Agenda and minutes

2.30

It was resolved to elect Councillor Don Seale as Chairman for the current year.

2.35

Councillor Anda Fitzgerald was elected to Deputy Chairman for the current year.

none

Councillor Skolar declared an interest by virtue of having a relative living in a care home outside of Oxfordshire.

Councillor Hannaby declared an interest as a trustee of Wantage Nursing Home.

2.40

To approve the Minutes of the meeting held on Tuesday 26 April 2011 (AS5) and Monday 9 May 2011, to be circulated separately, and  to receive information arising from them.

Minutes of the meeting held on 9 May 2011 were agreed and signed.  Minutes of the meeting held on 26 April 2011 were agreed with amendments recorded and signed off.

2.45

The Director of Social and Community Services will give the Committee a verbal update on current issues and answer questions.  The Cabinet Member for Adult Services will also be present to respond to questions from the Committee.

The Director of Social and Community Services gave an update on current key issues for Adult Services. 

Local issues:

The Director gave the following update on local issues:

Winterbourne View Hospital

There is a police investigation so there are limits on what we can say.

Winterbourne View is a specialist hospital for people with learning disabilities and mental health issues, run by a large national provider, Castlebeck.  OCC has responsibility for specialist hospital placements for LD, on behalf of the PCT, through the pooled budget and lead commissioning arrangements. Hospitals are regulated and monitored by the Care Quality Commission.

The hospital supports people experiencing a period of serious mental illness.  This often manifests itself in challenging behaviour that poses serious risk to the person and others. People are either detained under the mental health act following assessment by 2 approved doctors and an Approved Mental Health Professional, or they may agree to voluntary admission. The hospitals provide assessment and treatment and employ therapists including psychiatrists and psychologists. No placement should be permanent, though the length of time taken for people to recover enough for a safe discharge varies considerably

Oxfordshire commissions 9 inpatient beds in Oxford from Ridgeway Partnership. These are procured and closely monitored by the Council.

OCC’s policy is to minimise the use of out of area hospital placements, and they are only used for temporary placements when no local bed is available that can meet the needs. In the last 18 months Oxfordshire has made 3 placements at Winterbourne View.  No patients  are there now. Oxfordshire currently has 3 placements at other Castlebeck hospitals,

The Learning Disability Teams are part commissioned/part provided by the Council. Admissions to specialist hospitals are often urgent, may be out of hours. The psychiatrist in the Learning Disability Team normally seeks an available bed to meet the clinical needs identified, close to Oxfordshire if possible. A limited number of large national providers are used, of whom we have previous experience. Poor reports from the Care Quality Commission would exclude a provider.  There was no evidence provided to us before 13^th May that there were concerns about Castlebeck as a company or about Winterbourne View as a hospital.

Patients and families are involved in decisions. The Council funds the placement through the pooled budget. Once placed, the care manager, (often with a nurse and psychiatrist in the LD Team) monitors the placement, progress towards recovery, and plans for discharge or a move back to an inpatient bed in Oxfordshire. Regular contact is made and reviews held to ensure the person’s needs are met and they are happy.

Questions we are looking at:

·        We cannot replicate the role of the regulator, but what are the key indicators that we could check in out of area placements?

·        Should we work with other PCTs to establish an approved provider list?

·        Can we do more to enable service users and families to identify concerns and raise them with us?

Southern Cross

My summary of  ...  view the full minutes text for item 142/11

3.30

This item follows on from discussions at meetings in October of last year and March this year.  There is an opportunity to discuss issues around Continuing health care – looking at the responsibilities of the NHS and the Local Authority for the assessment and provision of care.

There will be a question and answer session with the Director of Social and Community Services and Nick Graham, Deputy Head of Law & Governance in attendance to respond to questions from the Committee.

This item was part of an agreed follow up to questions on this subject posed at earlier meetings.  Members were provided with some legal guidance and this session was intended to enable further questions and clarification on how it is applied locally.

Councillor Sanders initially commented that he thinks the law has been clarified by a number of legal cases such as Coughlin as was described in the legal guidance paper provided by Nick Graham.  However Cllr Sanders questioned whether staff are sufficiently aware of the law.  He also expressed the view that the NHS guidance on the matter is “misleading” and he was concerned that OCC staff allow themselves to be misguided by this.  In his view this meant there was a risk that there are people entitled to continuing care who are not getting it.

Cllr Skolar said he was not confident that calculations of those receiving continuing care had always been accurate making it difficult to establish a true picture.  But also that the NHS is targeting continuing care to achieve savings and questioned what we are doing to ensure people are getting continuing care when they should be.

John Jackson replied that there is a panel that sits including staff from OCC to decide who is entitled and the decision is based on what is law and policy in this area.  He agreed that NHS were looking to find savings in this area but this was focused on where people were receiving continuing care but were not entitled to it.

