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Agenda and minutes

Venue: County Hall

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

Items
No. Item

10/18

Apologies for Absence and Temporary Appointments

Minutes:

Cllr Glynis Phillips attended for Cllr Mark Cherry and an apology was received from Anne Wilkinson.

11/18

Declarations of Interest - see guidance note on the back page

Minutes:

There were no declarations of interest submitted.

12/18

Minutes pdf icon PDF 267 KB

To approve the minutes of the meeting held on 8 February 2018 (JHO3) and to receive information arising from them.

For ease of reference when considering any Matters Arising from the last meeting, an actions list for 8 February 2018 meeting is attached for information.

 

Additional documents:

Minutes:

The Minutes of the meeting held on 8 February 2018 were approved and signed as a correct record subject to the following corrections:

 

-       Page 4, Minute 7/18, penultimate paragraph – correction of ‘Nuffield Hospital’ to ‘Nuffield Health Centre’;

-       Page 5, Minute 7/18, references to ‘consultation’ in paragraphs 4 and 5 to be amended to ‘engagement’ – and in paragraph 5, the reference to the ‘final’ version of the Plan to read ‘first’ version;

-       Page 6, Minute 7/18, paragraph 2 – reference to the National Association of GPs’ to read ‘British Medical Association’; and

-       Page 6, Minute 7/18, penultimate sentence, to amend the word ‘re-registered’ to ‘allocated’.

 

There were no matters arising.

 

13/18

Speaking to or Petitioning the Committee

Minutes:

The Chairman had agreed to the following members of the public addressing the Committee immediately prior to Committee discussion on the item itself:

 

Agenda Item 8

Cllr Jenny Hannaby

Jane Febers and Helen Wigginton, senior officers of the Royal College of Nursing with responsibility for members in Oxfordshire, Buckinghamshire and Milton

14/18

Forward Plan pdf icon PDF 168 KB

10:15

 

The Committee’s Forward Plan is attached at JHO5 for consideration.

Minutes:

The Chairman assured the Committee that the meeting between the Chairman of Health & Wellbeing Board/Health Improvement Partnership Board/Oxfordshire Joint Health Overview & Scrutiny Committee had been postponed. However, it was hoped that it would take place in early May.

 

The Chairman confirmed that priority would be given to scrutiny of the Health & Wellbeing Board’s reorganisation by this Committee at either the June 2018 or the September 2018 meeting.

15/18

Healthwatch Oxfordshire pdf icon PDF 150 KB

10:25

 

George Smith, Chairman and Rosalind Pearce, Chief Executive Officer, will be present to report on the views and latest activities of Healthwatch Oxfordshire (JHO6).

 

Minutes:

George Smith, Chairman, presented the report from Healthwatch Oxfordshire on their views and latest activities (HWO6).

 

Professor Smith was asked what, in HWO’s view, were the NHS Trusts highlighted in the report doing differently or better than Oxfordshire. He responded that changes to locally based domiciliary services had been done very well elsewhere. For example, domiciliary care workers had been given additional training to help recognise deterioration or concerns needing assessment. These care workers were then more integrated with nursing teams who could respond where concerns were flagged.

 

A member asked if there was evidence of improved health and wellbeing as a result of the integration of health and social care in areas showcased by CQC.  Professor Smith responded that social prescribing incorporated others from a wide spectrum, for example, those who were lonely. He highlighted a recent venture where volunteers were giving companionship to older people in the Mendips area. This venture had resulted in a 20% reduction in health and care costs, together with an improvement in the quality of life for the older person.

 

The Chairman thanked Professor Smith for the report pointing out that the CQC was pleased with the way health and social care integration was proceeding with the Action Plan.

 

The Committee AGREED to thank HWO for the report and Professor Smith for his attendance.

 

16/18

Care Quality Commission Local System Review pdf icon PDF 89 KB

10:45

 

The Chief Executives of Oxford Health Foundation Trust (OH), the Oxford University Hospitals Foundation Trust (OUH), and the Oxfordshire Clinical Commissioning Group (OCCG), together with Oxfordshire County Council’s Director for Adult Services (OCC) will present for scrutiny Health & Social Care’s response to the outcomes of the recent CQC Local System Review and subsequent Action Plan (JHO7).

 

The Committee is RECOMMENDED to note the progress made and to provide any comments or observations that it believes may assist in assuring delivery of the agreed Action Plan.

Additional documents:

Minutes:

The Committee considered a summary report (JHO7) by the Oxfordshire system leaders in relation to the CQC Local System Review. It summarised the outcome of the Review, its recommendations and the high – level Action Plan developed by system leaders in response to those recommendations, as well as setting out the proposed governance for ensuring the delivery of required actions. This Committee was asked to note the progress made and to provide any comments or observations that it may assist in assuring delivery of the agreed Action Plan.

