• To eliminate the projected 2020/21 deficit of £479 million;
• Reduction in the use of acute services;
• To create out-of-hospital services operating from community hubs via a single point of access, integrated with primary and social care;
• To improve the health of the population, including reducing adult and child obesity, avoidable admissions through falls, and targeting alcohol, hypertension, and smoking.

Like other areas this STP aims to transfer services out of hospital and into the community. The concern is that financial pressure will mean that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.

A number of public consultations have taken place. From October to December 2016, Reading Council ran a public consultation on its Health and Well-being plan that had certain links with the STP. From January 2017 to April 2017, Oxfordshire CCG conducted a consultation on transforming healthcare in the area, including the closure of hospital beds. The final consultation report can be found here. In general, respondents felt the following:

• The vast majority of respondents did not agree with the closure of beds and redirection of the money to support care closer to home;
• Many people felt that too many acute hospital beds had been lost already;
• Uncertainty and a lack of confidence was expressed as to whether the new model of provision of out of hospital support would actually work;
• Concern over the loss of intermediate care beds and a fear that Midwife Led Units could be under threat in Phase 2;
• There was support for the principle of care closer to home, but also a view that re-ablement and integrated care services were not yet sufficiently developed to be able to support a reduction in beds at this point in time.

At the present time (January 2018) residents of this STP area can ask to be involved and give comments via the STP website here.

The future of Horton Hospital in Banbury, North Oxfordshire is under review, with changes to urgent care, obstetric and paediatric services likely. Options also include moving stroke services and some critical care patients from the Horton General Hospital to the John Radcliffe in Oxford.

In August 2017 Oxfordshire CCG confirmed the downgrading of Horton Hospital, despite considerable local opposition.

During the meeting, the Oxfordshire CCG board members voted to support the following proposals from the consultation:

• Transfer of Level 3 Critical Care from the Horton to the John Radcliffe (JR) in Oxford.
• A complete transfer of immediate care for suspected strokes to the JR.
• To make permanent the temporary downgrade of the Horton maternity unit from an obstetric to a midwife led unit (MLU).
• The permanent closure of 110 acute beds, followed by a further 36 bed closures dependent on approval by the Clinical Senate.
• An increase in planned care services at the Horton, including plans for a new diagnostic and outpatient facility.

Five local councils and the Keep the Horton General campaign, however, plan to continue to consult with legal representatives regarding the possibility of further action to prevent the downgrading.

In December 2017, a judicial review challenge to Oxfordshire CCG's decision to reconfigure services at the Horton General Hospital was heard, brought by a group of District Councils and campaign group Keep the Horton General.

The proposed reconfiguration included the removal of obstetric services, 46 bed closures and the removal of level 3 critical care.

It was argued that the consultation was unlawful for numerous reasons, including the fact it was split into two phases where many issues dealt with in Phase 2 were interlinked with Phase 1 issues. In addition, the CCG failed to consult on the new bed closure test which was announced by Simon Stevens, Chief Executive of NHS England, on 3 March 2017.

The decision to downgrade maternity services at Horton were referred by Oxfordshire’s joint health overview and scrutiny committee to the Secretary of State for Health, Jeremy Hunt, which means the plans go before the Independent Reconfiguration Board (IRP) for consideration.

In early March 2018, the Independent Reconfiguration Panel recommended that the Secretary of State, Jeremy Hunt, recommend that the changes proposed not be carried out and  “further action was required locally before a final decision is made about the future of maternity services in Oxfordshire”. The IPR said that Oxford University Hospitals must continue the recruitment process for obstetric doctors at Horton until a final outcome is reached.

The IRP also stated that Oxfordshire had failed to meet a “requirement to form a joint scrutiny board” of all affected local authorities, which included Northamptonshire and Warwickshire in addition to Oxfordshire.

The STP contained details of workforce changes in the area designed to save around £34.2 million. The STP said savings would be achieved by the “use of generic support workers (across health and social care), reduction of nursing grade input, increased use of healthcare assistants and physicians associates and more flexible uses of emergency care practitioners and advanced nursing practitioners”.

The plans for a change in workforce mix have attracted criticism; an article in The Nursing Times noted that the details of the change in workforce mix in the STP was released the day after a major new study highlighted an increased risk of death from diluting the skill mix of registered nurses with more support staff, sparking warnings about the risk of the new nursing associate role being used as a substitute for nurses.

The lack of transparency and the consultation procedure has been criticised by councils and MPs in the area. Oxfordshire's Health Overview and Scrutiny committee has criticised the STP and the consultation. Oxfordshire Clinical Commissioning group was hauled before representatives of the Oxfordshire Health Overview and Scrutiny committee to answer questions on how it had consulted on the STP. The consultation was described as "chaotic" by campaign groups.

In December 2016, Oxfordshire City Council overwhelmingly adopted a motion calling for moves to rein in the STP project.

The decision to downgrade maternity services at Horton were referred by Oxfordshire’s joint health overview and scrutiny committee to the Secretary of State for Health, Jeremy Hunt, which means the plans go before the Independent Reconfiguration Board (IRP) for consideration.

In early March 2018, the IRP recommended that the Secretary of State, Jeremy Hunt, recommend that alternative options be investigated and  “further action was required locally before a final decision is made about the future of maternity services in Oxfordshire”. The IPR said that Oxford University Hospitals must continue the recruitment process for obstetric doctors at Horton until a final outcome is reached.

The IRP also stated that Oxfordshire had failed to meet a “requirement to form a joint scrutiny board” of all affected local authorities, which included Northamptonshire and Warwickshire in addition to Oxfordshire.

NHS England plans for all STP areas to develop into Integrated Care Systems, previously known as accountable care systems.

In June 2017, Simon Stevens announced the first eight “accountable care systems”, which will each receive a share of up to £450m in transformation funding.

Two of the eight areas lie within this STP - West Berkshire and Buckinghamshire. This new model of care is designed to increase integration between hospital, community and primary care.

Further details can be found on our New Models of Care page and Accountable Care Organisation page.