Hundreds of beds set to go in major hospital shake-up

On Monday, Oxfordshire Clinical Commissioning Group unveiled a series of bold proposals that make up phase one of its 'Big Consultation'.

They include the closure of 200 acute beds in the county's hospitals, the centralisation of stroke and critical care and a shake-up of services at the Horton General Hospital, with its Special Care Baby Unit to be moved to Oxford.

And maternity services look set to be permanently downgraded in Banbury and potentially taken away from Chipping Norton.

David Smith, chief executive of OCCG, defended the plans. He said: "In the first phase, the key driver is clinical safety. These proposals are about delivering safe, quality services.

"The NHS does have to make savings, and some of that will come through being more efficient, but it's also about how we provide services in different ways."

Health and social care services in Oxfordshire cost about £1.2bn a year and by 2020 a funding shortfall of £134m is predicted.

Providers also face rising demand as the population grows and ages, with the county's over-85s alone likely to increase by 48 per cent in the next ten years.

Plans put forward by OCCG constitute the local arm of a broader 'sustainability and transformation plan' being developed for Buckinghamshire, Oxfordshire and Berkshire West for NHS England to streamline the health service and avoid an overall deficit of £587m by 2020.

Mr Smith said: "There are very clear proposals in this document and we have been at pains to be as explicit as we can to explain what these changes are.

"They proposals have been through an independent panel of clinicians, the Clinical Senate, and also met tests by NHS England.

"The needs of the population are changing. There are more older people and people with complex conditions, and services have to be able to respond to that."

Phase one focuses on the long-term future of the Horton and services in North Oxfordshire as well as a paring-back of acute beds across the county.

The Banbury hospital could see investment in diagnostics, elective surgeries and outpatient care, but also faces the loss of some critical and stroke care facilities and the temporary downgrading to a midwife-led unit (MLU) last September being made permanent.

The next phase of the consultation will focus on A&E services, primary care and community hospitals in Oxfordshire.

Banbury MP Victoria Prentis said she was 'extremely disappointed' it had been split into two parts and was 'genuinely worried' people would not understand its content.

She said: "I don’t understand myself. It is almost impossible for the people of North Oxfordshire and beyond to express their views on what is being proposed when we have absolutely no idea what will be proposed in phase two. It is simply wrong that we are not getting the full picture.

"The CCG will be holding two public events in Banbury. I hope that everyone who wishes to can attend.

"It is essential that we present a united front and try our best to engage in this consultation, despite its shortcomings. I will do all that I can to ensure that this can be done."

Eddie Duller OBE, a former editor of the Oxford Mail and chairman of Healthwatch Oxfordshire, said the launch marked a 'completely new phase' for the local NHS.

He said: "What the authorities are trying to do is change the system completely. It’s the biggest change for many, many years."

Mr Smith said that under the plans, treatment for the sickest patients would be centralised in Oxford while other care would be located in the community.

He said: "We need centralised services. The John Radcliffe, the Churchill and the Nuffield Orthopaedic Centre are providing services across the whole of the patch. For a large number of patients, if there's a heart attack or major trauma, the best outcome is going to be being seen within the JR, which is where all the specialist care is.

"But we also need to provide as much care as we can locally. There are people living in North Oxfordshire who travel to Oxford for routine appointments.

"Why does that need to happen? These services could be provided much more locally, at the Horton."

All consultation documents are now online and anyone living in the county, or who uses NHS services based in the county, is invited to have their say before April 9.

Case study: Horton General Hospital, Banbury

The bulk of phase one focuses on the Horton General Hospital in Banbury, which OCCG says will undergo changes that will make it 'fit for the 21st century'.

It intends to increase the number of outpatient appointments by 60,000 a year and create a new diagnostic unit with MRI and CT scanners and ultrasound equipment.

The hospital could also provide more chemotherapy, renal dialysis and day case surgery to halt the need for so many people to travel from Banbury to Oxford's hospitals.

Mr Smith said: "These are people living in North Oxfordshire who travel to Oxford for routine appointments.

"These services could be provided much more locally, at the Horton. Given concern about travel times and parking at the JR it would relieve substantial pressure."

