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Agenda and minutes

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Contact: Julie Dean Tel: 07393 001089  Email: julie.dean@oxfordshire.gov.uk

Items
No. Item

27/17

Election of Chairman - 2017/2018

To elect a Chairman for the municipal year 2017/2018.

Minutes:

Councillor Fatemian was elected Chairman for the municipal year 2017/18.

28/17

Election of Deputy Chairman - 2017/2018

To elect a Deputy Chairman for the municipal year 2017/18.

Minutes:

District Councillor Monica Lovatt was elected Deputy Chairman for the municipal year 2017/18.

29/17

Apologies for Absence and Temporary Appointments

Minutes:

Cllr Jenny Hannaby attended in place of Cllr Alison Rooke; District Cllr Lorraine Hillier for District Cllr Nigel Champken-Woods; and an apology was received from Keith Ruddle, co-opted member.

 

It was reported that Moira Logie, co-opted member, had tendered her resignation on account of her moving away from Oxfordshire. Members joined in thanking her for all her valuable work for the Committee.

30/17

Declarations of Interest - see guidance note on the back page

Minutes:

District Councillor Andrew McHugh declared a personal interest on account of his appointment as a short-term locum at West Bar GP Surgery, Banbury; also on account of his recent appointment to the Cherwell Community Partnership Network; and finally on account of his role as a non-voting attendee on the Cherwell Locality Network.

 

Councillor Jenny Hannaby declared a personal interest on account of her appointment as Chairman of the Wantage Hospital League of Friends.

 

Dr Simon Clarke declared an interest on account of his appointment as a public governor serving on the Council of Governors of the Oxford University Hospitals NHS Trust.

31/17

Minutes pdf icon PDF 219 KB

To approve the minutes of the meeting held on 6 April March 2017 (JHO5) and to receive information arising from them.

 

Minutes:

The Minutes of the meeting held on 6 April 2017 were approved and signed as a correct record.

 

Matters Arising

 

In relation to Minute 24/17 ‘Quality Accounts’, page 8, bullet point 2, the Committee asked for an update on the Delayed Transfers of Care situation to include an update on recruitment.

32/17

Speaking to or Petitioning the Committee

Minutes:

The following addresses from speakers had been agreed. Each speaker had elected to give their address prior to the item itself:

 

Agenda Item 9 – Oxfordshire Transformation Plan (OTP) Phase 1 – Consultation Outcomes

 

Joan Stewart – representing ‘Keep our NHS public’

Cllr Mark Ladbrooke – Oxford City Council

33/17

Forward Plan pdf icon PDF 137 KB

10:15

 

The previous Committee’s Forward Plan is attached at JHO7 for information. Committee members are asked to consider priority areas for scrutiny in 2017/18.

Minutes:

The Committee considered the Forward Plan attached (JHO7).

 

The Committee AGREED the Forward Plan and that Anaesthetist training at the Horton General Hospital be added to the Plan. It was noted however that this would most likely be included within the broad Transformation programme for consideration by the Committee in the near future.

34/17

Healthwatch Oxfordshire - Update

10:20

 

The new Chairman of Healthwatch Oxfordshire (HWO) will be introduced to the Committee and will share his priorities for the organisation during the next year. Rosalind Pearce, Executive Director, will also 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.

Minutes:

The Committee welcomed Professor George Smith, newly appointed Chairman of Healthwatch Oxfordshire (HWO). He was joined by Rosalind Pearce, Executive Director. He spoke of the need for HWO to challenge Health authorities to provide a clear vision on a longer horizon than at present. His major concern was that Health’s long term strategic plan was set at 2021 and not at the required 2031. In the current climate patients were being faced with cutbacks, for example, with reductions in bed numbers, thus causing a major mismatch between Health and the needs of the county. He added that the short-term message of the Oxfordshire Transformation Plan - Phase 2 was one of joint working, collaboration, integration was not visible in Oxfordshire. He made a plea, now there was a new County Council, for more partnership working and planning with the NHS. He believed that this was the way forward.

