The questions and answers below were submitted at public consultation events 26 January 2017 - 23 March 2017, but not responded to at the event because of time pressures or the information requested was not immediately available.

For all other responses to questions you can listen to audio recordings of the events on the Oxfordshire Clinical Commissioning Group YouTube channel.

 

Consultation Process

 

1. Why was the consultation not done as one because it is very difficult to gauge what impact the proposals are going to have on social care?
At the end of last year following further work and engagement with our GP practices to develop options for future services, it became clear that the emerging proposals for A&E, children’s services and community-based care (including community hospitals and primary care) would benefit from continued development with a wide range of stakeholders before a public consultation on any proposed service changes.

The areas that are being looked at in the first phase are those that require immediate resolution because of safety and quality issues for patients. The Oxfordshire Health Overview and Scrutiny Committee (HOSC) also advised they wished us to proceed to consult on proposals where temporary changes were in place; this included the emergency closure of the obstetric-service at the Horton General Hospital and changes to the use of beds at the Horton and the John Radcliffe . For stroke and critical care we are consulting now as we think all residents of Oxfordshire should have equitable access to the best care and as soon as possible.

2. The ‘survey’ is biased with questions to get the answers the OCCG wants.
The survey has been designed based on the proposals in the consultation and around our reasoning for those proposals. People are able to include comments on each of the survey questions. There are also a number of other ways people can respond to the consultation for example sending an email / letter; attend a consultation event or discuss feedback with a member of staff.

3. Are the plans proposed by the OCCG consistent with the legal rights and responsibilities articulated within the NHS Constitution? If not, please show cause as to why this is not the case.
Yes, in particular we are trying to adhere to the following rights about quality of services:
You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality.

You have the right to expect NHS bodies to monitor, and make efforts to improve continuously, the quality of healthcare they commission or provide. This includes improvements to the safety, effectiveness and experience of services.

See page 7 of the NHS Constitution which is available here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/480482/NHS_Constitution_WEB.pdf

4. DOH evidence forbids consulting on ‘done deals’ – having removed beds already why consultation on this? So what do we have to do to get OCCG to change its mind and respect Banbury public choice?
The proposals for changes being presented during this first phase of consultation are largely about proposing to make permanent the changes that have been in place on a temporary basis because of significant difficulties in staffing the services and to ensure the quality of care patients receive is what should be available to all. The timing, duration and approach to consultation was agreed in advance with the Oxfordshire Health Overview and Scrutiny Committee.

As part of the Oxfordshire wide Transformation Programme, NHS staff have been looking at ways to reduce hospital admissions in the first place - and to join up primary, community and acute hospital care to help deliver better patient experiences and outcomes. These plans will help us move from a dependency on bed-based care in hospital towards a model which provides continuing care and treatment for some patients in their own home or in a community setting, where appropriate.

Ambulatory assessment units have already been set up at both the Horton and John Radcliffe Hospitals. Open seven days a week, these provide urgent assessment and treatment of adults who are unwell, but may not necessarily need to be admitted to hospital. As a result, patients do not need to be admitted to an acute hospital bed for overnight stays.

5. The temporary bed closures are NOT temporary and despite NO beds at the Horton and patients sleeping in ED we are not allowed to open them. Why was the public not consulted on this?
The temporary bed closures are being consulted on in this phase, as agreed with the Oxfordshire Health Overview & Scrutiny Committee. The proposals for changes being presented during this first phase of consultation are largely about proposing to make permanent the changes that have been in place on a temporary basis because of significant difficulties in staffing the services and to ensure the quality of care patients receive is what should be available to all.

Not all patients coming into emergency departments will need an overnight stay in a hospital bed. As part of the CCG’s consultation process, clinical staff have been looking at ways to reduce hospital admissions in the first place - and to join up primary, community and acute hospital care to help deliver better patient experiences and outcomes. These plans will help us move from a dependency on bed-based care in hospital towards a model which provides continuing care and treatment for some patients in their own home or in a community setting, where appropriate.

