Agenda and minutes

To elect a Chairman for the municipal year 2015/16 – to the first meeting of the next municipal year 2016/17.

Councillor Yvonne Constance OBE was elected Chairman for the municipal year 2015/16 to the first meeting of the next municipal year 2016/17.

To elect a Deputy Chairman for the municipal year 2015/16 – to the first meeting of the 2016/17 municipal year.

Councillor Martin Barrett (West Oxfordshire District Council) was elected Deputy Chairman for the municipal year 2015/16 to the first meeting of the next municipal year 2016/17.

Apologies were received from Councillor Susanna Pressel, Dr Keith Ruddle and from Mrs Anne Wilkinson.

Moira Logie declared an interest in Agenda Item 8 on account of her work as a regional fundraiser for the Sue Ryder charity and its activity at the Townlands Hospital.

To approve the minutes of the meeting held on 23 April 2015 (JHO5) and to receive information arising from them.

The Minutes of the meeting held on 23 April were approved and signed. There were no matters arising from the Minutes.

The Committee noted that the Chairman had agreed to the following addresses, to be made at the items themselves:

Agenda Item 8 – Townlands Hospital consultation on changing the provision from the new building

-       Town Cllr Ian Reissman, Chair, Townlands Hospital Steering Group

-       County Cllr David Nimmo – Smith, local member for Henley  - on – Thames

Agenda Item 9 – Provision of Intermediate Care Beds in Chipping Norton

-       Clive Hill, Chipping Norton Hospital Steering Group

-       Town Cllr Mike Tysoe, Mayor of Chipping Norton

-       County Cllr Hilary Hibbert-Biles, local member for Chipping Norton

10:10

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

The Chairman gave a report on the meetings she had attended and the visits made since the last meeting. These included:

·         Visits made to the Warneford Hospital and the John Radcliffe Hospital;

·         Attendance at Healthwatch’s Oxford ‘Hearsay!’ event;

·         Conference on the NHS 5 year forward view and the transformation programme; and

·         Attendance at the working group on Outcomes Based Contracting.

10:20

David Smith, Chief Executive of the Oxfordshire Clinical Commissioning Group (OCCG) will present a report on the proposed changes to the service model for the new Townlands Hospital that is being built in Henley.

The report includes initial feedback from the public consultation which closed on 15 June and sets out the proposed decision making process.

The Committee is RECOMMENDED to note the report and request a further report with proposals for the future of the Townlands Hospital to the meeting in September.

Prior to the start of the discussion the Committee heard the following addresses:

Cllr Ian Reissman – Chair, Townlands Hospital Steering Group

Cllr Reissman urged the Committee to instruct the CCG to devote more time to informing the community of the detail in relation to the new model such as information on the care available at the hospital, numbers of patients it was envisaged coming through the hospital, and how this would be monitored. In his view there were significant risks to the new model given the insufficiency of evidence available. He added that GPs in Henley did not appear to be supporting the plans and CCG representatives in neighbouring Berkshire had not commented.

Councillor David Nimmo-Smith

Cllr Nimmo-Smith, speaking as local member for Henley, expressed concern about the alteration to the model, which, at the start of the consultation period included Emergency Medical Units (EMU) and at the end had introduced Rapid Access Care Units (RACU). He reported concern that the consultation process had left their questions unanswered and he asked for reassurance that their medical needs would be fully addressed in the new model.

He added that the Henley and District community felt that the consultation was therefore incomplete and flawed and that the rush to get the building up and running as soon as it had been completed was at the expense of a robust plan and appropriate consultation. He added that it appeared that neither of the senior partners of the two Henley GP practices had endorsed the model.

Notwithstanding the above, Cllr Nimmo-Smith  felt that there was much that was good in the model and welcomed the facilities to be provided, such as more consultants and day care and an increasing outreach service from the Royal Berkshire Hospital in Reading. However, the community, who were the users of the facilities offered, had not bought into the new model. He urged the Committee therefore to ask why the CCG had structured the questions in a way that it made it easy to agree with all that they were proposing, why information had gradually trickled out which had changed the consultation; and why they had put to one side the comments made at the public meetings and in the Henley press.

