Agenda and minutes

Councillor Charles Shouler attended for Councillor Timothy Hallchurch and apologies were received from Mrs Anne Wilkinson and Councillors Jane Hanna and Dr Peter Skolar

There were no declarations of interest

To approve the minutes of the meeting held on 11 November 2010 (JH03) and to note for information any matters arising on them.

The Minutes of the meeting held on 11 November 2010 were approved and signed subject to the following amendments to Item 9, “The Future of the Link Contract”;

Lisa Gregory reported that Legal & Governance Services had advised that it would be deemed unlawful if the support for LINk was to be brought ‘in-house’ (within Social & Community Services).

Following discussion it was AGREED that the contract with Help & Care should not be extended and should be put out to tender once the funding situation was known.

There were no requests to speak to the Committee or to present petitions

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

The Director of Public Health reported on the flu situation in Oxfordshire. Flu cases, he stated, are running at normal seasonal levels in Oxfordshire and below national levels in the South East generally. Unusually, with the present outbreak younger people seem to be affected most. There are plenty of anti-virals and vaccine available in the County.

In answer to a question from the Acting Chairman, the Director of Public Health stated that flu was not causing any particular winter pressures.

The Chairman of the PCT, Fred Hucker, Sonia Mills, the Chief Executive and Jonathan McWilliam, Director of Public Health, will brief the Committee on the latest developments in relation to the restructuring of NHS services in Oxfordshire. John Jackson, Director for Social and Community Services and Nick Welch, Head of Major Programmes for Social and Community Services will also attend for this item.

The purpose of this item is to help members understand the latest developments in the restructuring of local NHS services including the possible implications of “clustering” Oxfordshire PCT with Buckinghamshire and Milton Keynes PCTs (the latter may be moved to a different cluster).

The Chairman and Chief Executive of the PCT were joined by the Director of Public Health and the Head of Major Projects from the County Council to bring the Committee up to date on the latest position with regard to the restructuring of the local NHS and other matters.

The PCT Chairman emphasised the fact that, whatever is happening in changes to the local health economy, the PCT will remain accountable for commissioning quality services until April 2013. There are three main tasks at present:

i           Managing the local health economy – i.e. the “day job”

ii          Developing the Oxfordshire GP consortium

iii         Creating the “cluster” authority with Buckinghamshire as required by he Department of Health

The Chief Executive expanded on these comments as follows:

GP Consortium

Following a report at the last HOSC meeting the GPs choice to create one countywide Consortium has now been confirmed with strong localities as a significant component. Six or seven localities will have devolved budgets within the Consortium with leaders appointed at locality level who would sit on the Consortium Board.

£2.5m will be available to the Consortium for 2011/12 to pay for additional running costs for the Consortium to develop its delivery capacity.  This reflects the £2 per head required to be allocated as per the NHS Operating Framework which also indicated a financial figure for Consortium of £25 – £35 per head when fully established, but this would include all running costs including, for example, leases and external contracts.

The Consortium will have to deliver national priorities. How delivery takes place will be decided by the locality groups and patients should have an input into those decisions.

It is planned that the consortium will develop into its form during 2011/12 and run in shadow during 2012/13 and will formally come into being from April 2013 when PCTs finally are abolished as the statutory base. The launch of the Consortium, its plans and work plan is scheduled for 27 January at the Kassam Stadium. All GPs in Oxfordshire are invited, together with relevant external bodies. The HOSC Acting Chairman will be attending the launch.

PCT Consortium Transfer of Responsibilities

The Consortium will have to take on the work programme of the PCT related to the national funding position and the need for service redesign to release resources to fund emerging and new priorities.  Consequently, the internal structure of the PCT is changing to reflect this merging of work functions as GPs become increasingly engaged in the mainstream PCT objectives.  The PCT will also be seconding staff to work directly as Consortium staff to speed up the transition and involvement, particularly in the £35m savings programme the PCT has to achieve in 2011/12.

Everything must be done against the background of a reducing budget.

PCT Clustering Arrangements

The clustering in this part of South Central will be Oxfordshire, Buckinghamshire and Milton Keynes [Note: this has subsequently been changed to Oxfordshire and Buckinghamshire only] and there will be Chief Executive and Executive Team appointments  ...  view the full minutes text for item 6/11

A review of paediatric cardiac surgical services in England began in 2008 in response to long-standing concerns around the sustainability of the current service configuration. It was considered that surgeons were spread too thinly across surgical centres (31 congenital cardiac surgeons spread over 11 surgical centres), leading to concerns around lack of 24/7 cover in smaller centres and the potential for sudden closure or suspension of smaller centres.

The review is being led by the National Specialised Commissioning Team (NSC Team) on behalf of the 10 Specialised Commissioning Groups (SCGs) in England and their constituent Primary Care Trusts. It was planned that proposals for change should go to public consultation in 2011. However, in October 2010 it was decided that the eventual options for reconfiguration to be put out for public consultation would not include the children’s heart surgery service at the John Radcliffe Hospital.

However, at the same time, the Trust was told that “not being included in options for consultation does not mean that the JCPCT [Joint Committee of Primary Care Trusts] has made any decision about the future of the service at the John Radcliffe Hospital.

The purpose of this item will be to broaden understanding of this issue and how the John Radcliffe Hospital could be included in the future consultation on changes to the service. Also, to hear from the Oxford Radcliffe Hospitals NHS Trust about the development of a proposal to establish an integrated service with Southampton University Hospitals NHS Trust that would enable a robust paediatric cardiac service to be provided at Oxford.

