Agenda and minutes

Councillor Neil Owen substituted for Councillor Pete Handley.

There were no declarations of interest submitted.

To approve the minutes of the meeting held on 5 December 2013 (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 5 December 2013 were approved and signed as a correct record subject to the references to ‘Mr Stephens’ in Minute 130/13 being corrected to ‘Mr Stevens’.

The Chairman had agreed to the following requests to address the meeting:

-                      Keith Strangwood, Chair, Keep the Horton General Group (Agenda Item 5)

-                      Jenny Jones, a member of the public (Agenda Item 5)

-                      Patricia Astle, a member of the public (Agenda Item 6)

Patricia Astle urged the Committee to scrutinise the OCCG plans to progress a new form of contracting termed Outcomes Based Commissioning as set out at Agenda Item 6. She believed the plans to be untried and untested leaving successful delivery in doubt.

Mr Strangwood asked the following questions of Andrew Stevens as a source of clarification in relation to Minute 130/13 of the last meeting:

• Did an independent review of the Emergency General Surgery (EGS) service take place by the Royal College of Surgeons?
• Did a series of workshops take place during the second half of 2013 and why were the public not aware of it?
• Why had a full consultation on the proposals not been carried out in a similar vein to that which took place in 2006 following the proposal to alter the maternity and paediatrics services at the Horton Hospital? He added that it was only during this consultation that all aspects, facts and consequences of the proposed service removal became clear. A Banbury public meeting to take place 12 months after the EGS service had been removed was promised at the last meeting of this Committee.

Mr Strangwood added that despite promises made at the last meeting from Dr Stephen Richards, a full year’s data had not been made available at this meeting for consideration, nor had 2 public meetings taken place. In his view, the public meeting, which was held at a country golf club during adverse weather conditions, was not adequate for its purpose and therefore did not constitute a full consultation. He urged the Committee to obtain an assurance from the Oxfordshire Clinical Commissioning Group (OCCG) that a full consultation would take place and if this was not given, to carry out a referral to the Secretary of State for Health on the grounds that consultation was inadequate.

Jenny Jones urged the Committee to request that a full consultation be carried out in order that all issues could be highlighted. It was her view that the service was not equitable across the county giving the example that Henley–on–Thames was situated less than 11 miles from the Royal Berkshire Hospital and that the OCCG had stated that 50% of the SE Locality Group referred their patients to this hospital. She also pointed out that her own village, Claydon, was situated at the most northern point of the county which was less than 20 miles from Warwick Hospital. In light of this, she added her personal discomfort about the service offered by the South Central Ambulance Service.

10:15

Ian Wilson, Interim Chief Executive of Oxfordshire Clinical Commissioning Group (OCCG) and Andrew Stevens, Director of Planning & Information, Oxford University Hospitals NHS Trust (OUHT), will present their reports (JHO5) on the public meeting held in February to discuss their plans and strategy for services for local people served by the Horton Hospital. The reports will also address the issue of emergency abdominal surgery which was temporarily suspended in 2013.

Attached are the following reports:

OCCG ‘Emergency Abdominal Surgery at the Horton General Hospital’ together with 2 appendices entitled:

Appendix 1 – ‘Patient Questionnaire in the Surgical Emergency Unit (SEU)’

Appendix 2 – ‘Questions and comments received from the public’.

OUHT –‘Emergency abdominal surgery at the Horton General Hospital’.

At its last meeting, the Committee had responded to a number of concerns voiced by the Keep the Horton General Group regarding their perceived lack of adequate consultation on changes which had been made to the emergency abdominal surgery service at the Horton Hospital, Banbury. This had been temporarily suspended in 2013 for clinical reasons that the Oxford University Hospitals NHS Trust (OUHT) had been unable to foresee (Minute 130/13).

The Committee had before them two reports from the OCCG and the OUHT (JHO5) on the public meeting held in February to discuss their plans and strategy for services for local people served by the Horton Hospital.

Members were asked to consider if the Trust Board’s rationale for its suspension of the emergency abdominal surgery was to their satisfaction and if not, whether the consultation was adequate in terms of content or time allowed; or whether the proposals would not be in the interests of the local health service; or, whether the reasons given for the suspension of the service because of an immediate risk to safety or welfare of patients or staff was adequate.

