We were misled over care beds, then kept in dark

“NEW hospital with no beds” read the banner headline of the Henley Standard on October 2, 2015, just a few months before the new Townlands was set to open.

Despite calls to install 18 beds in the new building, as originally promised, health chiefs agreed instead to “buy” eight from the neighbouring care home, which had not then been built.

The NHS Oxfordshire clinical commissioning group also said that six more beds would be made available “on demand” at the Chilterns Court care centre, run by the Orders of St John Trust.

A public consultation took place in May and June where residents were invited to share their views of the future of services at the £16 million Townlands “health campus”.

The commissioning group’s own poster campaign said it was responsible for the “planning, organising and purchasing” of NHS-funded “hospital and community” healthcare.

Residents and town councillors had wanted to see the 14-bed Peppard ward at the old hospital recreated in the new building and the Henley Standard launched its Save Our Beds campaign.

More than 3,000 people signed our petition and more than 2,000 people marched around the town centre in protest at the proposed cut in beds.

While the aim to reinstate the ward was unsuccessful, the commissioning group conceded that its own modelling found a need for between five and eight beds.

These would be used to support the rapid access care unit, an ambulatory model of care, which was preferred by the NHS as it could treat more patients.

This approach was outlined by John Jackson, then director of adult social services at Oxfordshire County Council, who wrote a report to its cabinet in October 2015.

He said: “Occasionally people may need a short stay away from home, either to avoid going into an acute hospital, or before they go home after treatment in either a hospital or through the rapid access care unit.

“To meet this need, the proposal includes commissioning a small number of ‘step up’ and ‘step down’ intermediate care beds from the Orders of St John Care Trust, which will have a residential care home on the same site as the new Townlands Hospital by summer 2016.

“The clinical commissioning group anticipates bearing the cost of the beds commissioned to support the ‘step up’ requirements of the rapid access care unit and ongoing ‘step down’ need from acute trusts.”

Henley MP John Howell hailed the new arrangement in a letter to the Henley Standard in response to readers who continued to criticise the lack of beds at the new hospital.

Mr Howell wrote that there were no beds at Townlands was “simply not true” as there were “permanent” beds at the care home next door.

He wrote: “There are up to 14 beds associated with the hospital — eight permanent, the rest hired on demand. Beds associated with the old hospital have been saved by working with the clinical commissioning group, not by throwing stones at it.

“The beds are located on the same site as the hospital, on the same campus, as part of the same medical village. Yes, they form part of the adjacent care home where the beds are likely to be co-located but precisely why does that matter?

“The important point is not where these beds are located but that there is excellent medical cover and good social care available for them.”

In April 2016, David Smith, chief executive of the commissioning group, provided an update to the Oxfordshire joint health and overview scrutiny committee.

In a paper, he set out how the services worked and outlined the arrangements that had been agreed with the Orders of St John for the Chilterns Court beds.

Mr Smith wrote: “Bed modelling confirmed the anticipated need of between five and eight beds to support the new rapid access care unit and to provide step down care for patients discharged from an acute hospital.

“Following the conclusion of negotiations, and to allow time for the new model of care to establish itself, the commissioning group has committed to a three-year contract with the trust for a total of 11 rapid access care unit beds and seven “step-down” beds in the new care home on the Townlands site and will use these beds flexibly.

“If demand rises to the point where 14 beds are required, the group will still have the ability to buy further beds by using Oxfordshire’s well-established spot purchase system.”

The new Townlands was officially opened in March 2017 by the then Lord-Lieutenant of Oxfordshire, Tim Stevenson.

He described the facility as “extraordinarily impressive”.

A press release issued by the Oxford Health NHS Foundation Trust demonstrated that the beds at the care home and the rapid access care unit were inextricably linked.

It said: “The opening of the rapid access care unit in January means care is now available closer to home… for those who need a little more time, there are also eight beds at the neighbouring Chilterns Court care centre.”

Healthwatch Oxfordshire, the county’s independent healthcare watchdog, issued a fact sheet about the new health campus at Townlands which confirmed the link between the beds and NHS care. It said: “A patient who has attended the rapid access care unit may be discharged and continue to be treated in their own home or admitted to a step-up bed at the Orders of St John Care Trust, an eight-bed facility in a separate building on the same site.”

The document also said that Henley town councillors had made representations to the trust about renaming the bedded facility at the care home the Peppard Wing as a reference to the old ward. This was ultimately rejected.

Fast-forward to 2021 and the four rapid access care unit beds were scrapped.

This followed a public consultation during which the commissioning group demonstrated that they were underused and the money could be better spent elsewhere.

A meeting of the Townlands Steering Group, which was set up to scrutinise the services and levels of healthcare associated with the hospital, heard that occupancy rates averaged just three per cent between early 2018 and early 2020.

This dropped to zero in 2020/21 during the coronavirus pandemic lockdowns with additional restrictions for the medically vulnerable.

Dr Ed Capo-Bianco, locality director of the commissioning group, said GPs across the Henley area were confident that scrapping the beds wouldn’t adversely affect patients. Those still needing “step-up” care could be offered a bed at Wallingford or Didcot Community Hospital.

The commissioning group funded two hospice beds in Wallingford instead.

The beds at Chilterns Court, which were for step-down care, were unaffected.

Then in September last year, the Henley Standard revealed that these beds, by then known as “short stay hub” beds, were to close at the end of December.

