Agenda and draft minutes

Apologies had been received from the following:

-        Cllr Nigel Champken-Woods

-        Cllr Mark Lygo.

The following interests were declared:

-        Cllr Jane Hanna declared that she worked for SUDEP Action.

-        Barbara Shaw declared that she was a chair of a cardiovascular charity.

To approve the minutes of the meeting held on 08 February 2024 and to receive information arising from them.

The Committee is recommended to AGREE the minutes as an accurate record having raised any neccesary amendments.

The minutes of the committee’s meeting on 8 February 2024 were assessed for their accuracy.

The Committee AGREED the minutes as an accurate record of proceedings and that the Chair should sign them as such.

Members of the public who wish to speak at this meeting can attend the meeting in person or ‘virtually’ through an online connection.

To facilitate ‘hybrid’ meetings we are asking that requests to speak or present a petition are submitted by no later than 9am four working days before the meeting i.e., 9am on Friday 12 April.  Requests to speak should be sent to Scrutiny@oxfordshire.gov.uk

If you are speaking ‘virtually’, you may submit a written statement of your presentation to ensure that your views are taken into account. A written copy of your statement can be provided no later than 9am 2 working days before the meeting. Written submissions should be no longer than 1 A4 sheet.

Liz Peretz addressed the Committee on behalf of Oxfordshire Keep Our NHS Public.

She expressed deep concerns about the Primary Care Model, which she, along with the BOB Local Medical Committee, Oxford Patient Network, and others, opposed. Their concerns were:

Ø  NHS England had not made this model mandatory, and if adopted, it could be much more expensive and potentially lead to worse health outcomes than the current system.

Ø  If implemented, it could end the concept of the family doctor and risk the crucial connection between a local surgery and the population it served.

Ø  The proposed two-tier system, distinguishing between users of Same Day Hubs and Neighbourhood Teams for the 'chronically sick', did not make sense. In this system, a patient who had not needed the doctor for years would be diverted to far less trained staff.

Ø  The Primary Care Model had not been tried and tested. It was not a system tested to destruction by strong research, simply an idea put forward in the Fuller Stocktake report.

Ø  The Committee was encouraged to speak up against the 'roll out' by their ICB of the new Primary Care Model. Instead, she asked for support for the GPs in their Primary Care Networks to come up with their own solutions to the current crisis, and to listen when they said adequate funding and flexibility in how to use it was what they needed.

Cllr Hanna will provide a verbal update on relevant issues since the last meeting.

There are THREE documents attached this item:

1.    A HOSC report containing recommendations from the Committee on the South Central Ambulance Service’s CQC Improvement Journey, which was discussed during the 08 February 2024 HOSC meeting.

2.    A HOSC report containing recommendations from the Committee on the John Radcliffe Hospital’s CQC Improvement Journey, which was discussed during the 08 February 2024 HOSC meeting.

3. A HOSC report containing recommendations from the Committee on the Director of Public Health Annual Report.

The Committee is recommended to NOTE the Chair’s update having raised any relevant questions.

One matter that has arisen since the previous meeting involves the need for the Committee to agree a future arrangement for ongoing Scrutiny of the NHS’s Oxford City Community Health Hubs Project. It is RECOMMENDED that the Committee DELEGATES to the Chair and Health Scrutiny Officer to establish a small HOSC Working Group to engage in detailed and ongoing scrutiny of this project.

The Chair outlined the following points to update the Committee on developments since the previous meeting:

Ø  A report (containing recommendations from HOSC) had been submitted to the Oxford University Hospitals NHS Foundation Trust regarding the South Central Ambulance Service’s CQC Improvement Journey, which was discussed during the 08 February 2024 HOSC meeting

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Ø  A HOSC report containing recommendations from the Committee on the Director of Public Health Annual Report could also be found in the agenda papers.

Ø  The Chair and the Health Scrutiny Officer had requested a written briefing for the Committee relating to the temporary closure of the ADHD referral list, with a view to understanding the reasoning behind the closure as well as the potential impact it could have on those affected.

Ø  The Committee had requested a briefing from Oxford University Hospitals NHS Foundation trust on the recent CQC maternity inspection at the Horton.

