Agenda and draft minutes

Apologies were received from Cllr Nick Leverton.

Cllr Hanna declared her interest as an employee of SUDEP Action.

Barbara Shaw declared she was a Trustee for Healthwatch and a patient safety partner for Oxford University Hospitals (OUH) NHS Foundation Trust.

To approve the minutes of the meeting held on 21 November 2024 and to receive information arising from them.

The minutes of the meeting held on 21 November 2024 were AGREED as a true and accurate record.

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 24 January 2025.  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.

Ms. Joan Stewart from "Oxfordshire Keep Our NHS Public" raised concerns about eyecare services in Oxfordshire. A Royal College of Ophthalmologists' report highlighted issues with private companies delivering NHS eye services, including a rise in private cataract treatments, fewer NHS operations, and financial incentives for referrals, causing inaccurate diagnoses and more strain on NHS hospitals. The report urged halting outsourcing and investing in NHS eye departments to meet demand.

The Committee has received Acceptances and Responses to recommendations made as part of the following item(s):

1.    Winter Planning (held during the 12 September 2024 HOSC meeting)

2.    Epilepsy Services (held during the 12 September 2024 HOSC meeting)

3.    Medicine Shortages (held during the 12 September 2024 HOSC meeting)

The Committee is recommended to NOTE the responses.

The Committee NOTED the responses to the recommendations made as part of the following items:

1.    Winter Planning

2.    Epilepsy Services

3.    Medicine shortages

The Chair noted the three avoidable deaths from medication shortages, including two epilepsy cases. The Committee's findings and recommendations on medicine shortages were shared with the All-Party Parliamentary Pharmacy Group. The Committee were informed that Neurology services and specialist commissioning will transfer to Integrated Care Boards (ICBs) in April 2025, raising funding and provision concerns.

The Chair will provide a verbal update on relevant issues since the last meeting.

There are FIVE documents attached this item:

1.   A HOSC report containing recommendations from the Committee on Maternity Services in Oxfordshire, which was discussed during the 21 November 2024 HOSC meeting.

2.   A HOSC report containing recommendations from the Committee on promoting healthy weight amongst Oxfordshire residents, which was discussed during the 21 November 2024 HOSC meeting.

3. A letter on behalf of the Buckinghamshire, Oxfordshire, and Berkshire West Joint Health Overview Scrutiny Committee sent to the Secretary of State for Health bring to government’s attention the likely impacts of increasing Wage and National Insurance Contributions on General Practice throughout the BOB geography.

4. The response from the Department of Health & Social Care to the aforementioned BOB HOSC letter on the impact of Wage and NI increases on General Practice.

5. A report by the Health Scrutiny Officer providing an update on the ongoing activities of the HOSC Substantial Change working group around the project to redevelop Wantage Community Hospital.

In relation to the HOSC working group report, the Committee is RECOMMENDED to:

1.    NOTE the work of the HOSC substantial change working group around scrutinising the project to redevelop Wantage Community Hospital since the previous update provided to the Committee in January 2024.

2.    CONFIRM its support for the continuation of the working group’s existence and its ongoing scrutiny of the project to redevelop the Hospital.

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

The Chair outlined key events since the previous HOSC meeting to the Committee:

1. A HOSC report containing recommendations from the Committee on Maternity Services, which was discussed during the 21 November 2024 HOSC meeting, was published in the agenda papers for the current meeting.

2. A HOSC report containing recommendations from the Committee on Oxfordshire Healthy Weight, which was discussed during the 21 November 2024 HOSC meeting, had been published in the agenda papers for the current meeting. This report was also presented to the Council’s Cabinet on 21 January.

3. A letter was sent on behalf of the Buckinghamshire, Oxfordshire, and Berkshire West Joint Health Overview Scrutiny Committee (BOB HOSC) to the Secretary of State for Health and Social Care to bring to government’s attention the likely impacts of increasing wage and National Insurance Contributions (NIC) on General Practice throughout the BOB geography.

4. A response was received from the Department of Health & Social Care to the BOB HOSC letter on the impact of wage and NIC increases on General Practice. The response was published in the agenda papers for this meeting.

5. A report by the Health Scrutiny Officer providing an update on the ongoing activities of the HOSC Substantial Change working group around the project to redevelop Wantage Community Hospital was also in the agenda papers.

