Agenda and minutes

Apologies were received from District Councillors Christopher Hood and Hilary Hibbert-Biles and Mrs Ann Tomline and Anne Wilkinson.

Councillor Elizabeth Gillespie substituted for Councillor Hood and Councillor Martin Barrett substituted for Councillor Hibbert-Biles.

Councillors Rose Stratford and Lawrie Stratford declared an interest as members of the Bicester Hospital League of Friends.

Councillor Dr Peter Skolar declared an interest as a member of the Townlands Hospital League of Friends.

Councillor Jenny Hannaby declared an interest as a member of the Wantage Hospital League of Friends.

To approve the minutes (JHO3) of the meeting held on 15 September 2011 and to note for information any matters arising from them.

The minutes of the meeting held on September 15th 2011 were agreed and signed as a correct record of the meeting.

The following points were made:

Item 56/11 – Councillor Strangwood commented that nobody from the NHS had been present at the meeting and so it was not possible for HOSC members to ask questions about changes to the gynaecology service at the Horton General Hospital.

Councillor Hannaby asked when the proposed review of Alcohol services was likely to begin. The reply was, as soon as possible.

There were no requests to speak or petitions to present.

10.10

The Director of Public Health will bring the Committee up to date on progress in the development of the Oxfordshire Health and Wellbeing Board. A paper (JHO5) is attached.

The Director of Public Health for Oxfordshire presented his report on the development of the new Health and Wellbeing Board (H&WB). Dr McWilliam stressed that the Board would provide an excellent opportunity for providing joined up solutions to health and social care issues. The Board must not be allowed to become a talking shop but must deliver change and set and ensure the achievement of realistic and meaningful targets.

The HOSC would have a key role in scrutinising the work of the Board and ensuring that the focus on improving healthcare for the residents of Oxfordshire was maintained and that positive outcomes were achieved.

It is expected that the Board would have three main themes:

1. Prevention
2. Breaking the cycle of deprivation
3. Joining up finances

Of the four supporting Boards three; Children and Young People, Adult Health and Social Care and Health Improvement, would meet before March 2012 and clarify their membership, terms of reference and aims. The Public Involvement Board, to be chaired by the Chair of HealthWatch, would be developed over the next year. It would be important to take care to involve as wide a range of stakeholders as possible in the development of the Board.

Finally Dr McWilliam stated that the Boards would not be adding layers of bureaucracy but would use existing mechanisms wherever possible.

During the subsequent question and answer session the following points were made:

• Minutes of the H&WB and supporting boards should be made available to the appropriate scrutiny committees and H&WB minutes should be included with the HOSC agendas.
• Dr McWilliam would be invited to a future HOSC meeting to give a presentation on “prevention”.
• To ensure that the Board is effective it should be expected to produce a work programme containing “practical deliverables” with local targets that could actually make a difference. The programme should contain the names of accountable officers/members together with dates for achieving targets.
• The HOSC should examine the programme and monitor the achievement (or not) of the targets.
• Concern was expressed over whether or not the Board was fully representative of the whole County. It was explained that the membership of the Board had been decided by the County Leaders’ Group (the Leaders of the County, District and City Councils).
• Concern was also expressed that the new set up would lead to increased costs with more meetings and officer and member time and resources being used. It was pointed out that the level of bureaucracy should not be increased as the Children’s Trust and the Health and Wellbeing Partnership would be abolished and the Adult Health and Social Care Board would use existing management groups to undertake much of the work. Members remained sceptical.
• It was noted that the Leader of the County Council was to chair the H&WB. Members of the HOSC questioned whether this was appropriate in view of the level of work that would be entailed on top of the Leader’s already heavy workload. Would it not be more effective  ...  view the full minutes text for item 66/11

10.30

The aim of the ACE programme is to bring health and social care organisations across Oxfordshire together to deliver and commission health and social care services that would provide every adult with care that is acceptable and appropriate to their needs in the 21^st century.

The expected outcomes are:

• A viable community provision that would avoid admissions and deliver a comprehensive Early Supported discharge service across the county for the 18+ population

·        Reduced over-dependence on acute care and bed based long term care in Oxfordshire

·        Improved and increased utilisation of community staff and a reduction in the quantity of acute provision

·        A fundamental change in culture and practice and in the way providers work with each other, especially across the integrated clinical pathway approach

·        A joint health and social care approach that would be delivered and sustainable

Alan Sinclair, Lead Commissioner Social Care for Adults and Fenella Trevillion, Head of Partnerships at the PCT will explain the programme and outline the practical implications for care services across Oxfordshire.

A paper (JHO6) is attached.

Prior to the presentation of the report Councillor David Turner, member for the Chalgrove Division asked a question specifically related to Watlington Care Home. Cllr Turner wished to know when the proposals in the ACE report were likely to be developed such that it would be possible to identify specific implications for parts of the community, e.g. Watlington Care Home. He also asked whether the private sector should be represented on the Programme Board.

