Agenda and minutes

Councillor Arash Fatemian attended in place of Councillor Tim Hallchurch.

There were no declarations of interest.

To approve the minutes of the meeting held on 17 November 2016 (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 17 November 2016 were approved and signed subject to the following:

-       Min. 62/16, line 2 - Declarations of Interest - deletion of the word ‘Banbury’

-       Min. 68/16, page 11, penultimate paragraph – Oxfordshire Transformation Plan and Sustainability & Transformation Plan for Buckinghamshire, Oxfordshire & Berkshire West – Updates – deletion of the words ‘would be’ and addition of the word ‘would’ after ‘engagement

The Chairman had agreed to the following speakers. All speakers to speak prior to discussion at the item itself:

Agenda Item 7 – ‘Management of Pressures on Urgent Care’

·         Ian Davies – Director of Operational Delivery, Cherwell District Council & South Northamptonshire Council

·         Councillor Kieron Mallon – Banbury Town Council

·         Eddie Reeves, Local Resident, Banbury

Agenda Item 8 – ‘The Buckinghamshire, Oxfordshire & Berkshire West Sustainability & Transformation Plan

·         Keith Strangwood – Chairman, ‘Keep the Horton General’.

·         Veronica Treacher – Member of ‘Keep our NHS Public’

Agenda Item 9  - Oxfordshire Transformation Plan – Plans for ‘Big Health & Care’ Consultation

·         Valerie Ingram – Horton Hospital Facebook Page and its supporters

·         Clive Hill – Member of ‘Chipping Norton Hospital Action Group’.

Agenda Item 11 – Closure of Deer Park Medical Centre, Witney

·         Councillor James Mills – Leader, West Oxfordshire District Council

·         Councillor Toby Morris – West Oxfordshire District Council

·         Brenda Churchill – Chair, Patient Participation Group, Deer Park Surgery, Witney

·         David Bailey – Patient at Deer Park Surgery, Witney

It was AGREED that Agenda Item 7 ‘Management of Pressures on Urgent Care’ would follow Agenda Item 5 ‘Forward Plan’.

10:10

A draft Forward Plan is attached at JHO5 for consideration.

The Committee AGREED the Forward Plan (JHO5).

10:30

In light of recent increases in emergency department waiting times, representatives from the Oxfordshire Clinical Commissioning Group (OCCG) will attend to explain the system-wide approach to managing pressures on urgent care. An urgent care update report is attached at JHO7.

Ian Davies addressed the meeting in relation to Agenda Item 9 also. He urged the Committee to look at services under threat at the Horton Hospital as a whole, and not as a two stage consultation process, adding his warning that there was a real possibility that Accident & Emergency and Paediatrics service would also be closed. He added his concern that the two stage process lacked clarity and caused a prolonged uncertainty for the public. He pointed out that there were several small birthing units in the country with fully integrated obstetric services made up of a large number of doctors and which fully satisfied their training needs. He urged strong challenge from the Committee and for these services to be reviewed as a matter of urgency.

Cllr Kieron Mallon urged the Committee to consider the ‘excessive’ travel time from Banbury to Oxford in the event of a need for obstetric care as a result of complications. To add to this, as had been extensively reported on local BBC news, the Committee should consider the lack of public transport to Oxford from the suburbs of Banbury should travel by car be not an option; the 90 minute to 2 hour travel time; and the need to allow up to 1 hour for parking at the John Radcliffe. He highlighted his concern for vulnerable mothers from the ethnic minority population in the Banbury area who had been cited in studies as more likely to suffer complications in pregnancy. He reminded members that areas of Banbury had been included in the top 20% of the most deprived households in England, pointing out there had been no evidence to suggest that Health had considered demographic evidence in detail. He added that the Brighter Futures Programme had documented the importance of a feeling of safety as a contribution to a state of well-being for the most disadvantaged. Cllr Mallon also cited the ‘misleading maternity information’ given to pregnant mothers that most of the young were a low risk. In conclusion, he asked, on behalf of Banbury Town Council, that the proposals be reviewed as a matter of urgency.

