Agenda and minutes

Apologies were received from Barbara Shaw.

Councillor Nick Carter attended as a Temporary Appointment for the vacant position.

The Chairman also welcomed Councillor Kevin Bulmer as a permanent replacement for Councillor Mike Fox-Davies and Councillor Susanna Pressel as a permanent replacement for Councillor Laura Price.

The Chairman thanked Councillor Laura Price for all her work and effort on behalf of residents across the county and added that he had always valued her counsel.

The Chairman also thanked policy officer Martin Dyson who is leaving the Council shortly and thanked him for his work in support of the Committee and wished him well in his new job.

Dr Alan Cohen is a trustee of Oxfordshire Mind.

Jean Bradlow is involved in a voluntary capacity with Oxford University Hospital’s Early Alert Test System for COVID-19 and her husband is a consultant rheumatologist at the Royal Berkshire NHS Foundation Trust.

To approve the minutes of the meeting held on 24 September 2020 (JHO3a) and to receive information arising from them.

For ease of reference when considering the Matters Arising from the minutes, a list of actions is attached at the end of the minutes (JHO3b).

The minutes of the meeting held on 24 September 2020 were approved.

Dr Alan Cohen updated the meeting on the question of early discharges from hospital.  He had a meeting arranged with the Director for Adult & Housing Services and will report back to the February meeting.

This meeting will be held virtually in order to conform with current guidelines regarding social distancing. Normally requests to speak at this public meeting are required by 9 am on the day preceding the published date of the meeting. However, during the current situation and to facilitate these new arrangements we are asking that requests to speak are submitted by no later than 9am four working days before the meeting i.e. 9 am on Friday 20 November 2020. Requests to speak should be sent to colm.ocaomhanaigh@oxfordshire.gov.uk  together with a written statement of your presentation to ensure that if the technology fails then your views can still be taken into account. A written copy of your statement can be provided no later than 9 am 2 working days before the meeting.

Where a meeting is held virtually and the addressee is unable to participate virtually their written submission will be accepted.

The Chairman had agreed to the following requests to speak at this meeting:

Item 5 – Forward Plan

Councillor Jane Hanna

Item 6 – Oxfordshire Health and Care System COVID-19 Update

Janet Phillips

Councillor Jane Hanna

Item 9 – Community Services Strategy

Julie Mabberley

Councillor Jane Hanna

Councillor Jenny Hannaby

Item 11 – Proposed changes for health scrutiny

Councillor Jane Hanna      

Item 13 – Chairman’s Report

Councillor Jenny Hannaby

Councillor Jane Hanna

10:20

This item will provide a report on the key issues for the Oxfordshire system.

Janet Phillips spoke in favour of a local test and trace system.  She noted that the Government had put £22 billion into the centralised organisation named NHS Test and Trace which was actually a string of private companies with no prior experience of testing and tracing.  She believed that the model was fundamentally flawed and that the only way to fix testing and tracing was to hand the money and the work over to the experts in our local public health bodies.  She called for support for a motion on local test and trace coming before Oxford City Council on 30 November and urged those from other parts of Oxfordshire to put similar motions to their own councils.

Councillor Jane Hanna supported the call for local test and trace system and said that she regretted the lack of a boost for local public health funding in the Government’s recent financial settlement.  She noted the high level of deaths among those with learning disabilities, especially in the 18 to 40 age bracket who were 30 times more at risk of death.  She urged that they be prioritised when vaccines become available.

Nick Maynard, Surgeon and Oxford University Hospitals Cancer Lead, summarised the situation with cancer services which he said had performed better through the pandemic than in other areas of the country.  The services that have had the greatest difficulties are the breast cancer and breast symptomatic services and the colorectal service and a lot of effort has gone into tackling those with robust action plans in place.

All cancer pathways have been reviewed.  The risk/benefit balance may have changed for some given the risk of COVID infection.  The harm reviews of changes to the pathways have not found that any obvious harm has resulted.  There have been no reductions to services in the second COVID-19 wave.

Ruth Wilcockson, Managing Director, Thames Valley Cancer Alliance, added that OUH not only provided more capacity but also provided leadership through the crisis.  The Alliance was supporting improved data including live dashboards to monitor where patients were on their pathways.

Nick Maynard and Ruth Wilcockson responded to questions from members of the committee as follows:

·         At first there was no data on risks and then only anecdotal evidence.  A national scoring system was introduced.  For example, patients requiring major thoracic treatment were a particularly high risk should they get COVID.  Only one cancer patient contracted COVID during the first wave and that was right at the beginning.

·         Endoscopies had been maintained at a lower rate with a comprehensive triage system.  There had been a review of those that had been postponed which had not shown any evidence of harm.  The main concern was the drop off in referrals at the start of the pandemic which meant that more people would be coming in quite late.

·         Staff who had to self-isolate could still work with remote outpatient clinics.

