Agenda and minutes

The Chairman extended a welcome to Rosie Rowe, Oxfordshire Clinical Commissioning Group (OCCG) who was attending got Agenda item 12 ‘Primary Care Report’.

He also took the opportunity to thank outgoing Board members, Councillor Mark Booty and Mrs Jean Nunn-Price for their good work as Chairman of the Health Improvement Board and Chair of Oxfordshire Healthwatch.

Apologies were received from Joanna Simons and Peter Clark.

There were no declarations of interest submitted.

There were no requests to submit a petition or to make an address to the meeting.

To approve the Notes of Decisions of the meetings held on 13 November 2014 and 8 January 2015 (HBW5) and to receive information arising from them.

The note of the meeting held on 13 November 2014 was approved and signed subject to the correction of ‘Outcome Based Commissioning’ to ‘Outcome Based Contracting’ in Minute 6/14.

The note of the meeting held on 8 January 2015 was approved and signed as a correct record.

2:10

5 minutes

Board Member(s) responsible:      Director for Adult Social Services and Clinical Chair, OCCG

Persons giving the report:              Director for Adult Social Services and Chief Executive, OCCG

The update is attached at HWB6.

Action Required: to note the national approval of the Better Care Fund Plan and the next steps in implementation.

The Board noted that Oxfordshire’s Better Care Fund (BCF) Plan had been approved with minimal support. It was also noted that the OCCG, with need for only minimal support from colleagues in OCC was developing an implementation plan to monitor existing schemes within the plan and scope and project manage new schemes. This would be available by April 2015 and circulated by the CCG to Board members. In addition, the governance and reporting structures for the for the BCF programme was currently being determined which would be taken forward as a programme under the new system – wide Transformation Board, chaired by Stuart Bell, Chief Executive, Oxford Health. An understanding of the implications of the BCF area by area and the costings of it would be covered by the Single Plan as it rolled out, also by the introduction of neighbourhood teams during the course of this calendar year.

David Smith explained that contracts were currently in negotiation with both major Trusts and would be completed in time for the next meeting in July when more detail would be available.

2:25

25 minutes

Board Member(s) responsible:      Director of Public Health

Persons giving the report:              Director of Public Health and John Courouble, Research & Intelligence Manager

To consider a report (HWB7) on trends in local data which impact on health and wellbeing. It includes recommendations for updating the Joint Health & Wellbeing Strategy.

Action Required: to accept the Joint Strategic Needs Assessment as the basis for the updating of the Joint Health & Wellbeing Strategy.

The Board considered this year’s draft Joint Strategic Needs Assessment (JSNA) which monitors trends in local data which impact on the Board’s work. It also includes recommendations for updating the Joint Health & Wellbeing Strategy (HWB7). John Courouble, the County’s Research & Intelligence Manager, joined Dr McWilliam in introducing the draft JSNA.

Members of the Board considered a number of topics during their discussion including:

-       the breadth of this year’s JSNA and its comprehensive nature and the immense amount of work and support being given by a plethora of organisations and voluntary and community groups to combat such themes as social isolation and loneliness within the county (by community information networks, good neighbour schemes, for example);

-       the JSNA will prove to be useful, evidence based information with which to plan for particular scenarios such as housing growth within the county or to plan for the required resources for the projected high numbers of the population who will be 85 and over by 2050;

-       it  will inform issues and problem areas around service requirements, for example, whether there is an imbalance between housing benefit levels and housing rents; and the importance of extra care housing to be built into housing standards so as not to cause a real problem for the future;

-       previously there has been no linkage between council planning and health planning – this was a good opportunity to look at it in the round for Oxfordshire.

The Board AGREED to accept the JSNA as the basis for updating the Joint Health & Wellbeing Strategy and to thank the officers for their work in producing it.

2:40

15 minutes

Person(s) responsible:        All Partners

Person giving report:           Director of Public Health, Director for Social Services and Director for Children’s Services, Chief Executive, OCCG

The regular review of current performance against all the outcomes set out in the Health & Wellbeing Strategy is attached at HWB8 for consideration.

The Board reviewed current performance against all the outcomes set out in the Health & Wellbeing Strategy (HWB8).

Councillor Tilley highlighted the following in relation to the indicators for Children, Education & Families:

 2.3 ‘Maintain the current low level of persistent absence from school for looked after children’ – Councillor Tilley commented that work was in progress to meet the target.

2.8 ‘Improve the free school meals attainment gap at all key stages and aim to be in line with the national average by 2014’. Councillor Tilley pointed out that children in primary schools were not signing up because they were in receipt of school meals anyway.

4.7 ‘Of those pupils at School Action Plus, increase the proportion achieving 5 GCSEs at A* - C including English and Maths to 17% (baseline 10% 12/13 academic year) – Councillor Tilley reported that work was in progress on this.

John Jackson highlighted the following in relation to the indicators for Health and Adult Social Services:

He pointed out that most of the red indicators in adult services related to the relationship between acute hospitals and other Health systems, for example on Delayed Transfers of Care (DTOC) and Older People’s Reablement. He reported that hard work was in progress to bring the numbers down in the case of DTOC and delays in health funded care arrangements had also reduced significantly.

