Councillor Kieron Mallon attended for Councillor Simon Clarke and an apology had been received from Councillor Sean Gaul.

Dr Alan Cohen declared an interest in Agenda Item 7 on account of him being a trustee of Oxfordshire Mind.

To approve the minutes of the meeting held on 29 November 2018 (JHO3) and to receive information arising from them.

For ease of reference when considering the Matters Arising from the 29 November 2018 meeting, a list of actions is attached at JHO3.

The Minutes of the meeting held on 29 November 2018 were approved and signed as a correct record subject to the amendment of the phrase ‘If money was not a problem’ to ‘Had funding been available’ in Minute 57/18, page 6, paragraph 1, line 13 .

Matters Arising

With regard to Minute 57/18, page 6, paragraph 1, Sam Shepherd undertook to seek the result of the bid which had been submitted to provide additional capacity to support school health nurses in their ability to intervene and give them access to CAMHS, and to inform members accordingly.

The following requests to address the meeting had been agreed:

·         Didcot Town Councillor, Cathy Augustine, in relation to Agenda Items 5, 6, 8, and 10

·         Julie Mabberly, on behalf of ‘Save Wantage Hospital Campaign, in relation to Agenda Item 7

·         Maggie Swain, ‘Save Wantage Hospital Campaign’ – in relation to Agenda Item 7

·         County Councillor Jenny Hannaby, in relation to Agenda Items 7, 9 and 10

·         County Councillor Jane Hanna, in relation to Agenda Items 5, 7, 8, and 12

10:15

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

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

Prior to discussion at this item, the Committee was addressed by Didcot Town Councillor Cathy Augustine. Her view was that, in light of the new government guidance through the recently published national Long  -  Term Plan, and the introduction of new commissioning bodies, primary care networks and merged areas, there was a need for a new round of consultation to consider how it would affect Oxfordshire. She stated that its implementation would make the work of oversight and scrutiny more difficult for this Committee. Localised responses would be required. She added that no workforce planning had been included, leading to a risk that acute, short-term pressures would crowd out investment, which, in her view, was vital to putting local health services on a stable and sustainable footing. She urged the Committee to be aware of this bigger picture, as individual initiatives were scrutinised.

It was also her view that the effect of digital changes would be to reduce face to face primary care, threatening both the quality of care and continuity of care. It also went against the stated drive of the Oxfordshire long term plan to reduce inequalities.

With regard to primary care networks, she asked how would the growth of large primary care networks play out in rural Oxfordshire, where a lack of public transport impacted on the elderly, young families and those in poverty.

County Councillor Jane Hanna echoed Councillor Augustine’s fears concerning the uncertainties about the role of this Committee, resulting from health and care plans at a national and local level. She also expressed her concern that there may be nothing placed in the public domain, thus affording little opportunity for the public to have its say. She added that there were urgent workforce issues around work planning which would impact on the public in a most impactful way. She asked what plans did this Committee have to view the contingency planning which is taking place, in a timely manner?  Councillor Hanna gave the supply of medications as an example of an issue which related to the fundamental changes to the regulatory function, together with contingency planning for potential transfers away from doctors who were prescribing. She commented that in her view there was much to be said for the development of the role of pharmacy, in order to avoid mistakes being made, should events take place at great speed.

In response to the above, the Chairman commented that any transition was scrutinised readily by this Committee and it would continue to do so. He added that the long-term NHS Plan was to be covered by the Clinical Commissioning Group (CCG) at the Committee’s 4 April meeting

The Committee added the long-term NHS Plan to the Forward Plan, together with with an expanded Primary care item to cover the divide between primary care and community health services.

Actions included the following:

·         Committee training on the scrutiny of the integration of  ...  view the full minutes text for item 5/19

10:20

This item provides a report (JHO6) on the key issues for the CCG and will outline current and upcoming areas of work, including the presentation of the Primary Care decision tree. It will also include a verbal update from the Oxford University Hospitals NHS Foundation Trust (OUH) in response to the recent Care Quality Commission (CQC) inspection of operating theatres.

Prior to consideration of this item the Committee was addressed by Didcot Town Councillor Cathy Augustine. She asked the Committee to seek answers on how CCG’s would be affected by the national Long-Term Plan, which, in her view would give considerable powers to a newly created network of joint NHS England and NHS Improvement regional directorates who would report upwards. Alongside this new centralised structure, there would be 44 ‘Integrated Care Systems by April 2019. She asked how transparent and accountable would those new organisations be?  She also asked if, given that each Integrated Care System would be working towards an Integrated Provider Contract, CCGs would only be strategic and not possess commissioning powers? If so, who would have these powers and how would HOSC oversee this?