·         Screening services developed a backlog which was being worked through, prioritising the most urgent.  They were  ...  view the full minutes text for item 44/20

11:55

Locally-led research being undertaken on COVID-19 treatments.

The report was introduced by Dr Bruno Holthof, Chief Executive Officer, Oxford University Hospitals.  He highlighted the importance of the role of the Oxford Biomedical Research Centre and the benefit to UK taxpayers as a result of investing in the centre’s work.  They enrolled 3,000 patients in clinical studies which were a real benefit to those patients, accessing treatments they could not otherwise access.  Its current contract runs to 2022 when it will have to compete for funding again.

With regard to COVID-19, he was hopeful that both the Oxford vaccine and the Pfizer vaccine could be given temporary approval before the end of the year.  It was an example of collaboration between the trust, the university and spin-out private companies.

Hundreds of COVID-19 tests were researched at the JR Hospital.  The lateral flow test was now being rolled out for NHS staff and Tier 3 areas.  One floor at the hospital was being converted into a high volume testing area that will be able to handle 10,000 samples per day.

Dr Holthof responded to questions from members of the Committee as follows:

·         Studies on long-COVID were monitoring many organs including lungs, heart and liver to determine the long-term effects as well as looking at the mental health impact.

·         All staff – around 10,000 people – had been tested over the last six months, including asymptomatic staff.  In the early stages this helped them identify that some outbreaks resulted from some staff not wearing protective equipment during breaks and appropriate reminders were issued.

·         Risk assessments were carried out for all staff and they take into account the known higher risk for those from BAME communities.

·         Studies have been able to show that anti-bodies give a level of protection against a second infection.

·         Any side-effects from the vaccines were minor – similar to the flu vaccine – and were far out-weighed by the benefits.  Safety data from the vaccine for MERS coronavirus identified in 2012 was also available.

·         It was expected that the majority of people would be vaccinated in the first half of next year but people may need regular vaccination as with the flu.

·         It was important that people could trust the vaccine and that was why a more cautious approach had been taken.

The Chairman thanked Dr Holthof for the report and offered to write on behalf of the Committee in support of the Centre’s application for funding when the time came.

12:25

Update from Oxford Health on the progress of the community services strategy.

Julie Mabberley, Chairman of the OX12 Pilot Population Health Care Management Project Stakeholder Reference Group, welcomed the statement in the report that Oxford Health had analysed the data and started an asset mapping and data collection exercise for all existing community services and facilities.  She hoped that the work already done on this by the reference group would not be missed in this work.

She reminded the Committee that the Stakeholder Reference Group and several of the local Councils had asked for the OX12 final report to be withdrawn as it did not reflect the work done in the project.  She welcomed the opportunity for the Stakeholder Group to engage with the Trust in the exercises being performed in the next few months to ensure that the detailed views of the residents of OX12 were taken into account.

Councillor Jenny Hannaby, Chairman of the League of Friends of Wantage Hospital, summarised the history of the hospital and described how services and bed numbers had been reduced since it had been taken over by Oxford Health, culminating in the hospital being closed for four years due to a serious maintenance problem.  She contrasted the experience with that of Wallingford Hospital which was lauded in a recent report in the Oxford Mail.  She said that as Chairman of Wantage Town Council Health Committee she looked forward to meeting with Oxford Health to discuss the Strategic Development and Quality Improvement Plan.

Councillor Jane Hanna noted the data in the report which showed a reduced need for hospital beds which had been accelerated by the pandemic and the increased emphasis on discharging to home.  However, international data had shown that the countries with the highest number of hospital beds experienced lower mortality from COVID-19.

She asked if Adult Services had been included in the county review.  She noted that there had been no engagement with the Task and Finish Group since the last Committee meeting when the decision to close the beds had come as a shock to the Group.  She welcomed the invitation to the Town Council Committee but said that there had been a lack of timeliness and hoped that this had not reduced the possibility of influencing the outcome.

Dr Ben Riley, Managing Director Primary and Community Services, Oxford Health, summarised the report.  The team had progressed matters despite the demands of time imposed by the pandemic.  A new Strategy Development Officer had been recruited.  The data from the OX12 project would certainly be included but there was not the same level of information available for other areas.

There will be a lot of alignment with the OUH Strategy which talked a lot about community and services closer to home.  The main challenge will be to bring all the information together into a delivery plan.  He noted that there was a lot of data at the county level and at the local level but something of a gap in the middle at the district level at which community hospitals  ...  view the full minutes text for item 46/20

13:45

Update on proposals for scrutiny of issues at a BOB-wide level (Bucks, Oxon, Berks West).

The Chairman summarised the report.  The process had taken much longer than expected but he felt that the concerns raised had now been allayed.  The Centre for Public Scrutiny’s advice was sought on best practice.  The individual councils retained the right of referral on an issue even if BOB HOSC decided not to refer it.

