Agenda and minutes

Councillor Jane Hanna attended for Cllr Alision Rooke and apologies were received from Councillor Sean Gaul and Anne Wilkinson.

Councillor Hilary Hibbert-Biles declared a personal interest in Agenda Item 6 ‘Health Visiting and School Nursing Services’ on account of her former membership of the Oxfordshire Health & Wellbeing Board in a capacity as Cabinet Member for Public Health at the time when the contract for School Health nurses in the county’s primary schools was commissioned.

Councillor Monica Lovatt declared a personal interest in Agenda Item 9 – ‘New Governance of the Oxfordshire Health & Wellbeing Board’ on account of her membership of the Health Improvement Board which is a sub-group of the Board.

Dr Alan Cohen declared an interest in Agenda Item 9 also on account of him being a trustee of Oxfordshire Mind.

To approve the minutes of the meeting held on 20 September 2018 (JHO3) and to receive information arising from them.

For ease of reference when considering the Matters Arising from the 20 September 2018 meeting, a list of actions is attached at JHO3.

The Minutes of the meeting held on 20 September 2018 were approved and signed subject to the following amendments:

-       In relation to page 18 – the interim Director of Public Health, Val Messenger, came up to the table and undertook to circulate to members of the Committee a more correct meaning to the words ‘the Government was doing well in tightening the screening of obesity using non-legislative means and there was an increasing gradual awareness amongst the population’;

-       In relation to page 13, line 3, to correct ‘650 new homes’ with 6,500 new homes’; and

-       In relation to the top of page 19, sentence 1 – to delete ‘cardio -diabetes’ and correct to ‘people with severe mental illness’.

There were no matters arising.

The following requests to address the meeting had been agreed:

-       Didcot Town Councillor Cathy Augustine (Agenda Item 9);

-       Councillor Jenny Hannaby (Agenda item 9);

-       Maggie Swain, on behalf of Save Wantage Hospital Campaign (Agenda Item 11); and

-       Councillor Jenny Hannaby, Local Member (Agenda Item11).

10:15

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

The Committee gave consideration to the latest Forward Plan, as amended since the last meeting (JHO5).

It was AGREED to:

(a)  reinstate GP Federations onto the Plan, in particular in relation to smaller practices and their survival; and

(b)  make the ‘Social Prescribing’ item broader to encompass housing leisure services in order for the Committee to look at it ‘in the round’ – and to ensure that this is a major item on a future Agenda.

10:20

This item covers the following (JHO6):

·         the impact of changes to children’s centres on provision of health visiting service;

·         scrutiny of the newly commissioned service for 0 – 5 years health visiting services;

·         the impact of school health nurses in secondary schools and future service plans;

·         the recommissioned services.

The Committee welcomed the following representatives from the Health Visitor and School Nursing services in Public Health, OCC:

Val Messenger – Deputy Director of Public Health

Donna Husband – Lead Commissioner,

Emma Leaver – Service Director

Pauline Nicklin – Head of Service

Nicky Taylor – Operational Manager, Health Visiting

Angela Smith – Operational Manager, Health Visiting

Helen Lambourne – Family Nurse Partnership Supervisor

Margaret Fallon – Operational Manager, School Health Nursing

Each presented their part in a series of slides as attached to the Agenda at JHO6.

Questions asked by members of the Committee, and responses received, were as follows:

-       How is performance measured? -  There are key performance indicators included in the contracts, performance of which is managed by Health and the Performance Scrutiny Committee, OCC. There is a Public Health Outcomes Framework which is broken down into various categories. Sometimes the issues are hard to link to a specific activity and therefore not in contract management;

-       How are inequalities tackled? -  Equal access to all is offered, the service adapts to the needs of individuals, for example, health visitors offer the service where it is most suitable and convenient for the user and it offers a delivery of the service in the home itself, particularly in rural areas. It also uses interpreters where needed;

-       Where are the nine centres for Health Visitors located? -  the county is divided into 9 localities and within each there are 7 teams. For example, West Oxfordshire has teams in central Witney, Carterton and Chipping Norton. Additional services are also provided in Charlbury;

-       How do Health Visitors connect with people? – They establish good therapeutic relationships with people early, in order for relationships to be built. For example, if there are concerns regarding a person’s mental health during their ante-natal period, the health visitor may do the liaison work and carry out joint visiting with other professional to assist that person in their transition to another service;

-       How does the service support children with a fluidity of gender? -  The service is experiencing a growing need in this sphere and it has trained nurses to both help the children and also to assist teachers with how to respond to it;

-       What about the people that are not being seen – 73% of mothers attend antenatal classes, but what about the other 27%? – The service is offered to all people working with midwives. Some mothers feel that they do not require the service and there is an element of choice in that. There is a system in place for health visitors to work with midwives to identify those mothers they are most concerned about and they do endeavour to track them down. There is also contact with primary care colleagues. Thus, included within the 73% of antenatal contacts are some for whom there is some concern;

-       Up to 63% of women breastfeed their babies until they are 6 weeks old. Compared to other countries this is  ...  view the full minutes text for item 57/18

11:40

Rosalind Pearce, Chief Executive Officer, Healthwatch Oxfordshire (HWO) will be present to report on the views gathered by HWO and its latest activities (JHO7).

