JHO5(b) – page 1

THE SCRUTINY AND RECOMMENDATIONS OF OXFORD HEALTH OVERVIEW AND SCRUTINY SUB-COMMITTEE REGARDING THE CITY CENTRE LIFT PROPOSALS

REPORT TO OXFORD CITY PCT BOARD

23RD January 2006

Index

Page 3 – 4 / Recommendations and Next Steps
Page 5 – 6 / Introduction and Background
Page 7 - 12 / Section 1 – Consultation Evidence
Page 7 - 9 / Section 1.1. Public Consultation (S11 responsibilities)
Page 7 – 8 / Accessibility
Page 8 / Service Model
Page 8 / The cost of the project
Page 9 / Conclusions from the public consultation
Page 9 –10 / Section 1.2. Is the public consultation adequate?
Page 10 - 11 / Section 1.3. Responses from GPs and other clinicians
Page 12 / Conclusions
Page 12 - 13 / Section 2 – Business Case Evidence
Page 12 - 13 / Section 2.1 Strategic case
Page 13 / Section 2.2 Planning Issues
Page 13 / Section 2.3 Specific services on the site
Page 14 / Section 3 - Conclusions
Appendix 1 / Key lines of inquiry
Appendix 2 / Scoring matrix
Appendix 3 / Letters from GP’s & letter from Oxford Radcliffe Hospital Trust regarding diagnostic services

Recommendations of the Oxford Health Overview and Scrutiny Sub Committee (OHOSSC) regarding the City Centre LIFT proposals

The report of the OHOSSC details its key findings on the options proposed for the city centre LIFT scheme.

Decisions represent recommendations concluded as part of a section 7 and section 11 (Health and Social Care Act 2001) consultation more details of which can be found in the body of the report.

The main focus of the OHOSSC has been the section 7 consultation, with the results of the S 11 public consultation, only available at short notice before the final meeting. (This was unavoidable as land acquisitions deadlines have meant very tight deadlines for reporting public consultation outcomes to the OHOSSC) OHOSSC have identified some potential flaws in the public consultation process and seeks the boards clarification on these.

The OHOSSC wishes to thank PCT officers for their attendance and support during the process and in particular Melanie Proudfoot for acting as a point of access to PCT information. Latterly her role proved invaluable in obtaining information for members.

Decisions

  • That option 3, a site comprising of the Radcliffe Infirmary (RI) and Tidmarsh Lane, is in the best interest of the local health services in the area
  • That when considering the adequacy of the externally validated S11 public consultation duties, account is given by the Board to the following:

Whether a cohort of 200 respondents is adequate to determine views of over 10,000 residents in wards significantly affected by the proposals and a relevant GP patient base of 16,000. The Board is asked to comment to the OCHOSSC on this.

OHOSSC wishes to seek and be provided with clarification of the number of students consulted as part of this exercise and determine if this number is adequate. The Board is asked to clarify this and give comments to the OHOSSC

No evidence was provided of the involvement of the public in the options for consideration. This is part of the S11 responsibility and the Board is asked to comment on this.

That insufficient evidence has been provided to GPs to enable them to make a decision, within the consultation period. The Board is asked to comment on this.

  • The OHOSSC reserves it’s judgement on the choice of services within option 3 because of expected information in the following areas:

The desirability of the location of Genito Urinary Medicine and Family Planning services together and in particular whether Family Planning Services should be located permanently in the city centre or east Oxford. OHOSSC awaits a report detailing attendance rates at the Family Planning Services, since its move to the RI site. In particular whether it has mitigated the severe decline in attendance rates amongst target groups that were noted in the first six months of the move from East Oxford Health Centre to the RI site.

More robust modelling around clear aims for increased diagnostic capacity at the RI site. OHOSSC awaits the results of the financial and capacity modelling that is underway.

The results of further consultation work with GP’s.

Next Steps

The OHOSSC will meet on the 24th January to discuss the choice of option decided by the PCT Board. The view of this meeting along with this report and the Board decision will then be considered on the 26th.January by the County Council’s Joint Health Overview and Scrutiny Committee (parent committee to the OHOSSC). They will consider the recommendations of the OHOSSC.

Councillor Paul Sargent

Chairman and on behalf of the Oxford City Health Overview and Scrutiny Sub Committee.

Introduction and Background

The OHOSSC has been scrutinising the City Centre LIFT proposals since November 2004.

Oxford City PCT were initially considering one option, which was the development of the Radcliffe Infirmary (RI) site into a health complex, with up to seven GP practices together with clinical and diagnostic services traditionally delivered by secondary health providers.

The OHOSSC and the public moved for more options to be considered. The PCT responded positively to this and added three further viable options for consultation and consideration. However, there is no evidence of public involvement in the configuration of these options.

The OHOSSC has spent the last fourteen months obtaining business case and consultation data on site options for this proposed development.