Nick Graham made the point, not specific to Oxfordshire, that generally PCTs have tightened up on this and as a result Local Authorities have lost out.  And he commented that the case law has not helped LAs as it has confirmed that PCTs have responsibility for assessing continuing care in the first instance and LAs only have limited ability to challenge and in fact even in this sense the courts are reluctant to decide if the process used to reach the decision is reasonable.  However the assessment must be based on the law and although uncommon if other methods of dispute resolution do not work there is legally no reason why LA could not challenge NHS in court.

John Jackson said that staff are able to get advice from Nick if required and also that Age UK offer a dispute resolution service that could be used in these circumstances.  

The Committee were informed that Sarah Walters has taken over from Sandra Stapley as the officer within the Council responsible for making decisions regarding continuing care cases.

On the request of Cllr Sanders it was AGREED that the committee would be provided with statistics and a trajectory of continuing care cases over a period to give insight into the volume of continuing care cases and any changes in numbers over time.

3.45

This item will provide a briefing on the current progress of the Health and Social Services Bill and provide an update on the proposed relationship between Oxfordshire County Council and the NHS in the light of the revised Bill.  This will be an oral update and so there is no paper attached for this item.

The item will be presented jointly by The Director for Social and Community Services and Jonathan McWilliam, Director of Public Health.

There will be an opportunity for the Committee to ask questions following the presentation.

Jonathan McWilliam gave a general update on the developments for the new NHS clustering arrangements which, from 1 June, replaced PCTs with a single cluster board for Oxfordshire and Buckinghamshire.  The cluster board will meet quarterly.  Sonia Mills has been appointed to manage this cluster.  All of Oxfordshire PCTs formal business will be handled by the cluster.  Risk and governance issues are being managed by the cluster.

Under the new arrangement there is likely to be one GP consortia covering Oxfordshire with the exception of Thame and Shrivenham.  The Consortia will run with 6 localities and these will align with district boundaries with Cherwell and South Oxfordshire split into two. 

Responsibility for public health will transition to County Council in 2013.  Currently the shape of what this will look like is in place but there is very little detail and more information will need to be provided nationally before taking this forward at a local level.

Jonathan McWilliam gave a brief update on the government’s listening exercise: the future forum which reported during the course of the meeting. 

In response to a question from Cllr Hannaby, Johnathan McWilliam confirmed that Members will have rights of audience at PCT cluster meetings and commented that Health and Wellbeing Boards will be constituted as a sub committee of the County Council and would therefore be subject to OCC Constitution.  Area consortia arrangements for Thame were given as aligning with Buckinghamshire and for Shrivenham, Swindon.

Cllr Skolar commented that although there are other counties that are further along this process than us there is definitely a widely held view that Oxfordshire demonstrates best practice in terms of joint management arrangements and the use of pooled budgets.

John Jackson commented that we would like to see GP commissioning going forward as a way of challenging things in the acute sector.   He also reminded everyone that we do already have a Health and Wellbeing Partnership board here even if this is a different format to what will supercede it under the new proposals.

4.15

John Dixon, Interim Deputy Director, Adult Social Care will give a presentation giving the current progress on this strategy. The item will provide an overview of the broad policies under which this strategy is being taken forward. The presentation will be followed by a question and answer session. The Director of Social and Community Services and the Cabinet Member for Adult Services will also be present to respond to questions.

John Jackson gave a presentation to the Committee highlighting the Oxfordshire Care Partnership proposed contract variations. After the presentation John Jackson gave answers to questions from Members of the Committee as follows:

There was a discussion around the implications of transferring ownership of the freehold from the County Council.  John Jackson confirmed that there will be a formal report giving the details of these proposals presented to the Committee later in the year once it has been before the Cabinet.

4.45

An update given by members of the Oxfordshire LINk summarising current and future areas of work.  (A report is attached at AS10).

Adrian Chant gave a brief update from the Oxfordshire LINk.

The transfer to ORCC took place on 1 May and although there were some reductions in numbers of staff the LINk is now established at ORCC and is set to carry on with the core work.

The Committee’s attention was drawn to the recently published social care hearsay report which was circulated at the meeting.  Quarterly updates will continue to be produced on this piece of work.

There was a suggestion that the resources of LINk to visit and monitor care homes could be supplemented with the involvement of Committee Members.  The Chairman noted that it was important to maintain the LINk’s independence if this suggestion were to be taken forward.

5.00

A report from the Oxfordshire LINk giving feedback on the visits that have taken place to assess the standards of care homes funded by Oxfordshire County Council.  The report has previously been presented to the Oxfordshire Joint Health Overview and Scrutiny Committee on 19 May.

The report (a copy of which is attached at AS11a) will be presented by the LINk Liaison members who conducted the visits.

A report giving a response to the LINk report is attached at AS11b will be summarised for the Committee by the Director for Social and Community Services.  Andrew Colling Adult Services Contracts Services Manager will also with the Director to respond to questions from the Committee.

The committee received a report from the Oxfordshire LINk giving feedback on the visits that have taken place to assess the standards of care homes funded by Oxfordshire County Council. 

The report was presented by the LINk Liaison members who conducted the visits.

5.25