Agenda and minutes

Councillor Dr Peter Skolar was elected Chairman and Councillor Susanna Pressel was elected Deputy Chairman, for the 2010/11 Council Year.

There were no Apologies for Absence and Temporary Appointments. Councillor Alan Davies, West Oxfordshire District Council, was present as an observer, Councillor Richard Langridge having submitted his resignation by virtue of his appointment to the Cabinet of West Oxfordshire District Council and there being no replacement appointment for him as yet.

The Committee congratulated Councillor Langridge on his appointment and thanked Councillor Langridge both for his very active and valued service on the Committee and in his capacity as Deputy Chairman for the previous two years.

Councillor Jane Hanna declared a prejudicial interest in Agenda Item 8 by virtue of her partner being a Finance Director of one of the voluntary bodies affected by the proposals. She remained in the room in order to make a statement relating to the proposals being scrutinised and then left for the duration of the discussion.

Dr Harry Dickinson declared a personal interest in Agenda Item 8 by virtue of him being Chairman of ‘Mental Health Matters’, a charitable organisation.

Councillor Jane Hanna declared a personal interest in Agenda Item 10 by virtue of her being Director of ‘Epilepsy Bereaved’, a charitable organisation.

To approve the minutes of the meeting held on 11 March 2010 (JHO3) and to note for information any matters arising on them.

The Minutes of the meeting held on 11 March 2010 were approved and signed as a correct record.

Matters Arising

Minute 19/10 – Public Health – Immunisation Targets - in response to a question as to whether Public Health had reached a 100% target in respect of immunisation targets for killer diseases, Dr Habibula commented that the department had reached all of its targets for this area, but that 100% was ‘almost impossible’. Dr McWilliam added that compared with other counties, Oxfordshire was performing well and that more stringent targets were planned for next year.

Minute 19/10 – Public Health – Screening for Bowel Cancer – In response to a request for an update on the bowel cancer screening programme, Dr Habibula reported that the programme had been rolled out from 26 April to the whole of Oxfordshire. Uptake had been quite slow at this stage with 8,300 invitations having been sent to date, with an uptake of 3,200. However, it was very early in the programme and the Department were planning an extensive planning campaign to raise awareness and improve the uptake.

Minute 20/10 - Oxford Drug Rehabilitation Project – Recommendation (b) – Mr Edwards reported that a letter had been sent to Oxfordshire PCT and the DAAT and that they had confirmed that the re - provision was to proceed. Members asked that they be kept informed of progress at each meeting until the matter has been resolved.

The Chairman had agreed to the following people speaking to the Committee:

• Jacquie Pearce-Gervis representing ‘Patient Voice’ (a patient involvement body focussed on the Oxford Radcliffe Hospitals NHS Trust) (Agenda Items 5 & 9);

• Councillor Jane Hanna (Agenda Item 8);

• Dr Peter Agulnik representing a group of voluntary sector organisations (Agenda Item 8);

• Councillor Hilary Biles (Agenda Item 9);

• Dr Nixon, senior partner, Shipton under Wychwood Surgery (Agenda Item 9);

• Mrs Catherine Hitchins, spokesperson for the Patient Involvement Group, Shipton under Wychwood Surgery (Agenda Item 9);

• Councillor Larry Sanders (Agenda Item 12).

At this juncture Jacquie Pearce-Gervis addressed the Committee raising the following points:

• She informed the Committee that Patient Voice had been commissioned by the Oxfordshire LINk to carry out a survey of discharge procedures. To date they had received 42 responses, but would like more. She appealed to the Committee to encourage their constituents to support the survey as the delays were causing concern. Their findings were to be presented to the LINk on 24 June;
• With regard to Agenda Item 12, Oxford City Community Hospital, she commented that Patient Voice were concerned that the present accommodation was adequate, but rather ‘squashed’ and urged Community Hospital Oxfordshire and Oxfordshire Radcliffe Hospitals Trust to proceed towards a final proposal as soon as possible.

10.15 am

To date, no items have been received.

