Agenda and minutes

Apologies were received from Cllrs Champken-Woods, Leverton and Poskitt. Cllr Nala-Hartley sent word that she would be late to the meeting.

Cllr Hanna noted her position as Chief Executive of SUDEP Action.

Cllr Van Mierlo declared an interest on the basis of working as an independent consultant for companies making medicinal products for lung cancer.

To approve the minutes of the meeting held on 14 July 2022 and to receive information arising from them.

The minutes of the HOSC meeting held on 14 July were AGREED as an accurate record subject to the following amendments:

1)     That reference be made to Cllr Turner’s request to Oxford Health in item 43/22 for information concerning what had happened to those residents of South Oxfordshire who had been assessed for palliative care and not been able to access beds in Wallingford. No answer to this question had been received.

2)     That reference in item 43/22 be made to the Working in partnership with people and communities: Statutory guidance, specifically in respect of communities who had been worked with, and understood the history of change.

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

Requests to speak must be submitted by no later than 9am four working days before the meeting i.e. 9 am on Thursday 15 September 2022.  Requests to speak should be sent to colm.ocaomhanaigh@oxfordshire.gov.uk .

If you are speaking ‘virtually’, you may submit 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. Written submissions should be no longer than 1 A4 sheet.

None

10.10am

To receive a report and presentation from Cllr Mark Lygo, Cabinet Member for Public Health & Equality, Director of Public Health, Ansaf Azhar, and Derys Pragnell, Consultant in Public Health, in respect of the work already achieved as part of the Tobacco Control Strategy, and the reconfiguration of the Strategy, post-pandemic.

The Committee is asked to consider the report and agree any recommendations it wishes to make in response.

Cllr Mark Lygo, Cabinet Member for Public Health and Equalities, Ansaf Azhar, Director of Public Health, Derys Pragnell, Consultant in Public Health, and Katharine Eveleigh, Health Improvement Practitioner, attended to present a report to the Committee in respect of the work already achieved as part of the Tobacco Control Strategy, and the reconfiguration of the Strategy, post-pandemic.

Cllr Lygo, Cabinet Member for Public Health and Equalities explained the context of the report. Smoking was the leading cause of preventable death in the UK, and the single greatest modifiable risk factor in cancer, COPD, miscarriages, still-births and birth anomalies. To tackle this, in March 2020 the Council adopted a five-year Smoke Free Strategy with the ambition of reducing the prevalence of smoking to below 5% by 2025. Owing to the pandemic, progress towards this goal had been slower than originally envisaged.

Ansaf Azhar, Director of Public Health, noted that the health impacts of smoking were disproportionately experienced by those experiencing disadvantage in society. For instance, whilst Oxfordshire’s prevalence at the launch of the strategy was below the national average at between 10-11% those experiencing problems with serious mental health were at around 30%, likewise social housing tenants, and manual workers over 20%. The Council’s approach, therefore, needed to be targeted rather than universal. The Council had had the efficacy of different interventions independently assessed to identify the most effective ones for inclusion within the strategy. Evidence showed that a focus broader than simply smoking cessation services was required to underpin the ability of the majority of smokers to quit. This breadth was enabled by the strategy being a partnership document, signed by all the local councils, as well as local health partners, with specific actions for each partner. The effect of Covid was to put a complete stop to many of these actions for over two years. As a consequence, reaching the 5% target would be significantly more challenging. Nevertheless, not all actions had been stopped, and the importance of reducing smoking numbers meant it was important to keep on striving to meet the target on schedule. Looking from a national perspective, the Khan Review’s recommendations provided much greater impetus for smoking cessation than previously, and it was important to keep up the momentum in order to capture as much benefit from the Khan Review interventions as possible.

Derys Pragnell, Consultant in Public Health, presented the data as known at the time, which owing to Covid, was a little further out of date than would be expected. Smoking rates overall were declining, but with very significant spikes amongst a number of demographics, including those with serious mental health problems, routine manual workers and social housing tenants. Country of birth had a significant impact, with those born in Eastern Europe also displaying high rates. Following its habit of reviewing its strategy in light of new guidance, the Tobacco Control Alliance, made up of the County and District Councils, and health partners had recently begun co-producing interventions to help social housing tenants  ...  view the full minutes text for item 56/22

11am

To receive a brief report and presentation from Cllr Mark Lygo, Cabinet Member for Public Health & Equality, Ansaf Azhar, Director of Public Health, and David Munday, Consultant in Public Health OCC.