Rosalind Pearce, Chief Executive Officer, Healthwatch Oxfordshire (HWO) was present to present her report (JHO7) on the views gathered from members of the pubic and the latest activities of HWO.

She reported on the work HWO did around Healthshare and the information given to HOSC’s sub-group. Most of the recommendations given to the CCG had been accepted and put into practice by the CCG and she expressed her thanks to the CCG. She also pointed out that the report did not cover responses received from the CCG and Wantage Town Council with reference to Wantage Hospital, most of which was on HWO’s website. She added that HWO had not found out anything that was not already known, and hearsay had been reinforced by discussion with many people on the subject.

Rosalind Pearce was asked if HWO had undertaken any further work on dentistry sine the last report documenting this. Rosalind Pearce reported that HWO had now taken the investigation wider to include countywide access to NHS dentistry, including that offered to care homes. She undertook to send a copy of the wider report to members of the Committee. She pointed out that a new NHS dentist was opening up in Bicester in recognition of the commissioners need to address the lack NHS dentists within the county.

Councillor Lovatt expressed her appreciation to HWO for organising the pop-up shop in Abingdon which had attracted approximately 100 people, with no advertisement beforehand.  She also expressed her thanks for the work underway on the Musculo - Skeletal (MSK ) service and in respect of Wantage Community Hospital by both HWO and this Committee. She agreed that it was a success and added her aim to employ the use of pop-up shops on a wider basis in the future.

The Committee AGREED to thank Rosalind Pearce for the report and for her attendance.

11:50

The Chairman’s report is attached at JHO8. It includes an update on Health and Social Care liaison and the MSK Task Group.

The Committee AGREED to receive the Chairman’s Report (JHO8) which included updates on Health and Social Care liaison and the MSK Task Group.

12:00

With the recent reorganisation of the Oxfordshire Health & Wellbeing Board in mind, the Committee will ask the following:

·         how effective will the Board be to drive forward health, public health and social care integration?

·         Is there effective governance in place to deliver this?

·         How well is the Health and Wellbeing Board preparing Oxfordshire’s health and care system for greater integration?

A progress report is attached at JHO9.

Prior to consideration of this item and Item 11, the Committee was addressed by Councillor Cathy Augustine, Didcot Town Councillor and Oxfordshire delegate to the national Steering Group of the ‘Keep our NHS Public’ (KONP) campaign and County Councillor Jenny Hannaby.

Councillor Cathy Augustine stated that, in her view, despite the role of this Committee, unscrutinised change was happening now, at a pace, and without adequate public consultation. It was her concern that this made evaluation and scrutiny of the bigger picture for Oxfordshire almost impossible. Instead, the focus was on a loss of services in specific localities, which in her view was an attempt to confuse and distract, without recognition of the cumulative and domino-effect across the county. She added that HOSC was set up as an independence voice and should decide on its own, independent agenda on behalf of patients and residents. It should not fall into line with those bodies it was scrutinising, particularly in three key areas, governance, transparency and consultation.

She expressed her concerns that, in her view, the Health & Wellbeing Board papers contained ‘opaque layers’, which indicated a policy of secrecy behind closed doors, which, in turn made it closed to scrutiny by this Committee. For example, there was alarm that the Integrated System Delivery Board (ISDB), which was the main driver behind the proposed Integrated Care System (ICS), was buried deep within the structure, and, virtually invisible from the scrutiny by elected representatives. Meetings which, in her view determined policy, were in closed session with no public minutes being produced, and there was no democratically elected representative serving on it.

She therefore asked the Committee to examine and challenge this ‘flawed’ governance proposal.

Cllr Jenny Hannaby shared the concerns expressed by the previous speaker in relation to the ISDB stating that there was a real danger of privatisation ‘coming through the back door’. She added that the Joint Management Groups who managed the pooled budgets, only met in public once a year. Transparency and openness was a requirement.

She added her hope that the Health & Wellbeing Board would listen to these concerns. She stated, however, that not all was bad - she was pleased that the Board would be working with the Growth Board in respect of the Healthy Towns initiative as working with the district councils was the way forward.