 

The Chairman asked if it was possible for the Committee to receive an update on HWO’s findings in relation to their traffic/parking survey at the John Radcliffe site. Ros Pearce reported that they were in the process of drafting the report and when complete, would be placed on the HWO website. It would be submitted to the OCCG by the end of June. She undertook to send a copy to the Committee when it had been placed in the public domain. Professor Smith added that the Hospital had also authorised some of their employees to undertake some automated counting, to measure how long it took to find a parking space. However, it had also been recognised that the problems often started on the journey to the hospital on busy roads, and therefore it was important where the initial sensors were placed. Here lay the need for a level of engagement with the local authority.

 

Professor Smith was asked for his view with regard to the rise in population for the over 85’s and the problem this would cause for the Health economy. He commented that the profound changes to the demographics in relation to the over 85’s were now well known. However, what was less clear were the demographics of people moving into the county as a result of housing growth and its subsequent effect on Health services. These people would be likely to be younger and more economically active and the underlying planning assumption would then be to expect a rise in the birth rate, with respective health needs. This would require better career structures for Health staff and the integration, in the form of hubs, of care workers, of consultants (to provide diagnostic care) and specialist nursing staff, as had happened in the Netherlands. His view was that community hospitals could best provide the source where services could coalesce.

 

Professor Smith and Rosalind Pearce were thanked for their attendance.

35/17

Oxfordshire Transformation Plan (OTP) - Phase 1 - Consultation Outcomes pdf icon PDF 324 KB

10:35

The outcomes a 12 week public consultation on changes to a range of health services in Oxfordshire will be shared with the Committee.

 

The Phase One Big Health and Care Consultation, which took place between 16 January and 19 April, focused on improving the quality of services and making permanent some temporary changes made in 2016. Public views were sought on:

 

·         Changing the use of acute hospital beds across Oxfordshire

·         Planned care services at the Horton General Hospital, Banbury

·         Stroke services across Oxfordshire

·         Critical (intensive) care services at the Horton General Hospital, Banbury

·         Maternity services, including obstetrics, special care baby unit and emergency gynaecology services at the Horton General Hospital, Banbury

 

In November 2016 the Committee reviewed and approved the Clinical Commissioning Group’s (OCCG’s) plans for consultation, and requested that:

 

·         Information on any proposals relating to obstetric/midwife-led units in the north of the county that impact on surrounding services is included in Phase 1.

·         Any proposals relating to the closure of other services at the Horton Hospital are included and considered together, and if they are not, then nothing in Phase 1 should prejudice Phase 2 proposals.

·         Proposed delivery of planned care at the Horton would be included in the consultation and the impact of changes in GP delivery would be made clear;

·         That the geographical detail be easily identifiable so that the public can be clear about proposed changes to be made to services in their locality; and

·         There is clarity on the meaning of ‘ambulatory’ care.

 

The Committee scrutinised the detailed proposals in Phase 1 at a dedicated meeting in March 2017, and its formal response and recommendations were submitted in a letter to the OCCG before the end of the consultation period. The Committee’s response and OCCG’s reply can be read as part of the Chairman’s report from 6 April 2017 HOSC meeting (Agenda Item 10). Please find the link below:

 

http://mycouncil.oxfordshire.gov.uk/ieListDocuments.aspx?CId=148&MId=5104&Ver=4

 

Representatives from the OCCG will present the feedback from the consultation and explain the further work that is being undertaken before final decisions on Phase 1 are made at a OCCG Board meeting on 10 August 2017.  A report is attached at JHO9.

 

 

Minutes:

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

 

Joan Stewart – ‘Keep our NHS public’

 

Joan Stewart was of the view that there were many more questions that the Committee needed answers to before the OCCG meeting to make their decision on the Oxfordshire Transformation Plan – Phase 1 proposal. She listed her reasons for this as follows:

 

·         The OCCG’s response to this Committee’s letter was ‘evasive, disingenuous and high-handed’. They had ignored the Committee’s misgivings about the ‘domino effect’ that phase 1 decisions would have on phase 2, particularly on services in the north of the county. Also, why 146 acute bed losses formed part of phase 1, but proposals to shift care into the community would not be seen until Phase 2, when the beds would be gone;

·         Despite being the statutory, accountable body for the consultation, OCCG had attempted to ‘shift responsibility’ onto the Oxford University Hospitals NHS Foundation Trust (OUH) for solving access and car parking problems and for investment in the Horton Hospital. How this would be financed was in question;

·         OCCG had also ‘side stepped the fundamental question of whether proposals were workable and sustainable given the severe underfunding of health and social care, shrinking care home capacity, and chronic workforce shortages’ in Oxfordshire;

·         The OCCG’s response to concerns voiced by this Committee about how inequalities would be tackled was ‘the feeblest in their whole response’;

·         The findings in the full consultation report revealed a catalogue of ‘concerns, misgivings and reservations’ about the proposals. The findings also include ‘strong criticism of the consultation process, not least of which was the decision to split the consultation in the way it was; the lack of options; and the leading nature of many of the questions’.

