Oxfordshire Clinical Commissioning Group (OCCG) and Townlands Steering Group Committee (SGC) hosted a meeting last Wednesday to discuss the CCG’s new proposal for end of life in-patient care beds at Wallingford hospital for residents in South Oxfordshire.
Chair of the Townlands SGC, Councillor Ian Reissmann and County Councillor Stefan Gawrysiak are campaigning for Sue Ryder to re-provide 6-10 end-of life beds to replace those that were lost when the Joyce Grove Nettlebed hospice closed in March 2020.
No representatives attended the meeting from Sue Ryder; however statistics from Sue Ryder were presented which showed that demand for in-patient beds had decreased over the last 5 years. Feedback from families over the last year stated that there were no formal complaints, no serious incidents, and 47 compliments for their Hospice at Home service provided. Another figure shown was that 90% of people had their preferred place of death.
Pete McGrane Clinical Director at Oxfordshire Community Services announced at the meeting that the four in-patient beds the CCG commissioned at Chiltern’s Court Care home in 2017 for patients needing a ‘step-up’ bed facility who require further investigations after visiting the Rapid Access Care Unit at Townlands are being closed. He said, “No admissions have been made to these beds in 20/21, so we are closing these beds as we are spending money on them and they are not being used. A small number of people need to be admitted who have visited the RACU with infections or dehydration etc.”
The proposal by OCCG is to provide 2 end-of-life beds at Wallingford hospital. In Phase 1 two existing side room beds will be used as the palliative beds, however Oxford Health NHS FT are confident based on their data that the use of the existing rooms will not significantly impact the bed capacity of the community hospital to meet overall inpatient demand. In Phase 2 adjustments to the building are recommended to convert an un-used 4 bed bay to create 2 palliative beds in addition to the current bed base and to improve the patient experience. The CCG said they would be working closely with Sue Ryder on this proposal. Questions were asked whether this proposal was big enough for the 140,000 residents in South Oxfordshire and to met the demand for end-of-life in-patient care. Deputy Chief Executive of OCCG said, “We will be monitoring the situation but these beds are specialist in-patient end-of-life support beds and not respite beds.”
It was stated that the Sue Ryder Duchess of Kent hospice in Reading is not taking any admissions currently due to staff shortages and only 5 beds out of the 16 beds are currently available and those residents in Berkshire got priority. The recently built Thames Hospice in Maidenhead with 28 beds is full.
In a Joint Strategic Needs Assessment (JSNA) report dated 2017, the number of cancer deaths in 2015 in South Oxfordshire were 420. If you divide that number by 52 weeks, the number of beds for cancer patients alone could be up to 8/week. National cancer rates have declined by 2% from 2017-2018 but this would still mean the number of beds would dip just under 8/week.
Dr Silver from Nettlebed surgery said, “As a GP who worked at Sue Ryder for 25 years in the years before closure my impression was there was not a reduction in demand for inpatient beds but the emphasis was that patients should remain at home rather than being admitted. This led to the apparent reduction in demand. Patients dying at home are supported by Sue Ryder very ably but many of the tasks that would have been done by the Sue Ryder doctors now falls to GPs. This work is unfunded and has a very distinct impact on GPs workload as prescribing to this group of frail patients is time consuming and complex. Prescribing now falls to GPs where as inpatient prescribing rested with the Sue Ryder doctors when we had the facility in Nettlebed.”
A question was asked about the out-patient services Sue Ryder used to offer at Joyce Grove too and would these be offered from the Sue Ryder Palliative Care Hub in Preston Crowmarsh. It was hoped that these would restart soon but there was no room at the hub to offer these. Sue Ryder confirmed after the meeting that the Hub is big enough for their outpatient services and these will be resuming when they are able to.
Stefan said, “We need to a grip on the demand by asking the question, if you were offered residential palliative care would you have taken it? This obviously needs to be done in a sensitive and timely manner. Joyce Grove has been reportedly been sold for £20million. Heidi Travis, CEO of Sue Ryder said that did not need the money. They have a moral duty to give back to the community that have supported them for many years. We have asked them for £5m gift to a trust so that we can build a new hospice or gift a piece of the land at Joyce Grove behind the mansion.”
Ian Reissmann said after the meeting, “We welcome the fact that the community concerns at the reduction in palliative care services in the last two years have been recognised by the CCG. Obviously two beds are better than none, but we still feel that does not meet overall patient need and choices. This is based on the level of service provided prior to the closure of the Nettlebed Hospice, the level of services provided in other counties, and anecdotal evidence that patient need is not being met in South Oxfordshire.
“Since the meeting we have also received further expression of concerns from clinicians about both the number but also the qualifications and experience of the clinicians and level of care that will be provided compared to what we had in the Nettlebed Hospice prior to its closure.
“We would like to continue to work with the CCG to enable robust evidence to be scrutinised regarding patient need for palliative care and end of life needs. We will then argue strongly for that identified need to be met by the CCG in its commissioning role.”
If you would like to watch the meeting, it can be viewed here https://www.youtube.com/watch?v=-VQrmRJiJ0U&t=533s&ab_channel=HenleyTownCouncil