 

The Committee welcomed the following representatives to the meeting:

 

-       Stuart Bell CBE, Chief Executive, Oxford Health Foundation Trust (OH);

-       Dr Tony Berendt, Medical Director, Oxford University Hospitals Foundation Trust (OUH);

-       Lou Patten, Chief Executive, Oxfordshire Clinical Commissioning Group (OCCG)

-       Kate Terroni – Director of Adult Services, Oxfordshire County Council (OCC).

 

Kate Terroni, in giving a presentation to Committee, began by giving a recap on the CQC’s approach to the review, which was to look at the Health and Social Care systems as a whole and how people and patients moved through the pathways. She stated that one of the main messages of the report was the absence of a single vision in Oxfordshire and the need to set clear strategies where it was required to avoid fragmentation and duplication.

 

She then gave an update on the actions included in the Action Plan, which, she stressed, were a very real opportunity to bring all the organisations together under one umbrella. To this end, the Oxfordshire Health & Wellbeing Board (HWBB) had agreed to call a special meeting on 10 May 2018 to consider a governance review of the Board which would formally pull together the efforts and powers of all organisations to give a much more unified view of the health and social care systems, which would be easier to scrutinise and hold to account. She stressed that the governance review would indicate that it would be a different way of moving forward.

 

The Chairman stated that the Committee would like to see actual results before it could be deemed successful and asked that this be borne in mind during the discussions.

 

Lou Patten stated that the aim of the Action Plan was to bring people together and to be as productive as possible in its delivery via the Integrated Care Delivery Board, which would be accountable for the areas of transformation. She added that an example of the new leadership was that of two assurance meetings which had taken place this year when NHS England and NHS Improvement had brought the entire system together in order to have a regulations conversation regarding performance. Going forward this very positive type of meeting would now be employed as a system. The aim was to empower the patients situated at the front end of the service line, rather than that of the organisation itself. An example of this was the focus on those patients who were in a hospital bed who did  ...  view the full minutes text for item 16/18

17/18

OCCG: Key and Current Issues pdf icon PDF 275 KB

11:45

 

The Oxfordshire Clinical Commissioning Group has been invited to give an update (attached JHO8) on its key issues and upcoming areas of work. This includes:

 

·         An update on the West Oxfordshire Place based Plan

·         An update of the Transformation Programme

·         Integrated Care Systems – some reflection and learning from the Buckinghamshire experience (presentation)

 

Minutes:

Prior to discussion on this item the Committee was addressed by the following people:

 

Jane Febers and Helen Wigginton – regional officers responsible for members of the Royal College of Nursing (RCN) in Oxfordshire, Milton Keynes and Buckinghamshire.

 

Jane Febers gave a brief resume for the information of the Committee on the work of the RCN in support of nurses, health care assistants and students in a range of health care settings. The RCN aimed to improve the working life of staff by a number of means:

 

-       by offering its members free confidential advice;

-       by supporting and protecting a diversity programme, providing the tools to protect against discrimination in the workforce;

-       by lobbying governments to improve the quality of patient care and providing advice to parliamentary select committees - the NCT had no ties to any political party;

-       by attending UK conferences; and

-       by engaging in national research.

 

They concluded by stating that their members in Oxfordshire had very real and valid concerns with regard to future plans for health and social care and morale was low.

 

Veronica Treacher spoke with regard to the transformation of, and evolution of the NCO’s believing it to be an ‘americanisation’ of the NHS. She expressed her concerns that the recommendations relating to structural shifts rarely hit the headlines and that they required scrupulous scrutiny in order to understand the implications of what was about to happen. She added that, in her view, it would cause uncertainty in the future leading to an instability in the market, for example with GP practices proving uneconomical to run.

 

OCCG had been invited to give an update on its key issues and upcoming areas of work. This included:

 

·         An update on the West Oxfordshire Place based Plan

·         An update on the Transformation Programme

·         Integrated Care Systems

 

Lou Patten, Chief Executive and Catherine Mountford, Director of Governance, OCCG attended for this item and presented the report JHO8.

 

West Oxfordshire Place based Plan

 

Lou Patten reported that she had met with patients and public engagement bodies who were keen to work with the OCCG and to engage with patients in order to make it a more inclusive way forward. This she had found to be very helpful.

 

A local member for West Oxfordshire stated that the local communities in west Oxfordshire would like to see an impetus on GP services in the west to work in collaboration with each other in order to reach some kind of GP representation in the locality. She suggested that a portion of any funding available could be given to each practice to accommodate extra patients and to collaborate with other practices. Lou Patten responded that one of the key lessons learned at the meeting with the PPG was the confusion about the fundamental truth that GP practices are individual businesses which hold a contract with the NHS to deliver services. She added that the OCCG could not require individual practices to collaborate, but she believed that they could  ...  view the full minutes text for item 17/18

18/18

Response to the IRP - Consultant-led maternity services at Horton pdf icon PDF 85 KB

12:15

 

Attached are proposals from this Council and the OCCG to address the IRP recommendations on the permanent closure of consultant-led maternity services at the Horton General Hospital (JHO9).

