2005PCT

A hundred local townspeople turned out at 1.30pm today to welcome the PCT (Primary Care Trust) to Chipping Norton. This was a regular Board Meeting and they were here to stitch us up. You will not believe that there were twenty five people sitting round the top table - presumably all PCT functionaries of one sort or another. Twenty five!! What an incredible administrative leviathan to manage the fairly straightforward healthcare needs of the rural folk of North Oxfordshire. Imagine the cost of it all. No wonder they are running a deficit. No wonder they are about to be "rationalised". A brooding presence in the balcony to make sure the PCT did as he had instructed was Keith Mitchell - Leader of the Oxfordshire County Council. Because make no mistake. This is no longer about the healthcare needs of the people of this town. We have become a pawn in a political game. Today the first item on the agenda was to agree the way forward on the development of Chipping Norton Hospital. "Held in public - but not a public meeting". This mantra repeated numerous times by the Chair - our old adversary Anita Higham - means that the public can only speak when she gives permission. Today that ration was ten minutes at the beginning - to be shared between six speakers. "That's one and a half minutes each" announced the ex- headmistress of Banbury Girls School. Poor old Clive Hill - who has spent half his spare time this last year becoming totally expert in the close detail of hospital matters and has forgotten more about Chipping Norton Hospital than Anita Higham will ever know - just about had time to point out that the costs shown for the different options in the Board paper were completely misleading and absolutely no basis for taking a decision. Even so, he did better than Hilary Biles who was shut up within seconds of opening her mouth, "We know all that" snapped Ms Higham. "But perhaps the Public don't" said Hilary. "This meeting is being held in public but it is a meeting for MY board". At this point the audience started getting restless....after all Hilary is our elected County Councillor. Anita runs a quango. A bit more respect would have been nice. Half a minute later when Hilary was similarly interrupted again, some serious barracking broke out from the ranks and the headmistress looked like thunder. Not enough to stop Hilary reminding the lot of them that they better remember that they would be needing to justify any decisions not only to the Health Overview and Scrutiny Committee but to the Independent Configuration Panel as well. Because Mike Williams - a previous head of the PCT had already agreed a way forward which included keeping the nurses and the management of the Intermediate Care Beds in the NHS. That was the basis on which everyone had agreed things should move forward. The new Chief Executive seemed now to be backtracking on that agreement.

The new PCT Chief Executive took the floor. "Its all good news" he said. A brand new hospital, 14 beds, a maternity unit, x-ray.......making it seem as if all this has been volunteered to the town by a munificent PCT in a fit of magnanimity. He was our third Chief Executive in a year. Getting to this point has been like pulling teeth as we have extracted small concession after small concession from his predecessors. Compare what is on offer now with what was being offered a year ago. We were an ungrateful lot he seemed to be suggesting. But then he made an unexpected bid for popularity. "This week I visited Chipping Norton Hospital for the first time. I was absolutely appalled by what I saw. The standard of the service the PCT can offer is being totally compromised by the run down building and environment." You could almost sense the resentment that these amazingly insensitive remarks provoked. Who let it get into that state was the unasked question. The League of Friends has poured money into the hospital over recent years. Half a million pounds some say. The PCT has never been bashful about accepting contributions to help with the upkeep and improvement of the hospital - most recently for an MIU room. No word then about an appalling, run-down environment - fit only for closure. But we have come to recognise this aspect of the PCT's communications approach. They say what suits their case on any particular day. There is nothing consistent. No integrity. They have totally lost the trust of the town. If you want to change the message just change the Chief Executive.

For a short few weeks we built a relationship with the previous Chief Executive - Mike Williams - who seemed to be playing it straight with us. We reached an understanding. He wrote us a letter. It all seemed settled. But now it seems that was just for the election. Now the heavy mob is back in the driving seat. Keith Mitchell - OCC Leader - is turning the screws on the PCT and they have simply rolled over. Spineless. He now seems to be doing the same with the supposedly independent Overview and Scrutiny Committee. They look ready to buckle. There are big constitutional issues at stake here.

