Agenda and draft minutes

For the Committee to AGREE a Chair for the Joint Health Overview Scrutiny Committee for the 2024/2025 Council Year.

The Health Scrutiny Officer welcomed Members and Officers to the HOSC meeting, and proceeded to oversee the election of the Chair of the HOSC. Cllr Hanna was nominated by Cllr Lygo, and seconded by Cllr Hannaby for the role of Chair, with no other nominations.

It was AGREED that Cllr Hanna be elected Chair of the HOSC for the 2024/25 council year. Cllr Hanna assumed the position as Chair.

For the Committee to AGREE a Vice-Chair for the Joint Health Overview Scrutiny Committee for the 2024/2025 Council Year.

The Chair asked if there were any nominations for the position of vice-Chair of the HOSC for the remainder of the civic year. Cllr Katherine Keats-Rohan was nominated by Cllr Barrow and seconded by Cllr Lygo. No other nominations were proposed.

It was AGREED that Cllr Keats-Rohan be elected vice-Chair of the HOSC for the 2024/25 council year.

The following members tendered their apologies:

Cllr Nigel Champken-Woods

Cllr Michael O’Connor

Cllr Nick Leverton

Cllr Freddie van Mierlo, with Cllr Roz Smith substituting.

Cllr Haywood (who had attended the meeting upon being invited by the Chair to do so) declared his interest in working for the NHS.

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

To approve the minutes of the meeting held on 18 April 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 18 April 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 31 May 2024.  Requests to speak should be sent to scrutiny@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.

The Chair invited the registered speakers to address the Committee.

1.    Statement by Charlotte Bird:

Charlotte Bird, vice-chair of Keep the Horton General, expressed her disappointment over the Oxford University Hospitals NHS Foundation Trust's reduction of services at Horton Hospital. Until 2016, the hospital had a thriving obstetric-led maternity unit and Special Care Baby Unit (SCBU) in Banbury. A dossier that her organisation was compiling for distribution on June 17, highlighted stark differences in experiences pre and post-2016.

The Royal College of Obstetricians and Gynaecologists did not support the positioning of midwife-led units distant from the support of obstetricians, anaesthetists, and paediatricians. The Independent Review Panel (IRP) did not support the Trust's proposals to reconfigure services at Horton Hospital. Despite the IRP's judgment, the Trust removed Horton training accreditation and ended the clinical fellows system. The Trust also ignored applications from 50 Ugandan doctors for vacant obstetric roles. The IRP deemed it unsafe and inhumane for women in labour to be transported from Banbury to Oxford, yet this had been happening since Autumn 2016. She urged the Committee to use their power to remedy this situation.

2.    Statement by Keith Strangwood

Keith Strangwood, Chair of Keep The Horton General, urged the committee to take action on the Horton Hospital to prevent mothers from having to make the difficult journey to the John Radcliffe. He mentioned national figures indicating that 41% of the claims to the NHS were related to maternity, amounting to £2.6 billion paid out between 2022 and 2023 due to NHS faults in maternity. He shared a story of a child who did not receive adequate care at the John Radcliffe and had been in palliative care at home since October 2016. The child was nearly eight years old, and the family’s life was ruined.

The speaker suggested that maternity services in Oxfordshire should be included in the Committee forward work plan. He stressed that the issue was affecting everyone in Oxfordshire. He hoped that everyone would read the dossier being produced by Keep The Horton General and be moved by the stories it contained.

3.    Statement by Kristi McDonald:

Kristi McDonald spoke about her experience with epilepsy. She was diagnosed with epilepsy at age 6 and relied on life-sustaining medication, sodium valproate. She was very concerned to learn that the Medicines and Healthcare products Regulatory Agency (MHRA) policy could mean she may be removed off sodium valproate for another medication if a second consultant disagreed that she should remain upon it. The MHRA policy process meant there was no patient involvement in the decision making, and there was no process for the patient to appeal against the consultant's decision. She was being treated as if she was permanently pre pregnant. That she, along with other girls and women, must be on birth control to access life sustaining medication for a neurological condition breached their human rights. She had raised these issues with the MHRA and the Parliamentary Health Ombudsman. Kristy appreciated the Oxford Epilepsy Service but recognised  ...  view the full minutes text for item 40/24

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

There are THREE documents attached this item:

1.   A HOSC report containing recommendations from the Committee on General Practice Provision in Oxfordshire, which was discussed during the 18 April 2024 HOSC meeting.

2.   A HOSC report containing recommendations from the Committee on Dentistry Provision in Oxfordshire, which was discussed during the 18 April 2024 HOSC meeting.

3. A HOSC report containing recommendations from the Committee on the Oxford University Hospitals NHS Foundation Trust People Plan, which was discussed during the 18 April 2024 HOSC meeting.

