THE CABINET

13 FEBRUARY 2017

Subject:Response to Health Consultation - Oxfordshire

Lead Officer:David Buckland

Contact on 01789 260425

Lead Member/
Portfolio Holder:CouncillorT Jefferson

Summary

To inform The Cabinet of proposed changes to the health and social care sector within Oxfordshire. This report also considers whether it should be recommended to The Cabinet that the Council participates in a potential action in response to recent consultation.

Recommendation

To support the approach proposed in Appendix 3 as the basis of the Council’s response to the Oxfordshire CCG stage 1 consultation process.

1Background/Information

1.1The Council has been approached by South Northamptonshire Council and Cherwell District who have for some time been engaged in changes to the health and care sector within Oxfordshire. This has been achieved though active involvement in and support for the Community Partnership Network (CPN) primarily associated with the Horton General Hospital (HGH).

1.2The advent of the NHS’s Sustainability and Transformation Plans (STP) across the country has prompted a review of how health and social care services are delivered at a local level in order to reconcile the growing demand for services with available funding. In producing these plans, the NHS is attempting to address three national priorities;

  • Health and wellbeing: By promoting healthier lifestyles, to improve people’s quality of life, and reduce the pressure on our health and social care services.
  • Care and quality: To ensure that needs are met by services of consistently high quality.
  • Funding and efficiency:Efficient use of resources is essential if for services to remain effective, affordable and able to provide up-to-date treatments.

1.3The CPN has, since 2016, been engaged in dialogue with the Oxford University Hospitals Foundation Trust (OUHFT) over proposed changes to the services provided at the HGH as well as other local changes. The CPN is a stakeholder body consisting of local government, voluntary sector, public and health sector representatives.

1.4This issue is relevant for Stratford-on-Avon District Council as a number of residents from the south of the District use thefacilities at the HGH. It is equally relevant for other local authorities from outside Oxfordshire such as South Northamptonshire as it is the HGH which provides most of the general hospital based care to the western third of the District. More recently, these potential changes formed part of the Oxfordshire Transformation Programme for health and social care which forms the Oxfordshire part of the Buckinghamshire, Oxfordshire and Berkshire West STP.

1.5This report outlines the activities undertaken in relation to the local health sector within Oxfordshire, the nature of the proposed changes as reflected in the formal consultation process now underway.

1.6The report details a proposed approach which is being considered by Cherwell District Council and South Northamptonshire Council to respond to this consultation process, this is being considered by their Cabinet on 13 February 2017. Stratford-on-Avon District Council has been asked to consider whether it wishes to participate in this response.

1.7Community Partnership Network Activities

1.7.1Ever since the 2008 challenge to some of the HGH services was concluded in 2011 with the implementation of the Secretary of State’s directive that the HGH should retain consultant led acute obstetrics and paediatric services, the CPN has been very active. Its primary focus has been to monitor the continued delivery of consultant led services and considered these in the wider context of other HGH changes and wider health and social care service change in North Oxfordshire and surrounding areas including South Northamptonshire and South Warwickshire.

1.7.2In 2016, the OUHFT explored with the CPN a number of scenarios for service change at the HGH and its hospitals in Oxford which at that time were forming the secondary health component of the Oxfordshire Transformation Programme. The three emerging service models are summarised at Appendix 1. Needless to say, there was considerable concern expressed at some of the proposed downgrading of current services by moving most acute services to Oxford despite the strong intent to accommodate an enhanced range of diagnostic, outpatient and elective surgery cases at the HGH. The concerns stem from the fact that many of the proposals run counter to the position taken by the Independent Reconfiguration Panel and the Secretary of State in 2008 where the same distance/travel/patient safety concerns exist.

1.8Oxfordshire Transformation Programme Consultation

1.8.1On 16 January 2016, the Oxfordshire Clinical Commissioning Group (OCCG) commenced a formal two stage consultation process of proposed change relating to primary and secondary care;

Phase 1 consultation – 16 January to 9 April 2016

Acute hospital services (acute hospitals provide a wide range of specialist care and treatment including surgery, medical care, emergency care and tests):

• changing the way we use our hospital beds and increasing care closer to home in Oxfordshire thereby reducing the number of costly hospital bed provision and length of hospital stays;

• increasing planned care at the HGH (planned care includes tests and treatment planned in advance and not urgent or emergency care) such as increased diagnostic tests, outpatient appointments, planned day surgery and pre-surgery assessments;

• making permanent acute stroke services in Oxfordshire where most acute stroke episodes will be treated in Oxford but supported by an extended early supported discharge service at home and potentially with rehabilitation at the HGH;

• changing critical care (critical care helps people with life-threatening or very serious injuries and illnesses) at the HGH where the sickest (Level 3) critical care patients from North Oxfordshire would be treated at the Oxford Intensive Care Units (ICUs). The HGH should continue to have a Critical Care Unit. Patients living in South Northamptonshire and South Warwickshire might be treated at the critical care units in hospitals in Warwick, Northampton or Milton Keynes if closer;

• making permanent the recent changes to maternity services at the HGH including obstetrics, the Special Care Baby Unit (SCBU) and emergency gynaecology inpatient services where obstetric services will be provided at the John Radcliffe Hospital in Oxford, with the Special Care Baby Unit and emergency gynaecology inpatient services. A Midwife Led Unit will be maintained at the HGH (with women from north of Oxfordshire also having the choice to travel to Northampton, Warwick or Milton Keynes).