Eddie Reeves addressed the meeting as a local resident of Banbury Calthorpe ward. He stated that he often found it a chastening experience when, in his occupation as a local solicitor he drafted wills bequeathing monies to Horton General Hospital. He urged the Committee to ensure that it remained a General Hospital. He made reference to the written submission made to Committee Members from Cherwell District Council and to the fact that the local MP was collating journey times to the John Radcliffe Hospital made by her residents. Mr Reeves stated his view that there was a great need for a fully functioning Horton General Hospital in Banbury, in view of its growing size and stature and in its role as a strategic centre in the north of the County. He re-iterated Cllr Mallon’s belief that the two-stage consultation process was flawed and stated his concern  ...  view the full minutes text for item 6/17

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.

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

Eddie Duller wished to make it clear that HWO had no issue with the OCCG regarding the BOB STP engagement process, its issue was around the consultation process, and the fact that HWO had not seen the document prior to it being leaked.

In response to requests from three members of the Committee asking if the Witney Project could be extended to Wantage, Bicester and Thame in the future, Ros Pearce responded that HWO was trying to conduct geographically-based investigations and had not yet decided where to take them.

Eddie Duller was asked how HWO found the language and terminology in the OTP consultation document – which might either encourage or discourage the general public to truly reflect their views. He responded that he had found the language used ‘difficult to the extreme’, so much so that HWO had felt it necessary to run a translation service on their website.

In response to a question, Rosalind Pearce confirmed that HWO had not picked up any issues or concerns from other neighbouring counties about the consultations, despite their close working with other counties. She undertook to look to HWO counterparts in those areas.

Eddie Duller and Rosalind Pearce were thanked for the report.

11:30

Representatives from the Oxfordshire Clinical Commissioning Group (OCCG) will present an update on the development of the Buckinghamshire, Oxfordshire and Berkshire West Sustainability & Transformation Plan (STP) and its impact on Oxfordshire. A presentation is attached at JHO8. The public summary and draft submission are also attached at JHO8.

12:30 - LUNCH

Prior to consideration of this item, the Committee heard addresses from two members of the public:

Keith Strangwood thanked members of the Committee for its decision in relation to the closure of the Obstetrics service at the Horton General Hospital. He appealed to members to vote with their heart when its response to Phase 1 of the OTP consultation was considered on 7 March 2017.

Veronica Treacher stated that the capability of members of the public to influence many of the services featured in the STP was questionable, adding that despite the public engagement exercises carried out, it was driven by waiting times and audit. Plans had been presented as technical exercises and the language used constituted a language barrier. She added her view that the BOB STP largely remained secret and the public had not been given any information with respect to accountability and responsibility. Furthermore, that any changes had already been decided. She called for any re-configuration to be stress-tested to deliver effective services. She urged HOSC to make a stand and to call for further information about finance in light of public concern.

David Smith attended for this item in his capacity as both Chief Executive of the OCCG and the lead for the STP footprint over Buckinghamshire, Oxfordshire and Berkshire West. Stuart Bell, Chief Executive of Oxford Health also attended. Mr Bell stated that although he was working through some projects at the broader BOB level, which tended to concern specialist services that required a larger footprint (such as cancer services), much of the planning, consultation and delivery would be via the three local systems. Referring to the last speaker’s address, Mr Bell clarified that the STP did not exist as a statutory body.

Mr Bell advised that a new approach was to be taken based on local planning in contrast to the market situation which was the previous approach. This was reflected in the transformation process in Oxfordshire. Changes described in the STP were in line with those of the rest of the country. Furthermore, this federal approach meant that revised Terms of Reference were required for the Oxfordshire Transformation Board to ensure regular reports were provided on the STP and also to ensure an Oxfordshire view would be presented in the STP. An event had been held 2 weeks previously involving the wider local authorities, and a range of other organisations, to do a stock-take and to develop a process of engagement. There was recognition that this would involve significant numbers of the social care and home care workforce.

Members asked questions around the following areas:

·         Whether there were other plans that had been through the Clinical Senate and NHS England;

·         Why the BOB STP had not been consulted on and published as a holistic plan and not as part of the OTP consultation;

·         How the work plan for the OCCG and the Senate worked out across Oxfordshire;

·         Relation of the OTP/STP to common resource problems experienced by the Health service nationwide, such as  ...  view the full minutes text for item 8/17

13:00

Representatives from the OCCG will attend to outline the plans for consultation and communication with the public on the phase 1 proposals. The Committee will consider the adequacy of the planned consultation events, but not the content of the proposals.