In relation to the HOSC working group report, the Committee:

1. NOTED the work of the HOSC substantial change working group around scrutinising the project to redevelop Wantage Community Hospital since the previous update provided to the Committee in January 2024.

2. CONFIRMED its support for the continuation of the working group’s existence and its ongoing scrutiny of the project to redevelop the Hospital.

The Committee also NOTED the Chair’s Update.

Matthew Tait (Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board Chief Delivery Officer) and Stephen Chandler (Oxfordshire County Council Executive Director for People) have been invited to provide an update to the Committee on the BOB ICB operating model and the ongoing negotiations between the ICB and the County Council in that context.

There are THREE documents attached to this item:

1.    A report by the Health Scrutiny Officer outlining recommendations to the Committee on how to proceed with regard to the changes to the BOB ICB operating model in light of the response from the Secretary of State.

2.    A report from the ICB Chief Delivery Officer detailing the ICB’s revised operating model.

3.    The response received from the Secretary of State to the call-in request issued by the Committee in relation to the changes to the ICB operating model.

The Committee is RECOMMENDED to

1.    NOTE the response of the Secretary of State for Health and Social Care to the call-in request in relation to the Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board (BOB ICB) Restructure.

2.    AGREE to the need for the ICB to:

(a)  Engage in ongoing negotiations with Oxfordshire County Council to ensure that the ICB’s operating model supports effective commissioning and delivery of health and social care services at Place.

(b)  Ensure that delegated budgets relevant to Oxfordshire Place are retained at Place.

(c)  Support the continued existence of the role of Urgent Care Director for Oxfordshire.

(d)  Support the initiative to establish a Place Convenor for Oxfordshire, and for the ICB to clarify how it will be supportive of this role despite it not formally hosting this.

(e)  Clarify the nature and extent of the ICB Oxfordshire Executive Sponsor’s role and responsibilities.

3.    AGREE to engage in ongoing scrutiny of the changes to the ICB’s operating model until the above five points are addressed.

Matthew Tait (Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board [BOB ICB] Chief Delivery Officer); Stephen Chandler (Oxfordshire County Council Executive Director for People); Ansaf Ashar (Director of Public Health); and Karen Fuller (Director of Adult Social Care); were invited to provide an update to the Committee on the BOB ICB operating model and the ongoing negotiations between the ICB and the County Council in that context.

The Committee AGREED to the following recommendations concerning the BOB ICB Operating Model, which were outlined in the Health Scrutiny Officer report:

1.    NOTE the response of the Secretary of State for Health and Social Care to the call-in request regarding the Buckinghamshire, Oxfordshire, and Berkshire West (BOB) ICB restructure.

2.    AGREE to the urgent need for the ICB to:

a.    Engage in ongoing negotiations with Oxfordshire County Council to ensure that the ICB’s operating model supports effective commissioning and delivery of health and social care services at Place.

b.    Ensure that delegated budgets relevant to Oxfordshire Place were retained at Place.

c.     Support the continued existence of the role of Urgent Care Director for Oxfordshire.

d.    Support the initiative to establish a Place Convenor for Oxfordshire, and for the ICB to clarify how it will be supportive of this role despite it not formally hosting this.

e.    Clarify the nature and extent of the ICB Oxfordshire Executive Sponsor’s role and responsibilities.

f.      Clarify the role of associate directors for place.

3.    AGREE to engage in ongoing scrutiny of the changes to the ICB’s operating model until the above five points were addressed.

The Committee also NOTED the need to address the outstanding issues related to the BOB ICB operating model. These issues were identified in August 2024 and resolving them was important with the upcoming budget setting period.

The BOB ICB Chief Delivery Officer provided the Committee with a brief summary of the updated operating model. The Urgent Care Director role for Oxfordshire would focus on addressing local needs based on feedback the ICB received during its consultation period in the summer of 2024. As the Executive Sponsor for Oxfordshire, the Chief Delivery Officer would attend key meetings, engage with stakeholders, and represent Oxfordshire at the ICB board to address local issues. The Chief Delivery Officer would also participate in the Health and Wellbeing Board and Place-Based Partnership Boards, acting as the main representative for scrutiny Committees and involving experts when necessary. They were to act as a key decision-maker for joint decisions between the ICB and local structures, particularly in joint commissioning.