The interim Chief Executive of the OCCG, Ian Wilson, introduced his report explaining that the OCCG had put the same questions as the Committee had to the OUHT about their plans for public consultation, and had been satisfied with the responses given. The OCCG believed that the Horton Hospital had a good future ahead of it for the new provision of other general/specialist services and that the view that services at the Horton were being downgraded was ill-founded. He added that he believed the public meeting was both substantive and exhaustive of the issues brought to it; and could be viewed on the OCCG website. He expressed his satisfaction also that the patient survey of GP practices in the locality and a conversation he had had with the Keep the Horton General Group had taken into account all the salient points. However, he stated that important lessons and examples of good practice needed to be learned by everybody from this, particularly in light of an apparent history of mistrust for the NHS inherent within the local community of Banbury and its environs. He added that the OCCG was of the view that it was good practice to start public engagement early if there were changes that needed to be made. He apologised on behalf of the OCCG for any shortcomings in communication and informed the Committee of the OCCG’s intention to draw up mutual plans with all bodies, including the district council, to ensure that there is proper engagement with stakeholders in the north of the County in the future.

Mr Wilson stated that GPs within the locality had taken substantial clinical advice on the situation, and various feedback had concluded that the case for suspension of the service, and its eventual  permanent closure was compelling on  safety grounds. GPs had then engaged with colleagues to address some modification and extension to services provided by  ...  view the full minutes text for item 5/14

11:00

Ian Wilson, Interim Chief Executive of OCCG will discuss the feedback received from their recent series of ‘A Call to Action’ public meetings held around the county to understand what people want from their NHS service. He will explain how the public feedback has been taken into consideration in the drafts of the OCCG’s 5-year Strategic Plan and 2-year Operational Plan which are being presented to NHS England in February. February 2014’s update from the OCCG is attached at JHO6.

Ian Wilson, Interim Chief Executive and Dr Joe McManners, OCCG attended the meeting to present their OCCG update (JHO6).

During the presentation Mr Wilson referred to the OCCG’s revised constitution at which he paid tribute to Dr Stephen Richards, the former Chief Executive of OCCG,  for the considerable support he had given to him in his new role as interim Chief Executive. Members of the Committee took this opportunity to thank Dr Richards in appreciation for his contribution to the work of the Committee and wished him well for the future.

Mr Wilson made reference to a modified version of Outcomes Based Commissioning which the OCCG Governing Body had decided to take forward at their January 2014 meeting, as set out at paragraphs 2 and 3, of the report, which had taken the best elements forward using a collaborative approach, following consultation. The Committee received an assurance that the public would be able to see evidence of the new modified model in action in the OCCG Board papers online. In relation to mental health commissioning, Mr Wilson also reassured Members that because data would be collected in an assiduous manner, any problems would be picked up early which would in turn lead to better outcomes for patients and a better quality of service. The intention was to monitor this very closely.

Reference was also made to feedback received from the recent series ‘A Call to Action’ public meetings which were held around the county from November 2013 to January 2014 with the aim of understanding what people wanted from their NHS service. Since then, the OCCG had agreed six objectives for its 5 year Strategic Plan and 2 year Operational Plan (to be presented to NHS England in February) which had been revised in light of the public feedback. In response to a question, Mr Wilson confirmed that the OCCG had modified their objectives in response to public consultation, adding that once the objectives were put into practice, they would cease to feel like ‘motherhood and apple pie’.

In response to questions raised by Members of the Committee, Dr McManners confirmed that data on the ethnicity of patients was being collected by GPs. This was linked to the requirements of the Joint Strategic Needs Assessment (JSNA) to seek out where the inequalities were in the County and closer links between Health and Public Health teams were being forged. The Director of Public Health commented that the various responsibilities of Health and Public Health to contribute to the Joint Health & Wellbeing Strategy and the JSNA ensured that a close eye was kept on areas of health inequalities within the County. With regard to the issue of longer waiting times for patients in general practice, Dr McManners referred to the considerable emphasis being placed on preventative care which it was envisaged would serve to combat this problem. He added that there had been a large increase in people wanting appointments and considerable variability in how practices were responding. The Locality Teams  ...  view the full minutes text for item 6/14

11:40

Representatives from the Oxfordshire Clinical Commissioning Group (OCCG), Oxford University Hospitals NHS Trust (OUHT), South Central Ambulance Service NHS Foundation Trust (SCAS) and Oxford Health (OH) will present a report (JHO7) on emergency services in Oxfordshire. This item will address issues relating to the performance of Accident & Emergency, ambulance response times, community responders and services aimed at diverting pressure away from Accident & Emergency departments.

The Committee had previously raised various issues relating to the performance of Accident & Emergency, ambulance response times, community responders and services aimed at diverting pressure away from Accident & Emergency Departments and had expressed a wish to perform a scrutiny exercise on the services in question.