6. Why does the consultation document indicate no obstetricians available when at the September Scrutiny and Health meeting you indicated four had been appointed (2 required registration, induction and a further 4 had applied).
The consultation document refers to the difficulties recruiting doctors.  OUHFT is continuing to recruit to the vacant posts at the Horton with a rolling advertisement. In January, only three doctors were in post. In February there are five doctors in post, which is still well below the nine required to reopen the unit. There is a national shortage of middle grade doctors in obstetrics – even in posts that have training recognition (which the Horton does not), there is a vacancy rate of nearly 25%.

7. With these consultations does what the public think and feel really matter or is this just a done deal and you are going ahead with what you want regardless?
This consultation sets out proposals to change some health services in Oxfordshire. Oxfordshire Clinical Commissioning Group (OCCG) is keen to hear the views of people so they can understand the impact the proposed changes have on individuals and communities. Feedback will be taken into consideration by the Board of OCCG when they are making a final decision as to the future of those services being consulted upon. The views of the public form part of what the OCCG board will consider; the Board will also need to ensure that it is able to commission safe and effective services that can be staffed. 

8. Why have you done a split consultation when the services are interdependent and we have asked you not to?
Please see Q1.

9. If we all say we don’t want this will it stop? How meaningful is this consultation?
As above in Q7.

10. Is this STP? Not clear on your consultation.
The Oxfordshire Transformation Programme is part of the Buckinghamshire, Oxfordshire & Berkshire West (BOB) Sustainability & Transformation Programme, it is not separate. A way to explain it is that the work we are currently undertaking is the Oxfordshire ‘chapter’ of the BOB STP with common pieces of work across all of the geographical areas such as developing a sustainable workforce. As such our consultation contributes to the STP.

11. If HOSC changes its opinion will you postpone this part of the consultation?
We would consider any opinion from HOSC; however the areas that are being looked at in the first phase are those that require immediate resolution because of safety and quality issues for patients. We want to ensure that residents of Oxfordshire have equitable access to the best care and as soon as possible. We have agreed our approach to consultation with the HOSC.

12. Why have you planned 10 hours of the Jan-March meetings to take place at times when the working people who fund the NHS are unavailable to attend?
There are 15 public meetings being held during the consultation and we have booked them at differing times so that different people have the opportunity to attend. These meetings are spread across the county and in South Northamptonshire and are at a range of times; people are more than welcome to attend any of these meetings. Nine of these meetings are being held in the evenings and in addition some of the day time meetings have been full booked.  In addition the public meetings are not the only way for people to engage with the proposals and the consultation; all the material is available on our website which offers a variety of ways in which people can have their say. The website will be kept up to date and will include material presented at the public meetings and some frequently asked questions.

13. Was a Banbury GP asked to attend?
The Locality Clinical Director for the North of the County (a GP from Banbury) attended the meeting.

14. Are you listening? I have heard people’s points being ‘fobbed off’. What is the chance that our opinions will change the policy? I get the feeling you are going through the motions. We need you to act! Emergency C-Section at Horton in 2010 and SCBU for my twins. Babies and mothers will die. Are you listening? Will you act?
As above in Q7.

15. Will the next Banbury meeting be plenary or banquet? Will it be in St Mary’s Banbury?
The next Banbury meeting will be a plenary session and it will be held at St Mary's Church on 16 March from 7pm until 9pm.

16. How much did it cost to hire Mr Grey? Is he going to every meeting?
We have employed an external chair for each meeting. Gavin Grey and Gail Downey have introduced themselves as external chairs. They both have significant experience in chairing public meetings and we believe that we have all benefitted from their expertise. The cost has been £740 per meeting which includes their preparation and travel time.


17. What hasthe OCCG learnt from tonight’s consultation [Banbury 26/01]?   
The CCG wanted to make sure opportunities were made available across the county for people from all communities to get involved in this consultation. We anticipated the meetings in Banbury would be well attended which is why two were scheduled. This meeting was the first one and so the first opportunity for questions to be put face-to-face to the panel. The strength of feeling at the meeting was made very clear. Many people expressed their concerns about the impact of travel between Banbury and Oxford in different situations, whether it is to attend an out-patient appointment at the JR or in an emergency in an ambulance. Understanding the full impact of travel time, including parking is going to be important for the CCG before decisions can be made.