Adrian Chant, Oxfordshire LINk Locality Manager, together with two members of the Stewardship Group, Alderman Dermot Roaf and Richard Lohman, gave an update on recent Oxfordshire LINk activities. They reported as follows:

• The LINk had commissioned ‘Patient Voice’ to conduct a survey of discharge procedures at the John Radcliffe, the Horton and at the Churchill Hospitals (see Agenda Item 5 above) . A full report was expected by 24 June 2010;
• The recommendations emanating from the ‘Hearsay’ event planning process were currently being prioritised. The majority of the work concerned Social & Community Services and a report would be submitted to the Adult Services Scrutiny Committee on 6 June 2010. This could lead to a further event next year;
• In the meantime other projects in their programme were underway;

Richard Lohman, on behalf of the Oxford Drugs Rehabilitation Project, thanked the Committee for the letter which was sent to DAAT and to the PCT, as set out in Minute 20/10 of the last meeting. However he pointed out that the question relating to the lack of public consultation on the closure had not been addressed by the Committee. He added that Andrew Smith MP had written to the PCT to ask if consultation had taken place and they had responded that it was not justified because the Unit only treated 15 – 20 people per annum. It was AGREED that Roger Edwards be asked to write to Oxfordshire PCT requesting confirmation that the Unit would re-open by October of this year.

The LINk were asked  to give Roger Edwards and Julie Dean early notice of the items to be discussed in their regular slot on the agenda, so that the appropriate Health officials could be invited to respond to the matters raised.

10.30 am

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

Dr McWilliam brought the following topics for information:

• Vulnerable groups within Oxfordshire – Health Services for the Armed Forces and their families

Officers were meeting with families, identifying any vulnerable groups, such as those needing dental care, those with post natal depression etc. He undertook to request one of his deputies, Jackie Wilderspin, to brief the Committee further on this liaison work;

• Cleanliness of Oxfordshire’s Community Hospitals

The Care Quality Commission had carried out an unannounced visit to Witney, Wallingford and Abingdon Community Hospitals on 19 May 2010 and had found that there were no breaches of standards. Apart from very minor improvements required, all the hospitals had been given a clean bill of health;

• Preview of the Director of Public Health’s Annual Report – the following issues would receive prominence within this year’s report:

-                      Alcohol Abuse;

-                      Work in progress between the Armed Forces on Oxfordshire and the Health & Well-Being Liaison Committee;

-                      Diabetes.

Dr McWilliam was thanked for his report.

10.45 am

Fenella Trevillion, Head of Joint Commissioning for Mental Health, Oxfordshire Primary Care Trust, Ian Bottomley, Service Development Manager – Mental Health and Dennis Preece, Chairman – Mental Health Commissioning Programme Board will attend for this item. They will present plans to re-commission day services provided by voluntary and community services for adults over the age of 18 who have mental health problems. A paper which has been prepared by Ian Bottomley is attached at JHO8.

Prior to consideration of this item, the Committee were addressed by Councillor Jane Hanna and by Dr Agulnic. They each made the following points:

Councillor Hanna

• She spent four years as mental health lead during the course of her duty as non-executive director of one of the Oxfordshire PCT’s. During this time she endeavoured to accrue as  much information as possible on this highly vulnerable group of society;
• This Committee had a reputation for very careful scrutiny and she therefore hoped that its members would ensure that they were fully informed about the outcomes of service change for future and existing service users, when financial details were known;
• It was difficult to take a view at this time because there was an absence of key information in the form of the value of contracts going forward. It was understood that the specification for service suppliers was to be approved on 13 May;
• She hoped that an evaluation of the existing services would take place and that this would be an independent evaluation.;
• Much of the voluntary sector requires statutory funding;  and
• A timeline with regard to the management of this process would be useful.

(Councillor Hanna left the room at this point for the duration of the consideration of this item)

Dr Agulnic (accompanied by Patrick Taylor, Chief Executive, MIND and Benedict Leigh, Director of Oxfordshire RESTORE)

• Was a retired psychiatrist who had worked for the Trust for 32 years, based at Littlemore Hospital;
• He had had a keen interest and involvement within the voluntary sector and  had worked to represent some of the organisations listed on page 13 of the report;
• The county’s voluntary services were lead agencies of a very high quality comprising models of good practice and innovation;
• Particular applications, such as day services which promote recovery and rehabilitation should be regarded as front line services as they have to meet some exacting standards of governance;
• A critical mass of core activity was maintained to meet objectives. Thus, small cuts in funding would threaten the survival of the organisation as a whole or, at best, would take years to repair;
• The above would put increased breakdown pressure on an already stressed service. It would serve to prolong illness, which would result in increased costs to the NHS service;
• A feature of Oxfordshire was close, collaborative working of which there was a strong voluntary contribution;
• He urged the Committee to support at least the maintenance of the current level of voluntary service.