 

County Council recommendations:

 

The Committee is RECOMMENDED: to

 

(a)  note the IRP recommendations;

(b)note the requirements to form a new joint health scrutiny committee in response to the IRP recommendations, to be focused on consultant-led maternity services at the Horton General Hospital;

(c)  request Oxfordshire County Council’s Director of Law & Governance, in consultation with the Chairman and Deputy Chairman, to seek to negotiate the terms of reference for a new joint committee to be focused on consultant-led maternity services at the Horton General Hospital, to include a membership that is agreeable to all three Councils, for approval by the respective full Councils.

 

OCCG recommendation:

 

The Joint Health Overview and Scrutiny Committee are asked to agree the proposed approach

 

12:45: LUNCH

Additional documents:

Minutes:

Prior to consideration of this item, the Chairman made reference to the recent IRP judgement which directed the OCCG to consult the public again with regard to the maternity service at the Horton Hospital. He thanked members of the Committee and all who campaigned for the ‘real, tangible change’ which had been achieved.

 

The Committee considered proposals from this Council and the OCCG to address the IRP recommendations on the permanent closure of consultant-led maternity services at the Horton General Hospital (JHO9). A requirement of the recommendations was for Oxfordshire to form a new joint health scrutiny committee with Northamptonshire and Warwickshire County Councils.

 

Lou Patten and Catherine Mountford (OCCG); and Sue Whitehead and Glenn Watson (OCC) attended for this item.

 

Following a discussion the Committee AGREED to:

 

(a)  note the IRP recommendations;

(b)  note the requirements to form a new joint health scrutiny committee in response to the IRP recommendations, to be focused on consultant-led maternity services at the Horton General Hospital;

(c)  request Oxfordshire County Council’s Director of Law & Governance, in consultation with the Chairman and Deputy Chairman, to seek to negotiate the terms of reference for a new joint committee to be focused on consultant-led maternity services at the Horton General Hospital, to include a membership that is agreeable to all three Councils, for approval by the respective full Councils;

(d)  (nem con) in respect of (c) above, to include within the Terms of Reference that this committee be for the purpose stated only; and that the power of referral to the Secretary of State should sit with the new Committee only;

(e)  (nem con) it was this Committee’s view that a conversation between paediatrics and obstetrics was required as both services were inter-dependent ie. obstetrics require neo-natal services.

 

 

 

 

 

19/18

Oxford Health (OH) Quality Account

13:15

 

The Committee will scrutinise key progress against OH stated priorities. A presentation will be given (JHO10).

Minutes:

The Committee was asked to scrutinise the key priorities contained in the Oxford Health Foundation Trust’s (OH) Quality Account.

 

Due to time limitations as a consequence of the large amount of business on the Agenda, and the need for Health Officers to be at a meeting elsewhere, the Chairman requested, and it was AGREED that the Quality Account be circulated to members of the Committee for their comment and then collated for the Trust.

20/18

Oxford University Hospitals NHS Foundation Trust (OUH) - Quality Account pdf icon PDF 739 KB

13:35

 

The Committee will scrutinise key progress against OUH stated priorities. A copy of the presentation that will be made to Committee is attached at JHO11.

Minutes:

Dr Tony Berendt and Dr Clare Dollery (OUH) attended for this item. Dr Dollery gave a presentation.

 

The Chairman thanked Drs Berendt and Dollery for the presentation and opened the meeting out for questions and comment.

 

A member referred to a very useful presentation which had been given by OUH on cancer pathways and the One Stop Shop at the Churchill Hospital at the last meeting and asked if the priority to reduce the 62 days for referral to treatment could be met. Dr Berendt stated that it was hard to measure performance in this area. He added that the one stop shop may prove to be of overall benefit to the patient as recorded in performance targets relating to patient pathway, but it could not apply to forensic methods.

 

Also with regard to cancer pathways a member asked whether there were any areas identified where performance blockages had occurred. Dr Berendt responded that Board papers included integrated performance reports, not service by service breakdowns. Blockages were identified pathway by pathway but it had been recognised that there was a need to introduce changes which would identify blockages between pathways which required addressing.

 

Stemming from a request made at the last meeting, a member asked if every ward in the hospital now had a mental health champion who was identifiable to carers coming in with a patient with mental health needs. Dr Berendt responded that he needed to come back to the Committee on this matter. He added however that a supply teaching programme, which included patient mental health issues had now been completed. Dr Berendt was requested to return to members with information on whether a champion was available in every ward at all times. Dr Dollery responded that the immediate purpose was for them to be readily available.

