Agenda and minutes

Councillor Alan Davies attended for Councillor Hilary Fenton; Councillor Ray Jelf for Councillor Don Seale; and Councillor Anda Fitzgerald-O’Connor for Councillor Tim Hallchurch MBE. Apologies were received from Councillors Neil Owen and Jane Hanna OBE.

The Committee congratulated Cllr Hanna on receiving her OBE.

Councillor Lawrie Stratford and Councillor Rose Stratford  both declared a personal interest in Agenda Item 7 on account of their membership of the Bicester Hospital League of Friends. Councillor Dr Peter also declared a personal  interest  in Agenda Item 7, on account of his membership of Henley Town Council.

To approve the minutes of the meeting held on 20 May 2010 (JHO3) and to note for information any matters arising on them.

The Minutes of the meeting held on 20 May were approved and signed, subject to the addition of a recommendation (e) in Minute 32/10 at the bottom of page 8, to read as follows:

‘request the Working Group to submit their report to the next meeting of this Committee.’

The Chairman had given his agreement to the following people addressing the meeting:

• Councillor John Sanders, speaking in his capacity of local member, addressed the Committee on the Silver Star Maternity Unit – Item 10  Information Share;
• Patrick Taylor, Chief Executive, Oxfordshire MIND and Alex Taylor, Manager, Bridewell Organic Gardens – Agenda Item 9 – Chairman’s Report – ‘Keeping People Well Project Group.’

Councillor John Sanders expressed concern at the lack of notice given of the closure of the Silver Star Maternity Unit, John Radcliffe Hospital, resulting in an article in the Oxford Mail in which members of the public had expressed their worries about the risks relating to the closure. He asked for details of the planned closure and a timetable leading to its re-opening.

Andrew Stevens, Director of Planning & Information and Susan Brown, Senior Communications Officer, Oxford Radcliffe Hospitals NHS Trust had been invited to attend the meeting in order to respond to questions from the Committee. They commented that there had been a significant amount of miscommunication on the part of the media with regard to the situation and welcomed the opportunity to give a true account of the changes to the service. They informed the meeting of the following:

• The service was not closing, exactly the same range of services would be available over the summer months;
• The plans were to reconfigure the service over the summer months, as had happened in previous years, by reducing the number of floors from where the service was provided, from 3 to 2, in order to respond to demand for the service, staff holidays etc;
• The sole driver for the temporary closure was patient safety and midwifery contracts, there being fewer midwives recruited to contracts, due to staff summer holidays;
• In order to provide the same quality of care and effectiveness, services were to be rationalised with a reduced resource base;
• The Trust had monitored issues such as caesarean and mortality rates in past years and there had been no evidence that they had risen in the summer months. There was a 5 - 7% sub set of high risk elements to the service which had to be taken into account; but the Trust also had to ensure that they were looking to the safety of the other 93%. Therefore, in order to deploy resources to their full effectiveness, it was necessary to reduce the number of floors from which the service was provided over the summer;
• Any problems which had arisen in the past, the Trust had learnt from and thus the plans were more robust this year;
• There was no firm date for the reopening of the full service, it would depend on recruitment levels. However, last year the date was earlier than expected because the recruitment process had taken less time than was envisaged.

The Chairman thanked Andrew Stevens and Susan Brown for attending and asked if there would be any change to the level of service provided to the residents of Oxfordshire. Andrew Stevens responded  ...  view the full minutes text for item 42/10

10.15 am

To date, no items have been received.

Mary Judge, a member of the Oxfordshire LINk Steering Group reported as follows:

• The Hearsay Report had now been published and the recommendations relating to Social & Community Care had been agreed and were being monitored by the LINk;
•  Patient Voice were presenting the outcomes of their survey on Patient Discharge, which had been commissioned by the Oxfordshire LINk, to the Oxford Radcliffe Hospitals NHS Trust shortly and were due to present the same to this Committee at their 16 September meeting;
• The LINk were experiencing difficulty in finding people able to take part in their report on self directed support and were working on how to circumvent the problems;
• Their work with the Neurological Alliance in relation to the development of services, including the Parkinson’s Disease service;
• Oxfordshire LINk were discussing the future of LINks with their central office, whilst they awaited the White Paper;
• They intended to do some work with the Podiatry Service; and
• She asked how organisations like the LINk could assist with regard to the Public Health Annual report.

The Committee thanked Mary Judge for her update on the recent activities of the Oxfordshire LINk.