Patrick Taylor and Benedict Leigh were invited to comment. Patrick Taylor commented that he had found the tendering process talks encouraging and that the current services were valued. Benedict Leigh added that one of the aims of his organisation was to help people back into employment, which ultimately saved the Government money. Any cuts would result in a small saving, but the long term implications would be dire.

In response to a question asking what the £2m funding was spent on, Mr Taylor referred  ...  view the full minutes text for item 32/10

11.30 am

Alan Webb, PCT Director of Service Redesign, and Ginny Hope, Head of Primary Care Contracted Services will present a paper on PCT commissioning intentions for pharmaceutical services and the revised Control of Entry Regulations process which PCT’s are required to apply to new applications to open a new pharmacy in the PCT area. A paper which has been prepared for the Committee by Ginny Hope and Alan Webb is attached for information at JHO9.

The Chairman invited Jean Nunn Price and Mary Judge up to the table to comment on behalf of Oxfordshire LINk. Jean Nunn Price reassured the Committee that the LINk continued to challenge the PCT, where appropriate, with regard to the proposals. Indeed, both herself and Mary Judge had been involved in service changes over the last two years which had included carrying out a Pharmacy Survey (which had been presented to this Committee by the PCT’s Patient & Public Involvement Group) and sitting on a PNA Steering Group where challenges had been made on quantity outcomes, equity of location, opening times etc. Mary Judge commented that one of the issues from the survey had been the need for patients to have the appropriate facilities with which to discuss their needs privately.

Ginny Hope, Head of Primary Care Contracted Services, Oxfordshire PCT , introduced the paper (JHO9)  on PCT commissioning intentions for pharmaceutical services and the revised Control of Entry Regulations process, which PCTs were required to apply to new applications when opening a new pharmacy. A consultation on the Pharmaceutical Needs Assessment was required prior to submission to the Board.  The Committee were asked if they found the consultation process acceptable.

Prior to discussion on the above the Chairman invited Councillor Hilary Biles, local member for Chipping Norton, Dr Ahmed, Pharmacist, Shipton under Wychwood GP Surgery, Catherine Hitchins, spokesperson for the surgery’s Patient Involvement Group and Dr Nixon, senior GP partner, Shipton under Wychwood Surgery, up to the table. At the same time he advised that it was not within the remit for the Committee to be involved in individual applications for the development of new pharmacies, it being more strategic in nature. However, whilst the matter was not directly within the Committee’s sphere of activity, the PCT representatives had been advised that it may be raised at this meeting as an example of the complexities of planning pharmacy provision. It related to a recent decision of the PCT to give permission for the development of a new pharmacy in Shipton under Wychwood. At present, there was no pharmacy in the area, but the local GP surgery contained a dispensary. If the pharmacy were to be opened the, under current regulations relating to dispensing in rural areas, the surgery would lose the right to provide medicines to patients living within a 1.6km radius of the new pharmacy. They would still be able to dispense to any patients who were deemed to be in a rural area outside of the 1.6 km radius of the pharmacy. In this context the concept of a ‘rural area’ is one that has a population within 1 mile of the pharmacy amounting to more than 2750 people. Below 2750 was considered to be a ‘reserved area’ and the 1.6km regulation did not apply. The population of Shipton under Wychwood was 2,796.

Councillor Hilary Biles made the following points:

• The application affected 5k patients in what was a rural area;
• The PCTs decision  ...  view the full minutes text for item 33/10

12.15 pm

This item is an update on progress in improving services for people who are suffering from neurological conditions. It follows on from a discussion at the 16 July 2009 meeting (Minute 42/09 refers). Speakers attending the meeting will include Philippa Muir, Head of Specialist Commissioning and Clinical Networks; Sue Barnden, Service Development Manager and concerned members of the public. A ‘Health Needs Assessment for Long Term Neurological Conditions’ report which has been prepared for the Oxfordshire PCT Board is attached for the Committee’s attention at JHO10, together with a briefing for the Committee prepared by Philippa Muir and Sue Barnden.

