Agenda and minutes

Councillor Roy Darke attended for Councillor John Sanders and an apology was received from Mrs Ann Tomline.

There were no declarations of interest.

To approve the minutes of the meeting held on 16 September 2010 (JHO3) and to note for information any matters arising on them.

The Minutes of the meeting held on 16 September were approved and signed. There were no matters arising.

This being Julie Dean’s last meeting before assuming a different role within Committee Services, she was asked to minute the thanks she received by the Committee for her good work over the years within the Health Scrutiny sphere.

The Chairman had agreed to the following requests to address the Committee:

-                      Councillor Roger Belson (at Agenda Item 5)

-                      Councillor David Turner  (at Agenda Item 5)

10.10 am

In August this year, the County Council/NHS Pooled Budget Joint Management Group had decided to end a contract for short term Intermediate Care beds at Watlington Care Home. Following that, the County Council and the PCT had received a number of objections to the decision. In response to the objections, the Joint Management Group had decided to suspend the decision to end the contract, pending a review of the joint Intermediate Care Strategy.

The review will report its findings and recommendations to the next Joint Management Group on 12 November. The Joint Management Group will then decide how to proceed in respect of intermediate care in general and the Watlington beds in particular.

Paul Purnell, Head of Adult Social Care, Oxfordshire County Council, will attend for this item and members of the Committee will have the opportunity to scrutinise the policy decision and rationale.

In August 2010 the County Council/NHS Pooled Budget Joint Management Group  had decided to end a contract for short term Intermediate Care beds at Watlington Care Home. Following that, the County Council and the PCT had received a number of objections to the decision. In response to the objections, the Joint Management Group had decided to suspend the decision to end the contract, pending a review of the Joint Intermediate Care Strategy.

The review was due to report its findings and recommendations to the next Joint Management Group on 12 November 2010. The Group would then decide how to proceed in respect of intermediate care in general and the Watlington beds in particular.

The matter had created a great deal of concern in Watlington and its surrounding area and the Chairman had received  a number of letters including one from John Howell MP in which he had requested the Committee to support a proposal that a decision on the beds ‘remains suspended until a proper consultation has taken place with local residents and until the impact of the additional funds for the NHS and for social care announced in the Comprehensive Spending Review can be properly assessed against a strategy for the need of intermediary care beds’.

Mr Edwards advised the Committee that while the beds were provided by the County Council, they were in an NHS setting and medical care was provided by Community Health Oxfordshire. Therefore, it was an NHS service and any plans for closure would be subject to the same rules which state that any substantial service change should be subject  to full public consultation.

Prior to consideration of this item the Committee heard addresses from Councillor Roger Belson and David Turner, each of whom raised a number of points relating to the closure of 13 beds at  Watlington Hospital:

Councillor Roger Belson

-                      The much valued care home had opened 6 years ago following a vigorous campaign by the community who had raised £1.5m;

-                      The number of intermediate care beds had increased recently from 13 to 15;

-                      During recent months the level of dependency, due to mental health problems, had increased. The Care Home was well placed to cope with this, given the level of skills held by staff;

-                      The level of satisfaction from patients was ‘very high’;

-                      Local GPs were very supportive, their premises being adjacent to the Hospital site;

-                      Patient costs amounting to £700 per week were relatively low compared to those charged for acute care;

-                      Bed occupancy was 86%, which had reduced recently due to the inefficiencies of the referral system and the known pressures of delayed discharge;

-                      The ORH valued the beds;

-                      Could  beds be offered to bordering counties to alleviate the need to reduce costs?

-                      Any change to policy should take place following detailed consultation  with patients and local residents; and

-                      He urged the Committee to ensure that it considers the review carried out by the OCC/NHS Pooled Budget Joint  ...  view the full minutes text for item 63/10

10.45 am

There will be a 30 minute break for attendance at the Remembrance Day Service in the Common Hall Café, if wished.

The meeting was adjourned for 30 minutes whilst members, officers and members of the public attended the Remembrance Day service. The meeting was resumed at 11.15 am.

11.15 am

As part of a series of items of business aimed at bringing members of the Committee up to date on the position of local NHS Trusts, Sir Jonathan Michael, Chief Executive of the Oxford Radcliffe Hospitals NHS Trust will give an update on both the current situation and how he sees the future for the Trust.

As part of a series of items of business aimed at bringing members of the Committee up to date on the position of local NHS Trusts, Sir Jonathan Michael, Chief Executive of the Oxford Radcliffe Hospitals NHS Trust, had been invited along to the meeting to give an update on both the current situation and on the future for the Trust.

Sir Jonathan was welcomed to the meeting. He referred to a number of issues currently affecting the Trust:

-                      The Trust was working to a £47m reduction in the cost base;

-                      At the same time they were working hard to improve performance against standards of care, leading to improving targets;

-                      A new integrated management structure for clinical services had been introduced. Clinicians had responsibility for running the services and accordingly were accountable for them;

-                      There were six clinical divisions, each with significant health care business, each with a turnover of £100m and each with approximately 1,000 staff;

-                      The Trust’s financial performance was doing reasonably well, though there were delays in discharging patients from acute care. This situation was not unique to the ORH. An agreement had been reached with the PCT/CHO and SCS to allow the Hospital to discharge some of the patients waiting for healthcare packages and community placements. He expressed his support for the agreement as this would have an impact and would cause an abatement of pressures on the services. The current pressures on discharge had slowed down financial progress due to the inability to reduce the capacity within the hospital system in line with expectations of the PCT;

-                      With regard to Agenda Item 8 – Creating a Healthy Oxfordshire - the Trust was working with the PCT, CHO and the local GPs on a pilot in Abingdon to support patients who might otherwise have been admitted to a hospital bed and to support patients coming out of hospital. It was still ‘early days’ to measure outcomes;