The OHOSSC found the process of obtaining data on site options for this proposed development a difficult and protracted process, with most of the evidence for consideration delivered to the committee in the last three months.

In respect of the difficulties advice was sort from the Independent Reconfiguration Panel (IRP). A meeting was convened on 26th August between the Chair and Vice Chair of the OHOSSC, representatives from Oxford PCT and the IRP.

The meeting was successful in that it established:

  • A common protocol of working between Oxford City PCT and the OHOSSC
  • That S11 and S7 responsibilities would run in parallel due to time constraints
  • That the OHOSSC had a right to evidence that it considered to be of value to the scrutiny process
  • The imminent public consultation would be externally validated

As a result of this meeting a timetable of special meetings were arranged, focused on business case and public consultation evidence.

The table below shows the dates of the meetings and areas of consideration. Agendas and minutes of these meetings are available on request.

Meeting Date / Topics under consideration
17th October /
  • Overall Strategic direction and how the city centre development fits into future tranches
  • The business case for the city centre development
  • Update on the public consultation and its methodology

Meeting Date / Topics under consideration
22nd November /
  • The four short listed options for the city centre development

12th January /
  • Outcomes from the public consultation
  • Evidence requests from previous meetings. Significantly GP / clinician views on options, & service and financial modelling
  • Decisions on: the adequacy of the consultation and whether any of the options are in the interests of the health needs of the area.

Four main documents were provided as evidence by the Oxford City PCT to the OHOSSC:

  • The Oxford City PCT Strategic Service Delivery Plan (2nd Edition)
  • The Public Consultation Document ‘A new health centre for Oxford’
  • Site option appraisal analyses for the original eleven sites under consideration
  • Elemental cost summaries for the four short listed options.
  • Building for a Healthy Oxford : A new health centre for Oxford – Outcomes from Public Consultation

To help members of the OHOSSC through the information and to support debates officers and Members produced Key Lines Of Inquiry (KLOI) (appendix 1) This was used by Oxford City PCT to provide a focus for their presentation and helped identify significant evidence gaps.

To help Members evaluate all the information they both read and heard, officers and Members developed a scoring matrix (appendix 2) around the KLOI main headings. The matrix used Audit Commission techniques in assessing what might be prevalent in poor, fair, good and excellent cases under the KLOI main headings

The OHOSSC were further asked to evaluate, using the matrix, whether there were significant evidence gaps in relation to the strategic case for change and the options under consideration. Significantly the OHOSSC are still awaiting;

  • Final business case evidence, containing final costings.
  • Financial / service modelling information and plans;
  • Best practice sources regarding primary care building design;
  • Confirmation of potential lease income from the move of the Primary Care Research facility to the RI site, which represents a substantial income of £1 million per annum, within the financial plan.

Key findings linked to final decisions

These are presented in three sections:

Section 1 – Consultation Evidence (Section 11),

Section 2 – Business Case Evidence (Section 7),

Section 3 – Conclusion.

Section 1

Public Consultation Evidence

In considering this evidence it should be noted that a detailed public consultation report was received by the OHOSSC too late for detailed study by members and so a number of members relied on the presentation by the staff from the Public Health Resource Unit in making their decisions in this area. Other consultation evidence was received in a timely manner.

1.1. – Public consultation Evidence (Section 11),

1.2 – Is the Public Consultation adequate?,

1.3 – Responses from GP’s and clinicians

1.1Public Consultation (Section 11 responsibilities)

The aggregated preference as a result of consultation is for option 1. Detailed analyses of preferences by GP practices and electoral ward showed a range of preferences between a single site option 1 and two site options for a split site.

The OHOSSC considered some significant concerns and reservations expressed by respondents when considering this evidence. These have been categorised as;

  1. Accessibility including distance, transport and congestion,
  2. The service model,
  3. The cost of the project,
  1. Accessibility
  • Residents of North, Wolvercote, St. Margaret’s and Summertown wards; and the University cited the RI site as a convenient location but in contrast to this residents living outside of the these northern areas of the City expressed concerns about the walking distance and geographical location of a single site,
  • For those respondents expressing concerns the availability of public transport and long walking distances to see their GP were significant. The elderly and infirm being particularly affected by this. The eastern super output area of Central Carfax ward has only 1% of areas in England more deprived in health terms.
  • In considering this in relationship to the integrated service model some respondents suggested that access to the JR for diagnostic services would be easier than the RI site,
  • Parking seemed to be an issue for all options but respondents cited particular concerns about option 1 because of the numbers of people, the potential restricted access to the site and the general congestion in the area. Those living in the area of the RI site particularly expressed this last point.
  1. Service Model
  • Respondents favoured the improvement of primary care facilities and generally welcomed the integration of this with other secondary care services. However concerns expressed support the provision of multiple sites;
  • Respondents suggested that the spread of population may be better served by GPs located more evenly in the area;
  • Localised services were also highlighted as an issue with respondents attaching importance to the view that they have a family doctor that they can get to know. This would be difficult within a much larger complex building;
  • Respondents expressed a view that if GPs were not in favour of a single site then service delivery would suffer. There was a perception that GPs were not in favour;
  • The siting of Family Planning Services at a distance from what was perceived as it’s main client group was expressed as a concern;
  • Respondents felt that to access the secondary services on offer it was likely that patients would have to return on another day so from the patient point of view it did not matter if these services were separate from GP services.
  1. The Cost of the Project
  • Concern was expressed by respondents about the longer term and immediate affordability of this project given both the current and future financial situation
OHOSSC Conclusions
A clear desire had been expressed for GP services to be spread more evenly through the city centre and taking this with the clear public transport issues highlighted by respondents option 1 is not supported by the majority of members
Whilst accepting the “one-stop shop” model for GP and diagnostic services it was felt that in reality patients would often have to return on another day to access these services and so the choice of a split site would not undermine significantly the intentions of this model. The OHOSSC noted that the good practice ‘one-stop shop’ model had not been implemented by LIFTCo at the two developments in East Oxford and Blackbird Leys