Prior to the question and answer session with the invitees, namely Philippa Muir, Head of Specialist Commissioning and Clinical  Networks, Alan Webb, Director of Service Redesign, and Sue Barnden, Service Development Manager, Oxfordshire PCT; and Dennis Morgan, Chair, Oxford Neurological Alliance, members of the Committee were addressed by Mrs Dickinson, mother of John Dickinson, who had made representations to the Committee on 16 July 2009 (Minute 42/09 refers) about alleged deficiencies in the service given in Oxfordshire Health services.

Mrs Dickinson informed the Committee that since July 2009, her son’s treatment had not improved. She informed the Committee of a number of problems her son had encountered with the service and that they had lodged a formal complaint against the PCT and the ORH alleging a lack of leadership from within the Department, a lack of support staff and that the wrong drug had been used during a Drug Challenge test. She summed up by stating the following:

-                      Despite reviews of the service extending over two years, there was still no specialised Parkinson’s Disease nurse working exclusively for patients in the South and West Oxfordshire area;

-                      The part-time nursing post had not been extended to a full-time post;

-                      It was good news that the PCT had given £145k of funding for the neurological services, but it has come 3 years too late for her son;

-                      Her son had been refused a refund for travel fares to London for his treatment;

-                      Her son had disassociated himself from the services offered by Oxfordshire NHS , believing them to be of no relevance to the most vulnerable people of Oxfordshire.

Alan Webb, Philippa Muir and Dennis Morgan were invited up to the table. They put forward the following views:

-                      The PCT were aware of the anxiety and distress caused to Mr Dickinson had suffered and his views on the services in Oxfordshire;

-                      Discussions had followed questions raised by Mrs Dickinson at PCT Board meetings and there had followed an independent review and conciliation process;

-                      New information had now been brought forward with regard to the Drug Challenge Test and the PCT was working with Mr and Mrs Dickinson on it. There had been some progress made to improve these services but there was a need to ensure that services were available to all patients;

-                      Part of the Health Needs Assessment was about learning how many people were in treatment. This had been complemented by a service review which had been delegated to representatives from Health & Social Care and the voluntary organisations to do. A draft copy of this review had been presented to the Neurological Group last week;

-                      Funding had now been directed to the treatment of existing services and also to the commissioning of new services;

-                      On 12 May, the Local Implementation Group (LIG) comprising users, carers, voluntary and charitable groups looked at the draft service review. This Group, would be considering each commissioning model in July;

-                      There would  ...  view the full minutes text for item 34/10

13.30 pm

Matthew Tait, Director of Finance, Oxfordshire PCT; Geoff Rowbotham, Chief Executive, Community Health Oxfordshire (CHO); and Julie Waldron, Chief Executive, Oxfordshire & Buckinghamshire Mental Health Foundation Trust (OBMHFT) will explain the situation with regard to a proposal to merge both organisations as part of the Transforming Community Services (TCS)  process.  A report prepared by Matthew Tait is attached at JHO11.

Matthew Tait, Director of Finance Oxfordshire PCT; Geoff Rowbotham, Chief Executive of Community Health Oxfordshire (CHO); and Julie Waldron, Chief Executive, Oxfordshire & Buckinghamshire Mental Health Care Financial Trust (OBMFT), attended the meeting in order to explain the situation with regard to a proposal to merge OBMFT and CHO as part of the Transforming Community Services (TCS) process. A report which had been prepared by Matthew Tait was before the Committee (JHO11).

Matthew Tait, Julie Waldron and Geoff Rowbotham all gave brief presentations on the paper.

Matthew Tait undertook to provide the Committee with a report, at the appropriate time, indicating whether the proposals would entail a major service change.

Matthew Tait was asked if CHO planned to involve the district councils in the creation of a Housing Programme. He was also asked what further action was required of the TCS process. He reported that currently they were still in the process of developing and reviewing where they wished to go in the future. To date they had seen effective engagement with OCC and the wider GP practices in relation to the prevention agenda. They now needed to go to the next stage, to the wider stakeholders to get further buy in.

