Agenda and minutes

Apologies were received from Councillor Dr Peter Skolar and from Mrs Anne Wilkinson.

There were no declarations of interest.

To approve the minutes of the meeting held on 19 November 2009 (JHO3) and to note for information any matters arising on them.

The Minutes of the last meeting held on 19 November 2009 were approved and signed.

There were no speakers or petitioners.

10.10 am

Attached at JHO5(a) is a report which has been prepared by LINk Drug Recovery Project (DRP)  group. One of the members of the group, Richard Lohman, together with Adrian Chant, will be available to answer any questions members may have.

A written update on the LINk’s latest activities is also attached at JHO5(b).

The Committee had before them a report (JHO5(a)) which had been prepared by a LINk Drug Recovery Project (DRP) group. Also before them was a written update on the LINKs latest activities (JHO5(b)). A member of the DRP project group, together with Adrian Chant, Locality Manager for the Oxfordshire LINk, were available to answer any questions from the Committee.

Members thanked Richard Lohman and Adrian Chant for attending the meeting.

The Committee AGREED to

(a)    thank the LINk for the update on their activities and for their very detailed DRP report; and

(b)    in view of concerns that there might be a major service change requiring full consultation,  to defer full consideration of the report until the next meeting of this Committee on 11 March 2010; and to request the PCT and Jo Melling, Director of the Drug and Alcohol Action Team, to prepare a report on the changes made to the service.

10.30 am

Report by the Director of Public Health on matters of relevance and interest.

Dr McWilliam introduced his deputy, Dr Shakiba Habibula to the meeting. He reported three areas of interest which had arisen since his last report:

• The Demographic Challenge – Some good work had been done by the Health & Well Being Partnership. Moreover a multi agency, Healthy Ageing Strategy would be produced by March this year which would give some guidance on how to prevent a problem if it should arise;
• A new Bowel Screening Service was due to start the following week at the Horton General Hospital. Eventually the service would roll out to the whole of the county and would have positive outcomes; and
• A new community breast feeding service had been started which aimed at getting more children breast fed within the more deprived communities.

There were no new major areas of concern which had arisen since the last meeting. However, he did raise the following, together with a request for vigilance on the part of the Committee:

• Unease with regard to funding for Public Health, both within this county and nationally, as part of the aim to reduce overall NHS management budgets by 30%;
• The major opposition draft political manifesto on Health issues aimed to turn the Department of Health into a Department of Public Health nationally. While that would not be a problem, it would be important to ensure that prevention continued to be moved further up the agenda.

There followed a discussion on the above issues, together with a question and answer session with regard to the following:

• The proposal by Surrey PCT to no longer treat people with morbid obesity;
• Proposal by Government for free care for older people in the future, together with the possibility of free domiciliary care;
• The ‘poor’ accommodation and staffing quota given to breast feeding clinics by the ORH in the John Radcliffe Hospital;
• The policing of the use of antiseptic gel at the John Radcliffe Hospital, despite MRSA rates falling within the count; and

The Director and Deputy Director of Public Health were thanked for their valuable input to the meeting.

It was AGREED that Councillor Couchman be invited to the next meeting on 11 March 2010 to give an update on measures taken within Oxfordshire, post scrutiny review, to address the demographic challenge relating to older people.

10.45

At the November Oxfordshire Joint Health Overview & Scrutiny Committee (OJHOSC) meeting, members agreed the following:

‘The OJHOSC urges that discussions should continue with the Oxford Deanery aimed at achieving training accreditation for middle grade paediatric posts at the Horton General Hospital (HGH). The report from the Deanery visit to the HGH on 13 November should be made public as soon as possible.’

This referred to the Deanery visit, led by Mr Tony Jeferis, Acting Postgraduate Dean that evaluated the possibility of reinstating training accreditation for middle grade paediatricians.

The report has now been published and a copy is attached at JHO7. The outcome of the visit was that, due to insufficient workload, accreditation could not be given for training middle grade paediatricians. Mr Jeferis has agreed to attend the meeting in order to explain the reasons for that decision.

At the November meeting, the Committee had agreed the following:

‘The OJHOSC urges that discussions should continue with the Oxford Deanery aimed at achieving training accreditation for middle grade paediatric posts at the Horton General Hospital (HGH). He report from the Deanery visit to the HGH on 13 November should be made public as soon as possible’. This referred to the Deanery visit, led by Mr Tony Jefferis, Acting Postgraduate Dean, that evaluated the possibility of reinstating training accreditation for middle grade paediatricians.

The report had now been published and a copy was attached to the Agenda at JHO7. The outcome of the visit had been that, due to insufficient workload, accreditation could not be given for training middle grade paediatricians.

 Mr Jefferis had been invited, and had agreed, to attend this meeting in order to explain the reasons for that decision.

Mr Jefferis was invited by the Chairman to give a brief presentation of his report. Julia Cartwright, Chair, Community Partnership Forum and Andrew Stevens, ORH, were also invited up to the table with a view to forming a Panel, together with Mr Jefferis, to respond to questions from the Committee.

Members asked a number of questions, a selection of which are included below:

Q         How can the service be kept open?

