Agenda and minutes

District Councillor Yvonne Constance substituted for District Councillor Alison Thomson and apologies were received from District Councillor Dr Christopher Hood and co-opted member Moira Logie.

There were no declarations of interest submitted.

To approve the minutes of the meeting held on 27 February 2014 (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 27 February 2014 were approved and signed as a correct record subject to ‘Councillor Susanna Pressel’ being amended to ‘District Councillor Susanna Pressel’ in the list of those present at the meeting.

With regard to Minute 7/14, it was confirmed that further information on the falling ambulance response times across the county would be presented to the next meeting on 3 July 2014.

There had been no requests to address the meeting or to submit a petition.

10:15

Larry Sanders, Chairman of Healthwatch and David Roulston, Interim Chief Executive, will attend to present an update on their current work (JHO5).

Larry Sanders, Chairman and David Roulston, interim Director of Healthwatch Oxfordshire (HWO) presented their report (JHO5) and updating the Committee on the various matters which had arisen since it had been written.

The Committee noted that recent recruitment process had not produced a suitable candidate for the permanent post of Director despite the high level of interest

Mr Sanders highlighted the various projects supported by HWO Project Fund, the findings of the research, which was funded by HWO and carried out by a team of students into the healthcare experiences of students of Oxford University; ongoing work on the initial priorities set by Healthwatch; current work to increase awareness of HWO and to establish contacts; future events to be held during 2014 and matters to be called to the attention of Oxfordshire’s Health & Wellbeing Board.

Mr Sanders added that project work to date had mainly concentrated on work with user and carer groups relying significantly on their vast knowledge and experience. The problem was that the information required was not always fully available from people who had experienced problems with systems – consequently HWO were calling for experts by experience’ to come forward.  To illustrate this HWO were putting together a paper on the unnecessary death of Connor Sparrowhawk who died in the care of Southern Health NHS Trust.

Members of the Committee commented on the value of HWO as an important contributor to the work of the Committee, particularly in light of their decision to prioritise the smaller groups whose needs could often be overlooked. To this end they commended their priorities listed in the report as very pertinent.  Mr Sanders was asked if the questionnaire that had  extrapolated patient experiences with regard to access to GP services had included people’s access to their chosen GP. He responded that this was a one of the more detailed factors that were planned for future consideration.

Members  discussed with Mr Sanders and Mr Roulston  how this Committee could work together in an effective way. The Chairman  reported that his recent meetings with HWO had gleaned a number of ways of working including regular meetings between the Chairman and HWO, the Committee reinforcing any recommendations made by HWO with the groups involved as it saw fit, and the possibility of Committee members and HWO working together on particular issues of interest to both.

A member suggested that how the changes to the Benefits system  had affected the mental and physical health of service users and carers could be looked at by HO . Mr Sanders agreed that it was important to look at it from across the board, adding that HO has certain statutory powers which would enable it to ask what is being done for people affected by the changes. Part of its role is to bring together the various groups involved in research locally and, if it is shown to affect  a significant proportion of people in the county and there was a large volume of response to an  ...  view the full minutes text for item 14/14

10:35

The Director of Public Health, Dr Jonathan McWilliam, will give an oral report on the priorities for his next Public Health Annual Report (JHO6).

The Director of Public Health asked for the Committee’s views on his early thoughts for the topics to be included in his forthcoming sixth independent Annual Report. The proposed topics were:

·        A better start in life – with particular focus on maintaining the pressure for high levels for breast feeding and immunisation services within the county. Also to continue to maintain the current downward trend in childhood obesity levels.

·        Improving the quality of life for all –with particular focus on reviewing and thereafter keeping a watching brief on the status of people suffering with mental health problems in Oxfordshire. In the past this had often been highlighted by organisations as a difficult aspect to measure, thus placing it in danger of being overlooked. Other themes to this topic would include adult levels of obesity; a close watch on issues associated with drug and alcohol use; to keep a watch on smoking status and the health conditions which can ensue such as heart disease and cancer etc; and Ageing Well – keeping good physical functioning;

·        Reducing inequalities and disadvantages -  to look at the increasing diversity of the county with regard to ethnic mix ensuring that Oxfordshire’s services meet demands; to keep a close watch on the levels of thriving families and ensure that troubled families continue to get the help they need; to ensure that vulnerable groups are kept high on the agenda, to include the homeless, people who are hard of hearing, carers needs and people living in rural isolation;

·        Protecting and maintaining current levels of good health in the county – to  include the traditional topics on infectious diseases such as Tuberculosis and to keep an eye on sexual health such as the levels of syphilis; to ensure  that health checks in the county are as good as they can be in light of such diseases becoming more resistant to current medicines; and finally to report on what is the role of health prevention in an acute hospital.