18. Moving from illness to prevention is a great aim. In the interim this must increase costs. Is this covered in the proposal? 
Phase 1 of the Big Health and Care Consultation does not cover any specific proposals about prevention work. This will form part of Phase 2 later in 2017.

19. Talking about concentrating on ‘preventative’ care instead of treating illnesses/pregnancies is ‘utopian’ at best. What about people who already have these conditions?
AS Q18

20. If we all say we don’t want this will it stop? How meaningful is this consultation?
 As Q7

21. How many negative comments do you need to receive before proposal is overturned? X600+ here.
As Q7

 

Travel

 

22. Since the time of the Independent Review Panel in 2008 travel to the JR has become more difficult. How can the proposals be considered to be anything other than an elimination of patient services especially when we are told it is not about the money?
The Independent Reconfiguration Panel (IRP) report in 2008 made recommendations to the then Oxford Radcliffe Hospitals NHS Trust (now Oxford University Hospital NHS Foundation Trust- OUHFT) and the Oxfordshire Primary Care Trust (now Oxfordshire CCG) on the future of maternity, paediatric and gynaecology services at the Horton General Hospital. Sustained efforts have been made, including considerable financial investment, to maintain safe and sustainable services at the Horton.  The biggest change since the recommendation and subsequent programme of work to look at provision of services is that the Deanery removed training accreditation in 2012. To counter this, the OUHFT then developed Clinical Research Fellow posts to cover the middle grade rota.  Despite significant efforts with recruitment, including enhanced opportunities for doctors to work at the John Radcliffe, enhanced pay and opportunities for support with visa applications, the OUHFT has been unable to recruit and retain sufficient number of doctors to provide a safe obstetric service at the Horton.

24. The programme mentioned Immediate Assessment for stroke patients. How will the distance/time of travel to the JR from Banbury impact on assessment and care?
Since 2009, patients with suspected strokes who have had symptoms within 4hrs of the time they have made contact with an Ambulance service, are initially seen in their nearest Hyper Acute Stroke Unit where are assessed for thrombolysis (clot busting drug). The Horton General Hospital is not a Hyper Acute Stroke Unit and does not see this cohort of patients. The few patients (2-5 patients) who present each month at the Horton General Hospital with symptoms of stroke which have developed outside of the 4hour window, are assessed and discussed with the stroke physician at the JR as to the appropriateness of transferring them to the Hyper Acute Stroke Unit at the JR or remaining at the Horton Hospital for their acute stroke care and rehabilitation. The proposal in the consultation is that all the patients with suspected stroke will be transferred straight to their nearest hyper acute stroke unit.

25. How can we overcome the travel time issue to JR from Banbury?
One of the key proposals is to provide 90,000 more appointments at the Horton meaning people have to travel to the JR much less than currently.  OCCG and the OUHFT continue to work with the Local Authorities to review what else could be done to make travel and parking easier.

26. Speed of treatment in strokes is critical. What happens to someone unfortunate enough to have a stroke in Banbury with a 60-90 minute journey to the Radcliffe Specialist Unit? UCLA data (US) says for every 15 minute delay, there is 3-4% worsening of outcome for stroke sufferers.
These patients already go to the John Radcliffe Hospital. Since 2009 patients who have symptoms within 4hrs of onset are transferred to a Hyper Acute Stroke Unit where they can be assessed for thrombolysis.

27 When ambulance is withdrawn at what point beyond 40 mins travel time does it become unsafe?
There is no single answer as each woman would be assessed on her clinical need. What is known is that when access to a specialist obstetric team is needed, it is best that they are located as one team within a specialist unit.

28. Transport is a big issue and parking at the John Radcliffe is horrendous and parking is limited.
As Q25

29. Have you considered the appalling lack of parking for relatives who now have to go to Oxford?
As Q25.

30. Is this needed because of the traffic chaos around the JR on a Thursday?
The changes being proposed in the first phase are those that require immediate resolution because of safety and quality issues for patients.