At the same time, however, long-fought-for maternity services at the Horton are set to be downgraded for good.

The only two proposals put forward by the CCG include retaining the current midwife-led unit (MLU) and moving the Special Care Baby Unit to Oxford.

The hospital is set to retain its six-bed critical care unit (CCU), which last year cared for 488 patients, but 40 of the most serious cases a year could be moved to the JR.

All of those who are currently taken to the Horton after having an acute stroke - about 100 a year - would also be taken to the JR's Hyper Acute Stroke Unit under the plans.

Campaigners who have long fought to retain services at the Horton slammed the proposed changes yesterday as a 'dangerous sham'.

Above: Keith Strangwood

The Horton has provided hospital care since 1873 and has a catchment area of about 164,000 people, set to rise to 200,000 by 2026.

If plans go ahead in their current form, all expectant mothers facing a high-risk birth or complications during labour will continue to have to travel to the JR in Oxford.

People who suffer an acute stroke or are in need of the most urgent critical care - for instance those needing respiratory support or with multiple failed organs - will also have to travel to Oxford.

Keith Strangwood, chair of the Keep the Horton General campaign, said: "We need to boost outpatient appointments but it can't be at the cost of consultant services.

"If we lose maternity, it will be the domino that takes away anaesthesia as the Horton will lose training accreditation, and then A&E goes.

"'Patient safety' is nonsense. Someone's life shouldn't be dictated by a 24-mile car journey to the JR. It is downgrading and this isn't a consultation, it is an engagement. It's a sham."

Case study: Cotswold Birth Centre, Chipping Norton

Doubt has been cast over the future of a midwife-led maternity unit in west Oxfordshire as part of phase one of the plans.

OCCG has suggested that either two units, at the Horton in Banbury and the Cotswold Birth Centre at Chipping Norton, deliver services for expectant mothers in the north of the county - or the latter could be closed altogether.

The money saved would then be reinvested elsewhere in the county.If the service based at Chipping Norton Community Hospital is closed, facilities for antenatal and postnatal services would still be provided. 

But Clive Hill, chairman of Chipping Norton Hospital Action Group, said it was vital the town had its own health services, including a maternity unit, due to its location. 

He said: "In Chipping Norton we don’t have high speed links to other major hospitals in the county. 

"The distances to the JR and to the Horton can be life-threatening distances so we need a standalone service in Chipping Norton, and that includes maternity. 

"We are extremely worried about pregnant women, particularly in the winter months, having to travel to Banbury or the JR to give birth. 

"Our biggest concern at the moment is to make sure we keep our unit in Chipping Norton so that we can deal with our own straightforward births."

Hospital beds

A key aim for the NHS in Oxfordshire is to reduce the number of hospital admissions and the time patients spend in hospital.

Last year the county saw a dramatic drop in bed-blocking figures after trusts set up a ‘liaison hub’ to help move older patients from hospital to nursing home beds.

Over the winter of 2015/16 a total of 76 acute hospital beds were temporarily closed followed by a further 70 in September 2016.

A total of 101 of these were in Oxford’s hospitals and 45 were in Banbury, in areas including surgical emergency units, general medicine and orthopaedics.

OCCG has stated it would like to make the changes permanent and close a further 48 beds, re-investing the projected £4.9m in a new discharge service and outpatient care.

Stephen Attwood, a Bicester GP and the CCG’s north east locality clinical director, said: “Getting older people home will give the best clinical outcomes.

“It’s not a cut in our eyes but a question of rebalancing the system and to have these services available to the right people.

“Many of the beds we are talking about weren’t being used for acute care; they were basically being occupied by people who really needed to be at home.

“If we have services that work very well for our increasing older population, that will have a major impact on allowing beds to be available for younger people as well.”

‘Ambulatory assessment units’ - or in simple terms ‘outpatient unit’ have already been set up at the JR and the Horton for patients with complex needs who do not need to be in A&E.

Plans are also being developed to cement a new ‘acute hospital at home’ service, which is currently being trialled in Oxford and supports people in their own homes.