Matthew Tait was also asked if he was expecting a similar thing to happen in Oxfordshire as had happened in London where the Secretary of State had halted the re-structure. He responded that Oxfordshire’s was a major reconfiguration programme, but that it was not yet at the stage where there was a need to consider the full vision – also whether there would be reconfiguration programmes in certain localities. He added that currently they were taking a general approach to enhance the community services close to home to enable secondary care services.

The Committee AGREED to:

(a)               thank Matthew Tait, Geoff Rowbotham and Julie Waldron for attending their attendance and for responding to members’ questions; and

(b)                request a further update on the situation in the new year.

14.15 pm

Jonathan Coombes, Geoff Rowbotham, Chief Executive of CHO and Moira Logie, Director of Operations, Division A, Oxfordshire Radcliffe Hospitals Trust, will give an update and respond to questions from the Committee on progress in developing the new Oxford City Community Hospital. A report which has been prepared by Jonathan Coombes, is attached, for information, at JHO12.

Prior to consideration of this item the Committee received an address by Councillor Larry Sanders, a local member. He stated that the following issues should be given consideration in relation to Ox Comm. These were:

-                      With regard to medical cover, the staff were concerned about the rapid re-tendering which was required. He added that if the outcome of this was to hire cheaper suppliers, there would be less expertise available, less time available and the service could be less conveniently situated;

-                      Assurances should be given that there would be good continuity of service into the community;

-                      The situation with regard to the premises appeared to have been solved with the signing of a 7 year contract. The staff did not feel that this was a perfect solution, but that it was manageable. He was aware that many places that were suggested were not manageable;

-                      He declared that he was not 100% clear with regard to the delivery of a full service to the population of Oxford when 21% of patients would be non Oxford citizens. This was not a small figure. He asked if the situation could continue to be reviewed;

-                      Most community hospitals had lovely, communal gardens, something this hospital did not have, being urban in nature; and

-                      He asked if somebody would take the lead in the setting up of a functioning friends/supporters group.

Geoff Rowbotham, Chief Executive of CHO, Jonathan Coombes, and Dr James Price, Lead for Gerontology, Oxfordshire Radcliffe Hospitals NHS Trust, attended the meeting in order to present the paper JHO12 and also to respond to any question the Committee may have had.

Geoff Rowbotham introduced the paper commenting that a number of colleagues and organisations, including local GPs and the Oxfordshire LINk had all played a part in the proposals.  They had challenged with three major questions:

-                      Would the quality of provision be improved, in light of the Oxcomm experience?

-                      Are 20 beds sufficient?

-                      Was there long term commitment to having a permanent community  hospital within the City?

He took each in turn, commenting as follows:

Quality of Provision

Very good feedback had been received from patients and other links. There had also been very good support from colleagues at the ORH. The scores had indicated that they considered the environment to be good. The quality would be judged on whether they would be successfully rehabilitating patients and were getting them home within a particular period. Over 95% were within the period set for them.

Is 20 beds sufficient?

This had been discussed within the paper. He stated that it was currently it was believed that 20 was sufficient. On the privacy issue, male and female wards had been separated.

Commitment to having a community hospital within Oxford City environs

It was believed that it was the right thing to do to commit to a 7 year contract for people in the City. With regard to the question about whether it was in  ...  view the full minutes text for item 36/10

14.45 pm

The Chairman will report on the following meetings he has attended:

-                      ‘Catch up’ meeting with representatives from Oxfordshire & Buckinghamshire Mental Health Care Foundation Trust;

-                      ‘Catch up’ meeting with representatives from Oxfordshire PCT;

-                      Meetings(s) relating to the Joint Review of the South Central Ambulance Service; and

-                      Better Healthcare Programme Board meeting.

The Committee noted reports given by the Chairman in relation to meetings attended with the following Health organisations:

-                      ‘Catch Up’ meeting with Sonia Mills, the new Chief Executive of Oxfordshire PCT and colleagues;

-                      Meetings relating to the Joint Review of the South Central Ambulance Service;

-                      Better Healthcare Programme Board meeting.

15.15 pm

No items have been received to date.

There were no matters shared under this item.

The meeting closed at 3.25 pm.