Agenda and minutes

Apologies for absence were received from Keith Ruddle and Anne Wilkinson. Cllr Janet Godden attended in place of Cllr Alison Rooke.

Cllr Andrew McHugh declared a personal interest in Agenda Item 7 by virtue of his recent involvement with Horsefair Surgery, Banbury, as practice manager and also by virtue of his employment by the NHS supporting vulnerable surgeries in Swindon.

Cllr Jane Doughty declared a personal interest in Agenda Item 7 by virtue of her membership of the Deer Park Medical Centre, Working Group as set up West Oxfordshire District Council.

To approve the minutes of the meeting held on 15 September 2016 and the Special Meeting held on 30 September 2016 (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 15 September 2016 (JHO3) were approved and signed subject to the addition of Cllr Jenny Hannaby (attending in place of Cllr Alison Rooke) in the list of voting members present at the 15 September 2016 meeting.

The Minutes of the meeting held on 30 September 2016 (JHO3) were approved and signed, subject to (changes in bold italics):

Page 23 – address by Keith Strangwood-  sentence 1 -  ‘the petition had accrued round 18,000 signatures (and not 3,000) signatures to date’; and sentence 3 to be amended to read as follows:

‘ He added his view that the advertising for the vacant posts was ‘more than inadequate’ as it had only appeared in NHS Jobs and no other site, up until the end of September, and the first serious attempt at advertising in the British Medical Journal did not happen until August 2016.’

Page 23 -  address by Dr Peter Fisher – sentence 3 to read as follows:

‘The hospital had been allowed to develop an integrated service with the area’s GPs. This was no longer as effective since many consultants had been moved to the JR. He added that it was very significant that the number of applicants for posts as Clinical Research Fellows in Obstetrics had fallen since the beginning of 2015, but advertisements for a different type of middle grade staff had not been placed until April 2016.’

Page 27 – first sentence, paragraph 3 – to substitute the word ‘issues’ with ‘evidence’.

10:10

A draft Forward Plan is attached at JHO5 for consideration.

The Committee received the draft Forward Plan (HWO5).

The Chairman advised that, as the ‘Toolkit’ assessment for Deer Park Surgery had only just been received from the OCCG, members of the Committee would be meeting with OCCG representatives to look at the assessment privately in December. She also reported that there would be a special meeting of the Committee to consider the Sustainability & Transformation Plan for Buckinghamshire, Oxfordshire and Berkshire West in December[1].

The Committee AGREED that it would be more useful if the Health Inequalities report was to be submitted to a meeting of the Committee in approximately 6 months’ time, together with an update on expected actions from organisations.

10:15

Eddie Duller OBE, Chairman of Healthwatch Oxfordshire (HWO) and Rosalind Pearce, Executive Director, will update the Committee on the activities of HWO since the last meeting and provide information on key messages from the public in relation to items on the Committee’s Forward Plan. The update is attached at JHO6, together with HWO’s quarterly update 2016.

Eddie Duller OBE and Rosalind Pearce, Chair and Chief Executive respectively of Healthwatch Oxfordshire (HWO) presented their regular update to the Committee (JHO6).

Rosalind Pearce undertook to send a copy of the feedback from various groups held by HWO relating to GP provision to Katie Read who would then circulate it to all members of the Committee.

With regard to the article included in HWO’s Activity Update entitled ‘Reaching People’, a member commented on the low number of people consulted by HWO about their experiences of Health and Social Care services in Oxfordshire. Rosalind Pearce responded that HWO always wanted to speak to more people but only had a limited team of 2 outreach workers with which to carry out such work. However they were redesigning the way they communicated with people and aimed to balance quantity (‘yes/no’ responses) with quality responses.

With regard to paragraph 2.4 ‘care in private care homes’ a member asked if HWO intended to extend their reach into care homes. Rosalind Pearce responded that HWO was seeking to establish an ‘enter and view’ facility so that the perspective of patients and managers could also be gleaned. She added that it was important to look in more depth about why some homes were retracting from local authority contracts and if there were sufficient local authority places in homes. She added that HWO was developing a relationship with the Care Quality Commission, who was keen to hear feedback from residents, carers and family to whom HWO had spoken to in the homes in which were inspecting. She informed the Committee that HWO had prioritised their work with care homes for 2017.