Ø  The Committee made recommendations to the Integrated Care Board (ICB) and the parliamentary House Select Committee regarding a new policy issued by the medicines regulator. This policy pertained to anti-seizure medication and medication used for individuals with bipolar disorder called Valproate. As an update to that, the ICB established a task force comprising consultants, specialist nurses, medicines safety officers, representatives from charities and patients with lived experiences. The impact report outlined that there were unavoidable consequences, and current services were ill-equipped to handle the implementation of phase one of the medicines regulatory policy.

Specifically, it was anticipated that approximately 2,855 outpatient appointments would be lost due to the new requirements.

The report further predicted that reduced access would lead to increased mortality and greater morbidity, including emergency situations arising from uncontrolled epilepsy. Notably, this assessment did not encompass the impacts and risks associated with phase two of the policy, which could be even more significant.

Ø  The Chair also paid tribute to the Senior Patient Safety Manager at the ICB for his leadership of this taskforce, and the Committee offered their condolences to his family and colleagues.

The Committee NOTED the Chair’s Update.

The Committee AGREED the following actions:

1. For the Committee to DELEGATE to the Chair and Health Scrutiny Officer to write to the Health Secretary (and copying in the Parliamentary Health Select Committee) to bring the likely impacts of the Valproate Pregnancy Prevention policy to their attention, and to request that until the likely impacts and risks of phase 1 of the policy are assessed and safely addressed, that they allow local systems to delay implementation.

2. For the Committee to AGREE to the establishment of a four member HOSC Working Group, for the purposes of engaging in ongoing scrutiny of the NHS’s Oxford Community Health Hubs Project.

3. For the Committee to convene a public meeting item on medicine shortages, in line with increasing reports of such shortages across the board.

4. For the Committee to AGREE to DELEGATE to the Chair and Health Scrutiny Officer the responsibility to determine an approach to ongoing scrutiny of Oxford University’s Hospital’s  ...  view the full minutes text for item 27/24

Julie Dandridge (BOB ICB Lead for Primary Care across Oxfordshire) has been invited to present a report on GP provision in Oxfordshire.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Julie Dandridge (BOB ICB Lead for Primary Care across Oxfordshire) and Dan Leveson (BOB ICB Place Director, Oxfordshire) presented a report on GP provision in Oxfordshire.

The BOB ICB Lead for Primary Care across Oxfordshire introduced the report. Addressing an item on which the Committee had previously received a briefing, the partners at Botley Medical Centre had handed back their contract the previous year and the ICB worked with the residents and the Patient Participation Group around Botley Medical Centre and with local providers to find two new practices willing to take on the patients. The draft Primary Care Strategy had been co-produced with a number of stakeholders and the feedback was being collated into a final version, to be signed off by the ICB Board in May. There was a recognition of the increase in GP appointments, but also an acknowledgment that patients and the public were still having difficulty getting through to GPs by phone to get an appointment. There had been much progress in improving primary care estates. Some things were unfortunately beyond the control of the ICB, but work was continuing with GP leaders to try and improve access for patients.

The Committee asked in what respects had the National Recovery and Access to Primary Care Programme funded, influenced, and shaped the decisions and measures taken around GP provision in Oxfordshire. The BOB ICB Lead for Primary Care explained that the national primary care access and recovery. had come with some funding to support it. This funding was partly for practices to have time to implement what they called modern general practice, which involved assessing how and by whom patients should be seen. All their practices had submitted plans on how they would do this at the primary care network level. There was also funding for IT, specifically to ensure that all their practices had functioning cloud-based telephony and to drive forward other innovations in IT.

The Committee queried the extent to which the development of the Primary Care Strategy involved adequate levels of public and stakeholder engagement. The BOB ICB Lead for Primary Care had stated that engaging everyone was challenging. They had co-produced the draft strategy with GP leaders and Primary Care Network clinical directors, and held webinars and sessions for the public and professional colleagues. A detailed public engagement report was available, and Healthwatch had been used to disseminate information and hold seminars. Feedback received from public engagement indicated a need for more co-production of communications. The strategy would only work if the public was taken along, their concerns understood, and if they helped to drive it forward. Engagement on the strategy had closed as they wanted to get a final strategy out and ready. The strategy was put in place to help with the challenges faced by GPs and the public in terms of access. None of the components in the strategy were going to be mandated but were suggestions to colleagues in general practice on how to progress to enable better  ...  view the full minutes text for item 28/24

Hugh O’Keefe (BOB ICB Senior Programme Manager – Pharmacy, Optometry and Dental Services) has been invited to present a report on Dentistry Provision in Oxfordshire.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Hugh O’Keefe (BOB ICB Senior Programme Manager – Pharmacy, Optometry and Dental Services), Dan Leveson (BOB ICB Place Director, Oxfordshire) had been invited to present a report on Dentistry Provision in Oxfordshire. Ansaf Azhar (Director of Public Health) was also in attendance.

