Agenda and minutes

Councillor Charles Shouler attended for Councillor Peter Skolar; Councillor Nick Carter attended for Councillor  Neil Owen; Councillor Melinda Tilley attended for Councillor Don Seale and District Councillor Alan Davies attended for District Councillor Hilary Fenton

There were no declarations of interest

To approve the minutes of the meeting held on 20 January 2011 and to note for information any matters arising from them (JHO3).

The Minutes of the meeting held on 20 January 2011 were approved and signed.

It was noted that the item on Paediatric Cardiac Surgery that had been scheduled to be discussed at this meeting would now be taken in May.

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

The regular report from the Director of Public Health on matters of relevance and interest.

The Director of Public Health reported on four main topics:

1                    NHS Health Checks – This is a national initiative that is being piloted in 12 wards in Oxfordshire before being rolled out to the whole of the County. Checks take place of blood pressure, weight, height etc. The tests were offered to 2,300 people and were taken up by 924. The plan will be to offer the check-ups to 190,00 people aged between 40 and 74 over a five year period at a cost of around about £45 per person.

2                    Family Intervention Project – A collaboration between the County, City and Cherwell Councils, the PCT, colleges and the police to reduce the number of times people have to provide information. 80 families have been worked with so far saving £80,000 per family over a period of years.

3                    Prevention Profile 2010 – Members were provided with a fact sheet providing information on nationally mandated preventative health services and interventions. There were five areas where Oxfordshire showed up as being “significantly worse than the England average”. The Director suggested that HOSC members might wish to consider two of these, Chlamydia screening and access to a genitourinary medicine (GUM) clinic, as items for scrutiny later in the year.

4                    PCT update on organisational change –

·        Oxfordshire and Buckinghamshire Health cluster – the joint Chief Executive is to be appointed on March 23^rd followed by the Director of Finance and then an new executive board.

·        The GP commissioning consortium for Oxfordshire (excluding Thame and Shrivenham) now exists and a leader will be appointed shortly.

·        Public Health will be coming across to the County Council in 2013.

·        Other PCT employees will “gravitate” to the cluster or to the consortium.

In answer to questions the following emerged:

1. NHS Health Checks were initially targeted at hard to reach groups in disadvantaged areas in Oxford and Banbury. They could be differently targeted in future, possibly at specific sections of the community. Negotiations on whether or not GPs will be remunerated for running the checks are ongoing.
2. Thame is not included in the Oxfordshire PCT consortium as it is part of the Buckinghamshire PCT area. This is a historical configuration brought about some years ago because GPs in and around Thame look towards Stoke Mandeville and Wycombe hospitals rather than Oxford. The consortium will continue to organise within present health boundaries rather the County boundary.
3. The £80,000 saving from the Family Intervention Project is a notional figure that will only be able to be made subject to review once the project has been working for a while.
4. The Prevention Profile provides information relating to the whole of Oxfordshire. The DoPH undertook to provide figures relating the District and City Council areas.
5. The formal structure of consortia and health and wellbeing boards have not yet been decided. It will be important to ensure that local people are involved in some way and that effective scrutiny takes place. Precise governance processes and levels of independence  ...  view the full minutes text for item 15/11

The new Chipping Norton Hospital is due to open later this year. It will be run on behalf of the NHS by the Orders of St John Care Trust. In 2005 and again in 2007 the PCT stated the following with regard to the employment of nursing staff at the hospital:

i.          To enable staff at the Hospital to decide which choice was better for them as individuals, they would be given the option of whether to remain as NHS employees and be seconded to the Orders of St John (OSJ) for a period of three  years or to transfer under TUPE to the OSJ

ii.                  The PCT would not indicate a preference with regard to the above options

iii.                In the event that an NHS employed staff member was to leave during the three year period, their replacement would be placed on NHS terms and conditions for the remainder of the three years.

At the end of the three years a review would take place.

The transfer of existing staff is being undertaken in accordance with the first two statements above. However the PCT has now decided that new staff employed during the three year period would be employed by the OSJ.

The purpose of this item is to help members understand why the PCT view on employment has changed and for the HOSC to consider whether any further action is required. A representative of the PCT will attend the meeting.

Copies of two letters are attached for information:

1.      From the Acting Chairman of the HOSC to the PCT (JHO6a)

2.      The reply from the Chief Executive of the PCT (JHO6b)

This item was included because in 2005 and again in 2007 the PCT stated the following with regard to the employment of nursing staff at the hospital:

i.          To enable staff at the Hospital to decide which choice was better for them as individuals, they would be given the option of whether to remain as NHS employees and be seconded to the Orders of St John (OSJ) for a period of three years or to transfer under TUPE to the OSJ

ii.         The PCT would not indicate a preference with regard to the above options

iii.        In the event that an NHS employed staff member was to leave during the three year period, their replacement would be placed on NHS terms and conditions for the remainder of the three years.

At the end of the three years a review would take place.

The transfer of existing staff is being undertaken in accordance with the first two statements above. However the PCT decided that new staff employed during the three year period would be employed by the OSJ.