David Smith reported that, in the case of DTOC, a target had been set by the Secretary of State to reduce by 50% in four weeks. Four weeks ago there had been 173 people in hospital. This week the figure had reduced to 122. He added that this was a remarkable achievement but the 50% reduction had still not been met. He also pointed out that the OUHT had achieved the 95% target to see people presenting in A & E in four hours, but was struggling to deliver this on a continual basis. Mr Smith also added that the OCCG had put in a bid for £4.5m to the Prime Minister’s Challenge Fund to address particular issues one of which was to address avoidable admissions to emergency care, and the outcome of the bid would be known by the end of March.

Councillor Biles commented that she would like to see the expansion of first aid units (EMU’s) around the county, which would also serve to keep A & E only for acute cases. David Smith responded that the expansion of this model had already been included within the Better Care Fund range of initiatives.

Dr McWilliam highlighted the following in relation to the Public Health indicators:

8.2 and 8.3  - Health Checks -  there was still not sufficient people picking up to their health checks. Notwithstanding that the service had been recognised nationally as good practice, Public Health Officers were working with GPs, looking at the service in detail to see how it may be improved;

8.4 ’At least 3800 people will quit smoking for at least 4 weeks’ – Dr McWilliam reported  ...  view the full minutes text for item 8.

2:55

5 minutes

Person(s) responsible:        Director of Public Health

Person giving report:           Director of Public Health

A briefing which sets out the process for refreshing the Joint Health & Wellbeing Strategy priorities and outcomes for 2015/16 is attached at HWB9.

Action Required: to note the report.

The Board noted a briefing which set out the process for refreshing the Joint Health & Wellbeing Strategy for 2015-16 (HWB9).

3:00

15 minutes

Board Member responsible:           Chair, Healthwatch Oxfordshire

Person giving report:                       Chair, Healthwatch Oxfordshire

An update is attached at HWB10 which also summarises the responses to, and outcomes of the work undertaken by Healthwatch Oxfordshire.

Action Required: to note the report.

Jean Nunn-Price, Chair of Healthwatch Oxfordshire (HWO), and Rachel Coney, Chief Executive, gave a report (HWB10) updating the Board on the actions taken by commissioners and providers in Oxfordshire in response to recommendations made by HWO and its grant aided partners since April 2014. The report also provided an update on other internal and external HWO activity since the Board’s November meeting. Rachel Coney pointed out that they looked forward to making good progress on various patient and public involvement issues relating to Learning Disability Health Check take-ups, CAMHS waiting times (to be taken up with the Children’s Trust), cancer treatment time targets, four hour A & E waits, cancelled operations, hospital discharges and the provision of dignity in care.

Dr McManners reported that how people were admitted or discharges from hospital was to be a core focus for the CCG. The CAMHS waiting times review would be reporting shortly, its major focus being better targets for the numbers of patients seen in 8 weeks. The CCG had appointed a clinical lead to champion better targets for health checks for people with a learning disability and to seek evidence of good practice to share with those practices with a lower uptake.

They responded to questions from the Board in relation to the following:

-       The replacement of the Public Involvement Network (PIN)  representatives – Rachel Coney responded that she was due to meet with two PIN representatives in mid - March, and would be starting the process of recruiting new public representatives for the Health Improvement Board and Children’s Trust.

-       The Enter and View process – Rachel Coney responded that it was a rigorous process with check lists in place. Volunteers were all DBS checked, had undergone safeguarding training, and did not undertake the visit without a signed consent form and without being specifically invited. People giving their views on the discharge process would be directed online to a link for the form. Opportunities for assistance with focus groups would be offered to voluntary groups or individuals would be advised, if wished, on how to self - complete the form.

The Board noted the report.

3:15

10 minutes

Person(s) responsible:        Clinical Chair, Oxfordshire Clinical Commissioning Group

Person giving report:           Clinical Chair, Oxfordshire Clinical Commissioning Group

An update and plan is attached at HWB11.

Action Required: The Board is asked to endorse and support the aim, objectives and actions contained in the Plan.

Earlier this year, Dr McManners announced his intention to the Health Improvement Partnership Board to launch a three month, multi-agency Health Inequalities Commission for Oxfordshire asking what Oxfordshire needed to do over the next five years to reduce health inequalities.

The Board considered a paper (HWB11) giving the objectives of the Commission and updating members on progress and the next steps.

It was suggested that the district councils, HWO and local councillors should be invited to contribute, given the wealth of local knowledge they held. In addition, that the work of governmental select committees could be a fruitful source of information. Dr McManners agreed to do this, adding that NHS England was also a valuable resource in helping to give a national perspective. In addition, the JSNA and the HWB Strategy itself yielded a wealth of information and highlighted what key questions should be monitored and focused upon. Dr McWilliam advised that all organisations were charged with looking for health inequality and this was taken into account when planning their strategies. He added the importance of taking an urban, or rural, or market town focus when considering local detail.

