Agenda and minutes

Councillor Gearing (Councillor Hallchurch substituting), Councillor Strangwood (Councillor Nimmo-Smith substituting). District Councillor Hood, Dr Harry Dickinson and Mrs A Wilkinson.

Cllr Dr Skolar declared that when practising he had been the Chair of the LMC for his area in London.

To approve the minutes (JHO3) of the meeting held on 27 September 2012 and to note for information any matters arising from them.

The minutes were approved with the following amendment:

The first sentence of the second paragraph of item 61/12 should read: “Alan Webb explained that the visit had focused on a defined list of Key lines of Enquiry which by the end of the day over 90% were rated green”

Matters arising:

59/12 Health and Wellbeing Strategy

Cllr Pressel asked if the Committee’s request that the strategy include priorities for providers should be an action point. The Director of Public Health, replied that all comments had been logged and will be taken into account when the strategy is refreshed for the next year.

A&E waiting times

The committee asked OUHT to provide them with updates on A&E waiting times and delayed transfers of care.

Dr Ken Williamson of Keep our NHS Public (Oxford) addressed the committee. He asked about statements by the OCCG that it was obliged to adopt tendering of services under the ‘Any Qualified Provider’ (AQP) framework. He said that government policy and the law are different, as a press release by the Health Minister to the Stroud group has shown, and that the NHS is not legally required to put services out to tender. He said that AQP and competitive tendering gives GPs no guarantee of control over the service or control of quality.

The committee asked Dr Williamson if there was any case law supporting this interpretation of the law. He said that it came from a press release issued by the Minister. He will circulate the references and evidence to the committee. The committee will ask OCCG to respond under item 8.

Other speakers in relation to item 6 spoke at the start of that item.

10.15

The Director of Public Health, Jonathan McWilliam will provide the committee with his regular report on matters of relevance and interest to the committee.

Angela Baker, Consultant in Public Health, NHS Oxfordshire will present an update (JHO5) on work to address Tuberculosis in Oxfordshire.

The Director of Public Health, Jonathan McWilliam provided the committee with his regular report on matters of relevance and interest to the committee.

Obesity

The Director of Public Health was asked if the committee should write to the Government asking for tighter regulation of the food industry to combat obesity. The Director said that new food labelling rules are being introduced, providing the public with the information necessary to make sensible and informed decisions about their diet.

Tuberculosis

Angela Baker, Consultant in Public Health, NHS Oxfordshire presented an update (JHO5) on work to address Tuberculosis in Oxfordshire.

Tuberculosis is most prevalent amongst the homeless, drug or alcohol abusers, those with immunosuppressant conditions, and people from countries with a high level of the disease.

Cases in Oxfordshire are rare and stable.

There are three ways to combat it:

• Targeted screening
• Early detection
• Ensuring that patients complete the course of treatment
• This is especially important to reduce the risk of antibiotic resistance developing

In Oxfordshire, the following actions have been taken:

• Homeless Screenings
• Pharmacy campaigns
• Liaison with local language schools

The committee asked about the procedures for screening at ports of entry of visitors from high-risk areas. In the past, people were asked to complete a survey that was sent to the Health Protection Agency, but follow-up was difficult as people would move on from the UK address they gave. New regulations soon to come into force will require visitors from high-risk areas to provide a certificate of health or evidence of vaccination when they arrive.

The committee asked for an outline of how at-risk children are identified for vaccination. The decision on whether to vaccinate a baby is made if the parents are from high-risk countries or are either likely to visit one or have guests from them within the first six months of the child’s life.  Surveys, in various languages, are also given to parents during both the reception year of school and in year seven.

Control of the disease is passing to the Clinical Commissioning Group from April 2013, but public health will have a monitoring role.

The Director of Public Health emphasised that tuberculosis is not easily transmitted.