The Committee considered an update (JHO6) from the Clinical Commissioning Group (CCG) on key issues. It also outlined current and upcoming areas of work, including the work on the primary care decision tree. In addition, Sam Foster, Head Nurse, Oxford University Hospitals NHS Foundation Trust (OUH), attended to give a verbal summary of the action taken in response to a recent Care Quality Commission (CQC) inspection of operating theatres.

The Chairman invited Catherine Mountford, Director of Governance, CCG, Dr Kiren Collison, Clinical Chair, CCG and Sam Foster, Chief Nurse, OUH up to the table.

Catherine Mountford and Dr Collison presented the report JHO6. Catherine Mountford pointed out that, with regard to the GP Practices Procurement Decision Tree, work would continue with this Committee and the public framework as before, but it would also be widened to encompass changes if a contract came to an end. The framework highlighted significant public and patient engagement. The work on the framework with the Primary Care Commissioning Committee would be a very useful and the CCG would ensure that it be made very transparent. It had been tested against some historical decisions. Comments received would be recorded on the flip charts on the wall where the draft version of the decision tree had been placed. Once progressed to a sufficient stage the decision tree would then be digitally produced to make it more accessible. This would not mean it was a static document; it would continue to evolve as learning took place, but the CCG did not want to take the step of producing a digital document (with the time and expense involved), until there was a good level of confidence in the process set out.

Catherine Mountford and Dr Collison gave a brief overview of the vision and main themes of the Long - Term Plan which had been published at the beginning of January. They commented that the CCG was pleased to see how it aligned with the integration of services and how it also addressed health inequalities. Reassurance was given that the Oxfordshire Health system was looking to addressing it with the public via the Oxfordshire Health & Wellbeing Board and this Committee. Under the NHS Plan, the current statutory bodies would remain, together with  ...  view the full minutes text for item 6/19

10:50

The Committee will receive an update (JHO7) on progress in relation to the Review of Local Health Needs, including any possible revisions to condense the timescale for a decision, as requested at the last meeting.

Maggie Swain cited a research paper undertaken by the University of Birmingham entitled ‘Analysis of the profile, characteristics of patient experience and community value of community hopes’ 2019 which echoed the patient experience of those living in the OX12 area. In this document people had stated that it felt different to be a patient in a community hospital than elsewhere. This was due to the environment and the atmosphere. It had found that patients received a holistic and personalised approach to care, together with a different patient experience of staff care. She also referred to the Save Wantage Hospital Campaign’s Facebook request for accounts of patient experiences. A large response had emerged regarding the physiotherapy services provided by Healthshare, mainly focusing on travel difficulties for many patients journeying from Wantage to East Oxford and Bicester. She also highlighted problems experienced by patients leaving hospital being placed in care homes a long distance away from Wantage. She concluded by appealing to Health to carry out the repairs to Wantage Hospital so that people could receive their care in their own home town.

Julie Mabberly asked for an update on action in relation to the time frame presented by the CCG on Wantage Hospital at the September and November meetings of this Committee – and, furthermore, that it be presented in a professional manner. She circulated a chart which indicated that some of the promised actions were late. She stated that the campaign group had no confidence that the project would be brought to fruition. She also complained that the Terms of Reference for the project did not include representation from the Campaign Group.

Councillor Jenny Hannaby called for a wider vision to the project, to include all localities in the south of Oxfordshire. It was her view that the CCG was not progressing very quickly on the Wantage Hospital project. She pointed out that Wantage Hospital had not been included within the consultation under scrutiny at this meeting and this was not the correct manner in which to approach it, time had been lost. She urged the Committee to use its powers to refer the Wantage Hospital to the Secretary of State for Health.

Councillor Jane Hanna, commenting on this item and the next, made reference to the statement that there would be ‘a consistent approach to health care across Oxfordshire and wider innovative progress.’ She had found it difficult to see how the issue of governance and the experience of residents in the Wantage and Grove area connected with the work of the Integrated System Delivery Board (ISDB) and Government initiative. She asked where the funding would come from to fund a world class service, as expected. In her view, there was no transparency of funding contained within the local plan and decision making of the ISDB was not in the public domain. It demonstrated that local members had been excluded and not even given the opportunity to observe. She called for equity with health, and public scrutiny  ...  view the full minutes text for item 7/19

11:20

System leaders will provide a response to questions raised at the last meeting in relation to the Health & Wellbeing Board’s membership and its Integrated System Delivery Board (ISDB). The draft HWB Strategy is also attached for feedback (JHO8)

Prior to consideration of this item the Committee was addressed by Councillor Cathy Augustine. She thanked the Committee for challenging the lack of transparency and accountability of the Integrated Systems Delivery Board (ISDB), with some success. In terms of the Health & Wellbeing (HWB) Strategy, however, it was her view that consultation had been poorly publicised, causing participation to be low. She asked how input to the online survey was being encouraged and how could Didcot residents participate? Who has been invited to the stakeholder meeting on 28 February and could the list be shared?