Rosalind Pearce, in response to a query, commented that, to her knowledge, a hospital parking permit scheme had been introduced at the Oxford hospitals.

The Committee AGREED to receive the report and to thank HWO for their very high quality work and for responding to issues the Committee was raising.

10:30

Diane Hedges, Chief Operating Officer and Deputy Chief Executive, OCCG, and Julie Dandridge, Deputy Director and Head of Primary Care and Localities, OCCG will provide an overview of general practice in Oxfordshire; the pressures on primary care; and the work being undertaken to ensure the sustainability of general practice (JHO7).

Prior to consideration of this item, the Committee was addressed by the following members of the public:

Brenda Churchill expressed the concern of the Deer Park Surgery Patient Participation Group that most of the meetings relating to the closure of the Deer Park Surgery, Witney had appeared to have taken place behind closed doors, there being no reference to any discussions in the minutes of this Committee. She added that to close a well-loved surgery that, in their view, served them well and would expand next year did not make sense in the knowledge that other surgeries in the town did not offer the same services. There had been no consultation with patients on the decision to close, no environmental impact study, no risk assessment and no consultation with other doctors in the town who were expected to take 3,700 patients living in Witney. She added that by March 2017 there would be 200 more houses built in the Deer Park Surgery catchment area and an estimated 600 more patients would be seeking a doctor in Witney. She also made reference to the plans to build another 1,500 houses in Witney next year. She asked where they would they all go? She asked also that this Committee scrutinise the decision for closure and that it concludes that it is a substantial change to medical services for all of the 26,000 residents of Witney.

Julian Cooper, speaking on behalf of the West Oxfordshire District Council Working Party, urged the Committee to agree that the decision to close the Deer Park Surgery, Witney, was a substantial change in circumstances for one of the main communities in Oxfordshire. The reasons for this which he put forward were that:

·         The proposals to build an additional 2,000 houses in Minster Lovall, Brize Norton and Witney did not appear to have been taken account of. There was considerable doubt at the District Council that the practices within Witney had the capacity to absorb these 4,000 patients;

·         The Working Party has concluded that the wrong assessment of the age profile had occurred, adding that a considerable number of patients (approximately 60%) on the register at the Surgery exceeded the age of 65;

·         The main form of communication had been advertisements in the local press;

·         This part of Oxfordshire had lost Burford Hospital in the last 20 years and the further loss of this health infrastructure undermines the commitments given by the Health Authority to this part of the County.

·         He concluded by stating that other communities within Oxfordshire could be left defenceless in the future if this is allowed to go through.

The Chairman stated that the Committee was aware that the OCCG had extended the contract for GP services at Deer Park until March 2017. She added that a completed substantial change assessment (the ‘Toolkit’) had been received from the OCCG. This would now require an informal meeting of the Committee to examine the completed toolkit with OCCG representatives and for the full Committee  ...  view the full minutes text for item 67/16

11:30

Diane Hedges, Chief Operating Officer and Deputy Chief Executive of OCCG will update the Committee on the development of system-wide Transformation Plans (TP), including a draft plan for consultation and engagement for consideration by the Committee (JHO8).

Ian Cave, Sustainability & Transformation Plan Programme (STP) Director will present an update on the Sustainability & Transformation Plan for Buckinghamshire, Oxfordshire and Berkshire (BOB) (JHO8).

Prior to discussion on the Oxfordshire Transformation Plan (OTP) and the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Sustainability & Transformation Plan (STP), the Committee was addressed by the following speakers:

Roseanne Edwards, speaking in the interests of electors in Banbury, put forward the view that the public did not want the BOB STP, adding that the BOB STP Plan ordered that at every stage, communications experts were to be employed ‘to dress up the bad news as deliriously good’.  She commented that the Trust had made temporary, changes at the Horton ‘to make the STP easier to push through’ which demonstrated ‘how damaging and dangerous the STP would be.’ She recounted some recent  stories reported to her in the last week which demonstrated to the Committee and NHS managers, who ultimately bore the responsibility, that the consequences of STP wold be ‘unjustified and completely unacceptable.’