-                      The Horton Hospital – the Trust had now developed a vision for the way services should be run at the Horton Hospital site. The Board was keen to expand services, particularly for services for outpatients in order to reduce the frequency of journeys to Oxford;

-                      The integration of the NOC and the Trust. Discussions were ongoing, and progressing well, the business case was to be considered by both Boards on 2 December 2010. Following this, if approved, there would be a public consultation, following which, if given final approval, the proposals would then be submitted to the SHA and to the DoH in turn. If all were in agreement the integration would take place in mid 2011 and, following that, in 2012/13 the newly integrated Trust would apply for Foundation Trust status ;

-                      Paediatric heart surgery – following a number of unfortunate deaths at the beginning of 2010, an independent inquiry had identified weaknesses in the way in which the Trust organised its risks in the governance of services. There were,  ...  view the full minutes text for item 65/10

11.45 am

Oxfordshire’s NHS organisations and the County and District Councils are working together to try to ensure the continued provision of high quality and sustainable health and social care services. In the face of reductions to funding, the health and social care services need to respond to increasing demand, patient expectations and advances in technology and medicines. The plan is to improve the quality and value for money of health services provided in Oxfordshire in a way that will keep the system in financial balance. This will involve re-designing the wide range of health care services currently provided throughout Oxfordshire. Catherine Mountford, Director of Strategy & Quality, Oxfordshire PCT, will bring the Committee up to date on developments.

 A report, produced by Catherine Mountford, is attached at JHO8.

Oxfordshire’s NHS organisations and the County and District Councils were working together to try to ensure the continued provision of high quality and sustainable health and social care services. In the face of reductions in funding, health and social care services needed to respond to increasing demand, patient expectations and advances in technology and medicines. The plan was to improve the quality and value for money of health services provided in Oxfordshire in a way that would keep the system in financial balance. This would involve redesigning the wide range of health care services currently provided throughout Oxfordshire. The programme was known as Creating a Healthy Oxfordshire (CAHO).

Catherine Mountford, Director of Strategy & Quality, Oxfordshire PCT, attended the meeting in order to update the Committee on developments and to respond to any questions. A report (JHO8) which had been produced by Catherine Mountford was before the Committee.

Catherine Mountford presented her report and responded in the following manner to a number of issues raised by members:

-                      There would be a slight increase in funding over the next few years which would amount to 0.4% in real terms. As a consequence, things will need to be done differently and more would have to be done with available funding, for example on enablement;

-                      No policy decisions have yet been taken with regard to any potential changes which may be taken as a consequence of the permission given by the Government to disregard NICE recommendations;

-                      With regard to the Quality Innovation, Productivity Prevention Plan (QIPP) that related to maternity and mental health services - work was being undertaken on managing maternity care, maximising normal delivery and reducing the caesarean rate; and reducing hospital interventions. The largest part of the savings in mental health was the joint work being carried out on supported to independent living;

-                      The maximum numbers of women were giving birth in midwife-led units as part of the programme;

-                      The PCT would be working closely with GP consortia to take the Plan forward , beyond 2013, when the PCT would disband. Naturally, it may change and adaptations will have to be made as it progresses and new ideas brought forward. There was not as yet a balanced plan with regard to delivery;

-                      To date, 30 plus GPs had put their names forward to become more involved in the consortia;

-                      Informal consultation was going ahead with regard to developments for Bicester Hospital; and

-                      With regard to possible job losses due to efficiency savings, it was difficult to answer this question, but the aim was to effect this via natural turnover and vacant posts. The detailed planning with regard to workforce changes and contractual issues would be undertaken next year.

The Committee thanked Catherine Mountford for her attendance, for her update on developments and for responding to members’ questions.

12.25 pm

Lisa Gregory, Social & Community Services, Oxfordshire County Council, will talk about the future fro LINk and HealthWatch. The host organisation’s contract is due to finish at the end of March next year, but HealthWatch (the replacement for the LINk  - as outlined in the Health White Paper) is not due to come into existence until April 2012. This item should provide an opportunity for members to express a view on the future of the contract, in particular during the period between the end of the present host contract and the start of HealthWatch.

Lisa Gregory and Robyn Noonan, Social & Community Services (representing the host) attended to present a paper (JHO9 – attached to Addenda) and to respond to questions from members, with regard to the future of the Oxfordshire LINk and HealthWatch.

The Committee were asked to explore the options set out in the paper and then to express a view on the future of the contract, in particular for the period between the end of the present host contract and the start of HealthWatch.

Lisa Gregory reported that Legal & Governance Services had advised that it would be deemed unlawful* if the support for LINk was to be brought ‘in-house’ (within Social & Community Services).

Lisa Gregory and Robyn Noonan were thanked for their attendance  and for responding to questions from the Committee.

Following discussion it was AGREED that the contract with Help & Care should not be extended and should be* put out to  tender once the funding situation was known.

*amended at the meeting held on 20 January 2011

12.55 pm

The Chairman will report on the meetings he has attended since the last meeting.

The Committee noted the Chairman’s report on the following meetings he had attended with the Deputy, and letters received, since the last meeting of this Committee:

-                      Meeting with the Chief Executive of Oxfordshire & Buckinghamshire Mental Health Care Foundation Trust;

-                      Letter received from the Prime Minister responding to this Committee’s representations with regard to the NHS White Paper;

-                      The Chairman was sitting on a Member Team looking into the possible transfer of Public Health to this Authority;

-                      The Chairman was  also involved in discussions on the future structure of the Health & Well Being Board. He undertook to keep the Committee informed on this issue.