Patients desire to be close to, and within easy access of their GP

were shown to be significant in the consultation and were supported by OHOSSC

Further to the commentary above OHOSSC did not see evidence of how patients had been involved in the choice of options to go forward for consultation. This is a requirement of Section 11 and the Board is asked to clarify this.

An option based at the RI site and Tidmarsh Lane was found to present a better fit with consultation results and the PCTs desires to bring some secondary care services into the primary care arena can be achieved within this choice.

OHOSSC still maintain reservations about the siting of Family Planning Services at the RI site and understand that the PCT is in discussions with health clinicians about the desirability and the necessity for these services to be co-located with GUM services. Whilst accepting these are countywide services the OHOSSC wishes to see outstanding information on the reduced usage of these services amongst target groups since the Family Planning Clinic move to the RI site and the mitigation measures to be employed. The Committee received evidence from clinicians in the GUM service that expressed a desire to co-located with obstetrics, gynaecology and accident and emergency at the JR, not withstanding the need to work closely with the Family Planning Service. Judgement is reserved in this area.

1.2.Is the public consultation adequate?

As apart of the agreement between the OHOSSC, the PCT and the IRP the consultation undertaken was validated independently and found to be ‘good and better than expected’ in some areas. The Oxford City Patient and Public Involvement Forum also addressed the OHOSSC and detailed that they had been involved in detail terms with the process and were happy that it represented good involvement of patients. OHOSSC acknowledge this.

When considering the consultation base OHOSSC had two reservations which they wish the Board to consider in looking at adequacy. Conclusions:

  • The Chair of the OHOSSC had received information that students had not been consulted as extensively as the report suggested. This information suggested that the 1470 students detailed as surveyed were rather representative views from colleges on behalf of the 1470 students. OHOSSC had recommended to the PCT that they contacted all students. OHOSSC acknowledge that the PCT information was published in good faith. Students are a significant cohort within the patient base for this development and clarity is requested in this area.
  • Outside of the issues above the consultation base was 200 respondents out of possible patient base of 16,000. The OHOSSC saw no evidence of wider consultation amongst patients and GPs to reflect the city-wide and county-wide support for ancillary services. OHOSSC considered the target groups outlined by the research document and actions taken to inform and attract views. The view prevailed that 200 respondents is inadequate to inform choices on a large and complex project such as this.

1.3Responses from GPs and Clinicians

In an effort to find out the GP and clinician view of the proposals the OHOSSC wrote independently of the PCT to the following groups:

  • The 3 GP practices in Jericho Health Centre and Beaumont Street practices. Oral evidence was also taken from Dr Gant of King Edward Street surgery. In this area all joint responses represented the views of all doctors in the practice;
  • The Directors of GUM and Family Planning Services – Dr Edwards and Dr Greenhall; and
  • The Oxford Radcliffe Hospitals Trust on diagnostic services
Outcomes

All correspondence can be found at appendix 3

  • Beaumont Street Practices joint response

Lack of information on the proposals on which to base their decisions

Leasehold commitments they have to current landlords and the financial assistance required to meet these should they decide to relocate

Concerns regarding future ownership of the Radcliffe Infirmary site and whether NHS commitments on returns to the private investment company will compromise future funding for clinical services.

  • Jericho Health Centre - Dr Bognador surgery joint response and Dr. Williams surgery joint response

Acknowledgement of the need for Jericho Medical Centre practices to move to new premises due to cramped conditions & periodic flooding

Concerns were expressed around too many practices being located on one site and a view that this was not in the interests of the community. This suggested a strong preference for a two option solution.

Issues of poor access to the RI site particularly for residents to the south and west of the City, again reinforcing the need for a two site solution.

  • Jericho Health Centre – Dr. Chivers surgery – verbal response

This practice expressed a strong preference for option 1