Efforts were being made to establish a place convener for Oxfordshire with the Oxfordshire County Council Executive Director for People. The joint commissioning model supported by a section 75 agreement remained unchanged, with budgetary decisions staying the same.

The Oxfordshire County Council Executive Director for People highlighted that a strong partnership with the BOB ICB Chief Delivery Officer was being built, and referred their collaboration in managing organisational tensions effectively. The solid section 75 agreement as well as  ...  view the full minutes text for item 7/25

Karen Fuller (Director of Adult Social Care) has been invited to present a report with an update on the support for people leaving hospital.

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

Karen Fuller (Oxfordshire County Council Director of Adult Social Care); Ansaf Azhar (Oxfordshire County Council Director of Public Health); Dan Leveson (BOB ICB Director of Place and Communities); Hannah Berry (Home First System Lead); Sally Steele (Head of Service – Hospitals); Tasmin Cater, Head of Transfer of Care [TOC] Hub); and Isabel Rockingham (Commissioning Manager Age Well - Improve and Enable); were invited to present a report with an update on the support for people leaving hospital, and to answer questions from the Committee.

The Director of Adult Social Care introduced the report on hospital discharge support, noting the collaborative approach and ongoing improvements in performance and reablement outcomes. They also mentioned the positive work done in partnership with Healthwatch.

The Commissioning Manager described that since January 2024, Oxfordshire's Home First Discharge to Assess (D2A) service had significantly improved hospital discharge performance, reducing the average length of stay and increasing patient support. Despite higher demand and funding challenges, many patients were gaining independence through reablement pathways, with more referrals from community settings. Joint health and social care training sessions were ongoing, and efforts to support unpaid carers continue through a quarterly leads group. Nationally recognised for its approach, Oxfordshire had welcomed visits from NHS England and presented on national webinars. The next goal was to reduce non-elective admissions and prevent hospitalisations with proactive community care.

The Committee expressed concerns over a five-day hospital wait after medical optimisation, pointing out that it seemed lengthy and could lead to unsuitable discharges due to delayed patient accommodation assessments. The Director of Adult Social Care responded by explaining that the five-day average included complex cases, while patients on the discharge-to-assess pathway typically returned home within 24-48 hours. This timeframe also accounted for patients moving to residential placements or dealing with housing issues.

The Director of Adult Social Care further clarified that during the 72-hour assessment delay, known home environment issues were discussed prior to discharge, and a care provider assessed the home on the day of discharge to flag any rehabilitation challenges. It was emphasised that the discharge-to-assess model employed a trusted assessor approach to collaboratively evaluate the patient's environment and support needs. Any arising issues were promptly escalated and resolved, with specific cases being addressed directly if needed.

Members also raised concerns about the difficulty in accessing information related to the Disabilities Facilities Grant and other support options for self-funding individuals. Despite multiple assessments, many patients were not informed about their entitlements or how to apply for the grant. They also criticised the leaflet's suggestion to contact a GP, considering the limited availability of GPs, and questioned whether patients and carers were involved in creating the leaflet.

The Head of Transfer of Care (TOC) Hub acknowledged the challenge of including all relevant information in the leaflet, given that it was distributed to all hospital admissions. The leaflet aimed to provide general information and direct people to other organisations for further details. The Head of Transfer of Care (TOC) Hub also mentioned that the  ...  view the full minutes text for item 8/25

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

This item was taken following item 9.

Veronica Barry, Executive Director of Healthwatch Oxfordshire, attended to present the Healthwatch Oxfordshire Update Report.

The report covered critical issues related to rural inequalities and eye care. They highlighted reports that shed light on these topics and emphasised the organisation's efforts to engage the public through webinars discussing healthcare services, such as GP surgeries and integrated patient care.

Additionally, the Executive Director of Healthwatch Oxfordshire attended a workshop organised by patient participation groups to discuss the future of the NHS 10-year plan, reflecting strong public interest in healthcare. An ongoing survey by Healthwatch Oxfordshire was also mentioned, aimed at understanding how individuals navigate urgent and emergency care, with the goal of identifying areas for improvement.

A concern was raised about several GP practices in West Oxfordshire ceasing to accept repeat prescription requests by telephone, which could impact isolated individuals who were unable to use the internet. The Committee enquired whether Healthwatch Oxfordshire had noticed this issue and how it might be addressed. The Executive Director of Healthwatch Oxfordshire acknowledged that digital exclusion was a significant issue that Healthwatch had highlighted in their reports. It was mentioned that this concern had been noted in their enter and view reports into GP surgeries, where challenges related to accessing care and prescriptions for those not proficient with digital technology had been identified. It was also suggested that this was also a question for the Integrated Care Board (ICB) in terms of how they monitored GP contracts and ensured accessibility for all patients.