R         (Mr Jefferis) There needs to be a radical rethink in the way in which the service is delivered. The world has changed since the European Working Directive was introduced in August 2009. Nobody wants their children to have a lesser service but nationally we are having  to adapt to a shrinking, not an expanding service. Training can be offered at the HGH during the working day but it is what is happening at night which is the problem. We would be able to pick up the little problems which occur, but we would not be in a position to solve them all.

We were asked if we could look at the Portland Hospital model and this we did. However, we had some misgivings about it as it is run as a fully serving procedure. Infrequent, emergency occurrences are dealt with on a case by case basis.

Q         Have you considered the implications for Maternity in relation to the distances for patient travel?

R         (Mr Jefferis) We did consider it, but in the report we focused on the training aspect of it.

(Julia Cartwright) In  the Portland model there is a 24/7 consultant delivered service in obstetrics and no middle grade tier. With regard to paediatrics in Banbury, we are continuing the dialogue with the Deanery. There is a need to be at the forefront with regard to training and a little creativity is needed on the part of the Deanery so that everybody can access the services.

Q         How can a hospital improve if there is not the appropriate training available?

R         (Andrew Stevens) There are a number of problems, one of the European Working Time Directive coupled with equality issues. A  ...  view the full minutes text for item 7/10

11.30 am

The purpose of this item is to report on progress by Oxfordshire Primary Care Trust (PCT) and the Oxford Radcliffe Hospitals NHS Trust (ORH) in developing and improving stroke care and prevention in Oxfordshire. A paper by Suzanne Jones, Senior Commissioning Manager, PCT; Dr James Kennedy, lead consultant for Stroke at the ORH and joint regional clinical lead for Stroke; and the PCT’s Development Manager for Stroke is attached at JHO8.

Members of the Committee welcomed Sylvie Thorn, Mary Barrett and Suzanne Jones, Oxfordshire PCT;  and Dr James Kennedy, Consultant in Stroke Medicine, Oxfordshire Radcliffe Hospitals NHS Trust to the meeting. They gave a presentation to the Committee and afterwards responded to questions. There follows a selection of those that were asked and the responses received:

Q         To have a stroke is a very frightening experience, what kind of information is available to patients and their families and friends afterwards?

R         (Sylvie Thorn) We have tried to address this by setting up a one year pilot scheme whereby a Stroke Co-ordinator is based at the ORH Stroke Unit. That person will work with the patients, on a face to face basis, who have been admitted. The Co-ordinator will give them the advice and information they require and signpost them to other services, if needed. S/he will also contact patients at home and signpost them back into services if this is so required.

Q         Will services such as physiotherapy and speech therapy be available for patients in their home?

R         (Suzanne Jones) The PCT has put in some investment into this service. They have concentrated on the acute side first, then it will be the turn of the rehabilitation side.

Q         Will everybody be called in for some kind of screening for stroke?

R         (James Kennedy)  We are not investing in it – there are no risk factors for stroke. Dr McWilliam and his deputy reported that currently there is in situ one clinic in Oxford City and two in Banbury who are offering the service for one year for targeted patients. We invited GP practices in the area to identify screened patients from the 43 – 47 age group, who might be offered intervention or treatment. The programme plan is to eventually expand across Oxfordshire.

Q         At what stage does the County Council’s Adult Services take over? How does funding work out with the PCT?

R         (Suzanne Jones) In respect of the first question, the decision is made on a clinical basis. When somebody has a long term care need, any decision is made by the people looking after that person. In respect of the funding, at the moment it is carried out via a handover from Health to Social Care. The Stroke Association have a return to work programme on the voluntary side.

Sylvia Thorn commented that funding goes through the normal process integrating the additional services that have been developed since the Strategy started. We use the grant to try to develop services. At the end of the pilot scheme.

James Kennedy further commented that the Strategy is the paradigm of necessity for Health and Social Care to work together. Formerly the intensive acute model could not be matched with social Care. Now we are trying to run with Social Care in at the beginning of the process in order to manage people’s expectations and in order to smooth out the pathway and make it seamless. Our job is  ...  view the full minutes text for item 8/10

12:15 pm

The Centre for Public Scrutiny (CfPS) announced in November 2009 a two year programme aimed at raising the profile of overview & scrutiny as a tool to promote community well-being and help councils and their partners to address health inequalities within their local communities. As part of this the CfPS sought applications from scrutiny committees seeking to become what are to be called ‘Scrutiny Development Areas (SDA’s)’. SDA’s would share learning with other scrutiny committees via ‘action learning meetings’ throughout 2010 and a national conference in 2011.

The chosen scrutiny committees would undertake a project during 2010 that would be used to form part of a national resource kit aimed at developing the role of overview and scrutiny in tackling health inequalities. They would be expected to use ‘innovative approaches to undertaking scrutiny reviews’ and to work in partnership with one or more district council scrutiny groups as well as other partners such as community groups and NHS colleagues. There would be only four of these across the country and each would receive a small amount of funding (up to £5,000) to help with the project.

