Agenda and minutes

An apology was received from Cllr Martin Barrett.

There were no declarations of interest.

The Committee noted that the Chairman had agreed to an address by Councillor Jenny Hannaby prior to agenda item 9 – Outcomes Based Contracting.

At the last meeting of this Committee, Councillor Mrs Judith Heathcoat had expressed concerns about the level of service given by the South Central Ambulance Service (SCAS) at a serious incident they attended on 26 April 2014 in Coleshill. Councillor Mrs Heathcoat gave a resume on the facts and the points she raised at that meeting and then briefed the meeting on developments.

SCAS had attended a meeting of the Coleshill Parish Council in January to report the findings of their investigation, a summary of which is included within the papers for this meeting. Councillor Heathcoat informed the Committee that the villagers of Coleshill were concerned that the village is situated at the edge of the Oxfordshire boundary and, as such, there needed to be an awareness by both the South West Ambulance Service and South Central Ambulance Service of distances to travel. Good intercommunications and reciprocal arrangements between the two Emergency Operation Centres across Trust boundaries and Manager Communication was needed to ensure resilience. While understanding that ambulances could be posted to strategic positions, arrival times were too slow generally and communication between Wiltshire/Swindon and South West group was not working. This resulted in either no service or a number of ambulances arriving for the same incident. Concern was also expressed for areas within the Oxfordshire county boundary carrying an SN or an RG postcode – resulting in wrong assumptions being made on the part of the ambulance services.

To approve the Minutes of the meeting held on 20 November 2014 (JHO3) and to receive information arising from them.

To approve the Minutes of the meeting held on 20 November 2014 subject to the following amendments (amendments in bold italics):

-       Minute 53/14 – paragraph 3, penultimate sentence, ’due to lack of space at the West Oxford site’;

-       Minute 58/14 – page 11, paragraph 1, sentence 1, ’When asked about the sufficiency of car parking facilities’.

Matters Arising

-       Minute 51/14 relating to Minute 40/14, New Contract for Community Sexual Health Services - it was reported that the new Community Sexual Health Service would now be included on the Agenda for the 23 April 2015 meeting;

-       Minute 51/14 relating to Minute 43/14, ‘Emerging findings of the non-emergency patient transport services’ – officers undertook to follow up their request for the copies of literature prepared by the Trust which had been used to advertise and signpost the changes for patients using the non-emergency transport services;

-       Minute 57/14,Emergency Ambulance Services in Oxfordshire,  page 9, final paragraph – the Committee noted the executive summary of the serious incident referred to by Councillor Mrs Judith Heathcoat at the last meeting on 20 November 2014 and at this meeting. They requested that they be provided with at least one copy of the full report into the incident and that copies also be given to the complainants and to Coleshill Parish Council. Members also requested that responses to a number of questions, noted below be provided by the Trust prior to their attendance at the next meeting of the Committee on 23 April:

·         Why did the 999 call go to Bristol?

·         What was the reason for the mobile failure in the rapid response vehicle?

·         Why were four dual crewed vehicles out of service that day?

·         Why was there no upgrade of the incident after 45 minutes?

·         What are the protocols for cover during lunch breaks?

·         Why has the report into the incident taken so long to be produced?

·         What reflective practice and learning actions have derived from the incident? What action has been taken on the business continuity plan in light of the main systems failure and problems with call handling?

·         Was there a clinical impact on the patients?

·         How many incidents similar to this have there been?

·         How are first responders used?

10:15

Claire Phillips, Senior Policy & Performance Officer, Oxfordshire County Council will introduce the Toolkit for adoption and use by the Committee members (JHO5).

Claire Phillips introduced the proposed, revised Toolkit (JHO5) which had been designed to establish an agreed method for determining whether a proposed service variation or service development was ‘substantial’, and thus a matter upon which there should be formal consultation with the Committee.

The Committee AGREED to adopt the Toolkit.

10:20

Rachel Coney, Director of Healthwatch Oxfordshire, and Dermot Roaf, Vice Chair, will present a report on recent projects (JHO6), to include an update on recommendations and information on the progress of commissioners and providers in delivering change.

Dermot Roaf, Deputy Chair of Healthwatch Oxfordshire and Rachel Coney, Chief Executive presented their report on the actions taken by commissioners and providers in response to their recommendations since April 2014. It was noted that although some of the recommendations had not been implemented, the intention was to return to them. Healthwatch thanked both providers and commissioners for their assistance and transparency in their recommendation responses. It was also noted that the three areas where targets were being routinely missed, and where there was most concern, were health checks, CAMHS waiting times and cancer treatment time.

