Agenda and minutes

Councillor Jenny Hannaby attended for Councillor Alison Rook.

Councillors Stratford and Hannaby declared a personal interest in Agenda Item10 – Community Hospitals – on account of their membership of the League of Friends in Bicester and Wantage Community Hospitals respectively.

To approve the minutes of the meeting held on 18 September 2014            (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 18 September 2014 were approved and signed as a correct record subject to the following amendments:

Minute 44/14 – Healthwatch Oxfordshire – paragraph 3, page 6, to correct ‘She reported that HWO had established a reference group’ to ‘She reported that HWO were proposing to establish a reference group’.

Minute 45/14 – penultimate paragraph, page 8, to correct ‘Dr McWilliam undertook to provide further information in the future on health inequalities’ to ‘Dr McWilliam undertook to provide further information on health inequality in relation to oral and dental services.’

Matters Arising

The following issues were raised:

-       Minute 40/14 – Toolkit – a draft toolkit had been sent to HOSC members and Health partners for comment  and would be included on the 5 February 2015 agenda for adoption;

-       Minute 40/14 – New Contract for Community Sexual Health Services – Cllr Pressel commented that the new opening hours would prohibit young people from attending, as they were within college/school opening hours and did not include Saturday opening. In her view the change in hours and the transition from one venue to another amounted to a substantial variation of service. She added also that it would also exacerbate health inequality. Dr McWilliam responded that there appeared to have been a misunderstanding explaining that all contracts required a period of bedding in, and the hours of opening were still in transition. He added that new contracts tended to raise issues which could not be predicted before embarking on the process. Dr McWilliam added that all procedures had been followed correctly and, in fact, the new service had been improved by the introduction in the contract of a new service for sexually transmitted infections.  The Chairman agreed to include the matter on the agenda for the 5 February 2015 meeting;

-       Minute 42, resolution (e), top of page 5, officers undertook to request the Trust to include information on their staff recruitment and retention when they report their progress on the implementation of the action plans to the 5 February 2015 meeting;

-       Minute 43/14 – Emerging findings of the non-emergency patient transport services consultation - officers undertook to request copies of literature prepared by the Trust which had been used to advertise and signpost the changes for patients using the non-emergency transport services and then to circulate them to members of the Committee;

-       Minute 44/14 – Healthwatch Oxfordshire – paragraph 1, page 6 – Healthwatch Oxfordshire had informed officers that the film and transcript were still awaited but officers were following it up frequently;

-       Minute 45/14 – Oral Health of Children in Oxfordshire – paragraph 1, page 8, Dr McWilliam undertook to bring a report to a future meeting on national data used for local surveys by Public Health;

-       Minute 47/14 – an item on children’s mental health issues has been brought forward to the 5 February 2015 meeting.

It was reported that all other actions listed in the Minutes had been  ...  view the full minutes text for item 51/14

It was AGREED to take Agenda item 9 after Agenda Item 10 to allow the attendance of Cllr Nick Hards.

The Chairman reported that she had agreed to three requests to make a public address/submit a petition. These were from:

·         Councillor Judith Heathcoat, local member for Faringdon, in relation to Agenda Item 8 – Emergency Ambulance Services in Oxfordshire;

·         Mr John Power, an Oxfordshire resident – submitted a petition                                                                                                                                                                                                                                                                                                                                                                                                                                                            in relation to the closure of a GP surgery in West Oxford; and

·         Councillor Nick Hards, in relation to Agenda Item 10, Community Hospitals (address to be prior to the start of Item 10).

Councillor Judith Heathcoat addressed the Committee with regard to a serious road accident which had occurred in April 2014 within her division.  There was concern about the inadequacy of the ambulance service attending the patient and the length of time it had taken for an ambulance to arrive. She read out a letter she had received from the Chief Executive of the South Central Ambulance Service (SCAS) offering his sincere apologies for the delay and explaining that demand had been very high that day, there were shortages of staff due to sickness and the satnav had directed the ambulance along a road which was too narrow.