Members congratulated Dr McWilliam on an excellent list of ideas and added their thoughts during the ensuing discussion. These included :

-          As part of the role of health prevention in acute hospitals to look at the length of time between the first and second outpatient appointment;

-          To look at the wider issues of homelessness such as poor accommodation and insecure housing, living in damp environments, bad landlords and air pollution;

-          More stress on earlier interventions at school, for example school nurses do not give a service until the child is 3 years old. Also to give some thought to  how parenting classes could be provided from birth and earlier identification of those families who are struggling the most;

-          The possibility of doing some work on how having a child in local authority care affects their families and some work around help for young carers.

With regard to the comment on earlier intervention, Dr McWilliam reported that the Health Visitor service was to transferred over the local  ...  view the full minutes text for item 15/14

11:00

11:00

The Director of Public Health , Dr Jonathan McWilliam, will present a report (JHO7) updating the Committee on the process for refreshing the Oxfordshire Health & Wellbeing Strategy. The report also sets out the proposed newly updated indicators and measures to be included in the revised draft Strategy which is due to be submitted to the Health & Wellbeing Board on 17 July 2014 for approval.

The Committee is RECOMMENDED to:

(a)                 consider and comment on the process which has been put in place to refresh the priorities in the JHWBS; and to note that a report will be submitted to the 3 July 2014 meeting which will include the draft JHWBS to be presented to the Health and Wellbeing Board on 17 July 2014; and

(b)                  comment on the current priorities as set out in Appendix 2 of the report together with the indicators currently used to measure progress / demonstrate improvement: and to note that any  suggestions and comments for changing and developing the current list of priorities and indicators will be noted as part of the revision process.

Dr Jonathan McWilliam, Ben Threadgold and John Jackson formed a panel to respond to questions on a report (JHO7) which updated the Committee on the process for refreshing the Oxfordshire Health & Wellbeing Strategy, a revised version of which was due for submission to the Oxfordshire Health & Wellbeing Board on 17 July 2014 for approval. It also set out at Appendix 2 the current priorities and indicators which were used to measure progress/demonstrate improvement for performance management purposes at each meeting of the Oxfordshire Health & Wellbeing Board.

The views of the Committee were sought on some initial ideas for the revised version to include:

-                      Better Care Fund indicators to be included so that progress could be measured in implementing joint plans;

-                      Partnership issues that are included in the Clinical Commissioning Group 5 Year Strategy;

-                      Other priorities raised by other groups or organisations or through the period of consultation.

The Committee commented that there was a real question of where realism (due to financial constraints as a result of the ageing population) met aspiration on the plan. It was felt that the current configuration of Health could be a real issue over the next 5 years and would require more integration of Health and Social Care to support it. It was also felt that the Committee should think about creating a tool kit to ascertain where the real issues were for scrutiny.

A member commented that access to services could also be an issue, pointing out that one third of those people using self directed finance suffered from dementia. Those who were the most vulnerable mentally could have problems accessing services and one stop shops were required for everything. Another member added it was important to be clear on outcome-based commissioning for frail and elderly people with mental health problems.

In response to a comment on the requirement for data on age ethnicity, Dr McWilliam pointed out that standard of data was improving continually. Information on ethnicity was gleaned from the census and GPs were now recording information.

A member of the Committee commented that the number of targets in the current Strategy was too high, in particular those on educational attainment. Dr McWilliam responded that these fell into one of the most important  categories which was to provide a good start in life.

