Agenda item

Cabinet Member: Adult Services

Forward Plan Ref: 2012/102

Contact: John Jackson, Director for Social & Community Services Tel: (01865)323574

Report by Director for Social & Community Services and Director of Public Health(CA6).

Oxford University Hospitals NHS Trust (OUHT) was formed in November 2011 from the Nuffield Orthopaedic Centre and the Oxford Radcliffe Hospitals NHS Trust. 

OUHT is currently applying to become a Foundation Trust.  Foundation Trusts differ from other NHS Trusts in that they have a membership drawn from communities served by the Trust and the staff that work for it.  The membership elects a Council of Governors which is involved by the Trust’s Board of Directors in setting the future direction for the Trust.  Foundation Trusts have the freedom to respond to local needs, and through their public and staff membership they are able to reflect the concerns and wishes of their local population.  The government has said that all NHS Trusts must become Foundation Trusts by 2014.

The purpose of this report is to set out the possible issues relevant to the application so that the Cabinet can express a view to both the Board of OUHT and also the Strategic Health Authority.  This paper reflects discussions with both the Oxfordshire Clinical Commissioning Group and the OUHT.

The Cabinet is RECOMMENDED to support the application of Oxford University Hospitals Trust to become a Foundation Trust on the basis that it is committed to the following principles:

(a)               Commitment to the highest standards of medical and nursing services for both secondary and tertiary care.  This includes ensuring that frail older people are treated with dignity and respect in accordance with the standards set by the Commission on Dignity in Care for Older People.

(b)              Continued and strengthened commitment to working in partnership with the rest of the NHS, local government and other partners to deliver the most effective and efficient ways of meeting the care needs of the people of Oxfordshire.

(c)               Actively supporting the move to providing more care within the community rather than in a hospital setting as part of a broader commitment to the local delivery of services.

(d)              Actively supporting developments which prevent people from needing care or limiting the extent to which they might need care.

(e)              Commitment to the continued existence of the Horton hospital providing district general hospital services to the people of north Oxfordshire.

Oxford University Hospitals NHS Trust (OUHT) was formed in November 2011 from the Nuffield Orthopaedic Centre and the Oxford Radcliffe Hospitals NHS Trust. 

OUHT is currently applying to become a Foundation Trust.  Foundation Trusts differ from other NHS Trusts in that they have a membership drawn from communities served by the Trust and the staff that work for it.  The membership elects a Council of Governors which is involved by the Trust’s Board of Directors in setting the future direction for the Trust.  Foundation Trusts have the freedom to respond to local needs, and through their public and staff membership they are able to reflect the concerns and wishes of their local population.  The government has said that all NHS Trusts must become Foundation Trusts by 2014.

Cabinet considered a report that set out the possible issues relevant to the application by Oxford University Hospital Trust (OUHT) to become a Foundation Trust so that the Cabinet could express a view to both the Board of OUHT and also the Strategic Health Authority.  The paper reflected discussions with both the Oxfordshire Clinical Commissioning Group (OCCG) and the OUHT.

Councillor Jenny Hannaby, Shadow Cabinet Member for Adult Services commended the full discussion held at the Joint Health Overview & Scrutiny Committee meeting a note of which was before Cabinet. Her main concern was that the focus on specialist services should not be to the detriment of more mundane general care including for the elderly and she gave an example of cataract operations. Communication was also a worry and she gave an example relating to midwifery services generally and the service in Wantage specifically where she had received conflicting information.

Councillor Jim Couchman, Chairman of Adult Services Scrutiny Committee, advised that he had attended one of the consultation meetings and had also been at the Joint Health Overview & Scrutiny Committee meeting. He sought clarity and assurances that the basic services would remain a principal role of the Foundation Trust. He also sought assurances that the OUHT would meet the financial tests for Foundation Trust status and would not be undermined by the existing PFI deals. He further hoped that there was a robust future for The Horton Hospital and that it would continue to improve.

Sir Jonathan Michael and Andrew Steven from OUHT and Ian Busby and Mary Keenan from OCCG were invited to the table.

John Jackson, Director for Social & Community Services in introducing the report explained the national context for the application, and highlighted the factors that needed to be taken into account to build a successful Foundation Trust in the eyes of the people of Oxfordshire. He noted that Sir Jonathan Mitchell had committed the Trust to the successful delivery of these issues and further noted the useful discussion that had been held with OCCG.

Issues highlighted included the concern mentioned above that specialist work receives greater attention than more routine District General Hospital work which more closely affects the people of Oxfordshire; the importance of maintaining the highest possible standards of care including nursing standards; the continued strong commitment to working in partnership; the move away from focussing most resources on hospital care to supporting people in the community including support  for the effective delivery of prevention and early intervention; and continued support for The Horton within  the commitment to make services as local as possible.

