Agenda and minutes

An apology was received from Moira Logie.

There were no declarations of interest.

To approve the minutes of the meeting held on 5 February 2015 (JHO3) and to receive information arising from them.

To approve the Minutes of the meeting held on 5 February 2015 subject to the following amendments (amendments in bold italics):

·         Minute 67/15 - page 5, penultimate paragraph, last sentence, ‘Surgeries would be grouped into bigger units, would be more commercial, managed more centrally and uniformly and more GPs would be salaried rather than independent.’

·         Minute 67/15 – page 7, recommendation (b), ‘that a recommendation be sent to all appropriate bodies that NHS England be considered as a statutory consultee when housing growth (large and small planning applications) is considered by Councils.

·         Minute 68/15 – page 8,  paragraph 3, sentence 2 should read: ‘Donna Clark pointed out that in Oxfordshire 100% of emergency referrals were seen on the same day and overall, 73% of young people were 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.’

·         Minute 70/15 – page 10 – ‘Claire Phillips agreed to update members on a number of topics which were on the national political agenda prior to the next meeting.’

Matters Arising

The Committee asked for updates to a future meeting on the following matters:

·         Minute 67/15 – Primary Medical Services - progress report on GP federations within the county;

·         Minute 67/15 – responses to the Committee’s recommendation that NHS England be considered as a statutory consultee when housing growth (large and small planning applications) is considered by Councils including clarification over responsibilities;

·         Minute 67/15 – progress report on recruitment and retention practices to meet the needs of GP practices in the modern age; and

·         Minute 69/15 – Outcomes Based Contracting – the outcomes of the forthcoming meeting with Catherine Mountford of the Clinical Commissioning Group to ascertain whether there was a process whereby the Committee could view a contract prior to signature.

The Committee noted that the Chairman had agreed to an address by Councillor Pete Handley at Agenda Item 7 - South Central Ambulance Service.

10:10

Rachel Coney, Director of Healthwatch Oxfordshire and Dermot Roaf, Vice - Chair of the Board will give an update on recent projects (JHO5).

Dermot Roaf, Deputy Chair of Healthwatch Oxfordshire (HWO) and Rachel Coney, Chief Executive, presented a report on their recent projects and findings (JHO5).

With regard to paragraph 2.2(c), they reported that, to date, 210 members of the public had completed a survey online, 80 face to face interviews had taken place, and 60 GPs, 26 pharmacists and 28 care providers had responded to professionally specific questionnaires.

With regard to paragraph 2.3 - Lay involvement in decision making – PIN representatives had been interviewed in time for the forthcoming Children’s Trust Board meeting.

With regard to paragraph 2.5 – Events – the countywide Hearsay! event had been arranged to take place on 20 June at the King’s Centre. They agreed to ensure that all members receive details of the events with times and locations.

The Committee noted that there had been no safeguarding issues arising from their discharge from hospital project and that HWO would be working with care providers in relation to their dignity of care project later on in the year.

Rachel Coney, when asked about HWO’s view concerning the proposed closure of the kitchen at the John Radcliffe Hospital, commented that they had not yet formed an opinion. She added that HWO may choose to add it to a range of possible issues to be included in their work programme. The Chairman also reported that the issue had already been brought to the Committee’s attention and information had been duly sought. Moreover, that although the Agenda for this meeting had been very full, the issue could be included on the Agenda for the next meeting should a request to do so be made.

Rachel Coney was asked if the County Council was contributing helpfully to their requests for information. She responded that HWO had been very pleased with the calibre of partnership working with all their partners and this aspect was monitored on a daily basis.

In response to a question about how HWO had been working with the six locality GP Forums, they reported that the Forum Chairs had agreed that HWO would provide them with administrative and marketing support for their patient and public involvement work, beginning initially with the West Oxfordshire Forum. If this arrangement was found to work well, it would be rolled out to the other 5 forums. They reported a concern of the PPG Forum Chairs, which had been escalated to NHS England, which concerned a perceived lack of monitoring of the self- declaration required in the new GP contract for GP practices to self-declare whether they operated an effective Practice Participation Group.

