Agenda and minutes

There were no apologies for Absence or temporary appointments.

There were no Declarations of Interest.

To approve the minutes of the meeting held on             2011 (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 5 September 2013 were approved and signed subject to attendee Tina Asmal being altered to Tina Ashwell the following amendment to line 1, page 5 (additions and amendments in bold)

‘A nutritional plan was put in place for the duration of their stay if there were concerns and these were fed back to their GP on discharge.’

Matters Arising from the Minutes

With regard to Minute 122/13, paragraph 2, the Director of Public Health pointed out that it was vital that the broader Health community should try to focus together on topics. The Health and Wellbeing Board would take a joint, strategic view and this Committee would hold the outcomes to account. He added that officers were due to meet informally in the new year to look at how the different forward plans could be linked together.

The Chairman of Healthwatch Oxfordshire, Larry Sanders, addressed the meeting giving an oral report on activities and short-term priorities.

He reported that some short- term priorities had been set, looking at issues which could be done relatively quickly. These topics included:

• access to GP appointments
• care homes – focusing on patient experience
•  domiciliary care – in particular 15 minute visits
• whistle blowing

Keith Strangwood, Chairman of Keep the Horton General, read from his statement which had been circulated previously to members of the Committee. The Chairman agreed to it being appended to the Minutes.

10:15

Dr Stephen Richards, Chief Executive Officer, Oxfordshire Clinical Commissioning Group (OCCG) will discuss matters of relevance and interest to the committee.  Dr Richards will discuss the development of OCCG’s 5 year strategy and plans for public engagement. He will also give a verbal update on services in the North of the County. 

A briefing paper, produced by the OCCG, is attached at JHO5.

Dr Stephen Richards, Oxfordshire Clinical Commissioning Group (OCCG),and  Andrew Stephens, Director of Planning & Information, Oxford University Hospitals NHS Trust (OUHT) began by addressing some of the issues raised by Mr Strangwood with regard to services in the north of the County.

Mr Stephens advised the meeting that it had been necessary to make changes to the emergency general surgery service at the Horton Hospital, Banbury for clinical safety reasons that the OUHT were not able to foresee. The number of general surgeons at the hospital had reduced from 5 to 2 in a short space of time and the hospital was unable to recruit general surgeons as the changing medical standards issued by the Royal College of Surgeons had recommended that a patient should be treated by a specialist surgeon. The decision had been taken to suspend this service at the Horton. An independent review conducted by the Royal College of Surgeons had supported this decision.

While putting in arrangements for an alternative pathway the Trust had listened to patient and GP feedback and had taken measures in the interests of patients. This had resulted in the establishment of an emergency clinic for minor operations such as the drainage of abscesses, the outcome of which had resulted in fewer transfers to the John Radcliffe. It had also been recognised that it would be  possible to strengthen other pathways at the Horton Hospital, such as those for patients with thoracic or neurological problems. Assurance was given that full attention would be paid to improving the clinical outcomes for patients.

In conclusion he told the Committee that he saw a full and vibrant future for services at the Horton Hospital with far more patients being seen in the north of the county. However, some services would have to change and relocate to Oxford, not for cost reasons, but for clinical reasons. The Trust had been working with the OCCG and a consultation document would be submitted to the Committee for comment after the finalised strategies for the OCCG had been agreed.

Members of the Committee urged the Trust and the OCCG to consider holding a full public meeting in Banbury by the end of January 2014. During discussion the Committee asked that information on travel arrangements (particularly for travel in heavy traffic conditions) to Oxford for patients living in the north of the County who require emergency care be addressed. Mr Stephens responded that transport protocols had been agreed for patients.

The Committee asked why the issues relating to general surgery had not been anticipated within contingency plans for services. Mr Stephens responded that this had been anticipated via patient engagement with the Better Healthcare Programme for the Horton. As a result, the number of patients seen in the Emergency Trauma Clinic had been increased. The training of surgeons had also been raised as a part of this Programme, but unfortunately emergency action had had to be taken. The Trust would have liked to have addressed this in a planned way.

The  ...  view the full minutes text for item 130/13

10:55

Eddie McLaughlin, Anne Brierley and Ros Alstead from Oxford Health will discuss their plans for remodelling community and mental health services and their approach to safety and security. Attached  are the following briefing documents (all at JHO6):

• ‘Service Remodelling of Oxfordshire Adult Mental Health Services.’
• ‘Older People’s Care, Long Term Conditions and Urgent Care – Service Remodelling and Current Delivery.’
• ‘Oxford Health Safety and Security in Mental  Health Wards in Oxfordshire.’

Eddie McLaughlin, Anne Brierley and Ros Alstead from Oxford Health (OH) attended the meeting to discuss their plans for remodelling community and mental health services and their approach to safety and security. The Committee had before them the briefing documents (all at JHO6):

In response to questions from members, the speakers confirmed that OH was implementing its new model for mental health and older people’s care and addressing any logistical problems. OH was working with the Community Hospitals with regard to the provision of care on a geographical basis. It was noted that there were two specialist single sex wards located in the Littlemore Hospital.

Mental Health referrals to the service could be received from patients directly or from members of the public. Mr McLaughlan confirmed that there could be delays in accessing urgent care, for example when a patient was sectioned under the Mental Health Act, when social workers had to be present, as this was dependent upon demand for their time.

In response to a question, Mr McLaughlan advised that the Trust did receive alerts of vulnerable people from the general public about people living alone at home with deteriorating mental health , and this was acted upon with the appropriate support. He added that with regard to patient self referrals who present with enduring mental health problems, arrangements were made for them to return into the system as necessary. To allow ease of access, GPs would also be able to fit directly into slots for hospital care on a ‘Choose and Book’ basis.