The BOB ICB Senior Programme Manager for Pharmacy, Optometry and Dental Services explained that the report included an update on the progress made since the last HOSC meeting they attended the previous year. They had been dealing with continuous issues related to dental practices leaving the NHS, which had become a serious concern, and the report covered their actions in response to these departures.

The Committee asked whether there was any indication as to the geographical spread of practices in Oxfordshire that had not met the minimum target contracted activity required for NHS dentists to avoid financial recovery, and what the reason was for Oxfordshire’s inferior performance to Buckinghamshire and West Berkshire. The BOB ICB Senior Programme Manager explained that contract delivery before the pandemic used to run at about 90% in Oxfordshire, and there had been more of an impact from the pandemic in the longer term in Oxfordshire. It could not be said that there was a particular area in Oxfordshire that was doing much better than others, although West Oxfordshire and the Vale of the White Horse were seeing slightly lower levels of provision.

As the distance from the capital increased, challenges arose, particularly in more rural areas. Similar patterns were observed in Buckinghamshire and the West of Oxfordshire, but not so much in West Berkshire. These areas, especially the West of Oxfordshire, faced significant challenges, with numerous practices deciding to leave the NHS and go private. This trend was more prevalent in this county than in other parts of the system. Since 2021, about 5% of the capacity was lost, with approximately three-quarters of that loss occurring in Oxfordshire. About half of the loss was specifically in the West of Oxfordshire as practices in these rural areas were making decisions to leave the NHS.

The Committee enquired as to the challenges facing patients trying to access local NHS dental services. The BOB ICB Senior Programme Manager clarified that, in contractual terms, dentists were only responsible for patients while conducting the course of treatment, so they were not registered. Due to the pandemic, many patients discovered that they had not attended for more than two years and when they then called back in to the dentist they appeared as new patients.

The recovery of access was fairly rapid early on in 2022. Since then, it had been slowing, and the report discussed some of the issues including gaps in treatment, leading to worse oral health, meaning those treatment plans were taking longer to complete. Thus, the backlog was taking time to clear because of the needs that were presenting.

In answer to the Committee’s query about the low NHS pay to dentists, the BOB ICB Senior Programme Manager explained that when the NHS contract was  ...  view the full minutes text for item 29/24

Veronica Barry, Executive Director of Healthwatch Oxfordshire will present the Healthwatch update report. The Committee is invited to consider the report and NOTE it having raised any questions arising from the contents.

PLEASE NOTE: There are TWO documents attached to this item:

1.    The main Healthwatch Oxfordshire Update Report.

2.    An additional summary report on a mystery shopping exercise on NHS Dentistry.

Following on from the previous item, Veronica Barry, Executive Director of Healthwatch Oxfordshire,  described a visit to asylum refugee hotel accommodations in the Banbury area and where they spoke with several key stakeholders regarding the integration into flexible commissioning in dentistry. Efforts were directed towards collaborating with the welfare office in those specific hotels, as it was observed that their awareness of flexible commissioning was limited.

Additionally, work was undertaken with parents through community connectors in the Banbury area, focusing on oral health. Notably, parents of children with special educational needs were identified as potential users of specialist services. A report detailing these findings is currently in progress. Moving forward, the plan involved partnering with community-based dental services to highlight developmental information specifically for this group of parents. An effort was made to incorporate the voices of the public into the discussion through the appendix. The Executive Director of Healthwatch Oxfordshire reiterated that effective communication with the public was crucial. However, it was acknowledged that the public were currently navigating a complex system with various constraints.

Healthwatch had conducted a Mystery Shopper exercise that simulated patient calls to dental surgeries. This exercise highlighted the time-consuming nature of navigating the system for a member of the public. Despite this, the flexible commissioning scheme was seen as encouraging, although certain groups still lacked clarity on how to access it.

In response to concerns about Patient Participation Groups (PPGs) not being involved in the Primary Care Strategy, the Executive Director of Healthwatch Oxfordshire emphasised that Healthwatch made efforts to promote PPG engagement, including through webinars. An ongoing appraisal of the current state of PPGs revealed a strong need for improved communication around changes. The hope is that Healthwatch's report will enhance support for PPGs, and discussions with the ICB will address communication gaps with these groups.