The Committee thanked Dermot Roaf and Rachel Coney for their attendance and thanked them for the report.

10:45

Representatives from NHS England, (Thames Valley Team) Ginny Hope; and the Oxfordshire Clinical Commissioning Group, Dr Joe McManners and Rosie Rowe will present an overview of primary medical services within Oxfordshire.

Representative(s) of the Local Medical Committee (Paul Roblin), the City Federation and Primary Medical Limited will also attend to give a provider perspective.

The Committee will discuss challenges and service development. A briefing which has been prepared by NHS England (Thames Valley) team and the Oxfordshire Clinical Commissioning Group is attached at JHO7.

Ginny Hope from NHS England (Thames Valley Team) and Dr Joe McManners, and Rosie Rowe from the Oxfordshire Clinical Commissioning Group attended the meeting to present an overview of primary medical services and to discuss future challenges and service development within Oxfordshire. Dr Paul Roblin (Local Medical Committee), Dr Ben Riley (Oxford City Federation), and Dr John Harrison (Principal Medical Limited) also attended to give a provider perspective to the discussion.

A briefing which had been prepared by NHS England (Thames Valley team) and the Oxfordshire Clinical Commissioning Group was before the Committee at JHO7.

Dr McManners, Clinical Chair, OCCG, commented that the local Health and Social Care system was dependent on a high quality and well performing primary care system, which, if done well, could play its part in improving the quality of the whole system, including that of secondary care. Whilst Oxfordshire had been recognised as producing a high quality primary care, the role and function of the GP had changed gradually over the years and had reached crisis point. Reasons cited were increased demand for urgent appointments and more and more complex care combined with the expansion of the numbers of people aged 85 and over, less care taking place in hospital, and more preventative care being undertaken with patients. With the amount of resource as a proportion of the Health spend reducing, primary care is trying to do more for less. Dr McManners added that whilst there was much that worked well in primary care, there was a need to cluster groups of practices and integrate work with social care (and communities in local areas) in order to meet these changing needs. Thirdly he highlighted the need for more work to be done on recruitment and retention practices to meet the issues faced by a GP practice in the modern age.

Ginny Hope, Head of Primary Care, NHS England (Thames Valley team) commented that, following the recent reorganisation, NHS England held the legal commissioning contracts with all 80 GP practices across Oxfordshire and the whole of the Thames Valley region (240 GP practices in all, 10 CCGs). She added that the delivery of a high quality health service was being undertaken via co-commissioning with the CCGs and via close working with GPs and providers. NHS England was working with CCGs on different models of working and the transformation of primary care. They were also working with them on a demographic approach, looking to produce a mapping exercise across all counties. In addition, NHS England was also working with CCGs on questions for the new strategy based on expansion prospects and commissioning.  She informed the Committee that new funding was available via NHS England from a Primary Care Infrastructure Fund, undertaking to send officers the link to it for circulation to members.

Regarding the link between NHS England and CCGs who are unable to fund the transformation of practices into federations, or did not have the capacity to do so, Ginny Hope explained that NHS  ...  view the full minutes text for item 67/15

11:45

Sarah Breton, Lead Commissioner, Children, Young People and Maternity Services, and Pauline Scully, Service Director, Oxford Health, will present to the Committee on the current service and its re-commissioning plans. A report is attached at JHO8.

Sarah Breton, Lead Commissioner, Children, Young People & Maternity Services OCCG/OCC; Donna Clarke, Head of Community Child & Mental Health Services (CAMHS), Oxford Health; Sarah Ainsley, Children, Young People & Families, OCC and Dr Jonathan McWilliam, Director of Public Health, OCC gave a presentation on the current service and its re-commissioning plans.

The Committee had before them a briefing on the current service its plans for the future(JHO8).

When questioned about why there had been a large increase in referrals last year to CAMHS, Donna Clarke replied that the service had seen a growing number of referrals both locally and nationally. Families could now self - refer and also self - refer back into the service. The recession and consequent strains on the family unit was also a factor and the service was also seeing people with less complex issues than previously, for example, with anxiety. Dr McWilliam and Sarah Ainsley added that the ability to understand and diagnose was better in today’s society. Also the public were becoming more aware of the issues associated with abuse and more parents and children were coming forward. Some seek early assistance, others will seek higher level services.