Mr Sinclair replied that there was no timetable set but that regular reports are being made to the Creating a Healthy Oxfordshire (CAHO) Board and that Councillors would be kept informed of progress.

With regard to the Board; the aim had been to have a small and effective group that included commissioners, providers and clinicians.

Mr Sinclair then presented his paper. He stressed that the aims of the ACE programme were for more people to be cared for at home with a consequent reduction in the number of beds in use in both acute and community settings.

Beds need to be used more effectively and there is a substantial piece of work being done to identify how this could happen. Work is also being done to identify ways in which people could be helped to maintain their independence, to improve the use of pooled budgets and to improve communications.

Delayed Transfers of Care (DTOC) has no single cause and the present situation of high numbers of blocked beds could get worse before it gets better. Extra investment is not yet delivering change and new services which are being developed have yet to show benefits. However, rather than just concentrating on getting numbers down, the ACE programme is aiming to deal with the fundamentals that cause the delays.

Partners are now working more closely together to achieve common standards and criteria that all can subscribe to. There is also a common aim to bring about a change to the present risk averse attitudes that prevail.

The system needs to be simplified and clarified so that the understanding of GPs and others working in the field can be improved.

The intention is to concentrate on people and the quality of service rather than just numbers. What services should be provided within the funding available and where those services should be to provide the most good are overriding criteria.

Following the presentation members asked a large number of questions. Mr Sinclair and Ms Trevillion undertook to produce a written summary of the questions and to provide answers to them. The answers have been provided and are shown below:

Councillor David Turner

1.      Bed based intermediate care (Watlington specifically). When will we and providers know (particularly the Watlington care home) what the intentions of the Council and the PCT are in relation to the intermediate care beds?

As part of the ACE programme we are reviewing the type, volume and position of community beds that will be required to support the population of Oxfordshire for the future. This will not  ...  view the full minutes text for item 67/11

11.30

The Oxford University Hospitals NHS Trust is currently in the process of updating its strategy.  The strategic review is taking place within the context of the recent integration with the Nuffield Orthopaedic Centre NHS Trust, the strengthening of the relationship with the University of Oxford and other health and social care and academic partners and the preparation of the Trust’s foundation trust application. 

A paper (JHO7) is attached that provides an update on the emerging themes from this review of the Trust strategy.  The paper:

·        Identifies the drivers for changes faced by the Trust.

·        Summarises the key emerging strategic themes and objectives.

·        Identifies potential service changes.

·        Describes how the Trust intends to ensure there is full stakeholder engagement

The Chief Executive of the Trust, Sir Jonathan Michael, and Mr Andrew Stevens, Director of Planning and Information, will explain the strategy and answer questions.

Members of the public and councillors from Banbury will address the Committee to explain concerns that they have over the future direction of services at the Horton General Hospital.

Mr Ian Davies, Chair of the Community Partnership Network (CPN) for Banbury and the surrounding area, will also be in attendance to talk about the future plans for consultation between the NHS and the CPN.

At the start of the item the Chairman read out the following statement from Councillor Ann Bonner, member for Banbury Grimsbury & Castle;

“I have been asked by a number of my constituents to contact you to express concern about developments at the Horton General Hospital. In particular they are worried about the proposed changes to gynaecology services and the effect that they could have on single sex accommodation; bed closures and the possibility of the loss of training recognition.

People in Banbury believe that the conversion of G Ward to day cases and the consequent move of patients into E Ward could, as it would be a mixed sex ward, compromise women's privacy and dignity. Furthermore the closure of a number of beds might be seen to increase the threat of the withdrawal of training recognition. Furthermore the views of the staff on the ward are concerned about the whole idea of splitting up the service by locating the inpatient beds in a different area. Local people would like to receive a confirmation that the 6 beds concerned will be protected in that they cannot be used for other purposes without the consent of the Gynaecology Department.

In view of these concerns I would ask you to seek a public statement from the Chief Executive of the Hospital Trust that everything will be done to protect the privacy of women patients. Furthermore a statement should be made that changes to service configuration and bed closures will not lead to any reductions in services provided at the Horton and that they intend to fully honour the IRP requirement to do more to develop “clinically integrated practice” across the whole Trust.”

Following this Councillor George Parish Chair of the “Keep the Horton General” group introduced a number of members of the group. Charlotte Bird, Vice-Chair of the group, then read out a statement and asked a number of questions. The statement and questions were as follows:

Statement for HOSC

Can I ask that any questions that are asked, and any answers given, are minuted please?

1.      Gynaecology. Whilst we acknowledge that the enhanced range of day and outpatient procedures will be of benefit, we remain concerned about the effect of splitting up services by locating inpatient beds in a different area. This is based on the views of the staff on the ward (formally expressed in their published response) who are best placed to judge the practicalities of the safety or quality of the service.