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

The Chair outlined the following points to update the Committee on developments since the previous meeting:

·       HOSC reports containing recommendations were published in the agenda for this meeting on; General Practice Provision in Oxfordshire, Dentistry Provision in Oxfordshire, and the Oxford University Hospitals NHS Foundation Trust People Plan.

·       In May, the Wantage Working Group conducted a six-month review of the plan for the refurbishment of Wantage Community Hospital agreed upon in January. There was good progress on the plans so the bid could soon be submitted to obtain Community Infrastructure Levy (CIL) funding. A stakeholder group met to see the outline designs and to hear about progress on discussing which services would be coming out to Wantage. The Working Group was optimistic about the refurbishment timeline and successful delivery of the project.

·       Due to NHS pre-election guidance, briefings and visits with the NHS had been postponed until after the election period.

The Committee AGREED To DELEGATE to the Health Scrutiny Officer the task of compiling the Committee’s feedback following the briefing on 10 June on the Oxford University Hospitals NHSFT Quality Account in consultation with the Chair, and to submit the feedback to Oxford University Hospitals NHSFT prior to the publication date for the Quality Account on 30 June 2024.

The Committee NOTED the Chair’s Update.

The purpose of this item is to approve the draft of the Annual Report of the Joint Health Overview Scrutiny Committee. This report will be presented to Full Council on 09 July 2024, and summarises the key scrutiny activities that the OJHOSC has engaged in throughout the course of the 2023-2024 civic year.

There are TWO documents attached to this item:

1.    A cover report for the HOSC Annual Report.

2.    Annex 1- The full draft and wording of the HOSC Annual Report.

The Committee is RECOMMENDED to Delegate authority to the Principal Scrutiny Officer:

1.    for the design of the final report,

2.    to make minor updates or amendments as required, in consultation with the Chair and the Health Scrutiny Officer,

3.    for publication of the final report

The Committee AGREED to delegate authority to the Principal Scrutiny Officer:

1.    for the design of the final report,

2.    to make minor updates or amendments as required, in consultation with the Chair and the Health Scrutiny Officer,

3.    for publication of the final report

Lily O’ Connor (Programme Director Urgent and Emergency Care for Oxfordshire, BOB ICB) and Daniel Leveson (Oxfordshire Place Director, BOB ICB) have been invited to present a report with an update on Integrated Neighbourhood Teams in Oxfordshire.

There are TWO documents attached to this item:

1.    A cover sheet for the Integrated Neighbourhood Teams Report.

2.    The main report on Integrated Neighbourhood Teams.

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, BOB ICB) and Daniel Leveson (Oxfordshire Place Director, BOB ICB) presented a report with an update on Integrated Neighbourhood Teams (INTs) in Oxfordshire. Also in attendance were Dr Bethan Willis (GP Lead for Inequalities, Banbury Cross Health Centre and Frailty GP For Banbury), Dr Sarah Lourenco (Clinical Director of Banbury Alliance PCN), Dr Suzanne Summers (Bicester Health Centre, Integrated Neighbourhood Team Bicester GP), and Dr Joe McManners (GP and OX3 Primary Care Network Clinical Director).

The Programme Director provided a comprehensive overview of the Integrated Neighbourhood Teams (INTs) initiative in Oxfordshire, which included GPs, social workers, community therapists, district nurses, and other healthcare professionals. These teams worked collaboratively to address unmet health needs, in areas of deprivation such as Banbury, Bicester, and OX3.

The Programme Director explained that while many aspects of the initiative might seem like they should already have been happening, the challenge in implementing them lay in the lack of additional workforce and funding necessary for providing the level of care required in these areas. The INTs aimed to provide that additional funding and staffing, particularly in areas of unmet health needs.

The Chair thanked the Programme Director for her summary and opened the floor to questions from the Committee.

Question on reducing health inequalities and continuity of care:

The Committee asked for elaboration on how the existence and functions of INTs would help to tackle and reduce inequalities in Oxfordshire and deliver continuity of care, and whether this would be delivered in rural areas. The Programme Director responded that continuity of care was a fundamental component of INTs. The initiative ensured oversight and coordination across multiple healthcare professionals, which was crucial for patients who preferred to interact with a single trusted individual. This approach not only benefited patients but also enhanced job satisfaction among healthcare professionals due to the continuous relationship with the same patient group.

Regarding rural areas, the Programme Director acknowledged the challenges and explained the phased approach to expanding INTs. Currently, the focus was on areas with the highest unmet health needs due to limited funding, but there were plans to extend the initiative to other areas, including rural areas, if more resources became available. The Oxfordshire Place Director emphasised that in Oxfordshire they had chosen to prioritise supporting the development of integrated neighbourhoods through the Better Care Fund and it was a central part of their primary care strategy.

