Agenda item

11:30

Representatives from the Oxfordshire Clinical Commissioning Group (OCCG) will present an update on the development of the Buckinghamshire, Oxfordshire and Berkshire West Sustainability & Transformation Plan (STP) and its impact on Oxfordshire. A presentation is attached at JHO8. The public summary and draft submission are also attached at JHO8.

12:30 - LUNCH

Prior to consideration of this item, the Committee heard addresses from two members of the public:

Keith Strangwood thanked members of the Committee for its decision in relation to the closure of the Obstetrics service at the Horton General Hospital. He appealed to members to vote with their heart when its response to Phase 1 of the OTP consultation was considered on 7 March 2017.

Veronica Treacher stated that the capability of members of the public to influence many of the services featured in the STP was questionable, adding that despite the public engagement exercises carried out, it was driven by waiting times and audit. Plans had been presented as technical exercises and the language used constituted a language barrier. She added her view that the BOB STP largely remained secret and the public had not been given any information with respect to accountability and responsibility. Furthermore, that any changes had already been decided. She called for any re-configuration to be stress-tested to deliver effective services. She urged HOSC to make a stand and to call for further information about finance in light of public concern.

David Smith attended for this item in his capacity as both Chief Executive of the OCCG and the lead for the STP footprint over Buckinghamshire, Oxfordshire and Berkshire West. Stuart Bell, Chief Executive of Oxford Health also attended. Mr Bell stated that although he was working through some projects at the broader BOB level, which tended to concern specialist services that required a larger footprint (such as cancer services), much of the planning, consultation and delivery would be via the three local systems. Referring to the last speaker’s address, Mr Bell clarified that the STP did not exist as a statutory body.

Mr Bell advised that a new approach was to be taken based on local planning in contrast to the market situation which was the previous approach. This was reflected in the transformation process in Oxfordshire. Changes described in the STP were in line with those of the rest of the country. Furthermore, this federal approach meant that revised Terms of Reference were required for the Oxfordshire Transformation Board to ensure regular reports were provided on the STP and also to ensure an Oxfordshire view would be presented in the STP. An event had been held 2 weeks previously involving the wider local authorities, and a range of other organisations, to do a stock-take and to develop a process of engagement. There was recognition that this would involve significant numbers of the social care and home care workforce.

Members asked questions around the following areas:

·         Whether there were other plans that had been through the Clinical Senate and NHS England;

·         Why the BOB STP had not been consulted on and published as a holistic plan and not as part of the OTP consultation;

·         How the work plan for the OCCG and the Senate worked out across Oxfordshire;

·         Relation of the OTP/STP to common resource problems experienced by the Health service nationwide, such as over - use of agency staff,  NHS equipment not being returned, charging foreign visitors for use of services etc;

·         Sufficiency of staff numbers to undertake all that would be required;

·         The source of the monies for investment;

·         More managers meaning less money for the patients?

·         A guarantee that there would not be commissioning with the private sector across BOB;

·         How governance to tackle problems with a specialist service on the wider STP footprint would work– were there powers/sanctions to enforce by an oversight Board?

·         The temporary or permanent nature of the STP.  Will it become a new structure for the delivery of Health in this region and how would its governance work? Were STPs merely a re-invention of the Regional Health Authorities?

Mr Smith and Mr Bell gave the following responses:

·         Oxfordshire was the first of the areas within the BOB STP to go out to consultation on its local plans;

·         A plan is very different from a consultation. The STP was an attempt to pull together individual components relating to particular services, using the available resources in a more effective way. Each component would then need to be led by the appropriate statutory body - the components for Oxfordshire would be addressed by the OTP. Parts of the system were not delivering required quality of care, for example, waiting times and health inequalities that exist. It was necessary for the OCCG to do something about them, and this could not be done without making changes to the system;

·         Regarding publicising the STP, the documents were on the OCCG’s website, together with a short guide. There was a willingness to engage, and any comments on specific services included in the STP would be welcome. David Smith undertook to check whether the website was interactive;

·         Phase 1 proposals had been through the Clinical Senate’s assurance process which included a panel of clinical experts from outside the area. This report had been made public and Mr Smith undertook to provide a link to the report to members;

·         There were projects looking at equipment and staffing issues at the moment. In particular, looking at ways of attracting people back to work from other sources, rather than via agency use. This had proved successful in relation to finding nursing staff, but was less so with clinical staff. The OCCG was looking at workforce issues across the BOB area, for example, looking at how specialist services could be provided more locally within the BOB area. In addition, how the OCCG could make better use of electronic health records and also ways in which new digital technology could help provide healthcare and offset difficulties in recruitment;

·         Staffing issues were more of a risk/constraint as training could be long-term. The OCCG was therefore taking a more systematic approach to the recruitment of people with different skills: for example, work with universities within the BOB network and the introduction of bursaries and graduate career progression in order to make the most of people’s skills and supporting staff to operate at the top of their licence;

·         The use of the STP as a basis for allocating investments of monies locally had already begun with bids submitted for Psychiatric and Diabetes services. As long as plans were already in place, responses could be speedy. Capital and national investment was very limited (for example, the OCCG had put in a bid amounting to £50m for  investment in local GP practices, but only £2m was allocated). This made recycling a necessity, together with the need to seek opportunities for investment from other bodies. Mr Smith agreed that Health needed to tap into S.106 developer monies at every opportunity. The Committee would write to the Minister for Health about the underfunding of the NHS in Oxfordshire;

·         There would be no new managers. In fact discussions were being held about how costs could be reduced via cuts in back office services;

·         There was a Government Policy about Patient Choice and therefore the local NHS did commission services from the private sector. The OCCG was in the process of working up a delivery plan. Mr Bell commented that there was more provision of services in partnership with the voluntary sector;

·         STPs were here to stay. However there was no intention to embark on wholesale change in the NHS. Individual CCGs would work locally and investment decisions would be made locally, thus giving greater accountability and more local control over the totality of the picture. Investment decisions for specialist services would be made centrally via NHS England across the STP footprint in accordance with gaps in care or inequalities.  Some services might be commissioned on a bigger scale, for example, to include Swindon and Milton Keynes hospitals that were not in the BOB STP footprint. Conversely, this did not mean all commissioning of specialist services would be centralised through the STP: the OUH worked through a number of networks and alliances with other hospitals not in the STP according to the needs of patients and for better outcomes. One size did not fit all;

·         Powers of compliance were decided between the CCGs – each might have different issues. The OCCG Board and each CCG still held statutory responsibility, but would work with other organisations for the good of the patients.

Mr Smith noted that whilst HOSC recognised that the OCCG did address some problems, such as the availability of sufficient domiciliary care to meet the changes made at Townlands Hospital, the STP was focussing on specific services. The Committee needed to see the local NHS working much more closely with local Councils with regard to planning consent and housing development.

Mr Smith agreed to come back to Committee with the delivery plans when they were available. This would provide the Committee with more information in relation to how the new system would operate.

Mr Smith and Mr Bell were thanked for the report and for their attendance.