Agenda and draft minutes

The following members tendered their apologies:

Cllr Paul Barrow, with District Cllr Ron Batstone substituting.

Cllr Freddie van Mierlo, with Cllr Roz Smith substituting.

Cllr Hanna declared her interest as working for the health charity SUDEP Action.

Cllr Hannaby declared that she was involved with Wantage Community Hospital.

Cllr Haywood declared his interest in working for the NHS.

To approve the minutes of the meeting held on 02 August 2024, and to receive information arising from them.

The Committee is recommended to AGREE the minutes as an accurate record having raised any necessary amendments.

The minutes of the Committee’s meeting on 2 August 2024 were assessed for their accuracy.

The Committee AGREED the minutes as an accurate record of proceedings and that the Chair should sign them as such.

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 6^th September.  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.

No statements were made at this point.

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

1.    GP provision in Oxfordshire (held during the 18 April 2024 HOSC meeting).

2.    Integrated Neighbourhood Teams in Oxfordshire (held during the 06 June 2024 HOSC meeting).

The Committee is recommended to NOTE the responses.

The Committee had received Acceptances and Responses to recommendations made as part of the following items:

1.       GP provision in Oxfordshire (held during the 18 April 2024 HOSC meeting).

2.       Integrated Neighbourhood Teams in Oxfordshire (held during the 06 June 2024 HOSC meeting).

The Committee NOTED the responses.

Cllr Hanna will provide a verbal update on relevant issues since the last meeting.

There are two documents attached to this item:

1.     A report containing recommendations from the Committee on Palliative Care Provision in Oxfordshire.

2.     A brief statement from the BOB Integrated Care Board Director of Urgent and Emergency Care for Oxfordshire, which outlines the redesignation of the Urgent care centres on the Horton General Hospital and John Radcliffe hospital sites.

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

In addition, no details of the outcomes of discussions between the Council and BOB ICB in regards to the latter’s restructure since the last HOSC meeting have been submitted. Stephen Chandler will be invited to update the Committee on the current situation.

The Committee Chair outlined the following points to update the Committee on

developments since the previous meeting:

1.           A HOSC report containing recommendations from the Committee on Palliative/End of Life Care, which was discussed during the 06 June 2024 HOSC meeting, had been published in the agenda papers for this meeting.

2.           A brief statement from the BOB Integrated Care Board Director of Urgent and Emergency Care for Oxfordshire, which outlined the redesignation of the Urgent care centres on the Horton General Hospital and John Radcliffe hospital sites, was included in the agenda. Lily O’Connor, Programme Director Urgent and Emergency Care for Oxfordshire, BOB ICB, explained that this redesignation was primarily for governance and reporting purposes and did not affect the centres’ operations or names.

3.           The HOSC’s Oxford Community Health Hubs Working Group met with senior representatives of Oxford Health NHS Foundation Trust as well as the OCC Cabinet Member for transport to discuss the avenues of transportation and access to the newly developing health hubs for both patients and staff.

4.           Maternity Update: HOSC had been involved in close and ongoing scrutiny of maternity services. Members would have seen the dossier produced by Keep the Horton General, and the Committee had received a briefing from OUH in July on the state of maternity services and highlighted the issues emerging from the dossier, urging the Trust to have a clear plan and to take adequate measures to address the issues with maternity services. A public meeting on maternity services was scheduled for the next HOSC meeting in November.

5.           Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB) Proposed Restructuring: The Chair addressed the proposals for restructuring within the ICB, which was the focus of the HOSC meeting in August. The Committee had expressed concerns about the impact of these proposals on partnership working with local authorities, the NHS, and the voluntary sector. The Chair noted that positive negotiations had been ongoing, but the ICB had not provided a written statement to reassure the Committee.