31. What is the average time between an ambulance arriving and the patient being admitted to hospital both maternity cases and general?
In maternity cases the average travel time once the ambulance has arrived is 35-40 minutes. This is very similar to the MLU in Wantage.

32. How do you explain the discrepancies between numbers of critical and maternity patients of HGH and ORH? 1800 critical cases against 4/week, 8000 births against 4 per day. Is the northern half of the county 50 times healthier and 50 less fertile than the south, or is OUHFT diverting our sick and pregnant to Oxford to justify closure of services at HGH?
In terms of number of births there are a number of factors. The JR has 6,000 births from Oxfordshire women and an additional 1,000 births from non-Oxfordshire women. Banbury has 1,400 births of which 350 are non-Oxfordshire women and 1,050 women are from Oxfordshire. Women have the right to choose where they give birth and many women from Banbury and surrounding areas already choose to give birth in JR. Secondly all women at high risk of complications already give birth at the JR as that is where the specialist team in based. Thirdly the Banbury area does not make up half the population of Oxfordshire.  The Cherwell District Council population is about 145,000 and residents in the south of this area (e.g. Bicester and Kidlington) may already choose tor travel to Oxford for services.  The total population of Oxfordshire CCG is over 725,000.

33. Carparking and access. Horton does not have enough spaces, similarly JR and Churchill. Access to JR is dreadful – 30-60 minutes. What can the NHS do to encourage the council, particularly at JR to open the other two entrances currently closed?
 The Oxford University Hospitals Trust is reviewing car parking across all its sites and will be working with local councils as any plans develop.

34. If someone does not drive but has elderly relatives in the JR from Banbury how are you helping them with travel and visiting? Taxis are expensive and public transport not always accessible.
As Q25

35. Parts of Banbury are recognised as being the most deprived in S England. How will your proposals to move services to Oxford help eradicate (word that can’t be read) for those who can’t afford to travel or own a car.
As Q25

36. Have you taken into consideration the family members who are unable to travel to visit patients who need to stay at JR? Not everybody drives and it is not easy to get from Banbury and its surrounding villages to the JR by public transport!
As Q25

 

Maternity

 

37. You talked about ‘healthy women’ being better off in a MLU and that you want to improve health rather than just to treat sick people. While I agree that staying healthy is the best option, we as a country have a long way to go until our food industry and general culture enable widespread ‘good health’. Is Banbury being punished for poor health and a lower socio-economic status instead of being given the care we need and should be able to rely on? A MLU for ‘healthy women’ sounds as if it should be planned for Chiswick or Hampstead rather than an ordinary hard working town.
As part of the way the CCG is considering developing its proposals, it has commissioned an integrated impact assessment to be undertaken by an external company of the NHS organisations.  This will consider the proposals and the way in which they will affect the local populations (both in the North, across the county and beyond). This will be combined with the feedback from the consultation to help inform the way in which the proposals will develop in the next stage.

38. During pregnancy for complex case patients will they be looked at at the Horton or will they have to travel to JR for each assessment unit delivery?
Some antenatal appointments for high risk women will be delivered at the Horton. However all women with complex pregnancies will be booked to give birth at the JR.

39. How many additional neonatal and maternal deaths are statistically predicted as a result of intra-partum or immediate post-partum transfers required from Horton to JR? What about if the Chipping Norton MLU were also closed?
None.

40. Yet again many of Brackley’s residents will be left out e.g. a young mother from Brackley may have worrying pre-birth complications if this is suddenly discovered a very short time before the actual birth. This is extremely concerning as from Horton to Oxford can frequently take an hour plus, thus endangering mother and baby.
All pregnant women have regular risk assessments throughout their pregnancy, during labour and immediately after birth from midwives, obstetricians and from GPs. Midwives are highly trained and will make appropriate referrals to obstetricians. Consultant obstetricians will continue to run pre-natal assessment appointments and clinics at the Horton General Hospital.