David Smith, Chief Executive, OCCG gave a presentation on the model of care. He stressed that the hospital was due to be handed over to the NHS in November of this year and there had been an increase of £900k lease cost to bear thus making it very important that the best possible use of the facilities were made in the long term. He added that no decision had yet been made by the CCG and they planned to return to the 17 September meeting of this Committee in order to take any comments on board.

Andrew Burnett (OCCG) and Pete McGrane, Oxford Health, attended to explain the changes from the current model to the enhanced model. Andrew Burnett pointed out the expansion to outpatient  ...  view the full minutes text for item 90/15

10:45

There will be an oral update on the provision of intermediate care beds at Chipping Norton Community Hospital.

Prior to the start of the discussion the Committee heard the following addresses:

Clive Hill, Chipping Norton Hospital Steering Group

Clive Hill stated that last year the conclusion was, following the consultation which had begun in 2014, that the nurse provision was better provided by the NHS. The Chipping Norton community considered that the consultation process was binding and they were led to believe that the matter had been settled. He urged the Committee to conclude that the current decision to change NHS nurse provision to that of the Orders of St John Nursing provision was not viable on the basis that it had not been fully evaluated. He added that, given the rural setting of the town, there would be a need for fully trained, NHS nurses to ensure patient safety. Mr Hill urged the Committee to instruct OCC to extend the current arrangements to ensure that full evaluation of the consequences of employing Orders of St John nurses could be carried out, and if this was not done then to refer it to the Independent Reconfiguration Panel.

District Councillor Mike Tysoe, Mayor of Chipping Norton

Councillor Tysoe made the following factual observations which, in his view, would demonstrate that what was being planned was a significant change of service and not simply a change of management as currently claimed:

·         That the average length of in-patient stay under NHS management is 27 days. Over a comparable period under OSJ management, average stay is 40 days. This 13 day difference would represent a significant cost as it would cause bed blocking in the acute sector and also cause 50 fewer patients per annum to have access to the unit. This had not been factored in;

·         That under recent OSJ management, on average, active intervention and rehabilitation was delivered by physiotherapists for only 4 out of 14 patients at any given time. Currently, under the NHS management, an average of 10 out of 14 patients were receiving such care at a given time. This is a large difference and a completely different level of service.

·         That if part of the cost-cutting would mean fewer than two qualified nurses on duty during any shift, then that is a level of service which is below that which the NHS considers to be safe;

·         That currently, NHS management considers that a crash trolley on site should  be essential for safety, it was Cllr Tysoe’s view that this was not shared by the OSJ;

·         That he had been told that the training given to OSJ nursing staff did not compare with the NHS nursing and auxiliary staff training. This was a different level of service with whatever associated risks to patients.

Cllr Tysoe concluded by stating that all the above needed to be investigated further before any further decisions were made concerning the Chipping Norton Intermediate Care ward.

Councillor Hilary Hibbert-Biles – Local Member

Cllr Hibbert-Biles urged the Committee to ensure that there was a full public consultation on the issue of the perceived  ...  view the full minutes text for item 91/15

11:20

Local NHS organisations will present a report on their response to the Serious Case Review of Children A-F into Child Sexual Exploitation in Oxfordshire.

Representatives from NHS England South Central, Oxfordshire Clinical Commissioning Group, Oxford University Hospitals and Oxford Health will attend to present details of how they have responded to the findings of the report and what policies and procedures have changed as a result.

The Committee is RECOMMENDED to note the NHS’s response to the findings of the Serious Case Review into Children A-F, published in March 2015; and the further actions in progress.

12:20 BREAK

The Committee were given a presentation on the Health response to the findings of the Serious Case Review of Children A-F and further action being taken in response to child sexual exploitation in Oxfordshire.

The attendees were as follows:

-       Sula Wiltshire and Alison Chapman – Oxfordshire Clinical Commissioning Group

-       Ros Alstead, Lucia Bell and Alison Chapman – Oxford Health NHS Foundation Trust

-       Catherine Stoddart and Claire Roberts – Oxford University Hospitals NHS Trust

-       Julie Kerry – NHS England

-       Sarah Breton, Dr Jonathan McWilliam and Ruth Locke –  Oxfordshire County Council

Members were appreciative of the form of the presentation which allowed for case studies to be given by those presenting to highlight the response of Health staff when dealing with children in their care. Questions were taken from the Committee about each case.