The Committee is asked to consider the report and agree any recommendations it wishes to make in response.

This is a precursor to a larger item on rural health inequalities to be received by the Committee at its meeting on 24 November 2022.

Cllr Mark Lygo, Cabinet Member for Public Health & Equality, Ansaf Azhar, Director of Public Health, and David Munday, Consultant in Public Health provided a brief presentation and report as a precursor to the November report relating to the same topic.

David Munday, Consultant in Public Health broached the importance of population movements through changing birth and death rates, housing growth and migration in planning suitable health services for future demand. The Oxfordshire Joint Strategic Needs Assessment was the primary tool used by the Council for understanding these changes. Provisional data from the 2021 census indicated that population growth across the County over the last decade had been 11%, but that that growth had not been experienced equally across the County, with Vale of the White Horse experiencing the greatest. The fastest growing age groups within the County were people in their fifties and over 65. More granular, sub-district level data, would be available in the future release tranches of the 2021 census. The newest JSNA would be published in early October.

The Committee asked for more information regarding the process for the provision of primary care services in areas experiencing new housing growth. Though known to be an ICB responsibility, the exact process was not known and the issue was identified as one requiring fuller unpacking at the November meeting. Councillors agreed, given their own experience of the difficulties caused for residents when the process did not run smoothly. District members on Planning Committees suggested that there was not an equivalence between the concern accorded to the provision of education and that accorded to healthcare, and it was necessary to know who within the NHS could knowledgeably address this imbalance.

The Committee discussed the importance of recognising that rural inequalities stemmed partially from the inherent challenges of rural topography, but also from policy which meant that they were expected to take on more new housing than urban areas. A key issue the former of these challenges was ambulance waiting times, which in rural areas were necessarily higher simply owing to the greater distances needing to be travelled. For those without access to transport, access to primary care services in rural areas was also very challenging. Another area of concern in parts of the County was that of access to maternity services, and it was requested that data be provided on where future demand for such services would be required. In response, it was noted, however, that birth rates in localities were not the only determinant of demand for maternity services. Ethnicity, for example, was an important consideration in terms of access to maternity services, obesity rates during pregnancy and breast feeding rates were all core contributors to the outcomes for baby and mother in maternity services, and would also therefore impact where supply was located as much as simple levels of demand.

Jean Bradlow and Cllr Haywood were put forward to join the Chair and Vice-Chair in scoping the November report more fully.

11.40

To receive a verbal update on a joint Community First Oxfordshire and Healthwatch Oxfordshire report on Rural Isolation in Oxfordshire.

The report will be presented by Rosalind Pearce, Executive Director, Healthwatch Oxfordshire and Community First Oxfordshire.

Rosalind Pearce, Executive Director, Healthwatch Oxfordshire and Emily Lewis-Edwards, Chief Executive of Community First Oxfordshire presented the Healthwatch update, which focused on a report developed by Community First Oxfordshire on behalf of Healthwatch Oxfordshire on rural isolation.

Emily Lewis-Edwards highlighted Community First Oxfordshire’s historical links with rural issues as a driver for the report, but also noted the more immediate driver of Covid and the exclusionary effect for some of the move towards digital provision. In total, 528 people took part in surveys, focus groups or interviews. Overall, the feedback was that people knew their neighbours, had and used the internet, and owned their own private vehicle. However, in all three categories small numbers of exceptions existed, for whom their lack of neighbour support, internet or transport was highly problematic. Indeed, even amongst those owning private vehicles, lack of public transport was a contributor to isolation. Time, confidence or lack of physical capacity tended to be the reasons why individuals reported not getting involved in community activities, which were identified as crucial in challenging isolation. The key conclusions drawn were that any solutions to rural isolation should be multifaceted. Nevertheless, given the weight given to issues of transport, community activities and access to information full consideration should be given to how these needs could be met within a specific community.

In response to the presentation, the Committee explored a number of issues. These included the degree to which the issues raised were specifically rural issues or actually universal ones. In response it was recognised that physical distance was more of an issue for rural areas, but that many of the problems of access were the same in disadvantaged communities in rural or urban areas. Another issue explored concerned the means of collecting the underlying data, whether it itself by being primarily online was exclusionary. The limitations were recognised, but so was the fact that some aspects were online at the request of participants, and that feedback from those who were spoken to in person correlated with the responses received by those submitting their views online.  The Committee welcomed the way in which the report shone a light on the needs of individuals in a more granular way than the Joint Strategic Needs Assessment could, giving voice to those minorities in villages where the majority were generally managing.