John Jackson drew attention to the letter from Sir Jonathan Michael and the comments of the Joint Health Overview & Scrutiny Committee. He added that Sue Butterworth, the Chairman of the Local Involvement Network (LINk) was unable to attend. LINk represented public views about the NHS and adult social care to help identify ways in which they can be improved. However Sue Butterworth had commented: “I celebrate the specific developments within the NHS Trust towards Foundation status, as indeed I do with recent news of a newly funded partnership between Oxford University and the OUH NHS Trust. However, I am particularly interested in the full inclusion of the wider population of the County in any developments in this area and would want to see robust evidence of integration of some services; partnerships across the sector and improved communication between departments. Basic customer service costs nothing and is often overlooked.”

Councillor Fatemian in formally moving the recommendation commented that the benefits of Foundation Trust status were well set out in the report. He noted the widespread concern over specialist services overshadowing District General Hospital services and emphasised that the Council would want reassurance over the commitment to day to day services. He also paid tribute to the increased partnership working in Oxfordshire which was beginning to receive national recognition.

Sir Jonathan Michael responding to questions from Councillor Fatemian highlighted the Trust’s commitment to providing high quality care emphasising that the delivery of patient care was their business alongside education and training and research and development. It was difficult to prove their commitment to District General Hospital work but pointed to their strategic objective to provide high quality local services. Specialist work was still only 30% of income and they had responded to commissioners, sometimes by the reduction in the amount of certain specialist services. Partnership working was the key to delivering local services in an integrated way. Referring to the question of finance he gave an assurance that PFI was not an issue going forward.

During discussion the following points and further questions were raised:

(1) Reference was made to the Community Partnership Network in the North of the County, links to South Warwickshire and South East Northamptonshire

and how engagement with the public would be taken forward. A further point was made that the area stretched into West Oxfordshire.

(2) What effect would the European Working Time Directive have on the training of hospital staff and on services provided particularly at The Horton?

(3) Did the OCCG support the application?

(4) Councillor Hilary Hibbert-Biles proposed an additional point of principle seeking a commitment to continued support for services in Community Hospitals such as peripheral clinics, minor injuries units and midwifery units.

(5) Support was expressed for first responders in rural areas.

(6) It was queried whether clinicians had the skills to make good managers.

(7) Councillor Rodney Rose gave personal thanks for the excellent care he had received over the past year. However he noted that he lived some miles from the hospital and although it had been fine for him many people would find local services easier. He asked what vision there was for the local delivery of services?

(8) It was queried what steps were in place to ensure local influence of services and how far down it would go?

(9) It was confirmed that the recommendation point about ensuring frail older people are treated with dignity and respect was not an aspiration but a reflection of the current position.

(10) Would the lack of co-terminosity with County Boundaries have any impact?

In response Sir Jonathan Michael and Andrew Stevens explained the process to ensure genuine engagement took place and the commitment to working with commissioning colleagues. The experiences in the North of the County would shape how this was taken forward.

With regard to the European Working Times Directive there was a balance to be had between a reasonable working life and the experience needed to take the Trust forward. There would be a balance between trainees and fully trained staff and it was likely that there would be a slight move toward more senior staff delivering care. Trainees would continue to need practical experience.

Ian Busby stated that although it was for the PCT to give formal support the OCCG had contributed to the process and would also be commenting formally. They supported the principles laid out in the report but would identify a number of other areas where they would be looking for continuous improvement. The focus was about improvement for the community. They would be working very closely with the Trust to try and ensure that what the public wanted and needed in secondary care was delivered.

Mary Keenan referring to clinicians being managers highlighted that they would be helping clinicians to develop the necessary skills. Referring to her experience in Chipping Norton first responders had made a difference to response times.

With regard to the vision for more local services Sir Jonathan Michael commented that there was a balance. Some services such as major trauma were best centralised but this did not apply to all services. It was very much about the integration of services with care in a specialist centre but continuing support at a local level. It was hoped that closer collaboration would lead to more co-ordinated care.

Andrew Stevens gave a brief outline of how local influence through patient feedback would work. With regard to County boundaries it was not expected that lack of co-terminosity would have any impact as they provided services across a broad catchment area.

RESOLVED:             to support the application of Oxford University Hospitals Trust to become a Foundation Trust on the basis that it is committed to the following principles:

(a)               Commitment to the highest standards of medical and nursing services for both secondary and tertiary care.  This includes ensuring that frail older people are treated with dignity and respect in accordance with the standards set by the Commission on Dignity in Care for Older People.

(b)               Continued and strengthened commitment to working in partnership with the rest of the NHS, local government and other partners to deliver the most effective and efficient ways of meeting the care needs of the people of Oxfordshire.

(c)               Actively supporting the move to providing more care within the community rather than in a hospital setting as part of a broader commitment to the local delivery of services.

(d)               Actively supporting developments which prevent people from needing care or limiting the extent to which they might need care.

(e)               Commitment to the continued existence of the Horton hospital providing district general hospital services to the people of north Oxfordshire; and

(f)                 commitment to continued support for services in Community Hospitals:

            (1) peripheral clinics;

            (2) minor injuries units (MIU) nurses; radiographers;

            (3) midwifery units.