41. Why not rotate obstetricians so they gain experience?
This is not possible because doctors in training at the John Radcliffe Hospital are not able to work at the Horton. The Horton is not recognised as a training unit because of the low number of births.

42. Other hospitals have appointed to posts for combined consultants for obstetricians and gynaecologists. Have you explored that?
The consultants based at the Horton are already joint obstetrician/gynaecologist appointments. 

43. With the current transfer of maternity patients to the JR, is it right that almost half of the gynae ward is taken up with maternity patients as my wife experienced last week?
The maternity and gynaecology wards are separate and no maternity patients are on gynaecology wards. However, as a temporary measure, one of the gynaecology theatres is currently being used for planned caesarean sections. An additional temporary theatre has been brought in for gynaecology patients.

44.The ‘temporary’ downgrade of the Horton maternity unit was to be re-evaluated in January. What is the progress? Recruitment.
The OUHFT is continuing to recruit to the vacant posts at the Horton with a rolling advertisement. In January, only three doctors were in post. In February there are five doctors in post, which is still well below the nine required to reopen the unit. There is a national shortage of middle grade doctors in obstetrics – even in posts that have training recognition (which the Horton does not), there is a vacancy rate of nearly 25%.

45. We are sceptical about the effort made to recruit obstetricians. Copy of the offer of an agency contract made at the CPN for overseas recruitment ignored.
The OUH does already recruit successfully from abroad for many clinical posts. The lack of training recognition in obstetrics for the Horton makes recruitment a problem. The majority of doctors are keen to continue their training and so are looking for posts in hospitals that give them that opportunity. There is a national shortage of middle grade doctors in obstetrics – even in posts that have training recognition (which the Horton does not), there is a vacancy rate of nearly 25%. The OUH is continuing to recruit to the vacant posts at the Horton with a rolling advertisement. Despite efforts, there are currently only four doctors in post, which is still well below the nine required to reopen the unit.

 

 

Planned Care

 

46. Where on the Horton site will this new ‘diagnostic centre’ be sited? How much will it cost? Has this funding been agreed? Can we see the plans?
There is no fixed location for the centre, and the planning for this will take place following the public consultation and if the CCG decided to go ahead. The notional cost is £15m and it expected that this will be affordable, but funding has not yet been approved.

47. Horton General OCCG STP Consultation. Why can’t the Horton General Hospital A&E / maternity be upgraded not downgraded?
The trend within health services is for increasing specialisation in order to raise standards, and for some services this has led to centralisation at larger centres serving a larger population. Smaller centres such as Scarborough and Whitehaven have failed to attract sufficient skilled staff to maintain every service locally. The case for change for the consultation identified that workforce was a key constraint in providing services in the future.

48.  60,000 more patients to be treated at Horton. Can we know what these are and when they will happen? Will Oxford patients come to Banbury?
If the current proposals are approved following the consultation there will be an extended period of building and installing new equipment. This could take up to two years. The figure of 60,000 represents a variety of outpatient appointments and day surgery. This number is based on people in the Horton catchment areas who are currently travelling to Oxford for outpatient appointments/diagnostic tests.` Oxford residents may be offered a choice of location, and could travel to Banbury.

49. Before the M40 was built there was a public enquiry. It was only allowed to be built when it was proved that the Horton’s A&E unit would be able to cope with M40 accidents. So if A&E is removed from the Horton, as stated before in the query of last 1980s, the M40 is not safe. The enquiry then said without the Horton’s A&E the distance between available A&Es on the M40 was too great. This hasn’t changed. A&E cannot be closed.
This consultation does not propose to remove or downgrade the Accident and Emergency department at the Horton General Hospital; however the way that the emergency services and hospitals deal with major trauma has developed since the 1980s. Across the UK, major trauma patients are now transported further to centres of excellence, where outcomes for patients are better.

50. How many people will be coming from Oxford to Banbury for diagnostic or day care?
The proposal is to provide additional day surgery capacity at the HGH.  It is anticipated that the majority of patients will come from the North Oxfordshire area, but patients from across the county and south Northamptonshire may choose to have treatment in Banbury.