 

 She concluded by stating that there were many more questions that this Committee required answers to before the OCCG decision – making meeting in August. She asked when this Committee would:

 

·         be able to scrutinise the re-evaluation of the options for Obstetric services at the Horton?

·         be able to evaluate the criteria and results of the integrated Impact Assessment, the conclusions of which would be ‘critical’ to the proposals?

·         be able to assess the methodologies and quantitative and qualitative data being collected by Healthwatch and Mott McDonald on travel and parking: and

·         how would the revision of these consultation proposals reverse the crisis in health and social care?

 

‘Keep our NHS Public’ wished to urge the Committee to schedule a further public meeting with OCCG prior to 10 August when the final decision would be made -   or to refer to the Secretary of State for Health that day if it was not satisfied with OCCG’s response  to its concerns.

 

 

 

Cllr Mark Ladbrooke – Oxford City Council

 

Cllr Ladbrooke highlighted his concern that the health inequality issues in certain areas of Oxford were not being considered in sufficient proportion by the OCCG. He asked that the whole of Oxfordshire be considered  ...  view the full minutes text for item 35/17

36/17

Dementia Services

12:00

 

Early diagnosis for people with dementia has been shown to have benefits in terms of patient and carer quality of life and independence. There is also evidence to show that there is a financial benefit as a result of delayed need for care.

 

Representatives from Oxfordshire County Council Adult Social Care, Oxfordshire Clinical Commissioning Group and the Dementia Support Service will share with the Committee how they are working together to support people with dementia and their families, particularly in the context of recent changes to other services such as daytime support. A presentation to the Committee will provide an overview of dementia diagnosis, the dementia pathway, dementia support services and end of life care for dementia patients.

 

More information about dementia support services can be found on the website

 

http://www.dementiaoxfordshire.org.uk/

 

 

 

Minutes:

Early diagnosis for people with dementia had been shown to have benefits in terms of patient and carer quality of life and independence. There was also evidence to show that there was a financial benefit as a result of a delayed need for care.

 

The following representatives from Oxfordshire Clinical Commissioning Group, Oxfordshire County Council’s Adults Social Care and the Dementia Support Service attended to share with the Committee how they were working together to support people with dementia and their families, with particular reference to recent changes to other services such as daytime support:

 

-       Sonja Janeva – Oxfordshire Clinical Commissioning Group (OCCG)

-       Mandy Carey – Dementia Oxfordshire

-       Nicola Luxton – Dementia Oxfordshire

-       Benedict Leigh – Oxfordshire County Council

 

A slide presentation was given to the Committee which provided an overview of dementia diagnosis, the dementia pathway, dementia support services and end of life care for dementia patients.

 

During the question and answer session that followed, the Committee established the following:

 

·         Representatives were unaware of any new drugs on the market except for ones which allowed the slowing down of the degeneration process, which had appeared in recent years;

 

·         In recent years there had been a significant emphasis put on research and funding;

 

·         All care homes specialising in dementia came under Sonja’s remit;

 

·         There were benefits from the early diagnosis of dementia. It was important to know who had been diagnosed with dementia within a locality, so that need could be planned and support given. Furthermore early diagnosis also presented circumstances where personal preference would be taken into consideration alongside support;

 

·         There were two types of mental health services, one for older people, which largely focused on dementia, and one for working age people suffering from illnesses such as depression or psychosis. Those of a younger age diagnosed with dementia were automatically referred to the working age team. The cut-off age from one to the other was 65. Currently Oxford Health was exploring all age mental health teams and more teams focused on the frail elderly;

 