Concerns were raised by members regarding support for people who did not have the mental capacity to operate their personal health budget(PHB). OH confirmed that they would continue to work with the Department of Health to find an appropriate model of support.

Respite for carers was raised. OH stated that they were very committed to giving the right service for carers, this being one of the key priorities for the Health & Wellbeing Board. Carers breaks could be accessed via GPs.

As requested, the OH gave an update on safety plans following two recent security breaches. A CQC briefing focusing on physical security had been prepared and the subsequent actions for the Trust had now been signed off.

Members felt that there was a need to back up the report with substantive information and data, for example, with information of staffing levels and approaches taken with patients presenting with various problems. Ros Alstead agreed to provide this information advising that the Trust held a considerable amount of information which informed on whether services were effective. Furthermore, base line assessments could be done at the start and end of treatment, and at points in between.

The Committee thanked the representatives for their attendance. They accepted an invitation to return to a future meeting to review how the new model was working in practice.

11:35

The following representatives from Oxfordshire County Council, the Oxfordshire Clinical Commissioning Group (OCCG), Oxfordshire University Hospitals NHS Trust and Oxford Health NHS Foundation Trust will present a report on the issue of delayed transfers of care in Oxfordshire including current performance and trends. They will also discuss plans in place to improve performance.

John Jackson, Oxfordshire County Council

Dr Stephen Richards, Oxfordshire Clinical Commissioning Group

Andrew Stevens, Oxford University Hospitals NHS Trust

Yvonne Taylor, Oxford Health NHS Foundation Trust

An update paper, produced by the OCCG, is attached at JHO7.

The following leaders of the Health and Social Care community presented a report (JHO7) on the issue of delayed transfers of care (DTOC) in Oxfordshire.

John Jackson, Oxfordshire County Council

Dr Stephen Richards, Dr Barbara Batty and Kirsteen Murray (specialist consultant in DTOC) - Oxfordshire Clinical Commissioning Group

Sarah Randle and Dr James Price -  Oxford University Hospitals NHS Trust

Yvonne Taylor and Anne Brierley, Oxford Health NHS Foundation Trust

The aim of this session was to understand the complex issues involved in the integrated DTOC pathway and for the Committee to gain confidence in the future plans.

In response to a question, Kirsteen Murray, consultant, said that local leaders were very committed to solving the problems associated with DTOC in Oxfordshire and were working together despite financial difficulties within their own organisations. She added that their particular interests had influenced it also. John Jackson commented on the need for organisations to look at the entire pathway and not just their part.

Yvonne Taylor pointed out that one year ago the Discharge Pathway Policy had been introduced, which had resulted in targets reaching an  80% discharge rate, sometimes 92%. The 20% that was not working had been due to the fact that people’s needs, particular those of older people, could not be met in a single pathway. She added that an example of an improvement as a result of the Policy was the reduction of the average length of stay in hospital from 22 days to 19, resulting in the opportunity to take in more admissions.  A single point of access had also been introduced, the outcome of which was a more consistent average figure of 20 delays when previously there had been 30 – 40. They were working to dovetail Social Care into a 7 day per week hospital presence instead of 5 in order to increase the rate of discharges over the weekends so as to avoid problems for other organisations involved, such as domiciliary care. Advance notification from the Community Hospitals of social care required by patients on discharge had improved. John Jackson added that for the past year a provider had been commissioned to produce care packages from home as a continuation of the discharge process. A new provider had begun work that week with a key priority to secure an immediate response and this would be monitored closely.

 Access to care more generally was being considered by the OCC/OCCG Joint Management Group, one of its aims being to bring more people, such as Health Care apprentices, into the social care agenda to meet the rising demand in the domiciliary care market (number as well as size of care packages now needed).

Parallel working on assessments between health and social care was considered to be an important area by members as delays in assessments had existed for a number of years.  Complicated assessments could be completed in 10 minutes but there were a small number of complex assessments that could take a very long  ...  view the full minutes text for item 132/13

13:05

Teresa Anderson, Compliance Manager (Oxfordshire) and John Scott, Regional Communications Officer for the Care Quality Commission (CQC) will explain the role of the Commission, its work in Oxfordshire and the organisation’s response to the Francis Report recommendations.

A briefing document entitled ‘Update and Summary of Activity’ is attached at JHO8.

Teresa Anderson, Compliance Manager (Oxfordshire) and Nick Kerswell, Communications Manager for the Care Quality Commission (CQC) explained the role of the Commission, its work in Oxfordshire and the organisation’s response to the Francis Report recommendations.

It was noted that OUHT had been identified as one of the next tranche of acute trusts to be inspected in February as part of the Foundation Trust application.

It was felt that even pre-announced inspections of such large trusts would uncover issues.

Members were advised that procedural information about the future inspection of primary care would be announced during the next week.

The CQC confirmed commissioners would be consulted before a provider was inspected and CQC representatives agreed to take back a request that local government modes of communications and quality systems be linked in to their new model.

Teresa Anderson and Nick Kerswell were thanked for their presentation.

13:25

The Chairman will give a verbal update on meetings attended  since the last formal meeting of the Committee. There will also be an opportunity for members to discuss the Forward Plan. This is attached at JHO9.

The Chairman gave a verbal update on meetings he had attended since the last formal meeting of the Committee.

It was requested that the Oxford Health’s Annual Report be added to those items to be considered for inclusion in the Forward Plan. The current Forward Plan document was before the Committee at JHO9.