Phase 2 Consultation – Summer 2017

Acute hospital services:

  • Accident and emergency units in Oxfordshire
  • Children’s services
  • Community hospitals including Midwife Led Units (MLUs).

1.8.2The consultation document is attached at Appendix 2. This outlines the challenges facing the sector where continuing without change is not sustainable, a vision for how services should be improved, a vision for primary care and further detail about what is proposed in the stage 1 consultation. As the Oxfordshire Transformation Board proposals constitute the Oxfordshire part of the Buckinghamshire, Oxfordshire and Berkshire West STP, there is a clear consistency between them.

1.8.3Whilst all services currently provided for at the HGH serve the secondary health care needs of residents living in the southern part of the District for Stratford-on-Avon, the consultation proposals for some services will result in different future service delivery locations.

1.8.4The on-going concern with these proposals resulted in a public meeting in Brackley on 30 January. It is understood that the meeting was attended by over 100 people, significant concern was repeated about the nature of the changes and the uncertainty of what some of them meant in practice. All attendees were encouraged to participate in the Keep The Horton General campaign and to enter their travel experiences when travelling to Oxford hospitals in the survey which Victoria Prentis MP is conducting.

1.9Actions to Date

1.9.1With regard to the potential changes at the HGH, as many of these matters are clinical in nature, Cherwell District Council has engaged health sector specialists to advise on the clinical aspects of the proposals. This information has been shared with South Northamptonshire Council Stratford District Council (SDC) and West Oxfordshire District Council (WODC). The Council has expressed similar concerns about the proposed changes in their Districts and officers have indicated that there may be a wish to work collaboratively to provide consistent and joint responses to the consultation process and other associated activities.

1.9.2During the period of pre-consultation engagement, the Council has been informed of not only of the likely content of the consultation process but also the proposal to split the process into two phases. The CPN itself, did not support the two stage consultation process and made the following representation to the Oxfordshire Joint Health and Overview Scrutiny Committee (OJHOSC):

  • There is a risk that the first consultation will prejudice the outcome of the second consultation and, as far as services in North Oxfordshire are concerned, obscures the basic question around which community interest turns - “what will the future HGH offer in terms of health services”.
  • The starting point is that the Horton has historically provided a local acute service which has provided three core services: A 24-hour emergency service for adult medical emergencies: somewhere to have a baby, and somewhere to take a sick child. The first of these core functions is threatened if, as we understand it, the first consultation proposes the removal of critical care and acute stroke services.
  • There are clear linkages between obstetric, paediatric and anaesthetic services. The withdrawal of obstetrics has caused the removal of the Special Care Baby Unit and with it specialised nursing skills as well as demand for the expertise of paediatricians and anaesthetists. The OCCG of course do not support this view.
  • If the result of the stage 1 consultation were to be the permanent removal of critical care, stroke, obstetric and SCBU services, it is apparent that not only is the ability of the Horton to treat unselected adult medical emergencies compromised, even though the Emergency Department would still be in place, but the paediatric service would be weakened leaving both services potentially vulnerable to being removed as a result of the second stage of consultation.
  • The stratification of consultation means that there is no clarity as to what will be the ultimate outcome and fails, in the case of the Horton, to set out for North Oxfordshire residents what the shape and extent of the future local acute secondary care services they can expect to receive locally. This would in turn compromise the public’s ability to respond coherently to the proposals being put before them and probably fail the key test of public consultation – consistency with the need for patient choice. This position is compounded by the position of OCCG in that decisions on the services consulted in the first stage consultation will be taken before those in the second stage are consulted or consultation is completed.
  • Most of the local MPs have communicated with you in similar way expressing their concern over this matter. The County Council did receive their letter before the meeting where your Committee took the decision to endorse the two stage consultation but for some reason this communication was ignored. It is also Cherwell District Council’s view that the greater good is achieved through a single stage consultation of the whole of the Horton Hospital (ambulatory/DTOC/bed reductions apart) and the OCCG have been informed of this.
  • In the circumstances, the CPN is suggesting strongly that, in order to meet your obligations to the public, a single stage consultation setting out the consequences for the services at the Horton General Hospital for each of the options would be the appropriate course of action. This would ensure that the general public understood, even if they might not agree with what was on offer for the long term. The Horton would then be part of a comprehensive consultation about the totality of services enabling the public to make the link between enhanced primary health care and improving hospital services.
  • This approach would also be consistent with the whole hospital approach adopted by the OUHFT when engaging earlier this year to develop its emerging options. It would be in tune with the acknowledged need to consult early upon the Oxfordshire-wide ambulatory care proposal, in order to care for people in the setting appropriate to their needs and minimising delayed discharges, which we support. Furthermore, it would eliminate the risk of a legal challenge to staging the consultation on Horton-related services.