Councillor Jane Hanna requested that the Committee take a further look at what was constitutionally commercial. It was her view that all was of a confidential nature, which was not in keeping with the openness and transparency which local government endeavoured to capture. She also spoke about the need for contingency planning in the face of Brexit and the possibility of losing care workers.

The Chairman welcomed Councillor Ian Hudspeth and Kate Terroni, OCC; Catherine Mountford and Dr Kiren Collison, OCCG, up to the table. He clarified that the Committee was interested in two particular areas,namely, the question of how many elected members were on the Health & Wellbeing Board and the openness of the ISDB.

Councillor Hudspeth stated that the consultation in relation to the Board’s membership began in November 2017. All were given the opportunity to put forward their views including the voluntary organisations of which there are 200 within the county, and providers also. It was felt that, in light of the new Long-Term Plan, the NHS needed to be in a position to influence local solutions. It was now felt that the Board had the appropriate balance of county/district councillors, NHS and OCC Chief Executives and the statutory representatives (eg. Directors of Adult Social Care, Public Health, Children’s Services, Chief Officer and Clinical Chair of CCG, Chair of Healthwatch Oxfordshire, etc).

Catherine Mountford reported that a paper would be taken to the 14 March Health & Wellbeing Board on the use of different approaches to engage public and wider stakeholders, particularly in relation to the HWB Strategy. Healthwatch had agreed to provide the support for the development of a Stakeholder Reference Group, using people previously involved in the preparation of the HWB Strategy and then widening it to include the social media and online tools etc.

Kate Terroni stated that following the last system review on 20 November 2017, consideration was given to where the’ engine’  to deliver the work of the HWB was to come from. The recent CQC inspection had then given the impetus to go ahead with this in the form of the Integrated Strategic Delivery Board (ISDB). She pointed out that this is not a decision - making group, nor is it in a position of authority. Its views are fed into the HWB, or the respective organisations such as the Cabinet or a Trust Board(s) for those to decide the way forward. She added that in light of  ...  view the full minutes text for item 8/19

11:50

System leaders will attend to give an update on progress on the CQC Action Plan, as determined by the second local area review (JHO9).

Prior to consideration of this item the Committee was addressed by Councillor Jenny Hannaby. She commented that she had been pleased that the CQC had recognised the work which had taken place on better working relationships with Health partners; and that it had been found that strategic development to be more robust in the usage of performance data. She suggested that this Committee should carry out an investigation into how far the voluntary sector would like more involvement/collaboration with the Health & Wellbeing Board, which could lead to better services. She also suggested that this Committee take steps to encourage more progress in relation to the recruitment challenge.

The Chairman welcomed Pete McGrane (Oxford Health), Sam Foster (OUH), Diane Hedges (OCCG) and Kate Terroni (OCC) up to the table.

Kate Terroni, in her introduction, stated that Oxfordshire was the only one chosen out of the three systems for the CQC to re-review. She observed that Councillor Hannaby had focused on the work which was still required as a result of the inspection. As an outcome of the re-review, the CQC had noted that:

-       More work had been put into building trust between health and social care and thought given to how both could work together better, in order to improve the outcomes for patients and their relatives;

-       Winter Planning had been executed well, bringing the delay statistics down from 81 to 60-80. More steps had been taken under a single leadership so that patients could leave hospital in a timely way;

-       More thinking was needed on how to move away from the transactional working relationship with the providers;

-       A comprehensive review of carers and self-funders was required; and

-       Sufficient progress had been made on the tracking of patients.

Sam Foster stated that co-location was an important factor in terms of patients being treated in a seamless fashion. For those patients on pathway 1 (happy to be alone in between visits, there were co-located teams which could be scaled up in a place – related approach (‘Home First’). A range of pilots were taking place around therapy support, which was being driven by the A & E Delivery Board.

Questions from the Committee and responses received were as follows:

-       Much time and effort has been put into filling the gap between services as best as possible, what actions have been employed to do this? – Kate Terroni listed a number of actions including:

·         Health/Adult Social Care Chief Executives had a call a week to discuss any operational issues;

·         ‘Oxfordshire Pound’ work by the provider Trusts within the community;

·         Single team working in the John Radcliffe Hospital. This was successful as it was place-based approach to regulation as it required a place-based approach to regulation, which, in turn, required collective ownership of people and a joined-up approach.

Kate Terroni reported that a conversation was required on how to work with districts, HOSC’s and the voluntary sector in the face of absence of a formal mandate from the Government.  ...  view the full minutes text for item 9/19

12:30

The final report from the Committee’s Task & Finish Group on Musculo – Skeletal (MSK) services will be presented (JHO10).