Question on fragmentation of services and focus on specific conditions:

The Committee enquired about the focus on different conditions in different localities.

The Programme Director clarified that the INTs were designed to address the specific health needs of each local population, which was why the focus areas differed. The initiative was not limited to single conditions but took a holistic approach to managing the overall health of the population. The emphasis on different conditions in various areas was based on thorough background work and population-health data, ensuring that the INTs addressed the  ...  view the full minutes text for item 43/24

Dr Victoria Bradley (Clinical Lead for and Consultant in Palliative Medicine, Oxford University Hospitals NHS Foundation Trust) has been invited to present a report with an update on Palliative/End of Life Care in Oxfordshire.

There are TWO documents attached to this item:

1.     A report containing an update on the Rapid Intervention for Palliative and End of Life Care (RIPEL) project.

2.     A report providing a BOB Integrated Care Board Update on Palliative and End of Life Care.

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

Dr Victoria Bradley (Clinical Lead for and Consultant in Palliative Medicine, Oxford University Hospitals NHS Foundation Trust) and Zo Woods (Program Lead, BOB ICB) presented a report with an update on Palliative/End of Life Care in Oxfordshire.

The Chair invited registered public speaker Cllr Stefan Gawrysiak to address the Committee.

Cllr Gawrysiak highlighted his personal positive experiences with the home and outreach palliative care services, emphasising their excellence. However, he identified a significant gap: the lack of residential palliative and respite care beds. Cllr Stefan argued that the Committee should address this shortfall, noting that the existing reports failed to mention residential palliative care. He urged the Committee to advocate for the inclusion of residential care details in the report to ensure comprehensive palliative care coverage across Oxfordshire.

The Clinical Lead for and Consultant in Palliative Medicine provided an update on the project's progress and achievements. She highlighted the significant improvements made in patient and family experiences due to the specialist services introduced over the past two years. These improvements were attributed to funding from Macmillan and the Sobell House Hospice charity, which had enabled much-needed advancements in palliative care. Despite challenging financial circumstances, the service had managed to save more resources within the system than it spent. She emphasised the profound impact of enabling patients to die at home, in accordance with their wishes, rather than in less preferred environments.

Question on the involvement of the community and coproduction in the service design:

The Committee asked about the involvement of the community and stakeholders, and how deeply coproduction was embedded in the service design. The Clinical Lead acknowledged that while the service had always prided itself on being close to the community, there had been limited formal coproduction in the initial setup due to the speed required to implement changes. Moving forward, there was a strong emphasis on involving patients, families, and bereaved relatives in a more structured manner. This approach aimed to ensure that future service developments were closely aligned with the needs and preferences of those directly affected.

Question on ethnic minorities accessing palliative care:

The Committee raised a question about the underutilisation of palliative care services by ethnic minority groups. The Clinical Lead explained that an Equality Diversity Inclusion Officer, funded by charity partners, was actively working to identify key groups and engage with them to understand and address barriers to service access. This included outreach efforts to culturally specific communities, such as the mosque in Banbury, to discuss culturally competent end-of-life care.

Question on extending enhanced palliative care hub hours:

The Committee enquired about the justification for not extending the palliative care hub hours beyond the standard 9 AM to 5 PM. The Clinical Lead explained that while recognising that health crises occur outside regular working hours, pilot projects had shown minimal demand for extended hours. Embedding a specialist nurse within the Oxford Health single point of access from 5 PM to 8 PM resulted in very few additional calls, indicating that resources could be  ...  view the full minutes text for item 44/24

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

Sylvia Buckingham (Trustee for Healthwatch Oxfordshire) presented the Healthwatch Oxfordshire update report.

The Trustee listed some of Healthwatch’s recent activities. Healthwatch had:

·       spoken to residents in North Oxfordshire and identified that access to services and public transport was a significant concern raised by the community. These issues directly related to the challenges faced by residents in North Oxfordshire.

·       collaborated with Oxford Community Action to address the ongoing issues related to the cost of living and food insecurity. Their efforts aimed to improve the situation for residents in the area.

·       conducted research involving parents and carers of children with special educational needs and disabilities. The upcoming report, expected in July, would provide insights into the experiences and challenges faced by this group.

Healthwatch aimed to release its annual report by July 2nd, pending any election-related changes. They continued to actively engage with the public, receiving both positive and negative feedback on accessing services, including NHS pharmacies.

Rose Hombo (Deputy Director of Quality & Clinical Standards Oxford Health NHS Foundation Trust) has been invited to present the draft Quality Account of Oxford Health NHS Foundation Trust, specifically, the quality objectives for this year and the next.