The following representatives attended the meeting in order to respond to questions:

-                      Ian Wilson CBE and Dr Joe McManners, OCCG

-                      Sir Jonathan Michael, Paul Brennan and Andrew Stevens, OUHT

-                      Yvonne Taylor and Anne Brierley – Oxford Health NHS FT(OH)

-                      Steve West – South Central Ambulance Service NHS FT (SCAS)

-                      Martin Bullock – London Ambulance Service

The Committee had before them an Urgent Care Briefing, which had been produced on behalf of NHS Partners in Oxfordshire (JHO7), giving performance figures for Accident & Emergency, the Ambulance Services, Emergency Multidisciplinary Units, NHS 111, the Out of Hour service and Minor Injuries/First Aid Units.

Steve West and Martin Bullock, Community Defibrillation Officer for the London Ambulance Service were invited up to the table. Martin Bullock described his role in supplying a defibrillator, and giving training in its use, to 54 towns and parishes across West Oxfordshire district as a result of an anonymous donation and District Council funding, following concerns about falling ambulance response times. West Oxfordshire was the first rural district in the country to receive this level of coverage.

The Committee asked for clarification on the reasons for the falling ambulance response times across the county and asked for a table to be produced over a period of time to illustrate the exact size of the problem. Mr West responded that the bad winter of 2013/14 had created pressures at various points, a significant one being at the JR Hospital itself. SCAS were very grateful for the support given to them from the OUHT who had responded by designing the rapid nurse assessment system which is now in place on admission at the JR . This had helped enormously, though it had not completely eradicated the problem. The Committee asked that further data be presented in relation to this initiative.

In response to questions from the Committee clarification was given that there was no policy directing paramedic clinicians as to which hospital was appropriate for particular conditions which patients were presenting with. The Chairman asked that officers review the evidence on this matter. There was some discussion of the resources being invested and a query on what plan there was if matters did not improve. The Committee was assured that there was vigorous monitoring of the position and there was a recognition of the need to keep a focus on local areas. There was reference to the co-responding pilot with the Fire Service. There was a recognition that as demand continued to grow there was a need to look at doing things differently making use of the NHS Pathway.

There was some discussion of the Witney Emergency Multi-disciplinary Unit (EMU). Although it was recognised that it was early days, signs were  ...  view the full minutes text for item 7/14

12:50

Dr Jonathan McWilliam, Director of Public Health will give a verbal update on current public health issues. 

Jackie Wilderspin, Public Health Specialist, will explain the priorities of the 2014 Joint Strategic Needs Assessment (JSNA). The JSNA will inform the Health & Wellbeing Strategy for Oxfordshire. A briefing is attached at JHO8.

Jackie Wilderspin, Public Health Specialist explained the priorities of the 2014 Joint Strategic Needs Assessment (JSNA), a draft of which was to be considered at the Oxfordshire Health & Wellbeing Board on 13 March 2014. Councillor Hibbert Biles attended for this item.

Jackie Wilderspin undertook to circulate a copy of the JSNA to Committee members when it was available. The Chairman agreed it would be appropriate to receive what was being considered at the Health & Wellbeing Board and at a future meeting to review the priorities and to look at monitoring. Jackie Wilderspin confirmed that early input from members of the Committee would be most helpful.

In response to a question about monitoring Jackie Wilderspin stated that it was the intention to make as much data as possible available for use by all. The Health & Wellbeing Board would be monitoring progress.

A Member highlighted the role Government policies played in promoting better health (such as minimum pricing for alcohol) and queried what could be done to raise such issues with them. The Chairman felt that the data would be interesting and the Committee should focus on areas where it was possible to have a direct influence. He believed that the District Council’s themselves might well welcome the challenge and support from the Committee. Responding to requests for detailed information on a number of matters, the Chairman noted that the level of detail would be with the data when received.

13:15

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 (attached at JHO9).

The Chairman gave a verbal update on meetings he had attended since the last formal meeting of the Committee. Members also had the opportunity to discuss the Forward Plan (JHO9).

The Chairman indicated that it could be the last meeting for some of the Co-opted members and thanked them for their support and contribution to the work of the Committee. Dr Harry Dickinson replied that he had enjoyed his time on the Committee which he had found to be effective and well chaired. He also paid tribute to the officers and former officers who supported the Committee and in particular, Roger Edwards, Claire Phillips and Julie Dean.

The Chairman advised the Committee on the process to recruit co-opted members.

He noted that it would be Claire’s last meeting for some time as she was going on maternity leave and her role would be covered by Ben Threadgold who already supported the Health & Wellbeing Board. The Committee gave Claire their best wishes.