She asked what about post STP? commenting that managers did not know as it was untried. She asked then ‘what about Plan B? and if there was a way back ‘when it proved unworkable.’  She urged the Committee to act in the interests of electors and refer any Horton Hospital downgrading to Jeremy Hunt, adding that the loss of the Horton’s maternity, acute medicine, paediatrics, trauma and Accident & Emergency would cause ‘utter chaos’. She also stated her view that the John Radcliffe could not cope at present, and it too would have to reduce beds under the Plan. She added that ‘as a foundation trust it would soon be offering 49% of beds to private patients’.

Dr Elizabeth Peretz stated her belief that the Committee would be asked to endorse ‘devastating’ cuts to the Health service, via the STP and OTP and emphasised that these plans must be made available to the public to comment on. Also that they should be presented as a whole system as there would be no other way to see if they were sustainable or not. She also asked that the Committee seek clarity and assurances about the finances, and in particular, the timetable for signing off contracts, to ensure that they do not sign off any binding contracts before the final consultation document is brought before the public. In conclusion she called for an NHS that is both fully funded and public.

Clive Hill urged members of the Committee to remember that the primary role of this Committee was to ‘strengthen the voice of local people’ and its job to challenge OCC and the OCCG. During the course of his address he related some of his concerns about the proposals to be contained in the STP and OTP to a number of measures taken by OCC and the OCCG to, in his view, ‘downgrade’ the Chipping Norton Hospital. He urged the Committee not to be railroaded and to study the situation at Chipping Norton. He also put forward the view that the Chipping Norton Hospital had all its needs on one site, ie. beds, consultants, clinics, physiotherapy, maternity,  ...  view the full minutes text for item 68/16

12:45

Sula Wiltshire, Director of Quality & Innovation, and Lead Nurse, OCCG, together with Ros Alstead, Director of Nursing & Clinical Standards, Oxford Health, will attend to provide an overview of community nursing provision and the 2015/16 review (JHO9).

Sula Wiltshire, Director of Quality & Innovation and OCCG Chief Nurse and Ros Alstead, Director of Nursing & Clinical Standards, Oxford Health attended for this item. Sula Wiltshire introduced the report (JHO9) which provided an overview of community nursing provision and the 2015/16 review.

The Committee heard that there were 325 district nurses in the county and these were based in GP practices. They worked in teams and were managed by a senior district nurse and a senior matron provided general management support. Some worked closely with primary care services mainly focusing on housebound people. There was a big demand on the services from frail, elderly and housebound people with respiratory and cardio - vascular conditions. There was also a cancer service and they also provided insulin at home, along with bladder care and care for people suffering from leg ulcers. Some patients were being looked after by a relative, and there were standard procedures around how often they were to be seen and how well they managed their own care.

Ros Alstead was asked if she regarded 325 district nurses as sufficient and if there were any plans to cut numbers further? She responded that there had been an increase in demand given the demographics in the county. More staff would be needed in the future, including community nurses. She emphasised that this was a service which was not being reduced, but the needs of the service had risen considerably, hence the review. She added that the Care Quality Commission (CQC) had rated the service as good overall and had in general found staff to be very compassionate and caring.

A member asked how strong the link with GP Locality Teams was. Ros Alstead responded that work was currently underway within the integrated locality team to determine what needs to be provided at a GP level, or cluster level or at a more specialised level.

Ros Alstead continued that there were two elements to the review. It focused on finding different ways to provide integrated work with GPs and how to release time by changing practitioners and working more efficiently. Options considered and measures taken were detailed in the report.

A member asked if district nurse work was allocated by a team. Sula Wiltshire responded that this was via a conversation between the GP and the district nurses at primary care team meetings. She added that social workers, the practice manager and health visitors may also be involved in those meetings.

Ros Alstead was asked how the service worked with Carer’s Forums. She replied that community services could not run without the support of family carers. Individual support was given to carers regarding treatments, for example – and community nurses worked with carers to educate and support them. She added that it was important to ensure people with caring responsibility had the capacity of assessment and the ability to make judgements.

A member asked if there was an issue with morale within the profession and, if so, how could it be  ...  view the full minutes text for item 69/16

13:30

The latest Chairman’s report is attached at JHO10.

The Chairman introduced her latest report (JHO10).

The Committee AGREED to note the Chairman’s report. It was noted that the next scheduled meeting of the Committee would be all day meeting.

The following papers are attached for the information of the Committee (JHO11):

·         Update on the temporary suspension of obstetric services at Horton General Hospital 

·         A briefing on Community Pharmacy in 2016/17 and beyond.