Cllr Lygo, Cabinet Member for Health and Equalities, expressed the wish to see the work extended to more ‘on the ground’ consultation in relevant areas. Linking in with stakeholders relating to specific areas of focus, such as transport, would likely prove fruitful.

Rosalind Pearce also provided a verbal update relating to Healthwatch’s activity. Healthwatch had held a round-table on access to dentistry. Access to dentist for routine appointments was reported to be very challenging for those not already registered with a dentist. Out of hours demand for those without a dentist often provided a stop-gap but not permanent solutions.  At the round-table commissioners, dentists and public health officials agreed that local commissioning could,  ...  view the full minutes text for item 58/22

1pm

To receive a presentation, from Will Hancock, Chief Executive Officer, and Martin Chester, Clinical Operations Manager, South Oxfordshire, on the service provided by South Central Ambulance Service (SCAS), performance and the Care Quality Commission (CQC) improvement programme.

The Committee is asked to consider the presentation and agree any further action it wishes to take in response

The Care Quality Commission report, which acts as a background document to this item, is included in the agenda pack.

Will Hancock, Chief Executive Officer of South Central Ambulance Service, and Martin Chester, Clinical Operations Manager, South Oxfordshire, made a presentation to the Committee on the service provided by South Central Ambulance Service (SCAS), performance and the Care Quality Commission (CQC) improvement programme. They were supported by Tom Stevenson, Comms and Engagement Lead for the SCAS Improvement Programme, Mike Murphy, Director of Strategy and Governance at SCAS, and Kirsten Wells-Drewitt, Head of Operations in Oxfordshire at SCAS.

Will Hancock, SCAS Chief Executive introduced the report. The August report from the CQC, giving SCAS an ‘inadequate’ rating, was a significant departure from the organisation’s pre-pandemic trajectory, where it had been moving towards an ‘outstanding’ rating. The Board was disappointed to see the change in direction, but were committed to addressing the issues raised as a matter of urgency. The key issue of concern focused on emergency and urgent care, and an improvement plan had been developed to address the areas of concern highlighted by the CQC. A comprehensive governance structure was in place to hold the organisation to account, as well as ensure planned activities complemented other areas of the health care system. Broadly, the improvement plan focused on four key areas: culture and wellbeing, governance, patient safety and experience, and performance recovery. A number of priority actions had already been undertaken as part of the improvement programme, including increasing capacity in safeguarding teams, ambulance crews and amongst call-centre staff, enhanced equipment checks and provision, staff-support measures and a governance review. The CQC report did note some areas of outstanding work, highlighting the pride and hard work of staff, the kindness shown by staff, and the level of innovation shown. The organisation’s improvement plan needed to be delivered in the face of significant national pressures around recruitment and retention, as well as increasing demand for services. In terms of performance, SCAS was performing below the national for category 1 calls (the most severe) but was exceeding it in categories 2-4.

In response to the presentation the Committee raised multiple questions. More information was sought regarding the mechanics of how meaningful culture change would be effected. Whilst national surveys indicated that ambulance services were prone to poor cultural practices, the CQC report acted as a conversation starter with staff. Embedding appropriate values within the organisation was a strong component of the organisation’s leadership development programme. Taking measures to support the increasing the diversity within the workforce were being taken at staff-level and at Board level. Kirsten Wells-Drewitt, as a Chair of one of the People of Culture boards, confirmed their value in giving voice to staff to feedback on policies and practices, and making the workings of the organisation more transparent.

The Committee questioned whether sufficient financial resource was available to cover the work outlined in the improvement programme. It was confirmed that for the current financial year it was, and additional funding from NHS England meant that future funding was not currently a concern.

The importance of  ...  view the full minutes text for item 59/22

1.50pm.

To receive and note the responses to the Committee’s previous recommendations.

1. Cabinet Member for Adult Social Care Response to OJHOSC recommendation on the first 30 days of the Pandemic

Cllr Tim Bearder, Cabinet Member for Adult Social Care, will present his response to the recommendation made by the OJHOSC at its meeting of 09 June 2022. The Committee is asked to note and consider the response.

