Agenda item

11:45

The Oxfordshire Clinical Commissioning Group has been invited to give an update (attached JHO8) on its key issues and upcoming areas of work. This includes:

·         An update on the West Oxfordshire Place based Plan

·         An update of the Transformation Programme

·         Integrated Care Systems – some reflection and learning from the Buckinghamshire experience (presentation)

Prior to discussion on this item the Committee was addressed by the following people:

Jane Febers and Helen Wigginton – regional officers responsible for members of the Royal College of Nursing (RCN) in Oxfordshire, Milton Keynes and Buckinghamshire.

Jane Febers gave a brief resume for the information of the Committee on the work of the RCN in support of nurses, health care assistants and students in a range of health care settings. The RCN aimed to improve the working life of staff by a number of means:

-       by offering its members free confidential advice;

-       by supporting and protecting a diversity programme, providing the tools to protect against discrimination in the workforce;

-       by lobbying governments to improve the quality of patient care and providing advice to parliamentary select committees - the NCT had no ties to any political party;

-       by attending UK conferences; and

-       by engaging in national research.

They concluded by stating that their members in Oxfordshire had very real and valid concerns with regard to future plans for health and social care and morale was low.

Veronica Treacher spoke with regard to the transformation of, and evolution of the NCO’s believing it to be an ‘americanisation’ of the NHS. She expressed her concerns that the recommendations relating to structural shifts rarely hit the headlines and that they required scrupulous scrutiny in order to understand the implications of what was about to happen. She added that, in her view, it would cause uncertainty in the future leading to an instability in the market, for example with GP practices proving uneconomical to run.

OCCG had been invited to give an update on its key issues and upcoming areas of work. This included:

·         An update on the West Oxfordshire Place based Plan

·         An update on the Transformation Programme

·         Integrated Care Systems

Lou Patten, Chief Executive and Catherine Mountford, Director of Governance, OCCG attended for this item and presented the report JHO8.

West Oxfordshire Place based Plan

Lou Patten reported that she had met with patients and public engagement bodies who were keen to work with the OCCG and to engage with patients in order to make it a more inclusive way forward. This she had found to be very helpful.

A local member for West Oxfordshire stated that the local communities in west Oxfordshire would like to see an impetus on GP services in the west to work in collaboration with each other in order to reach some kind of GP representation in the locality. She suggested that a portion of any funding available could be given to each practice to accommodate extra patients and to collaborate with other practices. Lou Patten responded that one of the key lessons learned at the meeting with the PPG was the confusion about the fundamental truth that GP practices are individual businesses which hold a contract with the NHS to deliver services. She added that the OCCG could not require individual practices to collaborate, but she believed that they could work together in a more ‘linked’ manner, in order to, for example, share burdens. Moreover, the CCG Governing Body had considered a discussion paper about provider collaboration and it had been made a clear intention and high priority for the future. This enabled NHS providers who were not already doing so, to work together. In Witney GPs were already working together collectively.

The Chairman, on behalf of the Committee stated that all patients registered at Deer Park Surgery had now been allocated to another practice and the Committee was happy to draw a line under the matter.

Transformation Programme

With regard to the Transformation Programme, Lou Patten reassured the Committee that it would not be treated as a countywide approach, but as a locality one.  Her hope was that by describing a local approach it would promote a different type of public participation. She made reference to the address made by the representatives from the RCN earlier (declaring her interest as a registered nurse herself and on a RCN Board herself) stating that their voices needed to be as loud whether speaking with a locality voice or with a county-wide voice. She was asked if the OCCG recognised the concerns outlined to which she responded that she had not heard from OUH or OH, both of whom were very empathetic and challenges had been mainly around workforce issues.

A member commented on how pleased she was to see the plans for three free-standing units. Lou Patten was asked about the plans for Wantage Midwifery Unit which had been temporarily closed for 19 months, and, in the absence of a stage 2 consultation, would there be a consultation about its closure, as this would constitute a substantial change. She stated that it was her understanding that it was the inpatient beds that were temporarily closed and that the Midwife Led Unit MLU had continued to stay open. She added that there would still be an opportunity to deliver babies at the site in the form of an MLU. A local member referred to the presence of legionella found at Wantage hospital, commenting also that more and more new homes were being built in the area, thus causing a greater stress on GP services. She added that answers were required quickly. Lou Patten responded that she could not give answers at this stage as to whether inpatient beds at Wantage Hospital would remain open or closed and appreciated that work on the programme had to be completed as speedily as possible. She added that with regard to community hospitals, there was a need to look at local populations first before doing anything, together with the demographics of the people living there including their health and social care needs and how, for example, to support frail people. After that, the OCCG would describe how it would look to people. There would be a commitment to maintain buildings whilst this work took place, as far as it was possible. A member responded that pressure was required on the OUH to ensure that the Maternity Department at the Horton Hospital, which was in a state of temporary closure, was not allowed to deteriorate in the meantime.

In response to a question about the timescale of the Plan, Catherine Mountford replied that all the engagement and consultation activities would also be online. When asked whether finances had been protected for primary care, she responded if discussions centred on countywide services, this would require consideration. A member commented that in the past, resources for intermediate care beds had not been distributed on a geographical basis, adding that if local needs were to be looked at, then there was a need to look at the provisions for local bed care also. Lou Patten responded that if it was looked at in this way, there would be challenges around both workforce availability and affordability. There would be a need for community hospitals to work in a network capacity across Oxfordshire, as efficiently as possible.

Lou Patten was asked how much capital was required for community beds to be externally commissioned. She responded that one of the conversations that was needed was around issues relating to the workforce and the buildings.

At the end of the discussion, the Chairman, speaking on behalf of the Committee, welcomed the new approach, pointing out that HOSC had already accepted other recommendations subject to a number of caveats. He thanked Lou Patten and Catherine Mountford for the report and asked Lou Patten to report back to Committee based on what Committee requested at the time.

Integrated Care Systems

Lou Patten gave a presentation on Integrated Care Systems, which included some reflection and learning from the Buckinghamshire experience.

The Chairman then opened the meeting out to questions from members.

A member commented on the good diabetic care a member of her family had received from a local pharmacist.

Lou Patten was asked if this was a move to the ‘quasi unpicking’ of the marketing of care, in place of payment by results. She replied that payment by results comprised of a list of services with prices, some proving to be a false economy. Rather it would be about asking how much money was in the bank and how it could be used in the most effective way.

A member asked what protectors would be in place to prevent failed aspects infiltrating into how the NHS was managed, adding a views that whilst in pursuit of innovation, aspects of health and social care may crumble, due to there being no construct. Lou Patten referred to the integrated way of working in Torbay where health providers conducted discussions with teams in the wider community teams. This had resulted in greater job satisfaction for staff and more people applying for jobs. She stated further that she was keen to accelerate the aspect of more people being looked after independently at home and fewer people going into care homes.

A member stated that she would be interested to see what kind of rigorous protections would be put in place to stop the over-reliance on particular providers, and called for solutions to be embedded into the integrations. Lou Patten responded that this was a valid point and agreed that there was a need to reduce the overlap in care.

Lou Patten confirmed that she would still hold responsibility for a statutory organisation, and would remain accountable to the NHS, but she would be empowered to work together with other organisations. She added that there was a way to go before ensuring that all people understand that.

Both were thanked for their attendance for this item and for the presentation.