Revealed: beds funding secret

CAMPAIGNERS fighting to reinstate seven care beds in Henley say they were misled when these were first provided seven years ago.

They insist that there should have been a public consultation when the “step-down” beds were removed from the Chilterns Court care centre, next door to Townlands Memorial Hospital, last month.

The NHS Oxfordshire clinical commissioning group said in 2016 that it would commission the beds from the Orders of St John, which runs the home.

It said the beds were to support the rapid access care unit, an ambulatory model of care, for which it had commissioned four more beds at the £16 million “health campus”.

The care unit closed in 2021 following a public consultation. However, there was no consultation even with GPs when it was decided to remove the other beds.

The Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board and Oxfordshire County Council has said no consultation was needed as they were not NHS beds.

For five months, town councillors and patient participation groups have argued against this, saying that this was not the agreement with the community before the new hospital was built.

But Freedom of Information requests submitted by the Henley Standard have revealed that the county council commissioned all the beds.

The council said the old commissioning group had asked it to commission the beds in a “variation” to the contract between the council and Oxfordshire Care Partnership, comprising the Orders of St John Care Trust and Bedfordshire Pilgrims Housing Association.

The variation was signed in December 2016 and was for a term of three years. The contract was signed by the council and the partnership. The commissioning group and Oxfordshire University Hospitals NHS Foundation Trust were not party to the contract variation.

Henley MP John Howell, who helped to broker the “deal” with the commissioning group for the beds, say he is “deeply concerned” that the county council ended up funding the beds without another consultation and is calling for there to be one now.

He said all the beds were supposed to be funded by the NHS.

Mr Howell told the Henley Standard: “When the refurbishment of Townlands was under discussion a key element was to have interim care beds for patients in South Oxfordshire.

“This was a key part of the model and it was agreed that these would be in place in the adjacent care home.

“Further, they were to be funded by the NHS as the documentation indicates.

“I am therefore deeply concerned at recent correspondence that indicates that it is the county council that funded the beds and that, without consultation, it has decided to end the
agreement.

“This not only undermines the model but leaves the area without any intermediate care beds, thus adding pressure on both the acute hospitals and patients’ relatives.”

Mr Howell said he had first raised concerns about the lack of beds in South Oxfordshire with the care board in November but had not received a reply.

“I am following up on this,” he said. “I understand that others have been seeking clarity from various sources. I share the frustration of the Townlands Steering Group and the community on this.

“We need to get to the bottom of the situation for a full explanation and proper consultation on the matter.”

Town councillors Ian Reissmann and Stefan Gawrysiak say that the beds in the care centre were supposed to replace those in the Peppard ward at the old Townlands.

In a joint statement they said changing the status of the beds meant their use and management could not be properly scrutinised. They said: “The decision in 2016 not to re-provide the Peppard ward beds in the new Townlands Hospital was a great disappointment.

“After lengthy discussions with the commissioning group as part of the consultation, we accepted the alternative of NHS beds provided in Chilterns Court.

“This provided the community with the certainty that patients need for stepdown care provided by the NHS would continue to be met permanently in NHS beds.

“At the time we had statements from David Smith, chief executive of the commissioning group and our MP John Howell that these beds were commissioned by the group as permanent NHS healthcare beds.

“These have been secretly changed to non-NHS, beds commissioned by Oxfordshire County Council instead, which means those protections were lost.

“The result is that it has been much easier for the new integrated care board to have closed the beds.

“The commissioning group produced data clearly showing the beds in Chilterns Court were meeting real patient need and we consider that this need still exists. GPs share our concerns.

“Between them, the council, commissioning group and care board have manoeuvred matters so that the community is unable to scrutinise the new arrangements.

“These seven beds were commissioned as step-down beds based on clinical need. Since 2016 they have been supervised by GPs under an NHS contract.

“On December 31 the seven beds were removed without consultation, unlike the four rapid access care unit beds in 2021, which were commissioned at the same time and required an extensive consultation.

“We have always engaged with NHS bodies in good faith and we continue to call on the care board and council to work with us to ensure patient needs are met and to reassure the community.

“This must include fair access to short stay hub beds by residents of South Oxfordshire which, under the new arrangements, results in a population of 140,000 lacking local provision of this important service.”

Dr Philip Unwin, a retired GP at the Hart Surgery, said the beds at the care centre were NHS beds.

“Of course, they were,” he said. “It is my understanding that the beds were commissioned by the Oxfordshire clinical commissioning group, which was in charge of it, not social services.

“It is a great shame for Henley that we no longer have these beds.

“These were clinical beds. We looked after them. I used to do the ward round. They were medical beds and there was a ward sister.They were very well used and were well appreciated.

“They were beds for people needing rehab after surgery or a stroke and people not ready or safe to go home and to prevent the blocking of acute beds at the Royal Berks and in Oxford. They were for medical care, not residential care.”

Dr Peter Ashby, a retired GP from Nettlebed, said: “We were stabbed in the back by the clinical commissioning group when it went behind our backs and said we didn’t need beds and so we were going to have this wonderful bedless hospital.

“As a sop, this solution of beds in the care home was produced and it was the only thing on offer.

“My understanding was they were always NHS beds, commissioned by the NHS.

“They were for step-down use and used by the Royal Berkshire Hospital to move patients down to Henley to send home once they were fit enough. They appointed a senior nurse to oversee it all.

“They were always NHS beds and, if something has changed, there should have been a consultation.”

Dr Veronica Barry, executive director of Healthwatch Oxfordshire, said: “This shows how important it is for the now Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board and Oxfordshire County Council to clearly communicate with members of the public to enable them to fully understand decision-making about local care provision.

“In Henley, arrangements for the beds under discussion have become less clear to the public as models of care are constantly changing.

“We urge a clear and transparent timeline is provided showing how and when these beds were funded from conception to the present day.” Janet Waters, who chairs the Bell Surgery’s patient participation group, said: “We pushed and pushed to get those beds. The NHS set up the Townlands steering reference group and there we discussed the number of beds and their positioning within the care home.

“It was all led by the NHS and the clinical commissioning group. All the questions we asked about the beds were answered by the NHS and the NHS appointed the chair of the reference group.

“We did get one or two people from social services attending the meetings but it was led by the NHS.

“If these were county council beds then we were all misled.

“It strikes me that there was a deal between the NHS and local government on who was going to fund it and that hasn’t been communicated and they have used that as a way of saying we don’t need to consult because they are local authority beds. We will fight our corner.”

Dr Andrew Burnett, a retired GP who lives in Peppard, was the clinical director of the commissioning group for three years until 2017.

He told the Henley Standard that he “couldn’t remember” who commissioned the beds at Townlands in 2016.

Mr Smith, who chaired the commissioning group, could not be contacted for comment.

An Oxfordshire County Council spokeswoman said: “To support the roll out of the new discharge to assess programme, the council has significantly increased the amount of homecare hours being provided each week by more than 7.5 per cent to 31,095 hours.

“This is up from 28,885 hours per week last spring and 27,888 in the autumn of 2022.

“Due to the success of the programme and based on evidence from the initial pilot last summer, the council has been able to reduce the number of short stay hub beds in the region, which were originally commissioned to alleviate pressure on hospital discharges.”

The Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board did not provide a comment.