A member voiced concern in relation to priority 8.3 – ‘At least 65% of those invited for Health checks will attend (aged 40 – 74)’ – asking why the maximum age was only 74. Dr McWilliam responded that the age limit had been set by the Government. Actuaries would be reviewing the outcomes in the future in order to ascertain whether the health of the population had improved as a result of undertaking the health checks.

The Director for Social & Community Services  responded to a question about how it was ensured that the optimum numbers of extra care housing was built into the district council planning process. He explained that there was district council  ...  view the full minutes text for item 16/14

11:25

Ian Wilson, Interim Chief Executive, Oxfordshire Clinical Commissioning Group (OCCG), will give a presentation on  Oxfordshire’s CCG Strategic and Operational Plan. A link to the Plan appears below:

http://www.oxfordshireccg.nhs.uk/wp-content/uploads/2014/04/OCCG-5-2014-2019-strategy-and-2014-2016-plan.pdf

For ease of reference, a copy of the ‘Plan on a Page’  is attached at JHO8.

The regular update from the OCCG is also attached at JHO8.

Ian Wilson, Interim Chief Executive, OCCG, gave a presentation which invited the Committee’s views on the OCCG’s strategic and Implementation Plan. For ease of reference a copy of the ‘Plan on a Page’ was attached at JHO8. He stressed that the objectives did sound a little aspirational but as the OCCG and Social Care moved towards an even more integrated service, and practices becoming integrated, it made the plans realistic. He added that the Plan centred on the premise that care should be in the community and not in hospital if at all possible. He agreed that issues remained concerning access to GPs which needed addressing in spite of efforts being made in the last two years.

In response to a query asking why the OCCG had less spent on patients per head compared to CCGs in other parts of the country, Mr Wilson responded that the amount spent depended upon the health of Oxfordshire’s demographic. Oxfordshire was deemed quite a healthy county compared to most.

In response to a question about how the overall waiting times for planned hospital care would be improved, Mr Wilson explained that issues had emerged in the last quarter and it was the CCGs intention  to bring them back. There were 67 specialities counted within the 18 weeks referral time for treatment and he had received assurances from the Oxford University Hospitals NHS Trust that all but 6 of these would be back on track very soon; and the remaining 6 were working hard to be back by July. He added that Oxfordshire’s statistics in this area were comparable with the best in the country.

In response to concerns expressed about the continuing Delayed Transfers of Care problem, Mr Wilson commented that a downward trend had begun to manifest itself for the first time in 4 years due to the multi - agency approach bearing fruit. This had the effect of bringing a focus to it and there was a determination on all parts to solve the problem. He added that statistics showed that rural areas tended to be higher than those of the rural areas. Realistically then, next year’s targets aspired to getting out of the bottom quartile and thereafter to continue the improvement.

A Committee member commented that this was a very commendable but ambitious Plan and its financial sustainability would depend upon achieving the targets it has set. One which would require much focus and a great deal of capability. On being asked if there was a multi – agency contingency plan, Mr Wilson responded that a project management structure  would be put in place which would take a much tougher approach to business cases, the testing of them and the driving and implementation of them. He added that generally  Plans were much more realistic now and lessons had been learned during the first year of operation. The likelihood of Plans not being drawn to a conclusion was small. Mr Wilson stated that it would prove very difficult to have an  ...  view the full minutes text for item 17/14

11:50

Ian Wilson, Interim Chief Executive , Oxfordshire Clinical Commissioning Group, and John Jackson, Director for Social & Community Services, Oxfordshire County Council, will present plans for the Better Care Fund (JHO9).

Ian Wilson and John Jackson, Director for Social & Community Services presented plans for the proposed use of the Better Care Fund in Oxfordshire and its alignment with other key plans covering Health and Social Care within the county. Plans had now been submitted to NHS England (as an integral part of the OCCG’s Strategic and Operational Plans) on 4 April 2014 following agreement by the Oxfordshire Health & Wellbeing Board, Oxfordshire County Council and the OCCG.

A member asked if it would threaten the £37m funding if performance was not reached. John Jackson responded that there was an element in terms of the way the Scheme works which was dependent upon performance, but it did not depend on the success rate as a whole, but the success of each of the different targets set out in the proposals. He added that there had been much debate nationwide about this and it had been concluded that money would not be lost from the system. In relation to 2015/16 monies, this would not be known until national guidance was refreshed.