Questions asked by the Committee were in relation to the following issues:

A committee member asked about the approaches made by the Teams to build a relationship with any child thought to be in danger of exploitation, in order to support their health and social care needs. Sula Wiltshire and Dr McWilliam explained that there were a number of approaches. Each agency lead officer took responsibility for this area. Information sharing was a very challenging and complex area, but the multi-agency MASH teams had been established to meet this need. Key workers had been assigned and everybody was now aware of who to contact. Focus on the child safeguarding agenda was growing.

A member asked what provisions were in place for the Banbury area, particularly around the schools. Attendees responded that service provision covered all of Oxfordshire. Some active work was being undertaken in Banbury, but all market towns were being treated equally. Colleagues representing the Health and Social Care side were completely joined including support from paediatricians from the Horton Hospital.

A member of the Committee asked if patients’ records were shared by all the agencies. Sula Wiltshire responded that information on aspects of care was shared if it needed to be shared to help inform a situation. An illustration of how well this could work was given in the form of a case study by Ruth Locke, a school nurse working in Oxfordshire. They stressed the importance of good practice and it being sustained and the need for an evidential basis. Furthermore, it was important to get the services right for a child, whether these be from CAMHS, Oxford Health, Public Health, OUHT, Social Services etc.

The Panel were asked about the safeguarding health needs of children with a learning disability in special schools. Ros Alstead responded that the aim was to provide an integrated service. Within Oxfordshire there was a general and a specialised service and children’s care was coordinated and managed within the teams, often with CAMHS and with the clinicians closely linked in with the special schools. In all special schools there was a specialist nursing service for children with severe problems who were more at risk  ...  view the full minutes text for item 92/15

12:50

The Director of Public Health will present his Annual Report for 2014/15 (JHO11).

The annual report summarises key issues associated with the Public Health of the County. It includes details of progress over the past year as well as information on future work.

It is an independent report for all organisations and individuals.

The report covers the following areas:

Chapter 1: The Demographic Challenge

Chapter 2: Health, Houses and Roads

Chapter 3: Breaking the Cycle of Disadvantage

Chapter 4: Mental Health

Chapter 5: Lifestyle and Health: We are what we eat, drink, smoke and do

Chapter 6: Fighting Killer Diseases

The Committee is RECOMMENDED to comment on the report before it is discussed at the Oxfordshire Health & Wellbeing Board on 16 July 2015 and at Cabinet on 21 July 2015; and to consider its recommendations in terms of shaping the HOSC forward work plan.

The Committee had before them the draft Director of Public Health’s Annual Report for 2014/15.

Following a full discussion it was AGREED to share the following comments with the Oxfordshire Health & Wellbeing Board on 16 July and to Cabinet on 21 July.

Members of the Committee felt that the report was very comprehensive, very readable and that it explained how services were to be delivered in each section, thus enabling scrutiny to be conducted effectively. Members expressed the hope that future reports would continue to be approached and written in a similar way. It was satisfied that major areas such as Mental Health and Child Poverty continued to be given a high prominence. The Committee, in particular, endorsed the following factors:

Chapter 1 – The Demographic Challenge

The Committee was keen to flag up that more detailed information was required on the plans to commission a countywide dementia support service (page 10 of the report) to help patients and families throughout the disease and to help plan and navigate a path through services to make care less disjointed.

The Committee strongly endorsed recommendation 4 (page 13 of the report):

‘OCCG, OCC, OUHT, OH and NHS England should develop, as a priority, their joint work to collaborate in transforming the local health system. This is in order to provide new models of care closer to home, care focused on prevention and early detection of disease, improved care for carers, prevention of hospital admission and speedy hospital discharge through improved community services, the modernisation of primary care and the funding of primary prevention services by the NHS.’

The transformation programme is of major interest to the Committee and will be the subject of scrutiny at its September meeting.

Chapter 2 – Health, Houses and Roads

The Committee also endorsed strongly recommendation 2 (page 21 of the report).

‘The NHS should become a consultee for local planning decisions and the CCG should be offered membership on key planning groups. Planning and health infrastructure should be considered when developer contributions are considered.’

HOSC has already highlighted a disconnection between local authority planning and Health when planning large housing developments. Scrutiny of this issue forms part of the Committee’s Forward Plan and it is hoped that there would be a full response to these issues from NHS England at the Committee’s September meeting.