Sarah Breton stated that the pressures on the service were not due to disinvestment in the last 5 years, but were as a result of the pressures in meeting rising demand. She stressed that Oxfordshire ran a good service. Donna Clarke pointed out that in Oxfordshire 100% of emergency referrals were seen on the same day and overall, 73%of young people were being seen within 12 weeks. This was broken down to 50% of young people requiring a Tier 2 service and 23% requiring a Tier 3 or more. Specialist cases were being seen within 12 weeks.

Following a query about the availability of in-county beds for children with a learning disability, Sarah Ainsley stated that the lack of in-patient beds within the county was an issue and there was a need to create more specialist provision in the county for children with a learning disability at transition age, as they tended to stay in adolescence for longer and needed more assistance over a longer period. Sarah Breton pointed out that an-patient bed was the last resort and that Oxfordshire ensured that all the community services were in place, so that people could be cared for in the home. To this end it was incumbent on practitioners to ensure that the correct services/resources were available at the same time. The current consultation in adult mental health services (the Big Plan) was addressing the issues with transition from childhood into adulthood. In addition, Children & Families, in 2014 had  had made significant changes in the way the service managed children with a disability, introducing a transition Plan, together with a single Health & Education Plan to ease them over the transition.

Sarah Ainsley, in response to a question regarding looked after children with mental health problems, reported that a significant amount of work was being done with the Children’s  ...  view the full minutes text for item 68/15

12:30

At its last meeting the Committee received a brief paper on the work being undertaken by Oxfordshire Clinical Commissioning Group to develop outcomes based contracting for mental health and older people’s services.  The Committee asked for further clarity and detail in a number of areas.  This paper addresses the issues raised and is the basis for further discussion (JHO9).

Catherine Mountford and Barbara Battie of the Oxfordshire Clinical Commissioning Group will attend to present the item and respond to questions.

At its last meeting, the Committee had looked at the work undertaken by the OCCG to develop outcomes based contracting (OBC) for mental health and older people’s services. The Committee asked for further clarity and detail in a number of areas.

The Committee had before them a paper (JHO9) which addressed the issues raised and which would form the basis for further discussion.

Catherine Mountford and Barbara Batty, from the OCCG attended the meeting to present the item and to respond to questions.

Prior to discussion, the Committee were addressed by Councillor Jenny Hannaby and it was noted that she had recently attended a OCCG Governing Body meeting and she had been concerned to learn that 25% of patients who were classed as delayed transfers of care would have to leave Oxfordshire hospitals within the month.

Barbara Batty was asked to respond to the concerns of Councillor Hannaby. She stated that there was a recognised need to maintain people within the community but that it was also recognised that patients leaving hospital would require more care when they came out. All organisations were working together trying the relieve pressures on the system and to ultimately meet the targets set.

A member of the Committee asked how the outcomes would be measured. Barbara Batty and Catherine Mountford responded that there were four high level outcomes. Other outcomes, beneath them were being developed to support them. A starting point was agreed and the level of improvement which was expected year on year. The outcomes were currently subject to negotiation and once the contracts had been signed, they would be in the public domain. The Mental Health contract was due to start on 1 April 2015 until 1 April 2016. Each area had very specific indicators. They added that the older people contract was more complex and the service scope was currently under discussion with the providers. The outcomes put forward by the most capable providers were under consideration and would not be agreed for 2015/16.

When asked how it was intended that Committee should engage with the process, Catherine Mountford explained that when the mental health contract was signed, then this would give the Committee the opportunity to talk it through. Members felt that it was unacceptable that the Committee will not get to know the detail until after it had been signed, particularly if it would make major changes to the service. Catherine Mountford and Barbara Batty responded that no service change would be implemented without it being consulted upon and that this stage was only an indication to providers that their model was liked. No implementation or money would change hands until outcomes had been agreed upon.

Dr McWilliam commented that there were pros and cons to the process. Scrutiny will need to scrutinise whether the outcomes have been successfully achieved and also whether the process has proved satisfactory from the patient and public point of view. There would be a need to stay much more closely with provider and  ...  view the full minutes text for item 69/15

13:00

The Chairman will give an oral update on meetings she has attended since the last meeting. A draft Forward Plan is attached at JHO10.

The Committee’s forward plan was noted and agreed.

Claire Phillips agreed to update members on a number of topics which were on the national political agenda prior to the next meeting.

Please note that the Joint Committee will meet on the following dates from April 2015 to March 2016:

23 April 2015

2 July 2015

17 September 2015

19 November 2015

4 February 2016

The dates of future meetings were noted.