With regard to a question about HWO’s concerns raised with the Care Quality Commission about the quality of inspections carried out at Campsfield House, they reported that Healthwatch England had written giving their assurances that their concerns had been passed on. This would be take place once evidence had been gathered to assure themselves that all the relevant detail was to hand.

It was AGREED to note the  ...  view the full minutes text for item 76/15

10:25

The Committee will examine Oxfordshire’s response to the winter pressures with specific focus on Accident & Emergency departments and delayed transfers of care. Representatives will attend to account for the response from their organisations (JHO6).

The Committee examined Oxfordshire’s management of the impact of winter by the Oxfordshire Healthcare system. A report prepared by Alison Edgington, Deputy Director for Delivery and Localities (Interim), Oxfordshire Clinical Commissioning Group, was before the Committee at JHO6.  Representatives from the following organisations attended and responded to a number of issues raised by members of the Committee:

·         Dr Barbara Batty and Alison Edgington – Oxfordshire Clinical Commissioning Group

·         Yvonne Taylor – Oxford Health

·         John Jackson – Oxfordshire County Council and Oxfordshire Clinical Commissioning Group

·         Paul Brennan – Oxfordshire University Hospitals NHS Trust

Alison Edgington, in her introduction, outlined various initiatives which had culminated from closer agency working between Health organisations within the County highlighting the following:

·         Additional patient transport to be provided by the South Central Ambulance service;

·         Meetings with counterparts in other counties to learn how to move patients from out of county to nearer their own homes;

·         Additional week-end support for patients.

In response to a question relating to the problems of access to GP and the detrimental effect this had on numbers attending Accident & Emergency departments, Alison Edgington commented that there were varying reasons for the increase such as more visits by the elderly who were suffering from more complex, more serious illnesses and who required instant treatment. Paul Brennan added that there was no evidence that the national increase in numbers was due to alcohol related problems or to people not being able to get appointments with their GP.

A member of the Committee asked if consideration had been given to a solution which could meet the heavy amount of resources required to carry out winter pressures work, such as the provision of additional beds in community hospitals, more patient transport etc. Alison Edgington responded that additional community hospital beds had been opened during the winter in response to demand. However, this focus on increased bed numbers was not sustainable due to available staff numbers. The CCG and County Council commissioners were currently looking at all aspects of spending via the Joint Older People’s budget , looking at how the system worked as a whole, finding out what worked best and what did not, and then thinking about how resources could be targeted as a result. A comprehensive plan had been developed and a plan which had pulled together services across the system in Health and Social Care. Plans and policies already in existence would be evaluated in 3 months’ time.

With regard to Delayed Transfers of Care (DTOC), a Committee member asked when the issues relating to capital in the various organisations would be addressed, and what the position was so far. Alison Edgington responded that previously the different organisations had worked separately, adding that DTOC was not an easy problem to solve in light of the many different factors involved. However, a large amount of learning had occurred over this last winter and there would be a transformation of the current system via the Better Care Fund Plan. John Jackson added that one big  ...  view the full minutes text for item 77/15

11:00

As a follow up to the discussion at the November 2014 meeting, and following some recent incidents, representatives from the South Central Ambulance Service (SCAS) will attend to discuss key issues. These include working practices, staffing, response rates (specifically in relation to the rural dimension) and partnership working. A report produced by SCAS is attached at JHO7.

A letter from SCAS responding to the continued concerns expressed by members at the last meeting (Min. 64/15 refers) with regard to the road traffic collision incident in Faringdon in April 2014 is also attached at JHO7.

Prior to discussion of this item, Councillor Pete Handley addressed the meeting calling on the Committee to do a vote of no confidence in the South Central Ambulance Service (SCAS) on the grounds that the service was not fit for purpose in rural areas. He stated that insufficient money was being put into the service both nationally and locally, and, as a result, SCAS was still trying to find £15m in cuts. Moreover, Wales currently offered free paramedic training to students, compared to a cost of £3k per student in Oxfordshire. He urged the Committee to put pressure on commissioners to introduce fines for Ambulance Trusts who were not meeting their targets, the outcome of which may lead, in time, to a second provider being sought. Councillor Handley had circulated to members of the Committee, for their own information, a personal account of his own family’s experience of SCAS.