In response to a question asking what proportion of visits did the short visits of 15 minutes or less amount to, Mr Jackson informed the Committee that it was 20 – 25% and it would only apply to those clients receiving intimate care (approximately half of the 20 – 25%).

A Committee Member asked how did they see the pathway through it for a GP and for a Councillor. Mr Wilson responded that part of the new GP contract was to focus on the top 1% of patients in the most need and then to take steps to cluster services, such as district nurses, social care etc around them. Mr Jackson added that one of the targets in the existing Health & Wellbeing Strategy was to develop integrated working at local level. Social Care teams would work together with community based staff, including GPs, to enable different professionals to come into play. If a Councillor had concerns about a particular service then there would be a single point of contact via Customer Services.

In response to a question about cross boundary issues in Oxfordshire, Mr Wilson commented that there was a significant amount of work in progress on this, particularly in relation to the ambulance services. Apart from the usual cross border issues there was the added complication that two GP practices who were part of the OCCG were situated outside of the border.

The Committee AGREED to note the report.

12:15

Dr Ian Reckless, Assistant Medical Director of OUH will present the Trust’s Quality Account for 2013/14 (JHO10).

Dr Tony Berendt, Acting Medical Director, and Dr Ian Reckless, Assistant Medical Director of the Oxford University Hospitals NHS Trust presented the Trust’s Quality Account for 2013/14.

Mr Threadgold reported that he had also received a draft Quality Account from Southern Health for comment and that he was expecting more from the other main providers.

Members discussed the means by which their views could be conveyed to the Trust in order to meet the deadlines required.

It was AGREED that the full document, and the full documents of the other main providers, be circulated to all members of the Committee for comment and that the responses received be compiled by the Officers and sent to the Trust on behalf of the Committee.

12:35

A representative from the OCCG will present the proposed changes to the eligibility criteria for Patient Transport Services and will outline the approach to consultation and engagement (JHO11). The views of the Committee are requested.

Ian Wilson and Matthew Staples, OCCG, presented the proposed changes to the eligibility criteria for Patient Transport Services and outlined proposals for the approach to consultation and engagement, to which the Committee’s views were sought.

Members of the Committee were content with the approach to consultation and engagement. They asked that the OCCG begin disseminating information about the changes as quickly as possible. That way there would more of a likelihood of people commenting.

Ian Wilson undertook to send a list of proposed consultees to officers for circulation to members of the Committee for further suggestions.

Comments and suggestions made by members during discussion were as follows:

• Consultation should take place with the Older People’s champions in the City and in the other District Councils;

• There should be provision of transport in the City for those people who were unable to reach bus stops due to disability, or were unable to use public transport.

• Address the issues with the Ambulance Service first.

• The current criteria as quoted in the paper was more succinct than that quoted in page 69, which is more woolly; and

• Try to combine the best pieces of each criteria into Oxfordshire’s.

Mr Wilson and Mr Staples were thanked for their attendance.

12:40

The Chairman will give an oral update on meetings he has attended since the last meeting.

A list of proposed items for the Forward Plan is attached at JHO12.

The Chairman  gave a verbal update on meetings he had attended since the last formal meeting of the Committee. These were:

• An informal meeting with Dr Joe McManners, Clinical Lead of the OCCG;
• Two meetings with Healthwatch Oxfordshire;
• A meeting with Southern Health.

Members also had the opportunity to discuss the Forward Plan and decided to add the South Central Ambulance Service issues into the agenda for the July 2014 meeting. Further suggestions from members for additions to the list were the changes to the Health Advocacy Service and to report back on the Sexual Health Service one year on.

Members were asked by Healthwatch Oxfordshire to give some thought to topics which might be included in their Awareness Day to take place in January.

13:00

Please note that the Joint Committee will meet on the following dates during the 2014/15 municipal year:

-                      3 July 2014

-                      18 September 2014

-                      20 November 2014

-                      5 February 2015

The Committee noted the following meeting dates for the 2014/15 municipal year:

-                      3 July 2014

-                      18 September 2014

-                      20 November 2014

-                      5 February 2015