A link to the OCCG’s Transformation website, which contains the Consultation document is below, for information only.

http://www.oxonhealthcaretransformation.nhs.uk/

Please note a special meeting of this Committee has been arranged for 7 March 2017 when formal scrutiny of the Phase 1 proposals will take place. At this meeting the Committee will consider whether the proposals are in the interests of the Health service in Oxfordshire and  local communities.

Christine Ansell, speaking on behalf of Valerie Ingram, expressed concern, on behalf of the 22,000 supporters, that the Committee had voted to accept the split consultation. They considered it unwise, prejudicial and to the detriment of the people of Banbury and the surrounding area. It was their view that the services under review were interdependent. This would risk the potential removal of the obstetric led maternity unit, which would put into jeopardy the Special Care Baby Unit, Paediatrics and ultimately the Accident & Emergency department, effectively dispensing with all the acute services at the hospital. This would leave a rapidly expanding area with an inequality of health care, which in their view would go against council policies in core strategies drawn up by local authorities.

Christine Ansell queried whether maternity services were included within the discussion regarding the temporary closure of beds at the Horton.

She also put forward her view that the first consultation meeting on the plans, which had been held in Banbury, was not supported by any of the attendees. Furthermore it had been held in ‘banquet style’ rather than ‘plenary style’ which was limiting in terms of numbers able to attend, nor did it enable attendees to hear each other’s views. She added that many of the meetings were held during the day which precluded the majority of the working population from attending. It was her view that this style of organisation called into question how meaningful the consultations were.

On behalf of Val Ingram, she urged the Committee to vote against the split consultation ‘which delivered a second class health care service to Banbury’, adding that the County’s MP’s were also of this view.

Clive Hill reported concern within the Chipping Norton community that there had been a ‘complete lack of involvement of the people of Chipping Norton and district.’ He informed the Committee that a request had been made by the Chipping Norton Action Group (CNAG) to the OCCG to hold a public meeting in Chipping Norton before options for Phase 1 of the consultation were determined. Mr Hill stated that despite a promise made by the Chief Executive, this event had not taken place despite repeated requests. Thus, the options had been decided with no public involvement in Chipping Norton. Following publication of Phase 1 of the consultation, the CNAG asked that the Chipping Norton consultation meeting be no earlier than mid to end February to allow time to publicise it. This was not taken into consideration.  A meeting was arranged by the OCCG to take place on 2 February from 2pm – 4pm. This was not acceptable for a number of reasons, namely that it clashed with this meeting, was a weekday, most people were at work and young mothers interested in maternity services would be collecting their children from school. An objection was made, but a change was not forthcoming. There were also concerns about the layout which was ‘cabaret’ style where numbers would be restricted. He expressed his concern regarding  ...  view the full minutes text for item 9/17

14:00

Representatives from the Oxfordshire Clinical Commissioning Group (OCCG) will present the draft framework for Primary Care in Oxfordshire. The framework is attached at JHO10.

David Smith, Dr Joe McManners and Julie Dandridge, OCCG attended for this item.

The Committee had before them a paper produced by the OCCG setting out a draft framework for primary care in Oxfordshire (JHO10). The Chairman, in introducing the item, referred to the Committee’s discussion at the last meeting and the questions arising from it. A major issue raised was what could be done about the problems in the short term.

David Smith introduced the draft framework citing all the issues that primary care had experienced over the last 10 years, such as a rise in the numbers of older people with complex needs, double numbers of consultations for the over 80’s and the difficulties in recruiting and retaining GPs and other professionals in primary care. He explained that the OCCG was trying to identify a broad strategy to be used by groups of GP practices, localities and neighbourhood areas. This would entail looking at population groups, ways of expanding the workforce and at issues relating to premises. An action plan would be compiled looking forward and also looking at what was required in the short-term, such as how to attract more GPs and professionals and also to look at how to establish different roles within practice teams.

Questions asked by the Committee were in the following areas:

·         The size of the GP units – was there a standard size?