Dr Kiren Collison, Chair of the OCCG and Vice Chair of the Oxfordshire Health & Wellbeing Board, Kate Terroni, Director of Adult Social Care and Catherine Mountford, Director of Governance, OCCG

Dr Collison stated that this was a good opportunity to explain where the revisions to the Health & Wellbeing Board (HWB) had reached. As was recognised by the CQC last year, and also by the Board itself, the Board was not as valuable as it could have been. A full process review was then undertaken, which began with the engagement and discussion with a wide variety of stakeholders, including the voluntary sector, councillors and the Board members themselves about the way the Board  ...  view the full minutes text for item 60/18

12:30

This item provides a report (JHO10) on the key issues for the OCCG and outlines the current and upcoming areas of work, including an update on Cogges Surgery.

The Committee had before them a report (JHO10) on the key issues for the OCCG, which outlined the current and upcoming areas of work.

Louise Patten agreed to send to the Committee the draft pilot report following the revision of the CCG’s policy for working with the primary sector adoption. This involved a service review of the integrated respiratory partnership. She added that it would be helpful to see if the patient outcomes had been improved in relation to the management of long-term conditions. The Chairman requested that this be considered by this Committee before anything similar to this project is considered.

A member asked what the implications were when a private company was involved in the collection of data. She asked what was the governance around it, how it affected complaints and what would be the impact on health outcomes in the future. Louise Patten responded that much of this information was already included in CCG papers to the Board, provided by the providers, OUH, OH and the statutory voluntary organisations locally. Any issues around data was taken as part of the overarching description pack.

Dr Collison was asked about morale among staff in primary care. She stated that this was a national problem amongst the workforce. GPs were stretched, however certain conditions could now be allocated to nurses. In relation to waiting times for an appointment, not all data was collected in a coherent way. A large amount of work was being produced on the locality plan on this subject and it was thought that the reality wasn’t going to be as concerning as originally thought, particularly now that evening and week-end appointments were being offered to try to resolve the problem. It was important to distinguish between routine and urgent.  The Chairman reminded all that there would be an Agenda item on this subject in the near future.

Dr Collison and Louise Patten were thanked for the report and for their attendance.

12:40

The Committee will receive an update (JHO11) from the Oxfordshire Clinical Commissioning Group and Oxford Health Foundation Trust following the recommendations put forward at the last meeting on 20 September (Minute 47/18 refers), including proposals for the resumption of services and any necessary consultation on services at Wantage Community Hospital.

Two reports are attached entitled ‘Planning for Future Population Health and Care Needs’ and ‘Planning for Population Needs – Wantage’ (JHO11).

Prior to consideration of this item the Committee was addressed by Maggie Swain (Save Wantage Hospital Campaign Group), Councillor Cathy Augustine and Councillor Jenny Hannaby, Local Member.

Maggie Swain

Maggie Swain made the following points:

·         She was a ‘passionate advocate’ of the Hospital as a result of her mother’s past employment there and also in her own capacity as a volunteer up until the time of its temporary closure. Once her mother had become ill she had attended the hospital for regular respite;

·         The campaign group agreed with the future plans by the OCCG to restore the overnight beds, which it was understood were linked directly with the pipework, but there were other facilities that could be restored without the need for the pipework to be done;

·         In recent years it was the view of the campaign group that there had been a gradual decline in the services provides. These were the removal of X ray, the stoppage of clinics such as Ear, Nose and Throat and of Physiotherapy without consultation, and the temporary closure of the Minor Injuries Unit;

·         Besides Grove, there were at least 18 villages/hamlets within a 5 mile radius, most of which had no services or transport; and there was a reliance on Wantage for them. For someone living in Letcombe Basset without transport;

·         Since the Hospital’s temporary closure in July 2016, money had been spent on the following, none of which had been of any help to the people of Wantage:

-       Securing the building due to the loss of 24 hour cover with the closure of the beds;

-       Moving Physiotherapy into the main area of the hospital, then closing it;

-       Provision of security guards to protect the building; and

-       The conversion of rooms to accommodate NHS staff that had been moved out of the Mably Way Health Centre;

In conclusion, Maggie Swain commented that the Campaign Group were aware that the OCCG had opened a dialogue with the residents of Wantage, but it appeared that nothing would be decided for a further year. This was ‘totally unacceptable’ as this meant the Hospital would have been temporarily closed for nearly 3 and a half years. There was uncertainty whether there would be a slippage again or even cancellation. A way of gaining trust was to reinstate a service which had been lost.

Councillor Cathy Augustine spoke of her concerns that Phase 1 of the ‘Big Health and Social Care’ conversation spoke to only 900 people in total, across the whole of Oxfordshire, which amounted to less than 0.5% of the population. In addition, only 46 people responded to the South West Oxfordshire Locality Plan Survey and 4 in Didcot. As a result, Ed Vaizey, MP for Wantage and Didcot also raised a concern in Parliament about the lack of consultation.

She called for the Committee to exercise its powers of independent oversight and scrutiny to challenge NHS England on the imminent Integrated Care Service on the grounds that there may be potential  ...  view the full minutes text for item 62/18