For the last year the action groups in the town have been fighting to keep a proper hospital - with properly staffed Intermediate Care beds. As well as an X ray facility, a maternity unit and all other existing services. The County Council and the Primary Care Trust have devised a plan which is based on a new Care Home housing the intermediate care beds which would be staffed and managed by the Order of St John - the county's private care home partner. The PCT and the County are under enormous central government pressure to refurbish their facilities by forming partnerships between the NHS, County Social Care departments and private providers. The claim is that this is a more integrated, cost effective and appropriate way of providing for patient needs.

The town is worried that if they support such a scheme they may be saving a care home but losing a real hospital. They are convinced that hospital beds should be physically separate from the Care Home and proper hospital nursing care can only be provided by NHS staff reporting to NHS managers. They are deeply concerned that "privatised" OSJ-run hospital beds would be staffed by nurses with lower nursing qualifications than at present (who would not for example be able to help in an MIU) because cost savings and market considerations would take priority over clinical need. This would represent a real CUT in the present quality of healthcare in the town. This view is supported by the nurses themselves and most of our GP's.

The town wants hospital beds which are separate from the Care Home, staffed by the NHS but which can save money by sharing facilities like catering and cleaning. We are convinced that this mix could be provided within what we have been told are present budgets. The PCT have refused to provide costings for our preferred route but instead have put together three other options. Option 3 -Totally independent hospital beds in a totally stand alone building- which would be very expensive. Nobody has asked for this. Option 1 - Beds which are entirely within the Care Home - staffed and managed by the Order of St John. And a new compromise - Option 2 - which is now the PCT's preferred way forward. This "seconds" the nursing staff from the NHS to OSJ. The staff remain employees of the NHS. The nurses work under a Lead Nurse who reports to the OSJ Care Home manager. No guarantees about what happens when staff leave and new staff are recruited.

The town are convinced that this option leaves unresolved the conflict between clinical need and market demands and offers no reassurance for the future. In locating the beds in the Care Home we will have compromised what we regard as a "real" hospital. We cannot accept the latest proposal - particularly since the PCT have not prepared proper detailed costings (or a business case) for any of their three options or done us the courtesy of examining our own preferred solution.

We expected some of the Board members to ask some penetrating questions. After all that is what they are paid for - particularly the non-executives. We expected the Patient Forum representatives to show their teeth. Nothing. There was not a single question challenging any aspect of the costs of the three options. We expected to see the PCT Board doing what it is supposed to do - ensuring that the needs of our community are fully considered and as far as possible met in their provisioning of healthcare.

Liz Leffman - the Liberal Democrat spokesperson for Witney Constituency - wrote to Anita Higham after the meeting......."I am a non-executive board member of two charities. I also run my own business, and have been a senior manager in industry. I have never attended a board meeting, whether in the not-for-profit or the private sector, where so little interest was shown by the non-executive directors in the subject under scrutiny. There was no financial information to back your preferred option. There has been no consultation with the Hospital staff. Much of the content of letter written by Mike Williams following the meeting with the OJHOSC on June 9^th was ignored. In spite of this, the non-executive directors let it go on the nod. No-one asked to see a proper business case for option 2. No-one questioned the lack of real, hard information about how option 3 estimated costs were constructed. No-one asked why the staff had not been properly consulted, in spite of the fact that you are proposing a change in their employment contracts. Perhaps the full financial information was presented by the chief executive to the board at a separate meeting. In which case, why not make it available to the people of Chipping Norton On the other hand, if it has not, then the board is failing in its remit."

The PCT think they have taken a decision. They must convince the Health Overview and Scrutiny Committee. We are relying on that committee now to be genuinely independent and act as our watchdog. They are all we have - short of a judicial review. It was good to see so many District Councillors present today - including the cabinet Member for Health Ian Hudspeth. We are banking on him and the tireless Hilary Biles to persuade Barry Norton to go into battle again on our behalf.