It was proposed to develop a toolkit to decide what issues might go to BOB level.  Meeting dates would be in set in diaries in advance but if no issues met the test then there would be no meeting.

The membership split was proposed to be 7 Oxfordshire and 6 for Bucks and 6 for the Berkshire authorities.  The Terms of Reference were to go before Full Council on 8 December and to Bucks’ full council on 9 December.  The Berkshire authorities will also go through that process.

Councillor Jane Hanna stated that she was particularly concerned about the 80:20 expected division of issues.  She felt that there was still a lot unknown as to how this was going to work.  She believed that once you gave away power it was very difficult to get it back.  She was opposed to passing this proposal while the toolkit was still unknown and when the voice of residents had still not been heard.

Councillor Alison Rooke thanked the Chairman and officers for their work on this.  Some problems had been addressed in part but she noted that 22 questions asked by the Committee in the original engagement exercise had not been answered and there had been no feedback on the public consultation.  She did not find it acceptable that the toolkit, which was key, would simply be presented to the Committee without any input from it.

Dr Alan Cohen expressed concern that a single Healthwatch representative was not sufficient and asked if there was some way of providing them with more influence.

The Chairman responded that he did not see this as giving power away but providing an opportunity for scrutiny of BOB-wide issues.  Full Council could withdraw this delegation of powers to BOB HOSC at any time.  He clarified that the toolkit needed to be approved by the local HOSCs but did not need to go before the Full Councils and that nothing could go to BOB HOSC until the toolkit had been approved.

The Chairman proposed an amendment to paragraph 17 on the question of a representative for Healthwatch.  The first sentence would be amended to “The JHOSC shall appoint two co-opted members to the committee.”  A footnote would be added to explain how this will work:

“There is provision for two co-opted members on the BOB HOSC. One of these places will be offered to Healthwatch to represent patients and the public; it will be for Healthwatch across the BOB geography to discuss and determine whether this is the most effective way to have patient and public views feeding into the committee. If co-opted membership is deemed not

to be the most appropriate role  ...  view the full minutes text for item 47/20

14:15

Report on views of health care gathered by Healthwatch Oxfordshire.

Rosalind Pearce, Chief Executive, Healthwatch Oxfordshire, welcomed the moves to set up scrutiny for BOB-ICS (Integrated Care System).  She said that a decision had to be made whether it was better for Healthwatch to be part of the scrutiny body or separate from it.  BOB had agreed to fund a lead officer for BOB business for the five Healthwatch organisations across its area.

Rosalind Pearce responded to questions as follows:

·         While increased use of online and telephone contact works well for some, there is a danger that others may be excluded because they do not have access to the internet or find it difficult to use the phone – for example, people who are hard of hearing.  The message needed to be clearer that GP surgeries are open.

·         Healthwatch have been involved in partnership discussions on domestic abuse.  A report went recently to the Health Improvement Board which she was happy to share.

·         Dentists were supposed to be open for emergencies.  Healthwatch could look into any reports of specific cases.  It appeared that if you can pay, you can get any treatment.  Healthwatch was concerned about the long-term impact of people not receiving regular check-ups.

·         Claims of overcharging for PPE have been referred to the Clinical Commissioning Group and will be investigated by them.

·         Healthwatch is not consulted on the design of care homes but is consulting with care homes on their COVID experience.

·         They would check with the County Council if the fact that the PPE portal was open more widely now was being appropriately advertised.

10:15

The Committee’s Forward Plan is attached for consideration.

Councillor Jane Hanna asked if there could be another meeting of the Committee before the February meeting to update on the Winter Plan and discuss risks related to Brexit.  The Committee last year agreed to receive regular updates on preparations for Brexit.

The Chairman responded that extra meetings can be organised if there is an urgent item, otherwise he was comfortable with the current schedule of meetings.

It was AGREED to add the following items to the February meeting and to request that the COVID-19 update include psychological therapies and perinatal services:

·         Care Homes under COVID-19

·         Annual Report of the Director for Public Health

·         Update on Chipping Norton Hospital

The Chairman also AGREED to discuss with the OX12 Task and Finish Group how the review of community services should be scrutinised and to bring draft terms of reference to the February meeting.

It was AGREED to request a report on plans for the restoration of elective services and decide on the basis of that report if it needs to come on the agenda of a Committee meeting and perhaps requires a task and finish group.

14:25

To include an update on Population Health and Care Needs Assessment in OX12

Councillor Jane Hanna stated that in relation to the OX12 Task and Finish Group she had a permanent conflict of interest in representing the residents of OX12.

The Chairman welcomed the announcement that services at the Katharine House Hospice in Banbury were being contracted to Oxford University Hospitals in order to protect services into the future.

Dr Alan Cohen thanked the Clinical Commissioning Group for the report on OxFed in appendix 12 which had been very helpful.  It was AGREED to request a further update when the services have been recommissioned.