Agenda and minutes

Apologies were received from Cllr Lygo, and Sylvia Buckingham.

None were made.

To approve the minutes of the meeting held on 30^th January 2025 and to receive information arising from them.

The Minutes of the meeting held on 30^th January 2025 were APPROVED as a true and accurate record.

Members of the public who wish to speak at this meeting can attend the meeting in person or ‘virtually’ through an online connection.

To facilitate ‘hybrid’ meetings we are asking that requests to speak or present a petition are submitted by no later than 9am four working days before the meeting i.e., 9am on Friday 28 February 2025.  Requests to speak should be sent to scrutiny@oxfordshire.gov.uk and omid.nouri@oxfordshire.gov.uk

If you are speaking ‘virtually’, you may submit a written statement of your presentation to ensure that your views are taken into account. A written copy of your statement can be provided no later than 9am 2 working days before the meeting. Written submissions should be no longer than 1 A4 sheet.

Cllr Howson (Cabinet Member for Children’s Services), raised several points regarding the Director of Public Health annual report. He felt it presented mental health issues as a recent discovery, despite historical recognition, citing a 1970s study by Tony Travis on educational funding disparities. He emphasised the need for more data on neurodiversity, particularly post-COVID, and expressed disappointment at the lack of CAMHS (Child and Adolescent Mental Health Services) locality data. Cllr Howson stressed the importance of analysing Key Stage 2 performance in reading, writing, and maths by school, noting Oxford City's poor results. He highlighted that primary and special schools in Oxfordshire outperformed the national average in attendance, whereas secondary schools fell below. He questioned the estimated 35,000 children with mental health problems, comparing it to current EHCP (Education Health and Care Plan) and SEND action plan figures. He also argued against the report's portrayal of young people with mental health issues being marginalised, referencing low claimant counts for 18 to 24-year-olds in Oxfordshire. Additionally, he mentioned the budget's extra £2,000,000 for SEND and £1,000,000 for under-fives, calling for a more comprehensive view of Oxfordshire.

The Committee has received Acceptances and Responses to recommendations made as part of the following item:

1.    Maternity Services

The Committee is recommended to NOTE the responses.

The Committee NOTED the responses to the Maternity Services recommendations, however Members expressed concerns that many of the recommendations were only “partially accepted”.

The Committee also NOTED that they were awaiting responses to the Healthy Weight item Recommendations.

The Chair will provide a verbal update on relevant issues since the last meeting.

The Committee is recommended to NOTE the Chair’s update having raised any relevant questions.

The Chair provided a verbal update on recent issues including HOSC Report Submissions. Reports with recommendations on the Health and Well-being Strategy Outcomes Framework, the BOB ICB Operating Model, the Oxfordshire Health NHS Foundation Trust People Plan, and on support for individuals leaving hospital were to be imminently submitted to relevant system partners.

Letters were sent to Oxford City and Cherwell District Councils, urging them to adopt policies promoting healthier food advertising and restricting new fast-food outlets near schools and in areas with high levels of childhood obesity.

Epilepsy Services saw positive developments, including a change in MHRA policy and the distribution of a patient safety leaflet in 30 languages. However, there had been no progress on medication access for girls and women.

Concerning the government’s devolution plans, the Chair expressed that in the context of any future local authority changes, that efforts should continue in addressing rural inequities and supporting community integration in healthcare.

It was also highlighted that the Committee’s Working Groups on Wantage Community Hospital and on the Oxford City Community Hubs Project successfully contributed toward collaborative efforts to secure additional resources.

The Chair reminded the Committee of pending follow-ups on repeat prescriptions by telephone, on ophthalmology services, and on the closure of the ADHD waiting list.

Neil Flint (Associate Director, Performance & Delivery for Planned Care, Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) has been invited to present a report on Musculoskeletal (MSK) Services in Oxfordshire. The Committee has previously been involved in scrutiny of MSK services and has commissioned a report on this area with a view to receive an update on the current state of MSK services for local residents/patients.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Neil Flint (Associate Director, Performance & Delivery for Planned Care, Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) was invited to present a report on Musculoskeletal (MSK) Services in Oxfordshire. The Committee had previously been involved in scrutiny of MSK services and had commissioned a report on this area, with a view to receive an update on the current state of MSK services for local residents/patients.