The Committee expressed their disappointment with the level of output and the general organisation of the Oxfordshire LINK to date. They AGREED  to request Mr Edwards to write to the Host organisation giving the reasons for their views. They also expressed a wish to invite a representative from Help & Care’s procurement Team to come along to a meeting of this Committee.

10.45 am

This is the fourth Annual Report by the Director of Public Health (DPH) for Oxfordshire. It provides OJHOSC members with an opportunity to listen to and question the Director. Recommendations are made in the Report for all organisations and for the public. A copy of the report is attached at JHO6.

The aims of the Annual Report are:

1.                  To report on progress made in the last year and to set out challenges for the next year.

2.                  To galvanise action on five main threats to the future health, wellbeing and prosperity of Oxfordshire; and

3.                  To emphasise two strongly emerging threats to public health; namely those posed by dementia and alcohol abuse.

The five main long-term threats are:

• Breaking the cycle of deprivation
• An ageing population – the ‘demographic challenge
• Mental health and wellbeing
• Increasing obesity
• Fighting killer infections

The threat posed by dementia is described in the chapter on an ageing population.

The threat posed by alcohol abuse takes its place as the sixth long-term threat to health.

Progress will be monitored in future reports. Long-term success will depend on achieving wide consensus across many organisations.

Dr McWilliam presented his fourth Annual Report (JHO6).

The aims of the Annual Report were:

1.                  To report on progress made in the last year and to set out challenges for the next year.

2.                  To galvanise action on five main threats to the future health, wellbeing and prosperity of Oxfordshire.

3.                  To emphasise two strongly emerging threats to public health; namely those posed by dementia and alcohol abuse.

Dr McWilliam set out progress made in relation to the five main long-term threats which were:

• Breaking the cycle of deprivation
• An ageing population – the ‘demographic challenge’
• Mental Health and wellbeing
• Increasing obesity
• Fighting killer infections.

The threat posed by alcohol abuse took its place as the sixth long-term threat to health. Progress would be monitored in future reports. Long-term success would depend on achieving wide consensus across many organisations.

Dr McWilliam made reference to the speech made by the Secretary of State for Health the previous day which had highlighted the need for a stable Public Health service at national and local level and the need to judge by outcomes. He added the following:

• His concern for the public health function within Oxfordshire in the light of the government cuts and legislation changes, some examples being uncertainty around the future of this Committee and partnership changes;
• His hope for the future that the NHS, Public Health and Local Authorities will work together in partnership with a clear agreement on the prevention agenda; together with machinery in place to monitor measure and scrutinise. He emphasised the importance of the alliance between the OJHOSC and Public Health as an example of this, in that each were concerned with the population of Oxfordshire as a whole.

The two additional emerging threats to public health were welcomed by members of the Committee and, during the question and answer session which followed the following issues were highlighted:

-                      Many of the issues cited in the report entailed a behavioural change, for example, the combating of obesity;

-                      The importance of a good diet and exercise – Dr McWilliam agreed but commented on the lack of skills, time and life-style to grow and cook nourishing food as the nation did in the war-time period;

-                      The need for drugs abuse to be included with that of alcohol  - Dr McWilliam responded that drugs issues had not emerged as a pressing concern in Oxfordshire – they were also illegal;

-                      Concern about alcohol promotions – Dr McWilliam agreed that price was certainly key with regard to the extent of the problem. Moreover, to be effective, a decision would have to be made by the Government at national level as to whether to grapple with the issues. Binge drinking was a big concern for this county and there was a need to do more on this;

-                      The question about the needs of people with more severe mental health problems when currently the PCT do not run rehabilitation or day care services. Could the Keeping People Well  ...  view the full minutes text for item 44/10

11.45 am

Work has been going on for some time to develop new community hospitals in Henley and Bicester. This has included:

• Establishing a planning framework;
• Carrying out a number of surveys on the current sites;
• Looking at other site options in Bicester and work with key partners, including Cherwell District Council, on the wider developments in the area, such as the proposed eco town.

The PCT was going through the process of finding a developer to take on the work of re-developing the hospitals. However, legal advice led to a decision to restart the procurement process.

This item will give the Committee an opportunity to find out how this position was reached and what effect this delay will have on the future development of the hospitals.

Speakers will include:

Catherine Mountford – Director of Strategy & Quality at the PCT;

Councillor Ian Reissman, Chairman of the Townlands Steering Group (TSG). The TSG is the formal advisory Committee to the Henley Town Council. Membership comprises elected members; groups across and beyond Henley, business health groups, charities and church parishes around Henley; and

Dr Michael Curry, Chairman of the Bicester Community Hospital Engagement Forum (CHEF) which was set up by the PCT to enable local people to have their say in the development of the new Bicester Community Hospital.