Councillor Hilary Hibbert-Biles spoke to the Committee as the local member for Chipping Norton. Councillor Biles explained the issue as it appears to her and her Chipping Norton colleagues. They are concerned that if nurses are employed by the Orders of St John (OSJ) they would be seen as care staff and the hospital would eventually become a care home rather than a hospital. Councillor Biles expressed a view that the original agreements made in 2004 had already been “whittled away” with no additional consultation and that the PCT was challenging the authority of the HOSC. Members should insist that the original agreement should be upheld, i.e. that nurses employed at any time during the first three years of the hospital's life should be given the opportunity to opt for NHS employment.

Alan Webb, speaking for the PCT, first of all welcomed the fact that the new hospital is now open. He made clear that all staff at present seconded to the OSJ are NHS employees who would be deployed only in the hospital. What the PCT wanted to do was to ensure that staff employed in future would all be OSJ employees with the flexibility to employed throughout the unit. If new staff were not to be OSJ employees they would have to be employed by Oxford Health rather than the PCT and that would cause complications.

The PCT has decided that, rather than wait for three years before reviewing how the hospital was working they would undertake a review at the end of the first year of operation. The views of nursing staff would be sought monthly.

Mr Webb also referred to the “innovative model” that had been created for the First Aid Unit (FAU) whereby a paramedic from the South Central Ambulance Service would be placed on site with a triage link to Bicester Hospital. The Acting Chair of the HOSC made clear that the HOSC was happy with  ...  view the full minutes text for item 16/11

As part of a series of items of business aimed at bringing members of the Committee up to date on the position of local NHS Trusts, John Morgan, Chief Executive of the Ridgeway Partnership (Oxfordshire Learning Disability NHS Trust), will give an update on the current situation and how he sees the future for the Trust.

John Morgan, Chief Executive of the Ridgeway Partnership, gave a presentation to the Committee on the work of the Trust. Mr Morgan explained that around half of the Trust's work is social care – supporting people in their own homes. The other half comprises specialist health services, ensuring that people receive the right care in the right place.

The biggest challenge facing the Trust is to grow while at the same time maintaining the quality of service provision. They must grow to survive and have extended their work beyond Oxfordshire into Buckinghamshire, Wiltshire, Dorset and Somerset. In order to ensure that services do remain consistent and serve clients fully the most recent tendering exercise for services in Oxfordshire was shaped by service users and their families and carers. Staff training is particularly important in this respect.

It will become more important to publicise the work of the Trust and to ensure that there is an awareness that anybody can refer people to the service.

Personalised budgets are already in place in social care but not so well developed in health services.

Relationships with Oxfordshire County Council are very good. Colleagues from across the country come to see how it works. It will be important to see that the change to GP commissioning does not damage the relationship. District Council involvement comes mostly in the field of housing, particularly with regard to adaptations. Again, Mr Morgan reported that working relations are very good.

The Committee thanked Mr Morgan for his presentation and wished the Trust well for the future.

The Health Trainer initiative was set up by the PCT in July 2006 as an experimental approach to try to improve the health of hard-to-reach individuals. Recently the PCT undertook an evaluation of the service and decided that it could not be shown to be providing good value for money. The PCT is therefore proposing to close the service. 

The staff involved believe that changes could be made that would improve the outreach service and that, before the service is closed, there should be full public consultation.

Members should consider the evidence to be provided and decide whether they believe that this a substantial service change that would require full public consultation.

Speakers will include the Director of Public Health, the Convenor for the Oxfordshire PCT Unison Branch and a LINk representative. The following papers are attached:

1 Equality Impact Assessment (HIA) (JHO8a)

2 Consultation paper from the PCT (JHO8b)

3 Paper, “In Defence of Public Health” from Unison (JHO8c)

4 Oxfordshire LINk briefing (JHO8d)

The Health Trainer initiative was set up by the PCT in July 2006 as an experimental approach to try to improve the health of hard-to-reach individuals. Recently the PCT undertook an evaluation of the service and decided that it was not providing good value for money. The PCT is therefore proposing to close the service. 

The staff involved believe that changes could be made that would improve the outreach service and that, before the service is closed, there should be full public consultation.

Members were asked to consider the evidence to be provided and decide whether they believe that this a substantial service change that would require full public consultation.

Dr Jonathan McWilliam and Jackie Wilderspin introduced a report on behalf of the PCT. To summarise – Dr McWilliam stated that the staff have performed well within the constraints of what is in fact a flawed service model. In order to make the service anywhere near cost effective it would need to improve by around about 3,000%. The public interest would not be best served by continuing the service.

All of the services that trainers advise their clients to use would still be in place and patients would be continue to be able to get access to those services. The money saved by discontinuing the service would be re-invested in alternative services.

Dr McWilliam concluded by pointing out that the client base was very small and that, in his view, it was difficult to see what benefit there would be in consultation.

Mark Ladbrooke, on behalf of Unison and the Health Trainers, presented the case for retaining the service. Mr Ladbrooke pointed out that:

The PCT case was predicated on a costing per client whereas the trainers made multiple visits to each client. Many clients had multiple needs whereas only one was recorded. Partial success was never recognised and, although the service did appear to be expensive in fact only a small proportion of the cost related to staff costs. That was in part because the budget was always underspent thus reducing the number of clients seen and increasing the cost of each one against the budget.