A question was raised about Healthwatch Oxfordshire's visits to refugee groups, specifically the Refugee Resource Women's Group in Cherwell and the Cherwell Refugee Support Group. The inquiry sought to understand what had come out of these visits, particularly regarding the health of refugees and their access to GP services. The Executive Director of Healthwatch Oxfordshire explained that Healthwatch Oxfordshire conducted outreach to various groups, including regular visits to hotels in Banbury, which stemmed from their work on oral health and barriers to accessing dentistry. They also attended the ICB’s group on refugees and migrants to share insights. The Executive Director of Healthwatch Oxfordshire mentioned that they maintained ongoing communication with organisations like Refugee Resource and Asylum Welcome to address challenges such as accessing GP services and interpreting needs.

The Committee raised concerns about digital exclusion, asking Matthew Tait, the BOB Integrated Care Board’s (ICB) Chief Delivery Officer, if this was a topic that could be brought back to discuss at a future HOSC meeting.

Lunch was taken at 12:40 and restarted at 13:30. The Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board Chief Delivery Officer and Cllr Van Mierlo did not rejoin the meeting following the lunch break.

Ansaf Azhar (Director of Public Health, Oxfordshire County Council); David Munday (Deputy Director of Public Health); Dan Leveson (BOB Integrated Care Board Director of Places and Communities) have been invited to present a report with an update on the Health and Wellbeing Strategy Outcomes Framework.

There are FOUR documents attached to this item:

1.    A main report with an implementation update on the Health and Wellbeing Strategy.

2.    Annex 1- Oxfordshire Joint Health and Wellbeing Strategy 2024-2030 Outcomes Framework- Shared Outcomes, Key Outcome Indicators, & Supporting Indicators.

3.    Annex 2- Age Well Performance Report (Sept 2024).

4.    Annex 3- Thriving Communities Performance Report (Dec 2024).

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

Cllr Liz Leffman (Leader of Oxfordshire County Council); Ansaf Ashar (Oxfordshire County Council Director of Public Health); David Munday (Oxfordshire County Council Deputy Director of Public Health); and Dan Leveson (BOB Integrated Care Board Director of Places and Communities); were invited to present a report with an update on the Health and Wellbeing Strategy Outcomes Framework.

The Leader of the Council explained that the strategy emphasised health prevention and highlighted the importance of collaboration with district councils and health partners for better outcomes. By March 2023, the outcomes framework was approved, and ongoing progress reviews were initiated. At each Health and Wellbeing Board meeting, specific priorities were reviewed to ensure effective changes.

The Deputy Director of Public Health explained that the strategy represented a system-wide effort involving multiple partnerships and detailed the outcomes framework, including shared outcomes, key activities, and indicators. The Deputy Director of Public Health reported that three priorities had been reviewed thus far, with additional priorities to be addressed in future meetings. The 10 Health and Wellbeing Strategy priorities, derived from the Joint Strategic Needs Assessment, reflected Oxfordshire’s population needs and were collaboratively agreed upon, focusing on short- to medium-term progress indicators to achieve long-term goals.

A question arose regarding the absence of end-of-life care in the Health and Wellbeing Strategy. The Deputy Director of Public Health explained that, while end-of-life care was important, the strategy focused on key building blocks and health drivers. It was noted that end-of-life care was included in service-specific planning, such as the Joint Forward Plan held by the ICB, and its principles, like maintaining independence and providing care close to home, were reflected in the strategy's age well priorities.

The Committee questioned Officers on the potential ways to enhance engagement with schools, improve relationships with GPs, and better implement social prescribing. Both schools and GPs had been acknowledged as essential but challenging to engage effectively. A healthy schools advisor, funded by Public Health, collaborated with schools to promote physical activity, healthy food, and smoke-free environments. The reformed Children's Trust Board was seen as an opportunity to improve health outcomes for children and young people.