Work had been ongoing for a considerable time to develop new community hospitals in Henley and Bicester. This had included:

• Establishing a planning framework;
• Carrying out a number of surveys on the current sites;
• Looking at other site options in Bicester and work with key partners, including Cherwell District Council, on the wider developments in the area, such as the proposed eco town.

The PCT had been going through the process of finding a developer to take on the work of re-developing the hospitals. However, legal advice had led to a decision to restart the procurement process.

The purpose of this item was to give the Committee an opportunity to find out how this situation had arisen and what effect the delay would have on the future development of the hospitals.

Catherine Mountford, Director of Strategy & Quality, Oxfordshire PCT; Dr Michael Curry, Chairman , Bicester Community Hospital Engagement Forum and Dr Peter Ashby, General Practitioner, attended the meeting in place of Councillor Ian Reissman of the Townlands Steering Group (TSG).

Catherine Mountford expressed disappointment that the process had had to be re-started, but there had been no option but to cease development, given the level of risk involved, as advised by the Legal service. She added that it was deemed important to simplify the process as far as possible, given that a significant amount of work had already been completed on, for example, planning surveys etc. Moreover, there were plans to take to a business case to the September PCT Board involving two locations, which would include a preferred option. It  was expected that approval would be received by May 2011, subject to planning permission. She assured the Committee that the PCT were working closely with the local communities.

 Dr Michael Curry expressed also expressed regret that the project had been delayed by 6 months, but that a new, revised process was now to be drawn up. In his view, it was not possible to manage it via a committee process, rather it required input from an architect, and GP and nursing input also.

Dr Peter Ashby informed the Committee that the Steering Group, rather than taking a confrontational stance, had preferred to concentrate on working with the PCT to find a solution. He added that the PCT had given a commitment to re-provide the services currently offered by the hospital and the aim of the Group was to ensure that a hospital was kept open for the next 25 years. The Steering Group had asked the PCT to provide sufficient support and advice with which to deliver the Business Case for September.

During the debate, members of the Committee raised the following points:

-                      It was hoped that there would be no further problems with the legal side, in order to ensure success;

-                      There had been a lack of communication with the residents of Bicester with regard to the project. It was hoped that the PCT would be more vocal in managing the expectations of the  ...  view the full minutes text for item 45/10

12.45 pm

Early diagnosis for people with dementia has been shown to have benefits in terms of patient and carer quality of life and independence. There is also evidence to show that there is a financial benefit as a result of delayed need for residential care.

In Oxfordshire, Quality and Outcomes Framework (QOF) data shows that 34% of people currently receive a diagnosis of dementia. Memory clinics exist , provided by both Oxford Radcliffe Hospitals Trust (ORHT) and Oxfordshire & Buckinghamshire Mental Health Foundation Trust (OBMHFT). There is currently no clear pathway and no agreed service specification, leading to uneven levels of service and post diagnostic support. There is confusion amongst GPs around where to refer a patient with suspected dementia.

Building on recommendations in the National Dementia Strategy, the proposal is to commission an integrated Memory Assessment Service involving both providers working together to maximise the strengths of both. The need for an increase in the numbers receiving a diagnosis and current capacity issues would be partially addressed by enabling a specialist dementia nurse to undertake routine follow up appointments, moving to follow up appointments into community settings, such as GP surgeries; and freeing up consultant time for diagnosis and more complex cases. Agreed information and support would be provided at, or shortly after, diagnosis.

Duncan Saunders, Service  Development Manager for Older People’s Mental Health at the PCT will present the business case, which is attached at JHO8(a)), and describe what consultation has taken place to date (JHO8(b)). The proposed Care Pathway for early diagnosis in Dementia,  is also attached at JHO8(c)).

Early diagnosis for people with dementia had been shown to have benefits in terms of patient and carer quality of life and independence. There was also evidence to show that there was a financial benefit as a result of delayed need for residential care.

In Oxfordshire, Quality and Outcomes Framework (QOF) data showed that 34% of people currently received a diagnosis of dementia. Memory clinics existed , provided by both Oxford Radcliffe Hospitals Trust (ORHT) and Oxfordshire & Buckinghamshire Mental Health Foundation Trust (OBMHFT). There was currently no clear pathway and no agreed service specification, leading to uneven levels of service and post diagnostic support. There was confusion amongst GPs around where to refer a patient with suspected dementia.