The OJHOSC put in a bid to become an SDA, based around a project to review access to primary physical health care for people with mental health problems who find it more difficult to gain access to primary health services. This is compounded for people living in rural areas where access generally is more difficult. The project would seek to identify the evidence most relevant to developing future policy and action and attempt to describe how the evidence could be used to develop practical improvements that would reduce these health inequalities. Unfortunately the bid was rejected by the CfPS and members need to consider how to go ahead with this piece of work.

The Centre for Public Scrutiny (CfPS) had announced in November 2009 a two year programme aimed at raising the profile of overview & scrutiny as a tool to promote community well-being and help councils and their partners to address health inequalities within their local communities. As part of this the CfPS sought applications from scrutiny committees seeking to become what are to be called ‘Scrutiny Development Areas (SDA’s)’. SDA’s would share learning with other scrutiny committees via ‘action learning meetings’ throughout 2010 and a national conference would be held in 2011.

The chosen scrutiny committees would undertake a project during 2010 that would be used to form part of a national resource kit aimed at developing the role of overview and scrutiny in tackling health inequalities. They would be expected to use ‘innovative approaches to undertaking scrutiny reviews’ and to work in partnership with one or more district council scrutiny groups as well as other partners such as community groups and NHS colleagues. There would be only four of these across the country and each would receive a small amount of funding (up to £5,000) to help with the project.

The OJHOSC put in a bid to become an SDA, based around a project to review access to primary physical health care for people with mental health problems who find it more difficult to gain access to primary health services. This is compounded for people living in rural areas where access generally is more difficult. The project would seek to identify the evidence most relevant to developing future policy and action and attempt to describe how the evidence could be used to develop practical improvements that would reduce these health inequalities. Unfortunately the bid had been rejected by the CfPS and, as a consequence, members were asked to consider how to proceed with this piece of work.

Following a brief debate, it was AGREED to proceed with the project, on the terms expressed above, despite the bid having been unsuccessful and to convene a working group comprising Councillor Rose Stratford, Councillor Jenny Hannaby, Councillor Richard Langridge and Dr Harry Dickinson.

12.45

This joint review was instigated by this Committee following meetings with managers from SCAS. Members were concerned that the performance of the Trust was much worse in rural localities than in urban areas. This situation corresponded to that in other counties in the SCAS region and it was considered that it would be beneficial to undertake a joint project. Two select committee style sessions have taken place with a number of witnesses including members of the public, the Cabinet Member for Health from West Oxfordshire District Council, ambulance crew members, commissioners, first and co-responders, SCS managers and the Trust Board Chairman.

It is anticipated that a report will be available for public distribution shortly. When available, this will be circulated to members and added to the Committee’s agenda papers on the County Council’s website.

This joint review had been instigated by this Committee following meetings with managers from SCAS. Members had been concerned that the performance of the Trust was much worse in rural localities than in urban areas. This situation had corresponded to that in other counties in the SCAS region and it had been considered that it would be beneficial to undertake a joint project. Two select committee style sessions had taken place with a number of witnesses which had included some members of the public, the Cabinet Member for Health from West Oxfordshire District Council, ambulance crew members, commissioners, first and co-responders, SCS managers and the Trust Board Chairman.

It had been anticipated that a report would be available for public distribution prior to the meeting. Mr Edwards reported that unfortunately this had not proved possible. It was currently with stakeholders for factual checking. He added that there had already been a significant amount of public interest in it.

It was AGREED to note the report and to look forward to its consideration at a future meeting.

13.00

The joint OJHOSC/Children’s Services Scrutiny Committee Working Group was set up some months ago to examine progress on developing an improved strategy for reducing levels of teenage conception across Oxfordshire. The Working Group reviewed a joint County Council/PCT self assessment of progress and produced a number of recommendations for inclusion in the new strategy. These recommendations were all accepted, as can be seen in the attached letter (JHO11).

The strategy will be presented to the Children’s Trust Board in January. The Working Group plans to review progress nine months after the implementation of the strategy.

The joint OJHOSC/Children’s Services Scrutiny Committee Working Group had been set up some months ago to examine progress on developing an improved strategy for reducing levels of teenage conception across Oxfordshire. The Working Group had reviewed a joint County Council/PCT self assessment of progress and produced a number of recommendations for inclusion in the new strategy. These recommendations had all been accepted, as could be seen in the attached letter (JHO11).

It was noted that the strategy would be presented to the Children’s Trust Board in January. The Working Group planned to review progress nine months after the implementation of the strategy

13.15

• Report on an informal meeting with the Chief Executive and other senior managers of the Oxfordshire & Buckinghamshire Mental Health Foundation Trust (OBMHFT).
• Report on a recent meeting with PCT representatives on proposed changes to commissioning mental health services.

In the Chairman’s absence, Dr Dickinson reported on an informal meeting with the Chief Executive and other senior managers of the Oxfordshire & Buckinghamshire Mental Health Foundation Trust. The meeting was with regard to the reconfiguration of Mental Health day services provided by the voluntary sector. It had been decided to apply the ‘tool kit’ to determine whether the changes should be subject to full public consultation.

The report was noted.

13.25

No items have been received to date.

There were no information items shared.