Mr Ladbrooke also raised a number of questions about; (i) the lack of alternatives proposed by the PCT; (ii) the fact that while it was true that GPs were able to provide many of the same services as Health Trainers many of the Trainers’ clients were not registered with GPs; and (iii) the importance of targeting the service and that many services are actually generalised. Mr Ladbrooke also stated that the Health Impact Assessment was not acceptable.

He concluded by stating Unison’s view that there should be consultation with patients and that, if there were to be no consultation it could be seen as a precedent for the future every time the PCT chose to describe a service as “failing”.

The presentations were followed by a question and answer session during which the following further information was provided:

• The actual  ...  view the full minutes text for item 18/11

The Health and Social Care Bill that is going through Parliament now is intended to give effect to the reforms requiring primary legislation that were proposed in the NHS White Paper Equity and Excellence: Liberating the NHS. The Bill introduces a statutory duty for all upper-tier local authorities to create a Health and Wellbeing Board and develop a new joint health and wellbeing strategy.

The Director of Adult Social Care and the Director of Public Health will explain to members what the latest position is in planning and developing the new Board. Members will be able to follow up on their comments at the last meeting that the Board should be subject to the scrutiny of the HOSC. 

The purpose of health and wellbeing boards is “to improve health and care services, and the health and wellbeing of local people”. Subject to Parliamentary approval, health and wellbeing boards will be established from 2013, running in shadow form from 2012. 2011/12 will be a transitional year.

Local Councils have an important strategic leadership role in developing the boards and a number, including Oxfordshire, have joined an “early adopter network” with an aim to get the new Board set up in advance of the Government’s deadlines and share the benefits of each other’s experience.

John Jackson and Jonathan McWilliam updated the Committee on the present situation in the development of the new Health and Wellbeing Board. They explained that the PCT and the County Council are working closely together in developing proposals for the new Board and made the following points:

1.      What the Government has said should happen

Health and Wellbeing Boards

•         Will be a statutory requirement and a key element in increasing local democratic accountability for the NHS

•         Must develop a “Joint Health and Wellbeing Strategy”

•         Joint Strategic Needs Assessment (JNSA) at heart of the role – but flexibility to broaden this

•         Core purpose will be to join up commissioning across the NHS, Social Care, Public Health and related services & improve outcomes

•         Support and oversee the use of NHS Act s75 for formal partnerships and support informal arrangements

•         Could have functions delegated to them by local authorities

•         Should support the involvement of local stakeholders in the preparation of plans

•         Should consider whether GP Consortia and local authority commissioning strategies have proper regard to the Health and Wellbeing Strategy.

•         NHS Commissioning Board (the new central board responsible for overseeing the NHS) would attend when required for local commissioning issues

•         Scrutiny would remain separate but enhanced (Current scrutiny powers enable local authorities to request NHS bodies to attend before them to answer questions and to provide information. Powers in future would be extended to enable scrutiny of any provider of any NHS-funded service, and any NHS commissioner including private sector providers and local public health services).

Membership

•         The Board would be an upper tier responsibility but districts involvement encouraged

•         Duty to participate placed upon GP Consortia

•         Could be joint across local authority boundaries

•         Core membership must include a  locally elected  Councillor, Healthwatch and Directors of Adult Social Services, Children’s Services and Public Health

•         Flexibility around who other members could be; for example voluntary sector, clinicians and providers

2.      What is already in place in Oxfordshire

Oxfordshire

•         Long established history of joint working between local government and health including pooled budgets

•         Well regarded JSNA

•         Evidenced based Community strategy, strong partnership arrangements

•         Highly effective DPH acting as a bridge between NHS and other partners

•         The existing Health & Wellbeing Board has been co-chaired between the County Council and the PCT from the beginning. There is an active Children’s Trust. Therefore a strong  ...  view the full minutes text for item 19/11

The regular LINk briefing paper is attached (JHO10). LINk representatives will be available at the meeting to answer members’ questions if required.

Adrian Chant, LINk Locality Manager, reported that the host for the last year of the existence of the LINk has been tendered for and a recommendation has been made to the Director of Adult Social care. It is hoped that an announcement on the appointment of the new host will be made by May 1^st.  The future budget will be cut from the present £200,000 to £150,000.

The Acting Chair had attended a recent consultation meeting at the Kassam Stadium on the future GP consortium. Councillor Pressel reported that a number of GPs had expressed concerns about the future and members of the public asked about scrutiny of all health services including the GP Consortium and the Health and Wellbeing Board.

The Acting Chair also reported that the Safer and Stronger Communities Scrutiny Committee had requested that the HOSC should write to the Government in connection with minimum pricing of alcohol. Their view was that what has been proposed by the Government did not go far enough and that the minimum price should be higher.

Members AGREED that the letter should be sent and asked Roger Edwards to produce a draft in conjunction with the Assistant Director of Public Health.