51. My question of what inpatient services the Horton will have this time next year was not answered?
In Feb 2018 the HGH will provide all the current inpatient services with the exception of acute stroke care and emergency gynaecology surgery.  Any changes will be dependent on the agreement of the CCG Board to the Phase 1 proposals; at the earliest this will be in May or June 2017.


52. In the film ‘new build’ was mentioned for the ‘day case care home’ on what site?
There is a proposal to provide additional day surgery capacity at the Horton General Hospital site. This will require some building work and new equipment.

53. Horton as a comprehensive centre of excellence. Why is it not possible to extend the Horton’s provision to services on a level equivalent to those of the JR?
The John Radcliffe Hospital supports a larger local population than the Horton General Hospital and also provides tertiary hospital services to Buckinghamshire, Milton Keynes and Berkshire. The trend within health services is for increasing specialisation in order to raise standards, and this has led to centralisation at larger centres serving a larger population. Some smaller centres have failed to attract sufficient skilled staff to maintain every service locally. The case for change for the consultation identified that workforce was a key constraint in providing services in the future. Oxfordshire could not support two tertiary centres, in Oxford and Banbury.

54. I understand the Ramsay Centre is to close at end of July because a ‘new deal’ has not been agreed re. ‘rent’ of building.
This is not agreed; the CCG is currently looking for a solution.

55. What about elective orthopaedics and Ramsay Treatment Centre?
As Q56.

56. Ramsay Treatment Centre. Horton Treatment Centre (Ramsay) provides a lot of elective orthopaedics for Oxfordshire. We understand OUH has given notice on the building. Who will provide this service and what happens to the building?
OUHFT owns the building. We are currently looking at how the service will be provided and by whom.

57. Now notice has been given to Ramsay Horton Treatment Centre what does this mean?
As Q56.

58. What are you going to use the Ramsay Treatment Centre for?
As Q56.

59. Is the plan for us [Horton General Hospital] to be a day care hub?
There is a proposal to increase the amount of day surgery capacity at the HGH. This would be one of the many services provided in Banbury area for the foreseeable future.

60. Whilst we are very grateful to Oxford hospitals for their care in special departments they are very stretched themselves! Why not spend some money in expanding the Horton and let some patients travel to us for treatment to ease their problems? Also the black cloud continually over Horton does nothing to make it an attractive place to attract staff especially doctors to apply and come and work here!!
There is ongoing investment in services at the Horton, particularly in diagnostics.  The OUH vision is to expand services by increasing the number of outpatient appointments, diagnostic tests, and day case surgery undertaken at the Banbury hospital.  This means a further 90,000 patients a year will be able to travel to the Horton for their appointments, and will reduce the number of patients who need to travel to Oxford to be seen.
Although the residents of north Oxfordshire may have to travel further for specialist care in the future, the OUH is investing in the Horton with increased amounts of routine care being delivered locally.
The OUH and the OCCG are offering a vision of healthcare for north Oxfordshire which sees continued investment in the Horton and its development as a hospital fit for the 21st century.


Urgent care and other


61. Who is going to use the CCU beds? What happens when they are full? How many beds will there be?
The Horton General Hospital’s critical care unit has a physical capacity of six bed spaces and this is not intended to change. Patients who need additional monitoring or support will continue to use the service. Approximately 40 of the sickest patients will transfer each year to the specialist centre in Oxford, where assisted ventilation may be provided.


62. Will the A&E in Horton be closed?
This consultation does not cover any proposals for A&E at the Horton.

63. If the closed beds are not needed, why are patients waiting 4+ hours in A&E and on trollies in corridors?
Not all patients coming into emergency departments will need an overnight stay in a hospital bed. As part of the CCG’s consultation process, clinical staff have been looking at ways to reduce hospital admissions in the first place - and to join up primary, community and acute hospital care to help deliver better patient experiences and outcomes. These plans will help us move from a dependency on bed-based care in hospital towards a model which provides continuing care and treatment for some patients in their own home or in a community setting, where appropriate.