Stephen Chandler, the Director for People and Transformation, provided further details on the negotiations with the ICB. He mentioned that while there had been positive discussions, no written confirmation of this progress had been received. The Director expressed concerns about the ICB’s operating model and the potential impact on local services. He also highlighted the importance of prevention and early intervention, which could be undermined by the proposed changes. The ICB had chosen not to give an update on the state of the proposed changes until after their Board Meeting at the end of September, which would be held in private.

The Committee NOTED the Chair’s Update.

The Committee AGREED the following recommendations:

1.           For the Committee to DELEGATE to the Health Scrutiny Officer, in consultation with the Chair and Director for People and Transformation, to request a call-in (on behalf of the County Council) from the Secretary of State for Health & Social Care in relation to the BOB ICB proposed operating model.  ...  view the full minutes text for item 65/24

The Oxfordshire Joint Health Overview Scrutiny Committee has been closely involved in scrutinising and reviewing the Warneford Park Hospital Redevelopment Project. Oxford Health NHS Foundation Trust have approached the JHOSC with a view to brief the Committee on the proposals for the redevelopment, as well as to seek endorsement and support for the Trust’s bid for government funding to redevelop the hospital.

The purpose of this item is two fold:

1.    For the Committee to AGREE to the HOSC endorsement report (which is attached as a document to this item in the agenda papers). This endorsement report will then be sent to Oxford Health NHS Foundation Trust to support the bid for funding from government to redevelop the hospital.

2.    For the Committee to AGREE that the Warneford Redevelopment Project does NOT constitute a Substantial Change.

The Committee had been closely involved in scrutinising and reviewing the Warneford Park Hospital Redevelopment Project. Oxford Health NHS Foundation Trust had approached the Committee with a view to brief them on the proposals for the redevelopment, as well as to seek endorsement and support for the Trust’s bid for government funding to redevelop the hospital.

The Committee AGREED the following recommendations:

1. For the Committee to AGREE to the HOSC endorsement report. This endorsement report will then be sent to Oxford Health NHS Foundation Trust to support the bid for funding from government to redevelop the hospital.

2. For the Committee to AGREE that the Warneford Redevelopment Project does NOT constitute a Substantial Change.

Dan Leveson (BOB ICB – Place Director, Oxfordshire) and Lily O’ Connor (BOB ICB Programme Director Urgent and Emergency Care for Oxfordshire), have been invited to present a report on winter preparedness.

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

Lily O'Connor (Programme Director Urgent and Emergency Care for Oxfordshire), Ed Capo-Bianco (Urgent Care, Palliative and End of Life Care, Cardiovascular Disease Clinical Lead for Oxfordshire Place in BOB ICB), Ben Riley (Executive Managing Director for Community, Primary and Dental Care), Sally Steele (Service Manager Hospitals, Adult Social Services), Tamsin Cater (Head of Transfer of Care Hub, OUH), Karen Fuller (Director of Adult Social Care), Ansaf Azhar (Director of Public Health OCC), and Dan Leveson (BOB ICB Director of Place) submitted a report on Winter Planning in Oxfordshire.

The first question from the Committee focused on workforce and funding challenges for the upcoming winter. The Committee asked what measures were being taken to address these challenges in the short term. The BOB ICB Director of Place highlighted that the winter plan was essentially an urgent emergency care plan, with workforce being a significant challenge. The Director of Adult Social Care explained that across the Oxfordshire system, efforts were being made to maximise the workforce, ensuring the right people were in the right place at the right time. She mentioned an ambitious recruitment campaign that had yielded positive results, particularly in recruiting qualified social workers and occupational therapists. Additionally, work was being done with care providers to support hospital discharges and ensure a buoyant home care market.

The Committee then raised concerns about A&E and ambulance handover times. The BOB ICB Director of Place indicated that while the four-hour standard in A&E had been challenging, improvements had been made through partnerships and the establishment of urgent care centres. The performance had improved, with the target for the year being 78%. He also touched on the challenges faced by different trusts and the importance of system-wide collaboration to manage discharges and patient flow.