This will be jointly presented by the CCG and this Committee.

Prior to the consideration of this item the Committee was addressed by Town Councillor Cathy Augustine. She expressed her disappointment that after initially accepting the report, the CCG was now, in her view, distancing itself from parts of it. As a Didcot Town Councillor, she was concerned that the Didcot Physiotherapy Unit did not become over-stretched due to closures of similar units nearby, and also in terms of service levels and information provided. She added that patients were still reporting long waits and poor information. She concluded by stating that, as far as the residents of Didcot was concerned, this was not a task and finish group, but an ongoing issue.

Councillor Jenny Hannaby stated she had asked why services were not being brought back to Abingdon and Wantage. She reported that she had spoken to the Chief Executive of Oxford Health about Wantage Hospital not being allowed to take over facilities and he, as a result, contacted the CCG to offer the service at Wantage. Unfortunately, by this time, Healthshare had made other arrangements for the service to be provided at Faringdon. She hoped that Abingdon would receive the Service. Councillor Hannaby thanked the Committee for convening the Task & Finish Group, which in her view had opened the public’s eyes to the situation.

Sharon Barrington, Ally Green and Diane Hedges (CCG) and Rob Walker, Healthshare were invited up to the table.

Councillor Monica Lovatt, Chairman of the MSK Task & Finish Group introduced the report (JHO10) from the Group. She paid tribute to her fellow Group members, Councillor Laura Price, Dr Alan Cohen and policy officer Sam Shepherd for all their hard work. She emphasised that the report presented was the culmination of eight meetings which had taken place between June 2018 to January 2019, to hear the views of interested parties, in response to concerns raised to this Committee by residents and patients. She stated that the recommendations made by the Group had been designed to be constructive in nature. They were intended to support and encourage performance improvements and solutions where needed. On behalf of the Group, she thanked all the people who came forward to give their views and the following organisations for their openness and co-operation:

Healthshare (Oxfordshire), Healthwatch Oxfordshire, Oxfordshire Local Medical Committee, OUH and the clinicians who participated in the process, OH and OCC.

She commended the recommendations to the Committee.

Councillor Laura Price echoed all that Councillor Lovatt had said, stating also that the recommendations were not the end for this Committee. There had been some very serious performance issues contained within it and the Group now wanted to see some plans put in place to resolve these issues.

Dr Cohen echoed all that Councillors Lovatt and Price had stated commenting that the Group had thought hard on the performance issues and had found the lack of outcome data for Healthshare disappointing. The way identified information was being collected was incorrect.

Rob Walker stated that the findings of the Task & Finish  ...  view the full minutes text for item 10/19

13:10

Rosalind Pearce, Chief Executive Officer, Healthwatch Oxfordshire (HWO) will be present to report on the views gathered by HWO and its latest activities (JHO11) (to follow).

Rosalind Pearce attended for this item. She referred to the report (JHO11) which was on the Addenda for the meeting.

With regard to the Health Inequalities agenda, a member commented that she was pleased to see the information on outreach ESOL groups, asking if this would be written up? Rosalind Pearce responded that this would be pulled together in a report. It had been a steep learning curve as it was a question of finding ways to communicate and had taken a significant amount of time to build trust.  She added that HWO had been very pleased to undertake this project and the report would be made public after a few weeks.

Rosalind Pearce was thanked for the report and for her attendance.

13:20

The Chairman’s report is attached at JHO12. It includes updates on health and social care liaison and the Terms of Reference for the Wantage Community Hospital Task & Finish Group.

Prior to the consideration of this report, the Committee was addressed by Councillor Jane Hanna. She asked this Committee to consider a further step to build trust between the public and the CCG, the first being the request for Physiotherapy services to be provided at Wantage Hospital, to which assurances had now been given. The second related to the current proposals for two large GP practices to be provided This had raised concerns as the practices would have twelve thousand people on their books between them. She also asked for the words after ‘sufficient openness and transparency’ in paragraph 3:2, bullet point 3, of the Terms of Reference for the Task & Finish Group to be deleted. This would give an opportunity for the Group to consider addressing any contingency planning.

Councillor Alison Rooke moved, and Councillor Pressel seconded, a motion to amend the Terms of Reference to amend the membership to ‘two further Councillors and one local councillor for Wantage and Grove, providing they are not a member of the Stakeholder Reference Group.  This was AGREED unanimously.

A member highlighted the importance of clarity on the roles of the Task and Finish Group and the Stakeholder Reference Group. There was a need to ensure that this project had proper sponsorship. It was specifically a scrutiny task group set up from this Committee to ensure things happened. It’s role was not to run the project. The right governance was required to ensure the project was properly established.

It was AGREED to receive the Chairman’s report.