2.  Integrated Improvement Programme.

To note and consider a system response from Oxford Health NHS Foundation Trust by Dr Ben Riley, Executive Director for Primary, Community and Dental Care at OHFT, to the Committee’s previous recommendation

Cllr Tim Bearder, Cabinet Member for Adult Social Care, joined the meeting to discuss the Cabinet’s response to the HOSC recommendation made by the Committee at its 09 June 2022 meeting concerning the First 30 Days of the pandemic.  The Council’s intention was confirmed by Cllr Bearder to participate proactively in the relevant elements national review.  The Health Scrutiny Officer had been in contact with the national review to identify those elements and the deadlines for involvement, and it was AGREED that this would be shared with the Cabinet member and senior officers in the form of a briefing note to outline how the Council could proactively be involved.

The response to the Committee’s recommendation made in relation to the Integrated Improvement Programme was NOTED.

2.10pm

To review progress against the Committee’s agreed actions and recommendations.

Eddie Scott, Health Scrutiny Officer, to present an update. 

Eddie Scott, Health Scrutiny Officer, updated the Committee on actions from the Committee, drawing attention to the forthcoming Primary Care workshop, and the first meeting of the Integrated Improvement Programme sub group. Progress against the Committee’s actions and recommendations was NOTED.

The Committee was informed that the Health Scrutiny Officer had spoken with the commissioner responsible for a potential variation to the sexual assault referral centre in Bicester. It was confirmed that the plan was simply to make a change in location, with no change in services. The location change was owing to move to a building with a necessary kite mark for safety. The Committee AGREED that a subset of Members would undertake a review to determine whether it was a substantial variation and make a recommendation to the Committee if further work was required.

2:20pm

To receive an update from the Chair; and reports and recommendations from the Committee’s sub-groups and workshops since its last meeting.

1.    Care-home Report

2.    Covid-19 Sub-Group

3.    MSK Workshop

4.    Integrated Improvement Plan Sub Group

Cllr Hanna, Chair of the HOSC, introduced her Chair’s update to the Committee.

Cllr Barrow was invited to feed back on the visit undertaken to the Henry Cornish Care Home in Chipping Norton. He, Cllr Poskitt and Barbara Shaw had visited and seen first hand the understanding of infection control and infrastructure in place to support it. However, members were keen to visit a less well-equipped care home to see what experience for patients might be like at care homes which had suffered high mortality in the first wave of the pandemic, and which had suffered repeatedly high mortality rates across all waves of the pandemic. It was AGREED by the Committee that the findings should be submitted as a paper back to the Committee when complete, and submitted as evidence within the Covid-19 national enquiry along with the Committee’s previous two reports on the First 30 Days of pandemic. 

Cllr Hanna informed the Committee that the Covid-19 sub-group was designed to monitor the recovery of elective surgery temporarily closed during the pandemic to inform the focus of the ongoing work programme. Learning would be brought back to the committee.

Eddie Scott, Health Scrutiny Officer, provided an update on the activity of the MSK sub-group, which had met with Connect Health (the new MSK service provider) to discuss their vision, approach and plan for service user engagement and plans for meeting the KPIs set by the ICB. Members who attended were assured of the capacity of the service to provide a service which would meet the needs of users across multiple locations, but that there was room for improvement regarding communication with members around the self-referral pathway and some issues about the fitness for purpose of the website. One outcome was that a place was offered on the service’s Service User Engagement sub-group to the HOSC. It was AGREED that Barbara Shaw would be the HOSC’s representative.

Relating to the Integrated Improvement Programme sub-group, two recommendations were made to the Committee: 1) That members of the sub-group should seek to meet with the Chair of the BOB ICB to seek assurance of the ICB’s commitment to the Integrated Improvement Programme, and 2) That the Chair and vice-Chair meet with Sam Foster, from OUH, to discuss plans to reopen currently closed maternity units in Oxfordshire. These recommendations were AGREED.

2.40pm

To review and agree the Committee’s work programme for the remainder of the 2022/23 municipal year.

Eddie Scott, Health Scrutiny Officer, provided an update to the proposed work programme. The Committee was expected to have a further, more detailed item on Rural Inequalities in November. The February meeting would have an item concerning the MSK service, as well as an update from SCAS regarding the status of their improvement programme.

It was AGREED by the Committee that rather than the Committee taking them as items on the work programme, that the Chair would write to the Cabinet member to highlight concerns around the impact of LTNs with regards to access to health services, and maternity services at the Horton and that a written update be provided.

The proposed work programme was AGREED.