The vice-chair of the Health and Wellbeing Board was a GP, and there was strong representation from GPs on the board. Efforts were underway to improve relationships and engagement through primary care networks. Various social prescribers, including local area coordinators and community health development officers, collaborated with different stakeholders, especially in areas of need. Ongoing efforts aimed to map out social prescribers and maximise their impact.

The Committee raised concerns about children starting school unprepared, lacking social skills, and not being toilet trained, particularly due to insufficient family services in rural areas. In response, the Leader of the Council explained that, if passed at Council, next year's budget had allocated over £1,000,000 to support early years, with a focus on identifying and assisting children who needed help early on.

Public health funding ensured that children were systematically assessed at ages 2 1/2 and 4 for school readiness.  ...  view the full minutes text for item 10/25

Charmaine Desouza (Chief People Officer, Oxford Health NHS Foundation Trust); Zoe Moorhouse (Head of HR, Oxford Health NHS Foundation Trust); and Amelie Bages (Executive Director of Strategy and Partnerships, Oxford Health NHS Foundation Trust) have been invited to present a report on the Oxford Health NHSFT People Plan.

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

Charmaine DeSouza (Chief People Officer, Oxford Health NHS Foundation Trust) (NHSFT); Zoe Moorhouse (Head of HR, Oxford Health NHSFT); and Amelie Bages (Executive Director of Strategy and Partnerships, Oxford Health NHSFT) were invited to present a report on the Oxford Health NHSFT People Plan.

The Chief People Officer presented the People Plan’s development, emphasising its importance for community transformation and alignment with trust objectives. The Head of HR overviewed workforce demographics, noting 80% female employees, 25% from a BAME background, and 7.4% with declared disabilities. Collaboration with universities was also highlighted. The Executive Director of Strategy and Partnerships explained the strategic context, referencing the NHS long-term workforce plan and Oxford Health strategy, and detailed the annual planning process and KPI monitoring by the People Leadership and Culture Committee.

The Committee examined how the Oxford Health NHSFT People Plan aligned with the NHS long-term plan, focusing on patient transitions, nurse support, and community transformation initiatives. The Chief People Officer mentioned that the workforce plan published in 2023 was expected to remain relevant despite any changes in the NHS long-term plan. The trust had already considered collaborations with OUH and prioritised community health and care.

The Chief People Officer emphasised the importance of providing district nurses with adequate resources and supporting those who assisted heart failure patients at home. The trust committed to optimising resource allocation to strengthen community health. The Executive Director of Strategy and Partnerships recognised the challenges in collaborating with OUH. Despite this, both executive teams worked together to review pathways, streamline processes, and utilise staff more effectively.

The Executive Director of Strategy and Partnerships highlighted the innovative elements of the Community Transformation Programme, such as multidisciplinary team collaboration and deploying district nurses to support the GP workforce during weekends. The trust advocated for an alternative delivery model to address ongoing pressures.

The Committee enquired about the core purpose and roles of the Oxford Health NHSFT. The Executive Director of Strategy and Partnerships, and Chief People Officer explained that the Oxford Health NHSFT provided mental health services across the BOB ICB region and physical health services, including community health in Oxfordshire. The trust offered community acute inpatient mental health services, GP out-of-hours services, urgent care centres, district nursing, and school nursing.

The trust placed emphasis on workforce planning, recruitment, and retention to support service delivery. They focused on ensuring a well-planned and stable workforce to maintain the quality and availability of their services.

The Committee inquired about how Oxford Health NHSFT supported continuous professional development (CPD) for clinical and administrative staff. For clinical staff, the trust provided CPD through a well-established education centre and collaborated with Oxford Brookes University for postgraduate and master's modules for nurses. They also offered apprenticeship schemes allowing staff to pursue further education, including leadership and management apprenticeships.

For administrative staff, various courses, webinars, and e-learning events were available through NHS offerings and internal programmes. Overall, the trust demonstrated a strong commitment to CPD, which contributed to improved staff retention.

The Committee reviewed the initiatives  ...  view the full minutes text for item 11/25

The Committee is recommended to AGREE to the proposed work programme for its upcoming meetings.

The Committee AGREED to the proposed work programme, with the amendment to include an item on gynaecology in June, which would tie in with the Healthwatch item on women’s health.

Key questions would be submitted to the BOB ICB Chief Delivery Officer concerning eyecare. A briefing was also raised as a potential source of information depending on the answers received from the question.

It was AGREED to discuss the work programme at the pre-meet of the March meeting.

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.