Building on recommendations in the National Dementia Strategy, the proposal was to commission an integrated Memory Assessment Service involving both providers working together to maximise the strengths of both. The need for an increase in the numbers receiving a diagnosis and current capacity issues would be partially addressed by enabling a specialist dementia nurse to undertake routine follow up appointments, moving to follow up appointments into community settings, such as GP surgeries; and freeing up consultant time for diagnosis and more complex cases. Agreed information and support would be provided at, or shortly after, diagnosis.

Duncan Saunders, Service  Development Manager for Older People’s Mental Health, Oxfordshire PCT and Marie Seaton, Head of Joint Commissioning, Older People, attended to present the business case, which was attached to the Agenda at JHO8(a)), and describe what consultation has taken place to date (JHO8(b)). The proposed Care Pathway for early diagnosis in Dementia,  was also attached at JHO8(c)).

Following the presentation, members welcomed the proposals and raised the following questions/issues:

-                      The quality of life will decrease for the carer as well as the sufferer as the disease progresses;

-                      Sufferers can become quite isolated within their own homes – a good residential home can assist in giving them a better quality of life. is there a more holistic support available for them?

-                      Care homes can be very expensive, if sufferers could be kept safely within their own homes, this would be the best option. Are the resources given to it sufficient?

-                      Can there be more done to diagnose younger people with dementia?

-                      Day centres are an important stimulation for sufferers;

-                      Is access to drugs restricted?

-                      Have you taken note of the increase in numbers of older people living in rural areas?

-                      Shouldn’t there be more GP’s specialising in dementia treatment/care?

Duncan Saunders responded to the above points as follows:

-                      Much of the above questions has been covered by the overall work on the Dementia Strategy, for example, work around improving standards of care in some care homes. Also making sure that admissions, where possible, are planned from the early days of diagnosis;

-                      It was hoped that the pathway would make it easier for younger people (ie aged 65 and under) to get a diagnosis and be  ...  view the full minutes text for item 46/10

13.15 pm

The Chairman will report on the following matters:

-                      South central Ambulance Service NHS Trust review;

-                      Keeping People Well project group.

The Chairman updated the Committee on the following issues/meetings he had attended:

South Central Ambulance Service (SCAS)

Roger Edwards reported that a number of meetings had taken place with the South Central Ambulance Services as part of a project undertaken by the informal South Central  Scrutiny Group which looked at the underperformance of SCAS access targets in rural areas. A number of recommendations had emerged from this review which had been formulated in a letter to the commissioners, together with a number of further questions. A response was awaited.

In response to representations from the South Central Scrutiny Group, SCAS had set up a workshop to look at the way vehicles were deployed in rural areas as part of a departmental review. Furthermore they had invited major stakeholders to attend a meeting held in Newbury to discuss it. He added that there were some good outcomes emerging from this piece of work, which would be submitted to a future meeting.

The Chairman pointed out that an important outcome of the project would be an admission from SCAS that the national targets Service Level Agreement was different in rural areas and that they depended on an average figure.  He asked the Committee if it was prepared to accept that there was an inequity of access to rural areas compared to urban areas; given that there was no guarantee of the £6m funding required to guarantee equity of access. He pointed out the deemed failure and the frustrations inherent in not meeting the target when arriving 1 second  after the 8 minutes, whereas a floor level of , say, 95% arrival in 11 minutes would be more realistic. He also pointed out also that the new Government were removing NHS targets and replacing them with the concept of ‘outcomes’.

Members of the Committee joined in seeing the sense in the Government’s decision, believing that a realistic and pragmatic view was required. It was pointed out that different thresholds could then be placed on different circumstances, for example, there could be different outcome threshold placed on the area within the Oxford ring road compared with the outside. It was added, however, that priority had to be given to lobbying the Government for additional funding for rural services; indeed that there should be adequate monitoring of performance leading to service improvement, if necessary.

Keeping People Well (KPW) – Re - commissioning of Day Services provided by Voluntary and Community Services for Adults with Mental Health Problems.

At the last meeting, following representations from members of the public and a full discussion, it had been decided that a working group be formed (Minute 32/10 refers) comprising three members of the Committee, to work with the PCT commissioners to ensure that :

(1)   The KPW service level outcomes were equitable, there was equity of access and that the current level of service was maintained and/or improved;

(2)   That the process had been transparent throughout; and

(3)   Whether a full public consultation was required.

A report by  ...  view the full minutes text for item 47/10

13.25 pm

No items have been received to date.

There were no items for information put forward.