The Horton Obstetric Group on 19^th October was informed that, contrary to previous statements, the 6 beds to be allocated to Gynaecology will be ring-fenced, i.e. cannot be used for other purposes without the consent of the Gynaecology department. In view of earlier conflicting statements, this position needs to be confirmed.

We have raised the question of whether the changes would have any adverse effect on future recognition for training purposes – of vital importance in relation to the linked service of Obstetrics. Whilst the enhanced  ...  view the full minutes text for item 68/11

12.40

At their last meeting the Committee agreed that the question of the employment of nurses at Chipping Norton Hospital should be revisited at this meeting. That was because the Chairman was waiting for a reply to a letter that had sent to the Secretary of State in July seeking Independent Reconfiguration Panel involvement as an “honest broker”.

That reply has now been received and a copy is attached (JHO8a and b). Mr Alan Webb (PCT Lead Director) will report on the PCT’s latest position on this matter and he will be joined by Mrs Olga Senior (SHA Director of Corporate Affairs) who will represent the SHA to explain what they have been doing with the PCT to find a solution to this issue.

The Chairman reminded the Committee that the issue they were now dealing with related to whether or not a review of the service provided at the new Chipping Norton Hospital should take place two or three years after the opening of the hospital; i.e. in June 2013 or 2014. The original agreement had been that the review would be after three years and that any staff employed during that time would be given the option of being employed under NHS terms and conditions of service rather than those of the Orders of St John (OSJ) who manage the hospital. The PCT had sought to remove that condition altogether but, following objections from the HOSC, were now offering a review after two years with all new recruits, if they wished, being on NHS conditions during that period.

Alan Webb, representing the commissioners of the service, opened the discussion by stressing that the quality of care had to be the paramount consideration; that there was no intention to downgrade services at Chipping Norton and that managers from the OSJ were talking to local GPs about the type of service that they, the GPs, would wish to see provided. Since the hospital opened there had been no complaints recorded and a number of compliments.

The commissioners were committed to the review of care quality and the service specification. They would wish to work with HOSC members on the terms of reference and specification for the review. The review findings would be applied to all community hospitals in Oxfordshire.

Olga Senior, from NHS South of England (the clustered SHA), stated that they share the view of the PCT. They had undertaken their own survey since the hospital opened and had also found no complaints about the present service. They consider that the contract and specification that the OSJ was working to was “robust” and would help to ensure a high quality of service provision. It was clear that in future GPs, via the Oxfordshire Clinical Commissioning Group (OCCG), should have a pivotal role in deciding on what level of service should be commissioned. Quality must come first.

During the subsequent discussion the following points were made:

The commissioners would always ensure that staff at the hospital, regardless of who employs them, would be properly trained, qualified and supervised. There should be no difference between the safety and quality of the service provided at Chipping Norton than that provided in any other Oxfordshire hospital.

The service specification is part of the contract with OSJ and that enables the commissioner to have quite a measure of control.

Staff are managed by a clinical manager.

At the end of the discussion the Committee AGREED to the two year period for the review; i.e. the review would take place in June 2013. It was further AGREED that Councillors Hilary Hibbert-Biles and Lawrie Stratford should represent the HOSC in working with the commissioners on the review.

13.00

The regular update from the Oxfordshire LINk is attached (JHO9). Sue Butterworth, Chair of the Oxfordshire LINk, and Adrian Chant, LINk Locality Manager, will attend to answer questions. Alison Partridge, Engagement Manager  for Oxfordshire County Council  will talk about the development of HealthWatch.

The regular LINk report was presented by Adrian Chant. There were no questions.

Alison Partridge then updated the Committee on the latest position vis a vis HealthWatch. She explained that the County Council had a responsibility to establish HealthWatch by October 2012. It would have a wider remit than the LINk and the HealthWatch role would, by 2013, include advocacy and complaints. A widespread consultation process is going on to agree a commissioning model.

Ina answer to questions about the scrutiny and governance of HealthWatch Alison Partridge told the Committee that the contract would be with the County Council which would therefore monitor the quality of service and activities undertaken by Oxfordshire HealthWatch. HealthWatch England would also have some role but the finer points of the governance arrangements have yet to be worked out.

13.20

The Chairman will report on meetings etc that have taken place since the previous HOSC meeting.

The Chairman reported on the following meetings in which he had taken part:

• Toolkit meeting on gynaecological services at the Horton General Hospital
• A meeting with the PCT to discuss the provision of a new Townlands Hospital in Henley
• Oxford Health – informal “catching up” meeting with the Chief Executive and others
• A meeting with Nicola Blackwood MP for Oxford West and Abingdon and Simon Burns MP Minister of State for Health Services to talk about health services in the area

13.30

The meeting closed at 13.25.