The Committee inquired about the confidence in reducing ambulance handover times. The Head of Transfer of Care Hub reiterated that Oxfordshire was performing well in this area, with excellent relationships with the South Central Ambulance Service. She noted that it was rare for ambulance handover delays to exceed 60 minutes, and efforts were being made to further reduce this time.

The Committee asked about the maturity of community services. The Executive Managing Director for Community, Primary and Dental Care reflected on the challenges faced due to stagnant funding despite increasing demands from a growing and ageing population. To address these challenges, he discussed efforts to streamline and consolidate services, such as implementing a single point of access for planned, urgent, and emergency care. This approach aimed to free up clinical time and improve efficiency, with some success already seen in the planned care sector.

Additionally, the Director mentioned ongoing staffing changes to make services more sustainable, moving away from short-term staffing solutions to long-term employment plans. This shift was expected to reduce costs associated with agency fees and provide more reliable staffing. He also discussed the development of hubs to bring together services from multiple locations, aiming to deliver more care closer to home.

The Committee raised  ...  view the full minutes text for item 67/24

Rachel Corser (Chief Nursing Officer BOB Integrated Care Board) and Dan Leveson (BOB Integrated Care Board Oxfordshire Place Director) have been invited to present a report on Adult and Older Adult Mental Health in Oxfordshire. Also invited to be in attendance are: Chris Wright (Assistant Director of Partnership Development, BOB Integrated Care Board) Catherine Sage, Lola Martos (Head of Adult Services OUH NHS FT), Manny Jhawar-Gill (Commissioning Manager, Adult Social Care, OCC) and Pippa Corner (Deputy Director of Commissioning, Adult Social Care, OCC).

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

Dan Leveson (BOB ICB Place Director for Oxfordshire), Chris Wright (Assistant Director Partnership Development, Oxfordshire), Lola Martos (Head of Older Adult Services at Oxford Health NHS Foundation Trust), Manny Jhawar-Gill (Commissioning Manager, Improve Enable, Adult Social Services, OCC), Pippa Corner (Deputy Director Commissioning, Adult Social Services, OCC), Nicola Leavesley (CEO of Response and current Chair of the Oxfordshire Mental Health Partnership, OMHP), Catherine Sage (Head of Service for Mental Health Urgent Care, Social Care, and Adult Eating Disorder Service, Oxford Health), Jared Fellows (Health Improvement Practitioner, Public Health, OCC), Karen Fuller (Director of Adult Social Care, OCC), and Ansaf Azhar (Director of Public Health, OCC) presented a report on Adult and Older Adult Mental Health in Oxfordshire.

The Committee first inquired about the adult eating disorder service, specifically the contract between the BOB ICB and other providers covering community eating disorders. They asked about the extent to which these services were dealt with separately or as part of the overall mental health aspect, and the level of specialist provision available. The BOB ICB Place Director for Oxfordshire explained that specialist adult eating disorders services were commissioned on a larger scale through specialist commissioning, with Oxford Health as the lead commissioner. He clarified that the community services were delivered locally and were part of the system they worked on together. The Head of Service for Mental Health Urgent Care added that the regional services primarily included inpatient services and some intensive treatment services to avoid admission or support post-discharge. She mentioned that Oxfordshire had one inpatient service at Cotswold House in the Warneford Hospital and that the community adult eating disorder service covered the entire county.

The Committee then asked about the engagement of older adults, specifically those over 65, in the design and commissioning of older adult mental health services. The Head of Older Adult Services emphasised the importance of engaging service users and carers through active groups and working closely with the voluntary sector. She acknowledged the difficulties faced by older adults to have their voices heard, and this concern was always at the forefront of the service’s efforts. The BOB ICB Place Director for Oxfordshire added that Oxford Health had a long history of person-centred, goals-based care, and that patient feedback was integral to service design. The Assistant Director of Partnership Development at Oxford Health highlighted their strategic initiative to increase patient involvement in care, surpassing their 80% target with 88% of service users reporting participation. This approach aimed to enhance patients’ experiences and inform service delivery and commissioning decisions. Additionally, they planned to consolidate services for older adults and eating disorders under a single contract to offer a broader range of interventions. Patient surveys and external reviews were conducted to understand current service perceptions and identify gaps and challenges.