Speakers will include representatives of the ORH Trust; the Director for the NSC Team “Safe and Sustainable Services” programme and representatives of the “Young Hearts” a local charity that supports children with heart disease and their families.

The following papers are attached:

A letter from the Chair of the Joint Committee of Primary Care Trusts to the Chief Executive of the Oxford Radcliffe Hospitals NHS Trust

A letter from the Chairman of the HOSC to the Secretary of State for Health

The reply from the Secretary of State

Young Hearts briefing to MPs

A review of paediatric cardiac surgical services in England began in 2008 in response to long-standing concerns around the sustainability of the current service configuration for paediatric cardiac services. It was planned that proposals for change should go to public consultation in 2011. However, in October 2010 it was announced that the Joint Committee of Primary Care Trusts(JCPCT) would be advised that eventual options for reconfiguration to be put out for public consultation would not include the children’s heart surgery service at the John Radcliffe Hospital. At the same time, the Trust was told that “not being included in options for consultation does not mean that the JCPCT has made any decision about the future of the service at the John Radcliffe Hospital”.

Members wishes to address the apparent inconsistencies around consultation and to ascertain what the future consultation arrangements would be. The following speakers attended:

Jeremy Glyde – NHS Specialised Services Programme Director

Simon Jupp – South Central Specialised Services Director

Andrew Stevens – Director of Planning and Information at the Oxford Radcliffe Hospitals Trust

Dr Nick Archer – Lead Paediatric Cardiologist at the Oxford Radcliffe Hospitals Trust

Caroline Langridge }

Kim Holmwood } Young Hearts

Jude Kelly }

Jeremy Glyde started the discussion by explaining some of the background to the review and the decision to exclude the Oxford Radcliffe Hospitals Trust from the consultation.

There are long held concerns about the safety and sustainability of paediatric cardiac surgical services. It was considered that surgeons were spread too thinly across surgical centres (31 congenital cardiac surgeons spread over 11 surgical centres), leading to concerns around lack of 24/7 cover in smaller centres and the potential for sudden closure or suspension of smaller centres. The long-term aim would be to:

1.      Reduce the number of centres

2.      Implement new quality standards

3.      Develop new cardiac networks

The review is being led by the National Specialised Commissioning Team (NSC Team) on behalf of the 10 Specialised Commissioning Groups (SCGs) in England and their constituent Primary Care Trusts.

No paediatric centres would be closed but some would lose specific functions such as surgery. If surgery were to be removed from Oxford, it is proposed that all other core non-interventional paediatric services would be retained. A key standard for future viability is that a surgical centre must undertake a minimum of 400 paediatric surgical procedures a year and have a minimum of 4 surgeons co-located on the same site. The review team will recommend to the JCPCT that the ORH Trust is unlikely to be able to meet these and other standards based on an assessment of the John Radcliffe (and all other surgical units) by an independent panel of experts led by Professor Sir Ian Kennedy. As only viable options can be put forward for consultation, it will be recommended to the JCPCT that the inclusion of the John Radcliffe in any option would make that option un-viable. Mr Glyde further explained that nothwithstanding the  concerns about the Trust’s  ...  view the full minutes text for item 7/11

In May 2010 the HOSC considered proposals from the PCT to recommission day services provided by voluntary and community services for adults over the age of 18 who have mental health problems. Following that a working group was formed to work with the PCT commissioners to ensure that; the outcomes of the process led to a service that maintained equity of access to high quality services; the process was transparent throughout; and that there would be a clear and effective transition process.

The tendering process has now been completed with HOSC members observing the work of the implementation group. 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 and explain the outcome of the recommissioning process and the transitional plans. A paper which has been prepared by Ian Bottomley is attached.

Fenella Trevillion and Ian Bottomley from the PCT; Benedict Lee of Restore and Stuart Reid from Oxfordshire Mind attended for this item to explain the outcome of the tendering process for day services provided by voluntary and community services for adults over the age of 18 who have mental health problems and the transition plan for implementing the new services.

It was explained that the new service would be very different from what exists at present. The service will be divided into wellbeing and recovery services. All patients will have a long-term plan that will be subject to regular review. Places will be available in the wellbeing service for everybody who needs it and, while referral to the recovery service will not be possible for all, the option for referral will always be kept under consideration.

There will be an increased spread of services across the County than at present although that will mean fewer places will be available in the City. However, the aim would be for more services to be available locally, for example in Banbury, thus reducing the need for people to come into Oxford.

The experience that has been built up in the City will be used to help the service reach out to BME communities.

Dr Dickinson, who had represented the HOSC as an observer of the preparation of the specification and tender, considered that it had been a good process with a satisfactory outcome.

Members congratulated the PCT on the process and expressed satisfaction with the outcome and the transition plan. The Committee would be pleased to receive a progress report in 12 months time.

The latest Oxfordshire LINk newsletter is attached. LINk representatives will be available at the meeting to answer member’s questions if required.

Dermot Roaf reported that the County Council plans to tender the service with the intention of appointing the new host by May 1^st to run until the implementation of Health Watch. Funding will be less than now and it is not known at present what funding will be available for Health Watch.

There are two main projects being undertaken at present; one relating to care homes and the other, being undertaken on LINk’s behalf by the Patients’ Voices group, on hospital food.

Mary Judge reported on the care homes project. A random selection of 31 homes across Oxfordshire will be visited and reports made on each of them. The group will produce a report that will be made available to the HOSC.

The Committee thanked Mr Roaf and Mrs Judge for their contribution and stated that they look forward to viewing the report on care homes.

The Chairman will report on meetings that he has attended and issues that have arisen since the last meeting.

There was nothing to report that had not already been touched on in other agenda items.