 

A member asked if the Trust was seeking different quality measures, given that the CQC had been specially critical with regard to end of life care quality of care (ie the whole of the patient experience and process) and would it affect the Quality report. Dr Dollery responded that the Trust was very mindful of the CQC system and one of its aims was to take on one of the goals from the CQC report and to ensure that each pathway included pre and post pathways.  Dr Berendt added that there was a certain amount of work which had to be carried out on this aspect. For example, end of life care was very internally directed and there was a need to adopt a better joined-up system. There would be greater emphasis on conducting conversations externally on how to become more responsive, as there was now a higher volume of care available to patients who wanted to die out of hospital. Dr Berendt added however that currently there was a statutory requirement to have a separate quality account, but, as the system moved on, it may be possible to adopt a joint account which would be more effective.

 

With regard  ...  view the full minutes text for item 20/18

21/18

HOSC & Health 'Ways of Working' workshop report and draft principles pdf icon PDF 178 KB

13:55

 

The Committee is asked to consider and agree a Protocol for HOSC and health and wellbeing commissioner and provider liaison (JHO12).

 

The Committee is RECOMMENDED:

 

a)    to note the progress made against addressing IRP recommendation and the committee’s agreements made on the 8 of February 2018;

 

b)   to agree the draft protocol outlined in Appendix A of this report; and

 

c)    subject to agreement of the Protocol and the proposal, to establish a HOSC Planning Group and to request the HOSC support officers to negotiate terms of reference in order to ensure the Group meets to inform the next meeting of the committee.   

 

 

Additional documents:

Minutes:

Prior to consideration of this item, the Committee was addressed by Liz Peretz speaking on behalf of ‘Keep our NHS Public’. She spoke against the protocol and the establishment of the HOSC Planning Group on the following grounds:

 

-       HOSC had been set up as an independent voice with the power to call in any service leader. She asked if this access to senior officers would be compromised;

-       HOSC should decide on its own agenda, not those bodies whom it was scrutinising; and

-       It was her view that meeting in private would negate the public’s essential ability to challenge with regard to any service change.

 

She urged the Committee not to throw away the ‘real voice’ of the Committee and to make it into a ‘non-democratic’ Committee. She pointed out that transparency and the ability to carry out independent scrutiny would be lost.

 

The Chairman, in response to the points made in the address, stated that the protocol had been devised in mind of the principles contained in the IRP recommendations in relation to the ways of working that had led to the Deer Park referral. He stressed that this did not negate the scrutiny function or detract from the power of referral. Rather, the Committee would be better informed and could therefore plan for an issue in a better way, rather than having issues introduced to the Committee at a late date. He added that he was a big advocate for conducting business in the public domain as far as possible. However, when it came to planning, the Committee needed to hold flexible, informal meetings where no decisions were made.

 

Cllr Laura Price stated that in her view this document was an ‘enhanced version of the toolkit’, meetings for which were held behind closed doors. She added that the Committee was in danger of confusing what was a formal and an informal meeting, particularly when thinking about whether proposals constituted a substantial change of service.

 

Cllr Laura Price then proposed and Cllr Glynis Phillips seconded, that the Planning Group be held in public session. This was lost by 3 votes to 7. The Chairman than proposed, and was duly seconded, to formally adopt the recommendations contained in the report.

 

The Committee AGREED to:

 

(a)  note the progress made against addressing the IRP recommendation and the Committee’s agreements made on 8 February 2018;

(b)  agree the draft protocol outlined in Appendix A of this report; and

(c)  (by 8 votes to 3) establish a Planning Group and to request the HOSC support officers to negotiate its terms of reference in order to ensure the Group meets to inform the next meeting of this Committee.

22/18

Chairman's Report pdf icon PDF 201 KB

14:10

 

The Chairman’s report is attached a JHO13 which includes an update on health and social care liaison.

Additional documents:

Minutes:

The Committee considered the Chairman’s report (JHO13) which included an update on social care liaison.

 

Cllr Price agreed to join the MSK Task & Finish Group. The Chairman confirmed that all physiotherapy services were included in the Terms of Reference for the Group.

 

It was requested that the progress in relation to the implementation of the new Healthshare service be added to the Forward Plan in light of concerns expressed by Healthwatch Oxfordshire (HWO).

 

A member suggested that a HWO representative could be a better patient representative on the MSK Group, rather than an individual patient. The Chairman stated that the Task & Finish Group was in trial stage and it was his preference that it be left as a broad definition of an individual patient, but to include ‘or a HWO representative’.

 

The Committee AGREED to note the Chairman’s report.