The Board AGREED to endorse and support the aims, objectives and actions contained in the Plan.

3:25

15 minutes

Person(s) responsible:        Oxfordshire Clinical Commissioning Group/NHS Commissioning Board (South Central)

Persons giving report:         Clinical Chair, Oxfordshire Clinical Commissioning Group and Director of Finance, NHS England (Thames Valley)

A joint report prepared by Oxfordshire CCG and NHS England (Thames Valley) on the current state of General Practice in Oxfordshire and transforming primary care is attached at HWB12.

The Board is advised that this report was considered by the Oxfordshire Joint Health Overview & Scrutiny Committee at its meeting on 5 February 2015. The Committee was pleased to have a constructive discussion with commissioners and providers. It identified a weakness in the provision of primary care services in areas of growth and recommended that NHS England be considered as a statutory partner when housing growth (large and small planning applications) is considered by Councils.

Action Required: to discuss the report and to consider the inherent challenges and service development required.

The Board considered a joint report which had been prepared by the OCCG and NHS England (Thames Valley) on the current state of General Practice in Oxfordshire and transforming primary care (HWB12).

The Board were advised that the same report had been considered by the Oxfordshire Joint Health Overview & Scrutiny Committee at its meeting on 5 February 2015. The Committee had been pleased to have a constructive discussion with commissioners and providers. It had identified a weakness in the provision of primary care services in areas of growth and recommended that NHS England be considered as a statutory partner when housing growth (large and small planning applications) were considered by Councils. In response to this, James Drury reported that population growth within areas was one of the actions being taken forward by NHS England.

Rosie Rowe, Head of Provider Development (Out of Hospital), OCCG, attended for this item.

Dr McManners introduced the paper pointing out that the Oxfordshire GP service had been nationally recognised as a high quality service but highlighting the pressures on a service which had been designed 50 years previously. He reported that four federal practices had emerged, or were about to emerge in Oxford City, the South East of the county, Abingdon and in private practice (Principal Medicine Limited (PML)), each with their own autonomy and management. All were working to offer services across the various organisations to enable more services to be delivered closer to the patient’s own home. He added that more work was still needed to be done on the skill mix and it was envisaged that senior nurse practitioners, paramedics and home workers would work together with primary care teams to deliver locally based services, whilst working in partnership with acute trusts and other services.

James Drury reported that the joint commissioning process between NHS England and the OCCG was now in place.

At the request of the Board, Rosie Rowe provided further information on the Prime Minister’s Challenge Fund to which the OCCG had submitted a bid for finance to take forward some system-wide ideas such as:

·         A web - based directory – which would provide information on local self- management.

·         Same day primary care access with reference to a neighbourhood hub, giving immediate care where patients did not necessarily need to see their own GP. This would enable longer time to be devoted to appointments where doctors were seeing patients with complex needs and would also free up time for doctors to visit these patients at home. A scheme had already been started in the north of the county.

·         An early visiting service whereby urgent home visits for people with complex needs or frail patients could be undertaken by paramedics and senior nurse practitioners, whilst referring them to Emergency Medical Units (EMU’s) if necessary.

·         Care navigators to support GPs to link in closely with neighbourhood Community Health and Social Care teams (a pilot was underway in Oxford City).

·         New ways of working such an E consultations and the use of  ...  view the full minutes text for item 12.

3:40

5 minutes

Board Member(s) responsible:      Director of Public Health

Persons giving report:         `           Director of Public Health

A final draft version of the Pharmaceutical Needs Assessment is attached at HWB13.

Action Required: The Board is RECOMMENDED to accept this report and approve the process for publishing it along with any supplementary information as it is received.

The Board considered a final draft version of the Pharmaceutical Needs Assessment (HWB13).

The Board AGREED to accept the report and approve the process for publishing it along with any supplementary information as it was received.

3:55

5 minutes

Written reports on activities since the last full Board meeting in November (HWB14) from:

·         Children’s Trust

·         Older People Joint Management Group

·         Health Improvement Partnership Board

Action Required: to receive the reports.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                The Board had before them written reports on activities since the last full Board meeting from the Children’s Trust, the Older People Joint Management Group and the Health Improvement Partnership Board.

Councillor Tilley, Chairman of the Children’s Trust, reported that she would be attending a conference in Oxford on 19 March on Female Genital Mutilation.

Councillor Judith Heathcoat, Chairman of the Older People Joint Management Group, highlighted a paper which had been presented by Susanne Jones of Oxford Health on plans for further integration with Health and Social Services.

Councillor Ed Turner, Vice-Chairman of the Health Improvement Partnership Board, highlighted a useful discussion at the Health Improvement Partnership Board on bowel checks and the quitting of smoking.

The Board AGREED to receive the reports.

The following papers are attached for information:

·         A summary of correspondence with the Chairman is attached for information (HWB16).

The Board received the summary of correspondence with the Chairman (HWB15) for information.