Richard McDonald, Interim Area Manager, SCAS, and Sue Byrne, Chief Operating Officer, attended as a follow up to the Committee’s November 2014 meeting. The Committee had before them a report produced by SCAS (JHO7) which addressed the issues raised at that meeting. Members also had before them a letter, produced by SCAS, which responded to the continued concerns expressed by members at the last meeting with regard to the road traffic collision incident in Coleshill in April 2014, as reported by Councillor Mrs Judith Heathcoat.

In response to a question about staff sickness and whether plans were in progress to manage sickness absence better by drafting in staff in particular circumstances, Sue Byrne stated that the Trust tried to forecast demand and then to plan staff numbers. Moreover, additional cover was also added to what they believed was required, to accord with this. She explained that this was a resource issue and that there was a national shortage of paramedics. Notwithstanding this, the Trust had in the last few months, successfully managed to recruit a high number of high quality paramedics into the service using a number of recruitment and retention measures. She added that paramedics were to be added to the list of professionals where there shortages.

A member of the Committee asked if there was a shortage of vehicles.  Richard McDonald responded that there was no shortage of vehicles and that it was unfortunate that, in respect of the Coleshill incident, 4 out of 16 vehicles were out of service and the others were fully utilised on other calls and not available to respond to the emergency call.

The Committee queried the target handover time from ambulance care to Accident & Emergency care (70%). Sue Byrne directed the Committee’s attention to the information provided in their report pointing out that the Trust had improved the vehicle availability following handovers.

Sue Byrne confirmed that ambulances would not refuse to go out to establishments even if they had a defibrillator in the premises.

Sue Byrne also agreed to check if it would be possible to provide additional detail to reflect average response  ...  view the full minutes text for item 78/15

12:00

Oxford University Hospitals NHS Trust (OUH) is required to send a copy of their Annual Quality Account to a range of external bodies for review and comment. This is the Committee’s opportunity to provide comment and question the accounts. Clare Dollery, Deputy Medical Director, will attend from the Oxford University Hospitals Trust for the discussion.

The following documents are attached at JHO8:

·         Overview of draft 2014/15 Quality Account.

·         Quality Account 2014/15 – a summary for Oxfordshire Health Overview & Scrutiny Committee

The Joint Committee is requested by the OUH to note the contents of the Quality Account bearing in mind that it is in draft form and has not yet been signed off by the Trust; and to send a statement for inclusion in the published document.

Oxford University Hospitals NHS Trust (OUHT) was required to send a copy of their Annual Quality Account to a range of external bodies for review and comment. This was the Committee’s opportunity to provide comment and question performance accounts against last year’s priorities and priorities for 2015/16.

The Committee had the following documents before them at JHO8:

·         Overview of draft 2014/15 Quality Account

·         Quality Account 2014/15  - a summary for this Committee (a full report was available on the OUHT website)

Members were asked to note the contents of the Quality Account, bearing in mind that it was in draft form and had not yet been signed off by the Trust; to discuss the report and whether it met the needs of the population the Trust represented, and to send a statement for inclusion in the published document.

Tony Berendt, Medical Director, and Clare Dollery, Deputy Medical Director, attended.

A member commented that the report was difficult to read and be understood by the layman. Dr Berendt responded that there was a desire on the part of the Trust to paint a very comprehensive picture adding that the advanced executive summary was very easy to read.

Dr Berendt, when asked why there was only one reference to cancer and the psychological services, responded that the monitoring of these services had not yet been finalised. He added that cancer treatment was currently going through a major validation process. Moreover that currently the Trust was meeting the targets on the majority of indicators for which there was monitoring.

A member asked whether the priorities for the next year differed to the current ones and whether any were no longer top priority. Dr Berendt referred the Committee to the diagram on page 53 of the Agenda which highlighted the topics that were actively being worked on, such as the improvement of handover processes between Health and Social Care, and those topics which required ongoing work from 2013/14.