Matthew Tait (Chief Delivery Officer BOB ICB); Ansaf Azhar (Director of Public Health at Oxfordshire County Council), and Connect Health Officers Tony Collett, Mike Carpenter, and Suraj Bafna attended to answer questions the Committee had in relation to the MSK Services in Oxfordshire report.

The Associate Director and the Connect Health officers discussed the initial challenges when they assumed the contract. These included staffing shortages, a backlog of 19,000 patients, and the need to rebuild stakeholder relationships.

By February 2025, all service lines except pelvic health were within the target wait times of six weeks. The pelvic health service had a wait time of ten weeks. The service was nearly at its full staffing level, with only a 0.6 full-time staff shortfall. Delays in Health and Care Professions Council (HCPC) registration affected the start dates for new pelvic health clinicians.

The team conducted three community engagement events and planned to attend more, including those organised by the Oxfordshire Play Association. They arranged for Healthwatch to assess their services in April and May. A five-year plan to address health inequalities was implemented at the beginning of 2025, with quarterly updates provided.

The team engaged with primary care through network group meetings, stakeholder meetings, seminars, and newsletters. They also collaborated with secondary care teams, including rheumatology, orthopaedics, radiology, and gynaecology, to streamline pathways and address wait times. Contact with independent providers like Cherwell Hospital was maintained to help manage wait lists and alleviate service pressures. Finally, ongoing efforts were made to develop a unified model across the three counties (Buckinghamshire, Oxfordshire, and West Berkshire) to ensure consistent service delivery and mitigate postcode disparities.

Ansaf Azhar, Director of Public Health, joined the meeting at this stage.

Members asked about the innovative delivery models mentioned in the report, specifically how these models and the use of technology and Artificial Intelligence (AI) have contributed to reducing waiting lists. They suggested that if these models were effective, they could potentially be applied to other areas to cut down waiting lists.

The Associate Director, along with the Connect Health Officers explained that the innovative delivery models mentioned in the report included the use of technology and AI to manage musculoskeletal conditions. These models aimed to triage patients effectively, allowing those with less complex issues to self-manage with targeted advice and exercises. This approach freed up appointments for more complex cases, contributing to reduced waiting lists. The effectiveness of these models suggested that they could potentially be applied to other areas to cut down waiting lists.

Members had highlighted concerns regarding the long waits for rheumatology and orthopaedics, acknowledging these as serious  ...  view the full minutes text for item 20/25

Neil Flint (Associate Director, Performance & Delivery for Planned Care, Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) has been invited to present a report on Audiology Services in Oxfordshire.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Neil Flint (Associate Director, Performance & Delivery for Planned Care, Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) was invited to present a report on Audiology Services in Oxfordshire.

Matthew Tait (Chief Delivery Officer BOB ICB), and Phil Gomersall (Adult Audiology Team Leader Oxford University Hospitals NHS Foundation Trust) (OUH), also attended to answer questions from the Committee in relation to the Audiology Services in Oxfordshire report.

The Associate Director, Performance & Delivery for Planned Care discussed service commissioning in Oxfordshire and Buckinghamshire, which aimed to improve accessibility through the "any qualified provider" model with 26 community locations. He noted that there had been minimal complaints and positive patient feedback. Phil Gomersall described the adult audiology team, differentiating between community services for age-related hearing loss and hospital services for complex needs, including Ear Nose and Throat (ENT) diagnostics, specialist testing, balance assessments, and rehabilitation for non-age-related conditions.

Members inquired about the broader engagement process related to the commissioning of audiology contracts, beyond the market engagement mentioned in the document. The Associate Director and the Adult Audiology Team Leader explained that this process involved collaboration with communications leads to promote public involvement, although no members of the public attended the sessions. The team also reviewed historical complaints and feedback to address issues within the new service model.

The objective was to enhance accessibility and reduce waiting times. While detailed national comparisons were not provided, the service was designed to meet national minimum standards and effectively address local needs.

Members inquired about how the long waiting lists for more complex audiology services compared to the situation before the contract and the current scenario. Officers clarified that the waiting lists for these specialised audiology services had deteriorated since the pre-contract period. This was primarily due to the impact of COVID-19, which increased waiting times because of the close contact nature of audiology assessments. Additionally, there were national challenges concerning ear, nose, and throat services. Efforts are underway to enhance community providers to help ease some of the burden on secondary care. 