The Committee raised the issue of loneliness among older adults and asked about measures being taken to address this. The BOB ICB Place Director for Oxfordshire acknowledged the challenge, citing factors like rurality and transient populations. He highlighted  ...  view the full minutes text for item 68/24

To receive and discuss a report on Medicine Shortages and its impacts on Oxfordshire.

The following people have been invited to attend and present the report: Julie Dandridge (Head of Primary Care Infrastructure, Head of Pharmacy, Optometry and Dentistry, Lead for Primary Care across Oxfordshire BOB Integrated Care Board), Claire Critchley (Medicines Optimisation Lead Pharmacist, BOB Integrated Care Board), David Dean (Chief Executive Officer, Community Pharmacy Thames Valley), and Bhulesh Vadher (Clinical Director of Pharmacy and Medicines Management, Oxford University NHS Hospital Trust)

There are THREE documents attached to this item:

1.     A report from the ICB on medicine shortages.

2.     A report from OUH on medicine shortages

3.     A statement on medicine shortages from Dr Leyla Hannbeck (Chief Executive of the Independent Pharmacies Association).

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

Julie Dandridge (Head of Primary Care Infrastructure and Pharmacy), Claire Critchley (Medicines Optimisation Lead Pharmacist), David Dean (Chief Executive Officer for Community Pharmacy Thames Valley), Bhulesh Vadher (Clinical Director of Pharmacy and Medicines Management at Oxford University NHS Hospital Trust), and Rustam Rea (Consultant at Oxford University NHS Hospital Trust) and Leyla Hannbeck (CEO of the Independent Pharmacies Association) attended to speak on the issue of Medicine Shortages.

The Head of Primary Care Infrastructure and Pharmacy highlighted the multifaceted root causes of medicine shortages and the significant impact on patients and healthcare providers. She noted the anxiety patients face when their usual medications are unavailable and the challenges for pharmacists and clinicians in managing these shortages.

The Committee inquired about the main complexities causing medicine shortages. They asked about the international context of manufacturing capacity and whether the impacts of this had now been addressed. The CEO of the Independent Pharmacies Association responded, explaining that global manufacturing capacity issues, dependency on raw materials from countries like China and India, and geopolitical factors contributed to the problem. She also mentioned the impact of Brexit and the UK's pricing strategies, which make it less attractive for manufacturers to supply medicines to the UK. She highlighted the increased demand for certain medications, such as HRT and ADHD treatments, which exacerbated the shortages.

The Committee then asked how NHS contracts and pricing strategies impacted medicine availability. The Chief Executive Officer for Community Pharmacy Thames Valley explained that the national contract for community pharmacies had remained unchanged for several years, creating financial pressures that had led to pharmacies closing. He noted that the contract drove down prices, discouraging manufacturers from supplying the UK market and causing pharmacies to dispense many items at a loss.

The Committee sought clarification on distribution issues contributing to shortages and whether these issues were national or local in scope and what measures could be taken to address them. The Clinical Director of Pharmacy and Medicines Management at Oxford University NHS Hospital Trust explained that the distribution network itself was not the problem; rather, it was the availability of stock from wholesalers and manufacturers. He described the sophisticated systems in place within hospital pharmacies to manage stock and share resources regionally, contrasting this with the less coordinated systems in community pharmacies.

