities, and new limits on legal immigration of care workers’ families, were likely to put further pressure on the labour-intensive home care system.
Robert asked the Committee to imagine the situation of an elderly person, possibly themself a carer, being discharged from hospital with a spouse unable to care for a rehabilitating partner, or with no-one at home. The idea of servicing this rehabilitating minority only via an uncertain drop-in care service did not bear thinking about.
Failure to get this right would be hugely detrimental to those patients affected and to the functioning of the main hospitals left with further bed blocking pressure.
Robert concluded with the following questions:
Ø Why had there been no prior consultation, and why the subsequent refusal by NHS representatives to engage except at the most minimal level?
Ø What evidence was there that this decision, supporting data, and its implications had been fully exposed to and approved by HOSC?
4. Statement by Victoria Wright:
Victoria introduced herself as having worked in the public sector for over 15 years, having also been involved in spending review submissions and strategic planning. Therefore, she was fully aware of the austerity measures for the last 12 years, and the impacts this has had on buying power in terms of number of staff due to salary increases, and the rising costs of consumables and capital equipment. The NHS had not been immune to this, and the comments she was making were her personal opinions being grounded in the experience working in the public sector. Victoria became a member of the Wantage Town Council Health Committee in May 2023, and had been involved in the co-production exercise around the future of Wantage Community Hospital ever since. Victoria was impressed by the willingness of the Health partners to creatively develop a future for the local healthcare provision. This could not have been easy given the existing constraints, that they had come with ideas in relation to how they could work within the aforementioned constraints.
Throughout the Public Engagement Exercise, a number of stakeholder meetings were held, through which it became clear that there were 4 distinct needs for health services within Wantage:
1. Maternity Provision.
2. Access to local palliative care beds.
3. Access to Urgent Care through a Minor Injuries or First Aid Unit.
4. Access to local outpatient appointment following the success of the Pilot Schemes.
The above options were examined in detail by the NHS as well as by the Sub-Committee, and the NHS outlined that there were constraints around current workforce in specific areas as well as in funding for some options at this particular point in time. For instance, not only were the capital costs for a walk-in X-Ray facility unavailable at this time, but there was also a shortage of radiographers.
It was clear through discussions that both the size of the estate and the capital running cost would prevent all 4 of the aforementioned options happening within the Hospital. Victoria believed that the co-produced report provided a pragmatic and realistic set of recommendations on what could be provided at this point in time to provide the hospital with a sustainable future within the current funding constraints. The NHS had made an effort to ensure that the local community had been engaged in the co-production process thus far, including members of the co-production team standing in the market square to speak to residents; and that they had offered to continue engagements in the coming year. The engagements with Verve Consultants was also a useful addition to this process. At the local public meeting that was held the week prior to the HOSC meeting, residents raised concerns that some options were not being provided for given the growing population in Wantage. This was covered in the motion passed unanimously by the Town Council.
Victoria urged the Committee to consider this motion, and in particular, to consider the part of the report that mentions there would be ongoing considerations to Urgent Care and to a local offer of palliative care. Overall, the co-production exercise was a positive process with good engagement from the NHS. Victoria welcomed firm commitments from the NHS to explore all the recommendations, and expressed that it was not advisable to refer this matter to the Secretary Of State for Health and Social Care at this time, as doing so would add significant delays and lead to a likely loss of CIL (Community Infrastructure Levy) funding, which was the only source of capital funding at this time. A referral would prevent modernisation and keep the hospital in a temporary and insecure future.