Today's meeting was a complete disgrace. It is up to whichever of our elected representatives have any principles left to try and restore some of our faith in local democracy. It is a waste of time dealing any longer with unelected bureaucrats. The people of this town and the area around have a right for their voice to be heard.

There will be another Town Meeting in the Church on September 7th - a year on from the last one. An opportunity for everyone in the town to have a say. You may like to book that date in your diary now. We're not giving up!

To day I attended the PCT Board meeting held in Chipping Norton Town Hall as a member of the Hospital Users Group for the item No3 on your agenda.

Bearing in mind only ten minutes was allowed for members of the public who wished to speak I was appalled at the way in which you continually interrupted and in effect cut down their time to make the points they wanted to make.

When Mike Williams came to present the original costings to the group the visual presentation did not work, and we were given papers, which subsequently were incorrect.

Although we were able to get the new figures from your web site, no further presentation has been made to the User Group and therefore we did not have an opportunity to ask questions for clarification.

At todays meeting not a single Board member raised a question on the figures, and therefore I felt that the decision to go for option 2 had already been made.

In addition no mention was made of Mike Williams letter of 26^th May and Cllr. Dr. Skolars letter of 9^th June and I wish to point out the paragraph written by Dr Skolar "If these outstanding issues cannot be satisfactorily resolved,it is the Joint Committees view that any substantial changes to the current proposals must be subject to a formal three month consultation".

In my view your board has made substantial changes and therefore there should be a further consultation.

I am sure I speak for the entire User Group in that we are extremely disappointed in the way in which the Board has gone back on what was put forward by Mike Williams, and that the consultation has been ignored.

I am writing to you after a couple of days reflection on last Thursdays board meeting held in public. No doubt the PCT board members view the people of Chipping Norton as ungrateful, and stubbornly intransigent; it was apparent last Thursday that they were determined to tough it out.

From the point of view of the local healthcare users groups, charged with cooperating with the PCT and OCC to provide the best possible healthcare for the Chipping Norton district, last Thursdays meeting was unbelievably frustrating and disappointing. We have felt all along that the PCT, in the end, had no desire to listen to the public and now we feel stitched up and treated cynically. Let me try to explain why.

The consistent view of the Healthcare Users Group representatives from Chipping Norton has been set out in letters to Mike Williams in March 05 and to Hilary Biles on 4^th Feb 05, both of which were copied widely to district councillors, county councillors, to JHOSC and David Cameron, MP. I can send you copies of both, if desired, but here is part of the text of the latter:

"There is a more general fear amongst local people who are working towards the new hospital. This is that any new hospital will be downgraded by stealth over the years! and the suspicion is that the PCT is ultimately working towards that agenda. Therefore, local politicians and healthcare user representatives are understandably sensitive about the following:

People of this region want a hospital not a care home, dressed up as a hospital.

When we hear from the PCT officers talk of the Order of St. John managing clinical issues on market-driven values, and of 14 single rooms rather than 4-bed bays, talk of "outcomes rather than inputs" and talk of the "secondment" of NHS nurses, "and if you want to call that a hospital, I have no objection", as Nigel Webb put it on Thursday, we are understandably frustrated that our view has been ignored. What has been proposed as "good news for Chipping Norton" is, it seems to me, systemically different in nature from our consistently-expressed desire. This is especially frustrating after letters from Mike Williams on 26^th May (to me) and on June 9^th (to Dr. Peter Skolar, of the JHOSC,) which gave a commitment to keeping the nurses and 14 intermediate care beds within the NHS.

I have today attended the board meeting of the Cherwell Vale Primary Care Trust Board in Chipping Norton Town Hall, and am deeply concerned that the Trust has gone back on the written undertaking agreed to and signed by you on 9^th June, which would preserve the new hospitals staffing and management within the NHS. This has been done without any consultation with the staff of the present hospital, or with the users of the hospital.