The Committee asked about the impact of medicine shortages on individual patients, particularly those with conditions requiring specific medications. The Clinical Director of Pharmacy and Medicines Management at Oxford University NHS Hospital Trust provided examples of how shortages forced the use of alternative or unlicensed products, which could lead to further shortages. He emphasised the randomness of these shortages and the various factors that could cause them, such as manufacturing issues or supply chain disruptions. The CEO of the Independent Pharmacies Association explained that while national protocols, such as the serious shortages protocol, allowed pharmacists to switch medicines during shortages, high demand still led to product shortages, as seen with antibiotics and Hormone Replacement Therapy (HRT) medicines. Despite pharmacists’ extensive  ...  view the full minutes text for item 69/24

The Committee will discuss a report from the NHS on the current state of Epilepsy Services within Oxfordshire.

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

NB Please note that there is a statement from NHS England on this topic, which follows the main report.

Professor Arjune Sen (Consultant Neurologist, OUH), Jackie Roberts (Lead Learning Disability Epilepsy Specialist Nurse, OUH), Rohini Rattihalli (Consultant Paediatric Medicine, OUH), Marcus Neale (Epilepsy Specialist Nurse, OUH), Rustam Rea (Consultant, OUH), Jane Adcock (Consultant Neurologist, OUH), and Janice Craig (Medicines Optimisation Lead Pharmacist, NICE Medicines and Prescribing Associate, BOB ICB), Rachael Corser (Chief Nurse, BOB ICB) and Sarah Fishburn (Senior Clinical Quality Improvement Manager, NHS England) attended to speak on the topic of epilepsy services.

The Chair invited registered speaker Kristi McDonald to address the Committee.

Kristi McDonald shared her personal experience with epilepsy and the impact of the new regulations on her life. She highlighted the severe neglect and ignorance faced by epilepsy patients. She described the complexities of living with epilepsy, the mental health impacts, and the recent tightening of policies on sodium valproate and topiramate. She criticised the policy for stripping away patient involvement and breaching reproductive rights, sharing examples of how the policy had negatively affected other patients.

The Committee then asked the Consultant Neurologist to introduce the epilepsy team and provide an overview of the service. The Consultant Neurologist explained the unpredictability of epilepsy, the associated comorbidities, and the socioeconomic impact. He highlighted the significant demand on the service, the shortage of specialist nurses and neurologists, and the long waiting times for patients. He also discussed the impact of the Medicines and Healthcare products Regulatory Agency (MHRA) regulations on the service, including the need for additional patient appointments and the challenges of implementing the new guidelines.

The Committee asked why the Oxfordshire epilepsy team was significantly under-resourced compared to other areas with similar populations, and what the historical context and funding situation behind this disparity were. The Epilepsy Specialist Nurse reflected on the increasing complexities in neurology since the late 1990s. Despite prioritising patient care, the nurse highlighted the difficulties in sustaining services due to insufficient resources, staffing, and funding, especially when national programmes lacked additional support.

The Committee inquired about the rise in demand for services for patients with learning disabilities and epilepsy. The Lead Learning Disability Epilepsy Specialist Nurse had been working closely with Oxford Health and Oxford University Hospitals to streamline services for patients in Oxfordshire. There were two learning disability teams, each with experienced Band 6 and Band 7 nurses. These teams primarily supported individuals with epilepsy and other health conditions, ensuring medication compliance and addressing potential risks like SUDEP. A significant focus was on the transition from children's to adult services, with efforts to facilitate smooth transitions through transition clinics.

The Committee asked the Consultant Paediatrician about the complexities of managing epilepsy in children, particularly those with learning disabilities. The Consultant Paediatrician discussed the need for personalised risk-benefit assessments and the lack of a national framework to guide these decisions.

The Committee asked the Medicines Optimisation Lead Pharmacist about the regional approach to the MHRA regulations and the evidence of harm caused by the policy. The Senior Clinical Quality Improvement Manager at NHS England discussed the longstanding awareness of risks  ...  view the full minutes text for item 70/24

To AGREE the Committee’s proposed work programme for its upcoming meetings.

The Committee AGREED the proposed 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 progress made against agreed actions and

recommendations