Mr John Power addressed the Committee informing them that he had collected 700 signatures on a petition against the closure of the West Oxford GP Surgery which had occurred without consultation. His view was that the closure was a substantial variation of a service and therefore should have been consulted on. Mr Power directed members attention to a letter dated 13 January 2012 from the Practice Manager of The Jericho and West Oxford Practice (West Oxford Health Centre being a branch surgery of the Jericho Practice) advising of the move of both surgeries to the Old Radcliffe Infirmary site on Walton Street due to lack of space at the West Oxford site and inviting patients to two drop in sessions to discuss the plans. The letter also explained that the new site would accommodate the whole patient list.

The Chairman requested the officers to look into the issue and then to write to Mr Power, at the same time circulating the response to all members of the Committee. She also informed Mr Power that included in the Committee’s Forward Plan was an item on Transforming Primary Care to be scheduled for the forthcoming 5 February 2015 meeting.

10:10

Attached at JHO5 is a draft copy of the Joint Committee’s Constitution which has been revised in light of the new Regulations entitled the Local Authority (Public Health, Health & Wellbeing Boards and Health Scrutiny) Regulations 2013. There are no changes to how the Committee currently functions contained within the document, the only changes made are intended to align with the above Regulations and guidance.

Please note the Constitution as approved will be included in the Constitution and Governance Review which is being considered by Cabinet in December.

The Committee is RECOMMENDED to approve the revised Constitution.

 Members considered a draft copy of the Joint Committee’s Constitution which had been revised in light of the new Regulations ‘Local Authority (Public Health, Health & Wellbeing Boards and Health Scrutiny) 2013 and associated guidance. They were advised that the document contained no changes to the functioning of the Committee, and that any change made was intended to align with the Regulations and Guidance. 

Members felt that the decision made by the County Council to delegate to the Committee any referrals to the Secretary of State, as stated in the County Council’s Constitution, should be made more explicit so that there was no confusion.

The officers were asked to look into HOSC representation for residents of Oxfordshire whose range of services were provided by CCG’s based outside of Oxfordshire; and to report back to Committee.   

It was AGREED that, subject to the above revision, to approve the draft Constitution to be then submitted to County Council as part of the general review of the Council’s Constitution on 9 December 2014.                                         

10:20

Our main Health partners will provide an update on performance and planned actions to address delayed transfers of care (JHO6).

The following representatives will attend:

-       John Jackson, Director of Adult Social Services (OCC) and Director of Strategy &Transformation (OCCG);

-       Paul Brennan, Director of Clinical Services, Oxford University Hospitals NHS Trust.

The following representatives of the main Health partners attended the meeting in order to provide an update on performance and planned actions to address transfers of care (JHO6).

-       John Jackson, Director of Adult Social Services (OCC) & Director of Strategy & Transformation (OCCG);

-       Diane Hedges, Director of Commissioning (OCCG);

-       Paul Brennan, Director of Clinical Services (OUHT);

-       Yvonne Taylor, Chief Operating Officer, (OH)

In response to a question about delays in accessing available resources, John Jackson explained that Oxfordshire’s Better Care Fund Plan had not yet been signed off by Oxfordshire’s Health & Wellbeing Board due to specific financial challenges in the county, to the timetable for introducing Outcome Based Commissioning and in light of recent increases in the rate of emergency admissions. It was noted that a special meeting of the Health & Wellbeing Board would be held on 8 January at 1.30pm to consider the full Plan prior to its submission to NHS England on 9 January 2015.

The Panel were asked if the community hospitals were being used correctly for reablement and assessment purposes . Diane Hedges commented that a major cause of pressure was that expertise from individual organisations was not being pulled together sufficiently in order to drive action. Yvonne Taylor commented that delays were down, pointing out that three years ago 306 patients were waiting for a hospital bed, now the figure was 31. John Jackson also pointed out that the highest level of delay tended to be for those patients living in the rural areas of Oxfordshire, also adding that the longer people stayed in hospital, the more likely they were to require complex care packages. He also pointed out that new contracts had been introduced on 1 November this year and delays for home care were now at 30 per week. This was not the major problem. Anne Brierley pointed out that there had been a significant amount of investment in reablement services across the county recently, resources had been pooled, patient handover had become much slicker and any problems responded to in a quicker way. She added that the biggest challenge was how quickly patients were identified in the acute hospitals, particularly those requiring bed-based care outside of the acute hospital. There were no delays for those entering community hospitals.