10.35

Andrew Stevens, Director of Planning and Information and Jane Hervé, Head of Midwifery from the Oxford University Hospital Trust will report (JHO6) to the committee on the Trust’s decision to suspend the intrapartum (births) service at the Cotswold Maternity Unit, Chipping Norton for a period of 3 months to enable the Trust to complete a review of the unit.

Public addresses were made by:

Cllr Hibbert-Biles

Kim Murray, Susannah King mothers

Sarah Boyd, user representative, Maternity Services Liaison Committee

Oxford University Hospitals Trust were represented by:

Jane Herve, head of the OUHT midwifery service,

Andrew Stevens, the director of planning,

Tony McDonald, General Manager, Children’s and Women’s Division

Cllr Hibbert-Biles requested that this item be held in camera, but the committee decided to remain in public session. Due to the nature of some of her concerns, Cllr Hibbert-Biles will write to the chairman privately.

Cllr Hibbert-Biles raised concerns about mothers being discharged two hours after giving birth, of accounts of poor treatment requiring transfers to Banbury, that the service had broken down after the departure of two senior midwives, and new-born babies were not receiving the early health checks they require. She wanted a full independent enquiry and asked the HOSC to request this of OUHT. The Royal College of Midwives should be involved in any enquiry to ensure objectivity.

Kim Murray, a mother, addressed the meeting  with her experiences of the unit. She had experienced poor treatment by the management and poor service by one of the mid-wives.  She is aware of similar incidents from other women

Susannah King, a user representative for the MSLC, detailed her experiences of poor management andlack of confidence in the current midwives. She wants an extensive and independent enquiry.

Sarah Boyd, the Midwifery Services Liaison co-ordinator, said she had surveyed local women for their experiences over the last year. 30 responses were received, some positive and some negative. Many reported the lack of an overnight service, inconsistency of staffing, a mother having to be let in by the cleaner, and mothers receiving poor attention from the midwives.  However, the unit itself was highly valued.

Jane Herve, the head of the OUHT midwifery service, Andrew Stevens, the director of planning, and Tony McDonald, General Manager, Children’s and Women’s Divisionaddressed the meeting on behalf of OUHT.

The trust highly values the maternity unit and is absolutely committed to reopening it as soon as possible. There are issues surrounding the unit and its staff which cannot be discussed in public.

The unit was suspended in view of comments received, mostly about working practices rather than one single incident, and as a result of other evidence such as benchmarking the service against both the other three midwifery led units in the county and national targets. There were particular concerns about the high level of transfers which were far above the expected levels. There has been no evidence of poor clinical provision or adverse outcomes, however. Mothers can stay for up to 24 hours and it is not the Trust’s policy to discharge women after two hours, although they can voluntarily discharge themselves if they wish.

OUHT are happy to take external advice on the review, including from the Royal College of Midwives. They are open to agreeing who should be involved with the Committee, and to having independent representation on the panel. The committee  ...  view the full minutes text for item 70/12

11.05

This item enables the committee to look in detail at how the commissioning and delivery of primary care is changing. A background report (JHO7a) prepared by the current primary care commissioners at the Primary Care Trust sets out the background and key changes of the four areas of primary care; medical, dental, ophthalmic and pharmacy

Representatives from the Primary Care Trust, Clinical Commissioning Group, Commissioning Board (Local Area Team) and Local Medical Committee (GP representatives) will be attending the meeting.

The second paper (JHO7b) provides members with background and an update on the contract performance of the Banbury Health Centre (GP-led Health Centre).

Also included is an update report (JHO7c) outlines Oxfordshire PCT’s position on the provision of annual health checks to people with learning disability and reports progress so far this year.