Members inquired about the decision-making process for prioritising areas and determining which patients received services at the community diagnostic centres. Officers clarified that this process was directed by a national programme from NHS England. This programme outlined key diagnostic tests that centres had to offer to achieve accreditation. Initially, the centres focused on tests such as MRIs, X-rays, and ultrasounds, and later expanded to include audiology. The process involved submitting bids for additional funding to support these services. Access to the centres was managed through hospital pathways and self-referrals. 

Members asked about efforts to improve access to the service, raise awareness, KPIs for providers and contractors, and exclusions from the service. The Associate Director and Adult Audiology Team Leader explained that efforts to improve access and awareness included addressing complaints about ear wax removal and informing patients about the service.

Providers were encouraged to market the service effectively, and communications were sent to primary care colleagues to inform them about the service. The KPIs  ...  view the full minutes text for item 21/25

Veronica Barry, Executive Director of Healthwatch Oxfordshire has been invited to present a report from Healthwatch Oxfordshire.

The Committee is invited to consider the Healthwatch Oxfordshire update and NOTE it having raised any questions arising.

Katharine Howell (Senior research and projects Officer) was invited to present an update report from Healthwatch Oxfordshire.

The Healthwatch representative highlighted insights from their reports on various agenda items, including audiology and MSK services, cancer waiting times, prevention, and support for children and young people's mental health.

Members raised concerns about long wait times at Boots pharmacy in the city centre, mentioning issues with computer breakdowns and staff shortages. The Healthwatch representative acknowledged the feedback and encouraged reporting such issues directly to Boots and Healthwatch for further action.

The Committee paused for lunch at 12:45, and restarted at 13:27

Alexandra Poole (Lead Cancer Nurse, Oxford University Hospitals NHS Foundation Trust) and Nicky Swadling (Cancer Manager, Oxford University Hospitals NHS Foundation Trust) have been invited to present a report on Cancer Services in Oxfordshire. The Committee is particularly interested in waiting times as well as treatments being offered for cancer patients.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Oxford University Hospitals NHS Foundation Trust were invited to present a report on Cancer Services in Oxfordshire. The Committee was particularly interested in waiting times as well as treatments being offered for cancer patients.

Felicity Taylor Drewe (Chief Operating Officer, Oxford University Hospitals NHS Foundation Trust), Andy Peniket (Clinical Director for Oncology & Haematology OUH NHS FT), Matthew Tait (BOB ICB Chief Delivery Officer), and Ansaf Azhar (Director of Public Health), attended to answer questions from the Committee in relation to the cancer wait times and treatment report.

The Chief Operating Officer at Oxford University Hospitals (OUH), discussed the Annual Cancer Survey feedback, noting improvements and performance against other trusts. The report included Cancer Outcomes and Services Dataset (COSD) data on treatment access and clinical outcomes, with an emphasis on personalised care.

Members inquired about the methods used by staff to provide patients with relevant information on available support and treatments. The Chief Operating Officer at OUH and Clinical Director for Oncology and Haematology described the various approaches utilised to inform patients about available support and treatments. These methods included distributing informational leaflets, offering direct communication during appointments, and employing marketing strategies to promote NHS hearing tests and treatments. Additionally, there was a strong emphasis on patient follow-ups to ensure the effectiveness of treatments and to promptly address any issues. This comprehensive approach aimed to enhance patient awareness and engagement with the services provided.

The Committee inquired about the support available for patients who do not speak English, citing a Healthwatch report that highlighted an instance where a non-English speaking patient was unaware of their diagnosis due to communication barriers. Members asked about the challenges and monitoring of support for these individuals. The OUH Chief Operating Officer acknowledged that providing support for non-English speaking patients was a significant concern. The Committee therefore reiterated the need to address the challenges and monitor the support mechanisms for such patients.

Members inquired about the commitment to the well-being of patients and their families, particularly concerning mental health, and whether this responsibility rested with the hospital or was referred back to the local GP. The Chief Operating Officer and Clinical Director explained that the responsibility for the well-being of both patients and their families, especially regarding mental health, was recognised as significant.

The Officers clarified that this responsibility was shared between the hospital and the local GP, depending on the specific circumstances and needs of the patient. The hospital provided immediate and specialised mental health support, while ongoing care and follow-up were typically managed by the local GP. This collaborative approach ensured comprehensive and continuous care for the patient's mental health and overall well-being.