John Jackson was asked if the major problems were caused around the need for nursing care. He responded that if they were self - funding then a choice delay for a particular community hospital or nursing could ensue, if full to capacity. He added that the trend for numbers of patients waiting for a nursing home had taken a downward turn, with currently under 10 delays across the system as a whole.

When asked how many readmissions there had been on a monthly basis, Paul Brennan responded that winter pressures monies had been allocated jointly amongst organisations leading to increased patient bed capacity and 7 day working. In addition, colleagues in the South Central Ambulance Service (SCAS) had extended their period of  ...  view the full minutes text for item 55/14

11:35

Rachel Coney, Chief Executive, Healthwatch Oxfordshire will attend to present a report on recent projects (JHO7).

Rachel Coney, Chief Executive and Dermot Roaf, Vice Chairman, attended to present their report on recent projects (JHO7). They responded to questions from members relating to what action had been taken on their report recommendations and action being done to raise their profile.

Members of the Committee suggested other sources where views could be gleaned for the Discharge Review, such as from Parish Councils and from lists held by the Oxfordshire Rural Community Council.

It was AGREED to thank HWO for their update.

11:50

Steve West, Operations Director; Sue Byrne, Chief Operating Officer; and Linda Scott, Interim Area Manager, Oxfordshire from the South Central Ambulance Service (SCAS) , together with Diane Hedges, OCCG: will report on the service performance and commissioning of the service (JHO8).

The Committee welcomed the following representatives from the South Central Ambulance Service (SCAS) and from the OCCG who had been asked to attend to report on service performance and commissioning of the service, respectively. A report was attached at JHO8.

·         Linda Scot, Steve West and Sue Byre – SCAS

·         Diane Hedges – OCCG

In response to a question regarding the reason for increased demand in the service, Sue Byre reported that the chief executives of ambulance services in the south east region had commissioned an academic survey of reasons for this, the findings of which were:

-       Implementation of the 111 service - public use of the service had doubled over the last 2 years;

-       Increases in the over 65 population and increases in complex conditions; and

-       Changes in the climate and climate conditions affecting demand. For example, the dust cloud which had occurred earlier in the year, combined with pollution, had affected and exacerbated breathing conditions, which, in turn, had led to an unusually high demand in the service.

At a former meeting of this Committee, reference had been made to a pilot project operating in the Witney area which intended to make use of the base and ambulance resource of the St John’s Ambulance Service, in order to expand the reach of SCAS. In response to a request for progress on this, Steve West explained that in reality St John’s had struggled to provide the resource. It had not got up and running until August, but since then it had improved and SCAS were looking to provide a responder vehicle with a view to working within 6 minute drive zones. Performance was now getting to 85% within 8 miles of the Witney area but it did not operate in rural villages outside that zone. This service would be monitored over the winter period. However, SCAS were not looking to roll it out to other areas of Oxfordshire as it was too expensive to achieve.

In response to a question as to whether electronic patient records were compatible with GPS, Sue Byrne explained that efforts had been made to integrate it as far as possible and it now offered special notes in short form. The idea was to fully integrate access to a patient’s summary care record in the future. The patient care record would give the paramedic an idea of care required but would also give access to a directory of services for that particular clinical area so that the most appropriate pathway of treatment could be selected.

Steve West referred to the quality aspect of the 8 minute call out statistics which had been published on the Department of Health website. He added that it gave a good indication of how the service compared with other services in relation to, for example, whether patients had been sent to the correct treatment centre. He added that SCAS had compared favourably with other services.

In response to a question about how services to rural areas were affecting  ...  view the full minutes text for item 57/14

12:30

Yvonne Taylor, Chief Operating Officer, Pete McGrane, Clinical Director for Older People’s Services and Anne Brierley, Service Director for Older People’s Services, Oxford Health, will attend to provide an update on community hospitals with specific reference to Townlands, Didcot and Bicester.

Two reports are attached at JHO10:

·         A report on Didcot Hospital closures submitted to the South West Oxfordshire Locality Patient Participation Group.

·         A briefing paper from Oxford Health NHS Foundation Trust.