·         Whether practices were being encouraged or ‘nudged’ towards working together;

·         The recruitment of more doctors;

·         The appropriate circumstances to award a 15 minute appointment;

·         Progression of 7 day a week working in GP surgeries;

·         More funding for larger practices;

·         Installation of IT to support the changes;

·         Inclusion of patient transport in the framework – not just for older people, but for all ages needing it;

·         The impact of the framework on residents in Bicester and Banbury;

·         Whether practices were opting out of the Out of Hours service;

·         It had long been noted that patient discharge would be made more rapid in the future. Did the Framework take account of this?

·         When would there be consultation on the Framework?

Answers received were as follows:

·         The Strategy was not about stipulating practice size, it was more about working across practices of approximately 30-50k residents in a neighbourhood with multi-skilled teams. There was a need to look at having a few practices working together, sharing the risks and even teams. This was the direction of travel the service had seen over the last few years;

·         The OCCG was careful not to stipulate how practices should be organised because, for example, City practices were very different to those in Banbury and the strategy would have to work for the local area. This was a framework, not a plan. However, the OCCG would assist them in their move towards a better service, such as the establishment of clinical pharmacists in GP practices who would follow up on notes, blood results etc. Practices would also need to ensure that there is proper value for money  ...  view the full minutes text for item 10/17

15:30

There will be an update on activity since the last meeting on the decision by the OCCG to close the Deer Park Medical Centre, Witney. Attached is a record of the outcome of a confidential Toolkit meeting held with OCCG representatives on 12 December 2016 (JHO11).

In light of recent legal proceedings for judicial review against the closure, advice has been sought from the County Council’s legal team on the implications of this in terms of HOSC’s consideration of this issue. A report from the Director of Law & Governance  is attached at JHO11.

Prior to consideration of this item the Committee heard addresses from the following members of the public:

Cllr James Mills urged the Committee to support the closure of Deer Park Medical Centre as a substantial change of service. He expressed his concern that the informal meeting comprising some members of the Committee and representatives from the OCCG had not invited local representatives to attend, particularly when local issues around workforce and the local planning authority were to be aired. He pointed out that thousands of houses were to be planned which would cause major problems if there was insufficient provision of primary care.

Cllr Toby Morris stated that currently Witney was experiencing a 25% vacancy rate for GPs which caused concern particularly as 2,000 houses were due to be built in the Witney area. For this reason it was the Town Council’s view that the closure of Deer Park Surgery constituted a substantial change in service as it was an important satellite for patients living in the West Witney, Cogges and central Witney which amounted to half the size of Witney. He pointed out that Witney Town Council had not been consulted on the proposed change by the OCCG and expressed concern that the OCCG had sent letters to the dispersing patients that morning, which was immediately prior to discussion by this Committee.

Brenda Churchill referred to the Court decision, from the previous day, not to continue with the application for judicial review on the grounds that the application had not been made early enough.  It was the view of the Patient Participation Group that the OCCG should have discussed the procurement issues with them earlier. Furthermore, they believed that the OCCG should have conducted a broader and more meaningful exchange on the impact of the closure with the local public. She also expressed her concern that there had been too many meetings in private. She urged the Committee to take the view that it was a substantial variation in service, as requested by the district council, the local MP and others. She asserted that very few patients had left the surgery to go to other surgeries because they wanted to remain at the practice.

The Chairman assured Mrs Churchill that no conversation had taken place behind closed doors with the CEO of the OCCG at any time.

David Bailey stated that the decision to close Deer Park Medical Centre made even less sense after listening to the previous item relating to future changes in primary care in Oxfordshire.  He told the meeting that in 1993 he had suffered a heart attack and, since that time, the Deer Park Surgery, which had been rated as a ‘good’ surgery, had taken great care of him. He expressed his concern that the Ambulance Service and the OUH might struggle to respond to emergencies leading to patients not receiving the same level of care. He asserted that GPs were leaving other surgeries, yet the OCCG were planning to remove three GPs from Deer  ...  view the full minutes text for item 11/17

16:00

The latest Chairman’s report is attached at JHO12.

The Committee considered the latest Chairman’s report (JHO12).

It was AGREED to note the report.