Labelled the “Big Conversation” it was disappointing that only 11 members of the public were present to hear CCG and other stakeholders such Oxon County Council, Oxford Health, Oxford University Hospitals present on the future of health services in Oxon at a meeting in Henley on 2 March. The report below was kindly sent do us by Chair of the Townlands Steering Group, Councillor Ian Reissmann.
This is phase 1 of the two phase process which is part of the “Sustainability and Transformation Program” (STP) which is being carried out in 44 geographical areas across all of England. Oxon has been grouped with Bucks and West Berks, and the draft STP has already been published and is designed to identify £479M of “savings” in its area.
The following areas are included in this phase:
- reducing care in hospital beds, with more care in patients’ homes
- significant changes at Horton General Hospital in Banbury
- all acute stroke patients to be treated in Oxford
- critical care at Horton be moved to Oxford
- maternity unit at Horton to be downgraded from consultant led to midwife led
After a short presentation by Dr Andrew Burnett (GP and South Oxon CCG lead) and Sula Wilshire (Lead Nurse CCG) , the remainder of the session was taken up with Q&A.
Henley residents were already familiar with the practice of closing hospital beds in favour of care at home and use of a smaller number of beds leased from care homes. The meeting was told that 146 beds have been closed in the last year. Charles Langler asked about how the need to provide “step down” care from acute hospitals was to be met. The answer is that the leased beds in Chiltern Court Care Home will provide the beds. There is a unit of 8 beds, with 3 more spot purchased on demand. These beds are also used to provide “step up” care from the Rapid Access Care Unit at Townlands which has replaced the 18 bed unit Peppard ward. The RACU opened in Feb 2017. The provision of beds across the county is to be part of phase 2 of the consultation.
Cllr Ian Reissmann (chair of the TSG) asked about the Ambulatory Model of care in which beds (such as Peppard Ward) were replaced by care at home. He noted that while the model may work well in some circumstances, it depended entirely on Adult Social Care being available to support those being cared for at home, otherwise people would be stuck in Care Home beds, causing those in Acute beds being blocked from accessing step down beds, which in turn blocked A&E. Kate Teroni from OCC did agree that this had to work, and Adult Social Care was working closely with the CCG and other stakeholders to ensure that the system did work.
Dr Phil Unwin provided his view as a senior partner at the Hart surgery who also provides medical support for the RACU at Townlands. He express his support for the RACU and the work it did, even at this early stage. He indicated he had been sceptical originally, but now believed it to be a good model. His main concern was that at his most recent visit of 9 patients, 5 did not need a hospital bed but were unable to be discharged to be cared for at home because the home care package was not available. His concerns were noted.
Veronica Treacher expressed concern at the nature of the consultation, failing to explain the relationship to the STP, and that some of the items subject to the consultation had already been implemented such as the downgrading of the Horton and the bed closures. She was also concerned about the failure to address sustainability, as well as the waste caused by half of the new Townlands hospital being empty. The CCG felt the Horton had not been downgraded as some services had been enhanced. The loss of the consultant-led maternity unit was mainly due to recruitment difficulties.
Cllr Reissmann expressed concern that the STP was financially driven as the STP document explicitly stated that the changes needed to eliminate the funding gap of £479M predicted for 2020. Dr Burnett and Pete McGrane (Pete McGrane, Clinical Director at Oxford Health) responded that the changes were intended both to improve care and reduce spending. Cllr Reissmann that while accepting that the move to home care was presented as an improved model of care the STP and consultation it was important for the CCG to ensure that health outcomes were improved and asked how these were to be measured.
The consultation continues until 9 April and all members of the public can give their views at the remaining public events or by responding on line @ http://www.oxonhealthcaretransformation.nhs.uk/get-involved