Cllr Nick Hards was invited to address the meeting prior to discussion of the item. He raised a number of points relating to Didcot Hospital following a stint of voluntary work three years ago. These included:

·         Staffing – he had noticed a problem with agency staff having to travel long distances from places such as Gloucestershire each day;

·         An imbalance in facilities for the south of the county. Didcot was the largest growing area of Oxfordshire for housing. The hospital was very well situated near to the area where most of the additional housing was to be situated, adding that there was a substantial amount of land in which to expand. However, the site needed a strategic look at medical practice and mental health facilities. He asked that, for the above reasons, the Committee support a higher priority being given to the planning of health services.

The Committee welcomed Yvonne Taylor, Chief Operating Officer, Pete McGrane, Clinical Director for Older People’s Services and Anne Brierley, Service Director for Older People’s Services, Oxford Health, to the meeting to provide an update on community Hospitals, with specific reference to Townlands, Didcot and Bicester.

Two reports were attached at JHO10:

·         A report on Didcot Hospital closures submitted to the South West Oxfordshire Locality Patient Participation Group; and

·         A briefing paper from Oxford Health NHS Foundation Trust.

In relation to Cllr Hards’ address, Yvonne Taylor responded that there was a need to look at the shape and range of bed based care across Oxfordshire to ensure that the NHS were able to deliver sub - acute care. Work was ongoing with OUHT on this.

The Panel were asked what measures were being taken to attract qualified candidates into the service so that there was less reliance on agency staff. Anne Brierley responded that a balance was required between experienced and student nursing staff. There was no easy solution to attracting staff in view of the high cost of living locally, but there were key strategies in train to address this. For example, OUHT were looking at a programme of rotations of staff and were working with Oxford Brookes University on their ‘return to practice’ courses. They were also looking to recruit key nurses in London as the cost of living was slightly lower in Oxfordshire. In addition a number of successful open days had taken place in the hospitals, which had gleaned a better intake of high calibre staff. In response to a question from the Committee about the uptake of key worker housing, it was reported that this was proving less attractive to people nowadays than when it had first started.

Councillor Les Sibley, local member, asked why there had been a delay to the opening of Bicester’s new Community Hospital and why there was an insufficiency of beds for the ever increasing population of the Bicester area. He added that the Cherwell local Plan had indicated that an extension to the hospital was required to ensure that the Health  ...  view the full minutes text for item 58/14

12:10

Diane Hedges from the OCCG will provide an update on outcomes based commissioning (JHO9).

Diane Hedges (OCCG) and Yvonne Taylor (OH) introduced the report (JHO9). They were asked how they defined outcomes with which to measure mental health. Yvonne Taylor gave some examples of the key measuring indicators for the outcome ‘improving and functioning’ which were ‘reduced admission to hospital’ and ‘enjoying a leisure centre’. A further example of the key outcome ‘engaging and communicating’ might be ‘getting a job’. They added that all these factors would be measured using a single tool so that impact could be measured also. Various disorders would be measured by clustering and the evidence base for these would be done on a national basis.

In answer to a question about how outcomes were agreed and how they were monitored, Diane Hedges explained that there would be an engagement process at every level. The starting point for agreement of outcomes would be to take ‘I’ statements, or an individual’s wish for the future (for example, ‘I would like to get back into employment’) as leads in order to make it meaningful. If it could not be measured it would not be put into the process. As the process became more sophisticated these might be put in over time. Yvonne Taylor explained that the process has to state what the clinical model would be. This would then become part of the contract.

Yvonne Taylor offered to provide a workshop for members of the Committee to take them through more of the detail relating to Outcome Based Commissioning. The Chairman, on behalf of the Committee, welcomed this.

The Committee thanked Diane Hedges and Yvonne Taylor for their attendance and AGREED to review it in 6 months or by the September 2015 meeting, after it had become operational. The review would include a look at the clinical models for the mental health and older people contracts.

13:00

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

A Forward Plan is attached for consideration.

The Committee discussed the Forward Plan which had been circulated along with an Addendum. Members suggested that the following items be added into the Plan:

·         cancellation of scheduled operations. The Chairman suggested that HWO be asked to input an understanding of patient experience into the report;

·         Oral Health inequalities;

·         A review of Ofcomm (Oxford Community Hospital);

·         Health in prison in light of the increase in number of suicides and outcomes of the unannounced visits by the CQC and the area team.