64. Paediatrics have not been mentioned tonight. What will happen to them? What are plans for paediatrics at Banbury?
Paediatrics will be looked at in phase 2 of the Transformation Programme consultation. 

65. A simple question. At the end of the both consultation processes how many inpatient beds do you plan to take away from the Horton? As you know part of recovery is contact with family. How many vulnerable people will you deprive of regular contact because they have poor, vulnerable relatives who cannot visit them?
The main aim of removing inpatient beds is to focus care where patients need it most and to reduce the time patients spend in hospital by providing more care and treatment in or closer to people’s homes and on an outpatient or day case basis.  It is accepted that elderly people in particular will benefit from being treated as close to their own homes as possible, maintaining family and social ties.  Currently 45 inpatient hospital beds at the Horton have been closed as a temporary measure and 17 of these beds are now being used as day case beds. The proposal we are consulting on is to make this permanent. 

The resources released from having less inpatient beds will be reinvested (used) to provide care in or closer to people’s home to achieve better outcomes for patients in the right environment.  The Home Assessment and Reablement Team is being expanded to enable patients across the area to return home with additional support when they are ready.

66. A&E. Will the Horton have an A&E department? Is 40 mins acceptable a transfer time in an emergency?
This consultation does not cover any proposals for A&E at the Horton.

67. You have yet to address ‘the future’. With new builds and growing population WHY NOT improve the facilities etc. at the Horton rather than move it all to an already struggling hospital 1 and 1/2 hours away?
It is intended to improve the facilities at HGH for outpatients, diagnostic services and day surgery. These are the services that are used by large numbers of individuals and it would improve access to services for the residents of north Oxfordshire. The services proposed to move are those that cannot be safely maintained at Horton General Hospital due to the benefits of centralisation or a lack of skilled staff.

68. Talking about concentrating on ‘preventative’ care instead of treating illnesses/pregnancies is ‘utopian’ at best. What about people who already have these conditions?
People will continue to be treated by the NHS; however there still needs to be a focus on prevention. Obesity and diabetes are increasing locally with 55% of Oxfordshire’s adult population being overweight or obese; linked to this is the number of people with diabetes in Oxfordshire, which is forecast to increase by 32% to 41,000 by 2030.

69. Will you heed the anxieties of the people of North Oxfordshire? Neglect the North and you will exacerbate health inequalities in this county!
As part of the programme we have commissioned an Integrated Impact Assessment from an external company to assess the impact of proposals, in terms of inequalities and equality. These considerations will be used alongside the public consultation to inform the next stage of the development of the proposals by the CCG.  This work will use not only publicly available documentation, but seek out hard to reach groups to understand the specific impacts and mitigations that will need to be considered.

70. Have you considered the growing population of Banbury and surroundings?
Yes, we have mapped both the local demographic data and the wider regional demographic data in developing these proposals. In addition we have considered the Joint Services Needs Assessments by Oxfordshire County Council which inform both the growing population but also the changing demographic profile both at a county level

71. Are the figures on which these plans are made going to be valid in the next 18  months as population in Banbury area increases?
When considering service change, we need to think about what type of services will be wanted in the next five to 10 to 15 years, both within the different localities and across Oxfordshire and surrounding health systems.

72. All the new housing coming to Banbury. New residents also need hospital treatment covering everything. JR is already over booked. How long would waiting be?
The service proposals seek to bring additional nursing and doctor cover to the JR to make sure that we can support the needs of the population 24/7. However we also recognise that other services which do not need such a high level of doctor or nurse input, should be delivered either in local communities or within patients’ own homes. One of our proposals is to provide more planned care at the Horton site in Banbury - approx 60,000 outpatient appointments and 30,000 other diagnostic tests and investigations. Although the residents of north Oxfordshire may have to travel further for specialist care in the future, increased amounts of routine care will be delivered locally.