The beds were then jointly funded by the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board, which replaced the commissioning group in July 2022, and the county council. Medical cover for the beds was provided by the Bell and Hart surgeries in Henley but, along with the town council and Henley’s representative on the county council, they were not consulted about the decision to axe the beds.

This was despite the beds being occupied almost 100 per cent of the time, according to the GPs.

The care board and council refused to confirm the occupancy rate.

Dr Will Hearsey, a partner at the Hart Surgery, said: “There has been no consultation with us about them but we don’t have any control over them either.

“My understanding is that the beds were well used and served a great purpose and we will miss them. If there is no alternative and the funding doesn’t go into something that helps patients between hospital and home, it will be detrimental to them as they won’t have that support.

“It will mean that patients will stay longer in hospital and they may not be able to go home.”

The county council said that it did not need to consult on the closure of the beds because it was funding them, so they were not NHS beds.

The Townlands Steering Group and councillors disputed this and urged the care board and council to defer the closure so a public consultation could be held. They refused and turned down an approach to attend a public meeting to justify the closure.

They told the group that Oxfordshire needed to meet a national requirement for 95 per cent of people being discharged from acute hospital beds going home to live independently or with support.

They revealed that there were 90 patient admissions betwen April 2022 and the end of August last year and that 63 of those had subsequently gone home.

They also said that many patients, above a third of whom were not from Henley, could have gone straight home rather than to Chilterns Court.

The care board and council said that of the 58 patients discharged from the Royal Berkshire Hospital in Reading since August, four had been assessed as needing a short stay bed and two were placed at Chilterns Court.

But Ian Reissmann, a town councillor who chairs the steering group, said these figures were flawed and in fact showed the need to retain the seven beds.

He said: “They have set a target of 95 per cent for patients going from an acute bed to their final care destination, whether it be their own home or a care home.

“They have assessed 58 people that were in acute beds and say that four of them would be in need of a short stay hub bed.

“That would make seven per cent and they are aiming for five per cent, so on their own figures they haven’t got enough short stay beds.

“I have a lot of concerns about the information we are being given. There is a lack of firm, objective evidence.

“It is difficult to see that this is a health-driven requirement and can only be seen as cost-driven. They are fitting the figures around the targets.”

In November, the Henley Standard revealed that the decision to close the beds was due to “market factors”.

Patient participation groups in the Henley area were worried about the access to the remaining beds across the county which were to be reduced from 94 to 63 and then to 40 in April this year, with none in South Oxfordshire.

Janet Waters, who chairs the Bell Surgery’s patient participation group, wrote a formal objection to the closure of the short stay beds at Chilterns Court, describing the move as “another nail in the coffin” for healthcare in the area.

Her group compiled a document setting out how long it would take to reach the five care homes with the remaining beds by car, bus and train and the cost of a taxi. The furthest is Chacombe Park in Banbury and is 51 miles away, one hour by car and three hours and 21 minutes by train and bus followed by a four-minute walk. The estimated cost of travel is between £29 and £96.

By bus it would take four hours and 33 minutes, with three changes and walks of nine and five minutes. A taxi ride is estimated at £130.

The nearest is The Close in Abingdon and is 15.7 miles away and would take 23 minutes to reach by car. By bus, it is a journey of one hour and four minutes, alighting in a lay-by on the A4074, followed by a four-minute walk along the A415. A taxi journey would cost between £40 and £50.

Town and county councillor Stefan Gawrysiak tabled a motion for a meeting of the county council in December in which he described the lack of consultation on the bed closures as “unacceptable”. However, time ran out before the issue could be debated and the closure went ahead as planned.

Last week, Cllr Gawrysiak spoke at a meeting of the county’s health scrutiny committee where he called for the beds to be reinstated and for a consultation to be held but this too was turned down.

He said that the beds were commissioned in 2016 by the NHS to replace the Peppard ward beds in the old Townlands Hospital. Cllr Gawrysiak said: “The Henley step-down beds were NHS-funded to relieve pressure on the Royal Berkshire Hospital.

“These were provided by the Oxfordshire clinical commissioning group and were designated as permanent beds.

“If their status changed from NHS beds then please tell me when this change happened and what consultation took place?”

Robert Aitken, a trustee of the Friends of Townlands Hospital, said claiming the beds were commissioned by the council and not the NHS was “pure sophistry”.

He said: “The beds were a direct replacement for NHS beds in the old Townlands Hospital under an NHS contract.

“If that was subsequently switched, that too was without communication or consultation and the beds continued to function as step-down NHS beds.”

Daniel Leveson, place director for the care board, maintained that they were not commissioned or contracted NHS beds so a consultation was not necessary.

He said: “I do sympathise with communities who feel they are losing something but we have a responsibility to make decisions on behalf of the whole county.”

As reported in this week’s Henley Standard, a Freedom of Information request made to the care board and county council has revealed that both the rapid access care unit beds and Chilterns Court beds had in fact been commissioned by the county council.

No NHS bodies signed the contract for either set of beds, although a consultation was held when the rapid access care unit beds were removed.

This agreement flies in the face of publicly available documents, some of which are still available online, in public statements made to the Henley Standard and consultees to decision-making, including the Townlands Steering Group.

The community worked hard and campaigned for decades to first protect the old Townlands Hospital from closure and then to have it redeveloped to continue to serve the communities of South Oxfordshire.

It is now eight years since the hospital was reopened and it can legitimately be said that there are no beds.

Would the community ever have accepted a new healthcare model that had no NHS beds?

• What do you think? Write to: Letters, Henley Standard, Caxton House, 1 Station Road, Henley or email letters@henleystandard.co.uk