Additionally, patients had raised the issue of access to ADHD medication to Healthwatch and clarity had been sought from the ICB regarding patient pathways; especially considering changes in national guidelines.

The Committee thanked Healthwatch Oxfordshire for their work and NOTED the report.

Terry Roberts (Chief People Officer, Oxford University Hospitals NHSFT) has been invited to present a report on the Oxford University Hospital’s NHSFT People’s Plan.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

PLEASE NOTE: There are THREE documents attached to this item:

1.    The main report submitted for this item providing an update on Oxford University Hospital’s People Plan.

2.    The Oxford University Hospital People’s Plan Document.

3.    A summary of the Engagements undertaken by Oxford University Hospitals as part of developing the People Plan.

Terry Roberts (Chief People Officer, Oxford University Hospitals NHS Foundation Trust) was invited to present a report on the Oxford University Hospital’s NHSFT People’s Plan. Dan Leveson (BOB ICB Place Director, Oxfordshire) was also in attendance.

The Committee asked for clarification on the Oxford University Hospitals NHS Foundation Trust (OUH) vacancy freeze and whether an impact assessment had been completed to assess its effect. The Chief People Officer clarified that it was not a vacancy freeze, but a vacancy pause. This measure was implemented following instructions from the Integrated Care Board and NHS England, with the aim of balancing their financial books. The pause affected both clinical and non-clinical posts that were Band 8C and above, which included senior roles like managers with a salary of £70,000. Administrative and clerical roles were also paused. OUH still actively recruited to Band 5 and Band 6 nursing vacancies, healthcare support workers, and other direct healthcare roles. The primary goal of this action was to ensure financial stability. A quality impact assessment was conducted not only for the overall programme but also for each post under consideration. Recruitment to posts was not undertaken unless they were fully aware of the potential impact on patient care and their ability to meet constitutional standards.

The Chief People Officer added that OUH was directed to implement these measures. They had been striving to increase productivity and had a significant productivity programme in place for the entire previous year. It was noted that at the end of 2023/24, they finished with a deficit of £10 million. However, this was in the context of achieving £90 million in efficiency savings during the same period.

The Chief People Officer clarified that they did not want to pause the posts, as they were not extra and were indeed needed. However, they had been instructed to review them, a task not unique to Oxford University hospitals. They acknowledged the difficulty of the situation, particularly the administrative burden placed on staff due to the thorough quality impact assessment. They highlighted the financial constraints they were operating under, with a finite budget and a requirement to balance their books. They emphasised that unless key changes were made and tough decisions taken, they would not be able to fund investments to improve both patient and staff experience, as highlighted in the people plan.

The Committee enquired about the effect this could have on staff that were already under strain. The Chief People Officer stated that they were aware of the initiative's impact on their staff. They were constantly monitoring the staff's mood through quarterly staff surveys, a large annual staff survey, retention questionnaires, and regular people plan listening events where they heard directly from the staff. These methods helped them understand the feelings of their staff and were instrumental in developing the people plan.

The BOB ICB Place Director, Oxfordshire acknowledged that their costs, like many systems across the country, had exceeded the allocated funds. The proportion of money spent on staff, was typically  ...  view the full minutes text for item 31/24

The Committee has received Responses as well as Acceptances for the recommendations made as part of the item on the Oxfordshire Place-Based Partnership, which was held during the 23 November 2023 HOSC meeting.

The Committee has also received an additional progress update response to the recommendations made as part of the Oxfordshire Healthy Weight item, which was held during the 23 September 2023 HOSC meeting.

The Committee is recommended to NOTE the response and update.

The Committee received responses as well as acceptances for the recommendations made as part of the item on the Oxfordshire Place-Based Partnership, which was held during the 23 November 2023 HOSC meeting.

The Committee also received an additional progress update response to the recommendations made as part of the Oxfordshire Healthy Weight item, which was held during the 23 September 2023 HOSC meeting.

The Committee NOTED the response and update.

To AGREE the Committee’s proposed work programme for the upcoming meetings throughout the remainder of the 2023/24 civic year and beyond, having raised any questions

The Committee AGREED the proposed forward work programme.

The Committee is recommended to NOTE the progress made against agreed actions and recommendations having raised any questions.

The Committee NOTED the progress made against agreed actions and recommendations