73. Why did the Chief Executive or any other senior member of the OCCG fail to respond to meet with SDC’s Overview and Scrutiny Committee or provide any evidence, unlike the South Warwickshire CCG Chief Executive?
We have been in discussions with surrounding CCGs that are taking the lead on engaging with their own Overview and Scrutiny Committee. Where we have been invited to meet with other Scrutiny Committees, such as in Stratford upon Avon, we have agreed to meet them.

74. We realise the increase in demand, why not charge the new arrivals who have not contributed? Migrants, pregnant mothers from overseas and those who have injuries from wars.
We must act within the framework of NHS law and policy and we do need to be mindful that the UK has reciprocal arrangements for provision of healthcare across the European Union. Charging migrants is a complicated issue; OUHFT has in place a set of policies and procedures for helping to ensure that it captures as fully as possible all relevant income from overseas visitors who are liable for payment.

75. Where does the panel live in relation to the JR? Miles not actual addresses.
This is not relevant to the consultation. 

76. Are there guidelines or stipulation for hospital catchment areas? Size of population that must be served by an (acute) hospital? Acceptable length of travel to A&E or consultant-led maternity? What are our human rights?
The Royal Colleges provide a range of guidance on different aspects of change. For example the Royal College of Surgeon (2006) suggests that the catchment population for emergency surgery should be 450,000 - 500,000. The major standards consider population size as a key factor in terms of delivering safe and sustainable care to the local population. The Royal College of Obstetrician and Gynaecologists’ guidance is based on the number of births at a unit in order to ensure safe levels of clinical staffing.

77. What does this consultation seek to address in regards to ambulance waiting times? My fellow residents of King Sutton have often had to wait 2 hours + for an ambulance
No the consultation does not consider the length of wait for ambulances; however we will feed this point into the discussions by the clinical groups as part of the Transformation Programme.

78. When will the OCCG be meeting with Stratford District Council?
The CCG is meeting with Stratford District Council on 24 March.

79. I attended the presentation at Banbury town hall some months ago. The decision to make savings of £200+million (word that can’t be read), in my view the driving force of this consultation. A political choice of central government which has a small majority. Our MP has supported protest, will she join others in parliament with voting against the budget cuts? Surely the answer is to expand investment overall whilst retaining existing services in Banbury in an expanding population?
It is intended to improve the facilities at Horton General Hospital for outpatients, diagnostic services and day surgery. These are the services that are used by large numbers of individuals and it would improve access to services for the residents of north Oxfordshire. The services proposed to move are those that cannot be safely maintained at Horton General Hospital due to the benefits of centralisation or a lack of skilled staff.

80.  What are the savings projected over 3-5 years if all the service proposals are further adopted? Will the service be within budget at 3-5 years? 
The proposals in Phase 1 look at services which require immediate action to ensure safe and high quality services for patients - they are not about cost savings. Money saved from the closure of acute beds will be re-invested into services in the community. 

81. Who do we sue when the next person dies because of closing down?
Patient safety and quality are at the very heart of the proposals in this consultation. We have made it very clear that running an obstetric service without enough doctors is unsafe and changes proposed for stroke and critical care will mean everyone having access to the same high level of expertise and maximising their chances of survival and recovery.

82. The panel is keen for the people of Banbury to share the expertise available in Oxford. JR is already operating at full capacity and cancelling non-urgent operations. How can they cope with Banbury and surrounding areas? I was 25 hours on a trolley in March 2016 at JR.  
As Q59

83. Page 23 The Big Consultation: this article in orange talks about investing in the HGH. How? Money has already been established as an issue. Unable to recruit staff. How are you going to invest if you can’t keep or recruit staff?
We think there is a vibrant and exciting future for the Horton and we believe that this is recognised and supported by the local population. The vision is to develop an innovative health campus at the Horton with investment in new facilities and technology to deliver improvements for diagnostics and outpatient services.  The OUH has invested £2.6m in refurbishing the endoscopy unit at the Horton and work is starting on a £3.6m investment to replace the CT scanner.  We believe that staff will be attracted to new models of healthcare delivery that provides more outpatient and day case treatment in modern facilities.