·         There was no strong evidence to suggest that a person’s existing mental health condition could be masking dementia, even though they could be suffering from other mental health problems. However, there was an increased prevalence for people with a learning disability to develop dementia at a younger age than the norm. Ideally they should be offered an annual GP health check;

 

·         Many people suffering from dementia lived alone. This was dependent on how the person felt about that. Services such as ‘Phone Friends’ were available to them and there were other means of support given, such as dementia friendly aisles in Sainsbury’s. The Alzheimer’s Society also ran a ‘dementia friends’ service and Carers Oxfordshire, which came under the auspices of Age UK, also ran a ‘Guideposts’ service;

 

·         In response to a question about how we can prevent people with dementia being placed out of county, Benedict Leigh explained that   the Orders of St John and other partners were exploring the  ...  view the full minutes text for item 36/17

37/17

Health & Wellbeing Board (HWB) and Strategy Priorities 2018/2019 pdf icon PDF 652 KB

13:00

 

Representatives from the Oxfordshire Clinical Commissioning Group and Oxfordshire County Council will attend to give an overview of the Health & Wellbeing Board’s priorities and respond to questions from the Committee on the work of the Health & Wellbeing Board.

 

Representatives from Oxfordshire County Council and Oxfordshire Clinical Commissioning Group will present an overview of the performance against targets in the Oxfordshire Joint Health and Wellbeing Strategy 2016-17 and proposals for new outcome measures in the revised 2017-18 Strategy for discussion and comment. A summary list of the proposals is attached at JHO11.

 

Any recommendations from the Committee will be shared with the Oxfordshire Health and Wellbeing Board in July, where the 2017-18 Strategy will be discussed and agreed.

Additional documents:

Minutes:

Tan Lea, Benedict Leigh and Jackie Wilderspin, Oxfordshire County Council, attended to present an overview of the performance against targets in the Oxfordshire Health & Wellbeing Board’s Strategy 2016 – 17 and proposals for new outcome measures for new outcome measures in the revised 2017-18 Strategy for discussion and comment. All comments would be shared with the Oxfordshire Health & Wellbeing Board (HWB) at their meeting in July.

 

The Committee’s comments for the HWB are listed below:

 

Overarching comments

·         A graphical representation of the data and trends for these indicators could be helpful – to show how big the issue is and whether it’s getting better or worse.

·         Ensure the wording of targets makes it clear what is being measured.

·         Need a way demonstrate whether performance is improving over time, to show that we are always moving forward – i.e. if we’re always using last year’s performance as a baseline.

·         It was important for the Health & Wellbeing Board to do a regular ‘deep dive’ on a chosen target in order to ascertain where the issues lie.

 

Comments on each priority in turn were:

 

Priority 1

·         Child and Adolescent Mental Health Services (CAMHS) – the focus on lead times should continue.

·         It would be useful to have some context alongside the data that is presented.

·         The targets seem to be very low – should we be more ambitious?

 

Priority 2

·         2.3 – Educational Attainment – The Committee requested feedback once the baseline had been agreed.

·         2.6 – out of county placements.  The target should be reviewed and should be achievable – the numbers have been increasing steadily, rather than reducing as planned.

·         Should we be monitoring the rate of care leavers to compare with the number of people entering care and monitor how they fare on leaving care? It seems important to tell the whole story.

 

Priority 3

·         3.3 and 3.4 –  Children in need or on Child Protection Plans.  The Committee asked why we would want to reduce the number of children subject to a Child Protection Plan or the number of social care referrals – should the focus instead be on the nature of the circumstances behind the referral and on tackling the factors affecting this at a much earlier stage?

 

 

 

Priority 4

·         4.1 – Narrowing the gap in school attainment.  The Committee suggested that the national average be made available when published to see how Oxfordshire compares. If there has been a reduction in the rating, then this needs to be made clearer.

 

Priority 5

·         5.6 – 18 week waits.  The waiting time for treatment following a referral is very long – should we have a more ambitious target? It would be more valuable to look at the number of people where the 18 week deadline has been breached.

 

Priority 6

·         6.5 – People with mental illness in employment.  This seems a very low target, but if we’re doing better than the national average, should we display this on the table? Also need to be clear whether the percentage target  ...  view the full minutes text for item 37/17