The new acting chief executive of the trust actually said in an aside "Call it a hospital if you like", implying in a somewhat condescending way that the Trust intends to downgrade it. On their past record of misleading statements and attempts to bypass any real gathering of public views by having meetings when people are not home from work, or likely to be on holiday, I do not trust them much.

The plan passed by the Board today will second NHS nurses to the new hospital which will be run by the St Johns care organisation which runs Castle View at present. Good though they may be at running care homes, I understand that their total experience of running hospitals is three months at one in Gloucester. Moreover, there is to be no manager: only a head nurse. The prospect of such inadequate measures for running it is very alarming. Whatever the state of its buildings, the standard of nursing care, hygeine, and general care for the welfare of patients in the Memorial Hospital is very high. It seems all this would be jettisoned by the proposed new arrangements.

In addition, we have been told in the past that, if NHS nurses were seconded to the new hospital, there could no guarantee that they would be replaced by NHS staff. This sounds like a slippery slope to privatisation or downgrading.

I think it is very important that a proper NHS hospital should remain here. For anyone who cannot drive, or afford to hire a taxi all the way to Banbury or Oxford, for people in the surrounding villages especially, access to hospital could become difficult to impossible, especially at night and weekends. No account has been taken of the therapeutic value to patients of being in hospital where their friends and relations can readily come and visit them.

For all these reasons, I ask you to ensure that the proposal passed today is not allowed to go ahead, at least without a further period when people are genuinely listened to and their concerns more completely acted upon. At the moment, there is a general feeling that the Board takes as little notice as possible of the views of local people.

As Chairman of the Chipping Norton Hospital Action Group I feel I must write to express my utter disappointment in the way the PCT have completely ignored the views of the HAG , HUG and the public of Chipping Norton and District regarding the 14 intermediate care beds to be incorporated in the new Care Home/Hospital.

We have stressed all through the consultation that these 14 beds must be in the hospital wing of the new building together with the other services promised, X-ray, maternity, fall clinic, consultancy rooms, MIU etc., all to be provided, managed and staffed by the NHS.

Mike Williams, stated in his letter of the 26^th. May 2005, the PCT were pursuing plans to allow for the leasing of facilities in such a way that the nursing staff remain within the NHS and access to the beds be managed by the NHS, however since his departure, the PCT appear to have done a complete U turn.

May I remind you that your consultation document stated Better Healthcare- the way ahead Improving Healthcare Provision in Chipping Norton. To have the 14 intermediate care beds attached to the Care Home and managed by OSJ, who do not run hospital beds, appears a serious down grade rather than an improvement.

In option 2 of your Board Paper it states the present NHS staff at Chipping Norton Hospital will be seconded to the OSJ, even though you have not consulted properly with the staff regarding this, and it is our belief they are unlikely to accept this proposal., resulting in Chipping Norton losing the services of their wonderful devoted hospital staff.

For months both the PCT and OCC have been promising to produce foot prints of the proposed layout of the new building, together with a proper business case and other financial details, none of these have been forthcoming, and it is difficult to see how members of your board were able to agree an option without these.

How twenty five members of your board (goodness knows at what cost) could vote for an option without even discussing costs seems incredible. I am unable to understand why local board members and those who are supposed to look after the interest of patients, seemed unwilling to challenge the proposal for option 2, and to demonstrate an interest in the concerns of the people of Chipping Norton and district.

We are holding a joint meeting of HAG and HUG tomorrow 1^st. August, at which I believe members will press for the OJHOSC to insist on a further three month consultation as stated in Cllr.Dr.Skolars letter of 9^th. June, where he stated "If these outstanding issues cannot be satisfactorily resolved, it is the joint Committees view that any substantial changes to the current proposals must be subject to a formal three month consultation". This of course will delay things further, so I ask you to seriously consider your decision of Thursday and put into operation what both Mike Williams was proposing in his letter and for what the people of Chipping Norton and district have been crying out.