1.9.3The Council has been informed that the response from the Chairman of the Committee was that the Committee made clear its concern about the OCCG decision to separate the transformation consultation into two phases and sought assurances from the CCG that communities would be made aware of any specific impacts of the proposals on them. Particular concerns were raised in the meeting about the effects of decoupling the consultation on the Horton Hospital. The Committee therefore, agreed that the OCCG should proceed with Phase 1 of the consultation in January, with the request that:

  • Any proposal that impacts on services for obstetric/midwife-led units in the north of the county is included in the consultation;
  • Options around the closure of any other service at the Horton Hospital be included and considered together, and if not included in the first phase, then nothing in the first phase should prejudice the second phase;
  • The proposed delivery of planned care at the Horton Hospital is included in Phase 1 of the consultation;
  • The geographical detail be easily identifiable so that the public can be clear about proposed changes to services in their locality; and
  • There is clarity on the meaning of ‘ambulatory’ care.

1.9.4From the consultation documents and the report commentary above the clarity sought by OJHOSC has not been achieved. However, OJHOSC did on 2 February 2016 agree that the temporary measures for the Horton non obstetric MLU unit be referred to the SoS. This was on the basis of a substantial albeit temporary change without consultation. Further commentary on this referral is included in Appendix 3.

1.10Proposed Council Activity

1.10.1Specialist advice obtained by Cherwell District Council has been issued to this Council plus SNCand WODC. A resume of this is included in the confidential Appendix 3 to this report and includes further action the Council may choose to take plus an indication of the key components in the Council’s intended response to the OCCG stage 1 consultation process.

2Options available to The Cabinet

2.1Option 1 – To respond in line with the draft response attached at Appendix 3and thereby support the proposed action by South Northamptonshire Council.

2.2Option 2 - The option available to the Council is not to respond to the consultation process and let matters take their course. This is not proposed as the HGH is regarded as an importance piece of the District’s infrastructure.

3Evidence Base

3.1Information provided by South Northamptonshire Council.

4Members’ Comments

4.1Not applicable.

5Implications of the proposal

5.1Legal/Human Rights Implications

5.1.1External counsel has been commissioned to provide advice to Cherwell District Council on the consultation approach adopted and its potential for challenge. This has been received by the Council’s Monitoring Officer -Exempt Appendix 5 contains the written advice received.

5.2Financial

5.2.1The initial cost of engaging specialist advisers has been funded by CDC. Further specialist advice may be necessary and, at that point, the Council is likely to be asked to contribute on a shared basis with other District Councils engaged in the same process.

5.2.2These have not been quantified however, any costs to the Council are not likely to be significant and it is expected these would be contained within the existing budget framework.

5.3Environmental

5.3.1There are no direct Environmental implications arising from this report.

5.4Corporate Strategy

5.4.1The following items within the Council’s approved Corporate Strategy are directly impacted by this issue.

Key Objective 2 – People and their environment

The Council will work with partners to protect the character of the environment and support activities to improve the health and wellbeing of our local communities.

Priorities

Promote Health and Wellbeing including playing an active role in the Warwickshire Health and Wellbeing Board.

Key Objective 3 – Responsible community leadership

The Council will support our communities and the diversity of local interests within them. When opportunities arise, we shall embrace innovative solutions to provide the best results for residents and the Council.

Priorities

Seek opportunities to work with our partners to achieve benefits for our residents. Expand our programme of sharing services with other Councils.

Speak up for residents locally and nationally so that local communities are in a better position to help themselves.

5.5Equality Impact Assessment

5.5.1There are no direct Equality Impact Assessment implications relating to the proposed action from Council.

6Risk Assessment

6.1There are clear reputational issues for the Council if it is not seen to be acting in the best interests of its residents on what is a clear matter of some importance to them. Similarly, the HGH is an important piece of the District’s infrastructure that impacts in so many ways on local residents and businesses.

7Conclusion

7.1There are fundamental changes proposed for the local health and social care sector, some of which are the subject of a formal consultation process in neighbouring Oxfordshire running until 9 April 2017. Of very local and heightened concern are the changes proposed for the HGH where most acute services are to be transferred to Oxford hospitals, more care is to take place at home and in the community and increased planned care at the HGH.