Members inquired about OUH's performance in the National Cancer Patient Survey, particularly concerning the KPI that measures patients definitively receiving the appropriate level of support from their GP practice during treatment, which was at 50%. They also asked about patient involvement in discussing their treatment and ways to enhance the support experience from GPs.

It was acknowledged, by Officers, that the  ...  view the full minutes text for item 23/25

Ansaf Azhar (Director of Public Health) has been invited to present the draft Director of Public Health Annual Report 2024-2025. This report focuses on supporting the mental wellbeing of children and young people.

PLEASE NOTE: This report remains in draft form and has not been formally published. The final version of this report will be presented to Full Council in the near future.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Ansaf Azhar (Director of Public Health at Oxfordshire County Council), was invited to present the draft Director of Public Health (DPH) Annual Report 2024-2025. This report focused on supporting the mental wellbeing of children and young people.

Donna Husband (Head of Public Health Programmes), and Frances Burnett (Public Health Registrar), also attended to support the Director and help answer questions from the Committee.

This year’s DPH annual report focused on the mental health and well-being of children and young people, alongside economic inactivity among them. The report aimed to highlight these key issues and encourage action. The Public Health Director emphasised the importance of viewing mental health as an asset and the necessity for a diverse workforce in Oxfordshire by 2040.

The report detailed current mental health support provisions and underscored the significance of general settings in supporting young people. It recommended increasing the use of existing interventions, reframing discussions about mental health, and utilising anchor institutions to create opportunities for young people.

Members asked whether there were measures in place to assess the effectiveness of the various schemes and activities listed in the report. It was explained to the Committee that the principle avenue through which to evaluate the overall effectiveness of measures or projects to improve children’s mental health and emotional wellbeing was via the Health and Wellbeing Strategy’s Outcomes Framework. Children’s mental health sat within the Start Well category of the Health and Wellbeing Strategy, and the Health and Wellbeing Board was due to evaluate Start Well aspects of the strategy in April 2025.

Members asked whether it would be helpful for the DPH annual report to include information on how Oxfordshire compares in terms of deprivation and apprenticeships. They recognised the successes already achieved in these areas but also highlighted the importance of addressing ongoing mental health challenges. The discussion emphasised the need for a comprehensive approach that acknowledges both achievements and areas requiring further attention.

Members asked whether the various programmes listed in the report were working together in an integrated manner or operating separately from each other. It was responded that whilst some programmes aimed at improving children’s emotional wellbeing and mental health operated separately, they would all be evaluated as part of the Health and Wellbeing strategy’s aforementioned Outcomes Framework. Whilst each programme had their unique specificities and objectives, they all shared the common purpose of driving improvements to children’s mental wellbeing in Oxfordshire.

Members asked whether early intervention efforts were being coordinated with partners to determine who should concentrate on what and making recommendations more specific in this regard. They questioned whether these efforts were being coordinated with partners to determine specific areas of focus and to make recommendations more targeted. It was explained to the Committee that early intervention efforts were being coordinated between system partners, and that more work would follow in this regard. Various system partners would have their own contributions that they could make toward implementing the recommendations outlined in the DPH annual report.

Members asked about the  ...  view the full minutes text for item 24/25

Tom Hudson, Scrutiny Manager, has been invited to present an update report on the work of the Council’s Constitution Working Group, specifically as it relates to potential changes to the HOSC elements of the Constitution.

The Committee is recommended to consider and AGREE its support for the proposed changes.

Tom Hudson, Scrutiny Manager, was invited to present an update report on the work of the Council’s Constitution Working Group, specifically as it related to potential changes to the HOSC elements of the Constitution.

The Council updated its constitution, focusing on the Health Overview and Scrutiny Committee (HOSC). Motivated by the Health and Care Act, they revised the terms of reference for the Buckinghamshire, Oxfordshire, and Berkshire West Health Overview Scrutiny Committee, and the procedure for making referrals to the Secretary of State. They aimed to gather feedback from District and co-opted members before finalising the amendments.

The Committee discussed the need for flexibility in the order of deputy chairs. They suggested maintaining the current order but allowing changes with District Council agreement. Flexibility was important to accommodate practical reasons for deviations. 

The Committee is recommended to AGREE to the proposed work programme for its upcoming meetings.

The Committee AGREED to the forward work plan.

The Committee is recommended to NOTE the progress made against agreed actions and recommendations having raised any questions.

The Committee NOTED the action and recommendation tracker.