The Committee expressed a wish to see the quality outcomes in the final report as referenced on page 79 and highlighted as part of Oxfordshire’s Joint Strategic Needs Assessment (JSNA), with a view to seeing a focus on getting the basics right. For example, they felt that unless there was an improvement in A & E waits, then endorsement of the final document would not be wholehearted. Dr Berendt reassured the Committee that there was no intention to miss out any topics.

In response to a question about whether OUHT and the GPs were sharing the same computer system, Dr Berendt stated that this was not the case, although the summary care record allowed some patient information to be accessed. He added that a significant amount of work was still to be done to get all the systems to be compliant with each other and to share information. However, the eventual goal was to have a seamless transfer of information. A member asked what constraints there were to ensure that patient information was not  ...  view the full minutes text for item 79/15

12:20

A report is attached at JHO9 which provides an update on the range of sexual health services delivered by stakeholders in the county and discusses the services commissioned by the County Council to meet the sexual needs of the population of Oxfordshire. The Committee will examine how the new service is working.

The commissioner and representatives from provider organisations will be attending the meeting.

The Committee had before them a report (JHO9) which provided an update on the range of sexual health services delivered by stakeholders in the county and which discussed the services commissioned by the County Council to meet the sexual needs of the population of Oxfordshire.

The following representatives attended in order to respond to questions:

-       Oxfordshire County Council - Councillor Hilary Hibbert-Biles, Dr Jonathan McWilliam, Val Messenger, Donna Husband;

-       Andrew Stevens and Jackie Sherrard – OUHT;

-       Emma Leader and Pauline Nicklin – Oxford Health

-       Kieran Watts – Boots Pharmacy

The Chairman commented on the importance for the public to understand the complexity of the service organisation and commissioning as it was so complex.

In response to a question about the distribution of the school nurses in the County, Dr McWilliam explained that there were 35 school health nurses, most of whom worked term-time, but some on a  full-time basis, providing coverage every day.

A member of the Committee asked if condoms were distributed by GPs, to which Donna Husband responded that were distributed (via a number of sites) by the sexual health service to young people who were aged up to 21 years or 25 if deemed vulnerable. Safeguarding procedures were applied and followed up for young people under the age of 16.

A member asked why there were no school health nurses situated within the county’s primary schools. Pauline Nicklin explained that although there were none as yet, a robust team from Oxford Health liaised very closely with headteachers to provide sexual health education to groups of children in years 5 and 6. Subjects introduced included resilience, relationships, concepts of what a good relationship should be etc. They also worked in tandem with Social Services with children who are deemed to be more at risk. Cllr Hilary Hibbert-Biles added her recognition that school nurses were required in each primary school and it was hoped that this service would be provided in the future. However 6 qualified and 12 unqualified additional nurses had been provided to cover primary schools. Their working hours ranged from 25 to 30 hours per week.

In response to various enquiries, members were provided with the following information:

-       The lease of the service for Rectory Road was for the duration of the contract ;

-       Rectory Road premises also housed the drugs and alcohol service, the contract for which was from a different provider. Their presence did not cause any problems. There were discreet, separate entrances to each service within the building;

-       The Sexually Transmitted Infection service offered a same day service 6 days per week and offered appointments within 48 hours. If the client offered symptoms then they could be seen on the same day;

-       User feedback was collected across the county and more formal evaluation was also undertaken – it was also taken from people not using the service. Oxfordshire County Council also evaluated all their contracts;

-       School health nurses were correcting any literature which contained  ...  view the full minutes text for item 80/15

12:40

The Chairman will give an oral update on meetings she has attended and matters dealt with since the last meeting.

The Chairman will outline how it is proposed that the Committee scrutinise action by the Health Service to address the recommendations identified in the serious case review into Child Sexual Exploitation.

A draft Forward Plan is attached at JHO10.

The Chairman reported on the meetings she had attended since the last meeting.

The Committee updated their Forward Plan.

Please note that the Joint Committee will meet on the following dates:

2 July 2015

17 September 2015

19 November 2015

4 February 2016

The Committee noted the dates of future meetings for 2015/16.