Stephen Richards, Chief Clinical Officer, OCCG

Ginny Hope, Head of Primary Care Contracted Services, NHS Oxfordshire

Dr Geoff Payne, Medical Director, Thames Valley Local Area Team, NHS Commissioning Board

Dr Prit Buttar, Chair, Oxfordshire Local Medical Council

Dr Paul Roblin, Chief Executive, Local Medical Council, Thames Valley

Angie Eachus, Programme Manager, Primary Care, NHS Oxfordshire,

Primary Care

The Chairman introduced the discussion by explaining that about 90% of the public’s contact with health services is through primary care, but this committee has not examined it before.

Ginny Hope gave the committee a short overview of Primary Care in Oxfordshire. The NHS is currently undergoing its most radical reorganisation in sixty years. There are new functions and new relationships that have to be developed. Under the new structure there will be a single performance model and single set of performance data. There will be an increased role for local government through Health & Wellbeing Boards.

GPs

The chairman asked about the future of the various GP contracts currently in existence (GMS/PMS/APMS).

GP contracts will be negotiated at the national level, although APMS contracts will still continue. There will be reductions in the resources and funding available for GPs, although the exact figures are currently unknown. The committee will be informed once the amount becomes available.

Oxfordshire is considered a wealthy and healthy county, so will face greater funding pressures than elsewhere. The expectation is that most practices will lose several thousand pounds, but some will see six figure reductions. These losses will inevitably impact the services provided and staffing.  However, whilst funding has shifted to secondary in recent years, the introduction of GP commissioning and the move to community-provided services (mirroring in a way the old out-patient clinics) means GPs have faced an increased workload. There is a requirement for a mix of clinical and managerial skills in the service, but variation in the quality of management across the county’s 83 practices needs to be addressed.

Medicines Usage Review

There are far more medicines available now than in the past. Regular reviews ensure patients are taking the right medicines for their conditions. This is particularly important for those taking a variety of medicines as combinations can cause issues. There are benefits to working with community pharmacies to ensure reviews cover over-the-counter medicines and any herbal supplements people might be taking.

Rural dispensing

The committee asked about rural dispensing.

29 practices in rural areas can also dispense medicines. There are still gaps in provision, although rural dispensing is tightly-regulated to reduce potential conflicts of interest and impacts on other dispensers. No practice is allowed to dispense if there is a pharmacy within a radius of 1.6km.

Service commissioning

Primary Care will be commissioned by the Local Area Teams of the NHS Commissioning Board. Whilst there is a single operating model, they take a cross-Thames Valley approach. The relationship between GP commissioning and the local area commissioning team is an important issue for OCCG.

Cllr Pressel asked if the traditional model  ...  view the full minutes text for item 71/12

12.35

A representative of the Clinical Commissioning Group will attend the meeting to provide the committee with an update (JHO8) on the progress towards the authorisation of the clinical commissioning group.

Dr Stephen Richards, Chief Clinical Officer, OCCG

Keep our NHS Public

Stephen Richards repeated his commitment to meet with Keep our NHS Public. In response to Dr Williamson’s address (item 4), they are only using Any Qualified Provider for adult autism, podiatry, and audiology services. The OCCG considers that there is room for growth in these areas. Ultrasound services were considered for AQP, but based on the central model would have been too expensive.  They will report to the committee on the process.

Authorisation

OCCG are in the process of submitting five outstanding conditions to the NHS by December and expect to have authorisation in the new year.

Committee members expressed concerns about the complicated layers structuring involvement and engagement with the OCCG.

Dementia

OCCG applied for, and received, just under £500,000 of extra funding for dementia services along with partners.

12.50

Adrian Chant from LINk will attend to provide an update on the work of Oxfordshire LINk (JHO 9a) to include an update on the review of maternity services which HOSC members are involved in alongside LINk.

Also attached is the report on the LINk ‘Enter and View’ visit to the Howard House Drug & Alcohol Detoxification service (JHO 9b).

13.10

The Chairman will give a verbal update on meetings attended since the last formal meeting of the Health Scrutiny Committee in September.

Since the last meeting the Chairman has attended meetings of OUHT & CCCG

13.15

The meeting closed at 13.40