The Committee is recommended to: -

a)                      AGREE to provide comments on the account, in particular in relation to whether the account corresponds with HOSC member experience of the Trust over the last year, and whether they support the key areas of focus for the Trust over the forthcoming year.

b)                      DELEGATE to the Health Scrutiny Officer the task of compiling the Committee’s comments on the Quality Account in consultation with the Chair, and submit the feedback to Oxford Health prior to the publication date for the Quality Account on 30 June 2024.

PLEASE NOTE: The report for this item will be issued as an addenda.

Britta Klinck (Chief Nurse, Oxford Health NHS Foundation Trust) and Rose Hombo (Deputy Director of Quality & Clinical Standards Oxford Health NHS Foundation Trust) presented the draft Quality Account of Oxford Health NHS Foundation Trust. Dan Leveson, BOB ICB Oxfordshire Place Director was also in attendance.

Having introduced the Committee’s involvement in the Oxford Health quality account process, the Chair opened the floor to questions from the Committee.

Question on recruitment, levels of agency staff, and Oxford Weighting:

The Committee enquired whether there had been an increased reliance on agency staff, how successful the Trust had been with nursing recruitment, and what further steps the Trust would take to improve nursing recruitment. The Committee also asked about implementing an Oxford Weighting for salaries.

The Chief Nurse highlighted the Trust's efforts to reduce reliance on agency staff due to both financial constraints and the impact on care quality and patient relationships. She noted the importance of creating a positive work environment to attract and retain staff, mentioning partnerships with local universities and international recruitment efforts that had temporarily filled all vacancies in community hospitals. A notable success was the Trust's programme to train and retain local nursing associates, which had resulted in a substantial number of graduates from the local area, thereby mitigating some staffing issues.

The issue of an Oxford Weighting remained a national concern, but the boundary defining high-cost living areas would always be a point of contention. Oxford Health lacked the autonomy to address this matter themselves but were aware that the impact of this issue was significant, leading to staff attrition among those who wished to start families and own homes while working in the NHS. Any changes to salaries would need to be made in collaboration with other providers across BOB.

Question on support for staff wellbeing:

The Committee asked how the Trust had supported staff wellbeing overall and whether there was a means through which the Trust had measured the impact of support mechanisms for staff. The Chief Nurse outlined the various support mechanisms in place, such as supporting staff with cost-of-living pressures, clinical and managerial supervision and psychological support for traumatic events. They also focused on trauma-informed care for both staff and patients, along with initiatives like Swatch Rounds, which offered opportunities for reflection and processing. They assessed staff wellbeing through the annual NHS Staff Survey, and through participation in the People Polls survey (a monthly assessment administered by NHS England).

Question on patient feedback and experiences:

The Committee enquired how the Trust was utilising patient feedback and experiences to enhance the services it provided overall and whether there were any improvements in this area within the last year.

The Deputy Director of Quality & Clinical Standards explained the development of a more robust patient feedback system, including online portals and regular surveys. These tools were designed to gather comprehensive insights into patient experiences. Efforts were being made to ensure patient concerns were addressed promptly and effectively, including the introduction of patient liaison officers and  ...  view the full minutes text for item 46/24

The Committee will receive 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.

PLEASE NOTE: The report for this item will be issued as an addenda.

The Chair informed the Committee that OUH had requested more time to produce a joint paper with the ICB in relation to epilepsy, so this item had been deferred to the HOSC meeting on 12th September 2024.

The Committee has received Responses as well as Acceptances for the recommendations made as part of the following items:

1.    The South Central Ambulance CQC Improvement Journey Update, which was held during the 08 February 2024 HOSC meeting.

2.    The John Radcliffe Hospital CQC Improvement Journey, which was held during the 08 February 2024 HOSC meeting.

3.    The Director of Public Health Annual Report, which was held during the 08 February 2024 HOSC meeting.

The Committee has also received TWO progress update responses to recommendations made as part of the following items:

1.    Health and Wellbeing Strategy Update.

2.    Oxfordshire Healthy Weight.

The Committee is recommended to NOTE the responses

The Committee received responses as well as acceptances for the recommendations made as part of the following items:

1.    The South Central Ambulance CQC Improvement Journey Update, which was held during the 08 February 2024 HOSC meeting.

2.    The John Radcliffe Hospital CQC Improvement Journey, which was held during the 08 February 2024 HOSC meeting.

3.    The Director of Public Health Annual Report, which was held during the 08 February 2024 HOSC meeting.

The Committee also received two progress update responses to recommendations made as part of the following items:

1.    Health and Wellbeing Strategy Update.

2.    Oxfordshire Healthy Weight.

The Committee NOTED the responses and updates.

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

The Committee AGREED the proposed forward work plan, and AGREED to hold a public meeting item in the near future on Maternity Services in Oxfordshire

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.