In addition it endorsed recommendation 4 (page 22 of the report):

‘Cycling should be seriously encouraged in new road developments which are likely to attract high usage. Alternative cycle-only commuter routes using features such as rivers and canals should be considered.’

The Committee recognised the Government’s increased input into the provision of cycle paths and provision being made in the forthcoming Local Plan 4. It was their view however that local authorities should also be consulting with CCGs with regard to the provision of cycling routes for the purpose of improving the health of the local community, and advocated a policy to be put in place to ensure input into S. 106  ...  view the full minutes text for item 93/15

13:30

Dr Jonathan McWilliam, Director of Public Health, will present the revised draft Oxfordshire Health & Wellbeing Strategy for 2015/16 and proposed performance indicators for comment (JHO12).

The draft Strategy is due for submission to the Oxfordshire Health & Wellbeing Board on 16 July 2015 for approval.

The Committee is RECOMMENDED to comment on the report before it is discussed at the Oxfordshire Health & Wellbeing Board on 16 July 2015.

The Committee had before them the Oxfordshire Health & Wellbeing draft Strategy and proposed performance indicators for comment (JHO12).

Dr Jonathan McWilliam (Oxfordshire County Council) (OCC)), Jackie Wilderspin (OCC), Ben Threadgold (OCC), Eddie Duller (Healthwatch Oxfordshire (HWO)) and Rachel Coney (HWO) came up to the table to respond to questions in relation to the content of the document itself and in relation to the HWO input on quality issues.

Following discussion it was AGREED to convey the following comments to the Health & Wellbeing Board on 16 July:

HOSC felt generally that the manner in which the Strategy had been laid out was good but there were instances where some accompanying statistics had been quoted, but others where they were not. Furthermore, reference to how organisations would respond to changing circumstances was not apparent. For example the impact on projected numbers of children taking up early education, given that there was going to be changes to the services offered by Children’s Centres, and if any specific booster action had been identified in instances where progress was not being made. A further example of this would be to clarify what the plans were to improve the low numbers of carers receiving carers breaks (1,027) given that there are 16, 000 carers now identified in the county, Members were keen to understand the impact on the volume and the need for care from activity relating to the aim to ‘Reduce the number of people delayed in hospital (DTOC) from an average of 147 per day in 2014/15’ (page 18).

The Committee were pleased to see that the improvement of ambulance rural

response times had been included in the list of issues which had been agreed for organisations to work on (page 8/9 of the report). This has been an ongoing major concern for HOSC and it asks the Health & Wellbeing Board to play its part in helping to achieve improved response times. It has found, for example, that the SN postcode is often read by SCAS as Wiltshire and not Oxfordshire, which has affected response times.

13:45

Rachel Coney, Director of Healthwatch Oxfordshire and Eddie Duller, Chair of the Board will give an update on recent projects, to include details of key projects being reported on (JHO13).

14:00

Close of Meeting

Eddie Duller, Chair, Healthwatch Oxfordshire and Rachel Coney, Chief Executive, presented their report which gave an update on recent projects HWO were involved in (JHO13).

Eddie Duller reported that HWO were very concerned about areas that were adversely affected by financial constraint, such as those affecting Chipping Norton  and Townley Community Hospitals, the result of which were new plans which appeared to have very little association with the original public consultations. They expressed concern that the form of consultation to be undertaken by John Jackson with regard to Chipping Norton Hospital did not comply with the Government’s code of practice in relation to consultation. The Chairman responded that the Committee would require an adequate consultation to be carried out only where there has been a substantial service change. As the managers intended no change in respect of the base services to be provided, then this did not constitute a substantial change.

The Committee agreed that the report was good and contained some very worthwhile projects. A member asked if there were any further ‘Hearsay!’ meetings planned. Rachel Coney responded that there would be a ‘Hearsay!’ event each year either in the form of locality meetings or as one central meeting. She added that the Chairman and the Director of Adult Social Care had been present at Oxford’s Hearsay! event in June to listen to the concerns of users of social care.

With regard to section 7 of their report concerning the campaigns which HWO had been involved in, Rachel Coney agreed to circulate any pertinent correspondence around members of the Committee for information.

The Committee thanked Eddie Duller and Rachel Coney for the report and for their attendance.