Agenda and minutes

Councillor Jenny Hannaby attended for Councillor Alison Rooke, City Councillor Mark Lygo attended for City Councillor Susanna Pressel and an apology was received from District Councillor Monica Lovatt.

There were no declarations of interest submitted.

To approve the minutes of the meeting held on  2 July 2015 (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 2 July 2015 (JHO3) were approved and signed as a correct record.

The Chairman had agreed to the following members of the public addressing the Committee:

·         Local Councillor James Mills – Agenda Item 5 ‘Chairman’s Report’.

·         Local Councillor David Nimmo-Smith – Agenda Item 6 ‘Townlands Hospital Henley – Proposals for future services.’

·         Clive Hill, on behalf of Chipping Norton Hospital Action Group – Agenda Item 7 ‘Chipping Norton – Intermediate Care Beds.’

All speakers addressed the meeting prior to discussion on the relevant item.

10:10

The Chairman’s written report on meetings she has attended and matters dealt with since the last meeting is attached at JHO5.

Councillor James Mills, a member for Witney, addressed the Committee in relation to  item 1 of the Chairman’s Report ‘Witney Community Hospital – temporary closure of Wenrisc Ward. He queried the process that was followed, making the following points:

·         Should there have been a written account of the proposals in order for attendees to digest them fully, and should this have been made public?

·         Was an informal meeting the right place to take a decision of such importance?

·         A record should have been taken of the discussion?

·         Should local Members for Witney have been informed about the meeting and their input requested: and should substitutes be permitted to attend in case local members are unable to attend?

The Chairman thanked Cllr Mills for raising these points, noted that most of the points raised had been carried out and informed the meeting that she had referred the matter back to the Legal & Democratic Services Teams, the outcomes of which would be reported to the next meeting of the Committee in November.

Members noted the Chairman’s report (JHO5) on meetings attended by the Chairman and visits undertaken.

10:20

To provide an update (JHO6) on progress on the proposals for future services for the new hospital.

David Smith, Chief Executive, Oxfordshire Clinical Commissioning Group, will attend for this item.

Councillor Nimmo-Smith addressed the meeting emphasising that despite a number of meetings since the July 2015 meeting of this Committee, the Townlands Steering Group (TSG) was still not fully convinced that the intermediate care proposed was in the best long-term interests of the communities served by Townlands Hospital. He commented that he had joined the Committee visit to the Isis Care Home in Oxford and had seen the manner in which intermediate care, or recuperation, was delivered. However, whilst he was pleased by what he saw and with the discussions with staff, he was aware that the Henley model differed slightly.

Moreover, he wished to emphasise that the TSG wished to continue to work with OCCG in order to achieve the best possible medical pathway and provision for the Oxfordshire residents in the Townlands catchment area. He added that to this end members of the Committee had been sent a dossier containing the TSG proposals for combining an Emergency Multidisciplinary  Unit (EMU)with a bedded service. He added also that the key question was the manner in which the new model would be deployed and whether it would be successful for not; and that the TSG would like to assist in any way it could with this process in order to reassure the community that the new arrangements were at least as good as the existing ones. He stated also the TSG’s hope that the OCCG would continue to involve them in the process.

Cllr Nimmo-Smith also commented that TSG were pleased that the Royal Berkshire NHS Foundation Trust, Reading were working with the service commissioners to assess the impact of the bed model. However, the TSG had been informed that until that was concluded they remained concerned about the impact of the proposals on them.

He concluded by stating that the issues were about whether the change in the location of the beds would improve health outcomes for patients. Furthermore it was about whether it was possible to implement the change safely in the very short time which was left available.

The Committee had before them a paper by the OCCG (JHO6), the purpose of which was to provide the Committee with an update on progress on the proposals for the future services at Townlands Hospital, following the OCCG’s Governing Body meeting on 30 July 2015.

David Smith and Andrew Burnett of the OCCG were invited to introduce the report.

A member of the Committee asked if there had been attention given to acquiring the correct performance indicators that would inform on factors such as actual length of stay and readmissions, for example. Andrew Burnett responded that statistics would be evidence based and would be based on reablement beds and short-stay beds for patients assessed in the Rapid Access Care Unit (RACU).

Andrew Burnett was asked why it was proposed that care at Townlands Hospital be based on the RACU model rather than a combination of the RACU and EMU models. He explained that the RACU was based on a  ...  view the full minutes text for item 101/15

10:45

A report on Intermediate Care to be considered by the County Council’s Cabinet on 15 September is attached for information at JHO7. The outcome of discussions will be submitted by way of an Addenda to this meeting.

John Jackson, Oxfordshire County Council and Oxfordshire Clinical Commissioning Group, will attend for this item.

Clive Hill of Chipping Norton Hospital Action Group urged the Committee to advise the Cabinet to suspend its plans for changes at Chipping Norton Hospital and not to make any changes until a review of whole community hospital healthcare in Oxfordshire has been conducted, which would include a properly costed and integrated plan. His view was that the OCC proposal would make the Delayed Transfers of Care (DTOC) situation worse because patient lengths of stay under OSJ was an average of 40 days compared to NHS of 27 days, at an extra cost to the NHS of £750k per annum. David Cameron had confirmed that beds were ‘sub-acute’, meaning that they should be used for a higher standard of care than planned by OCC.

It was the view of the Action Group that John Jackson had made an intimidating ‘threat’ at the last meeting - and that the proposed consultation, giving only two options, was fatally flawed. They believed that a judicial review of the process would find it in their favour.

He stated that it was the view of the Action Group that the OCC plan under OSJ would significantly downgrade the current service provided by Oxford Health. He cited a recent Care Quality Commission report on the ISIS Centre which revealed that of the five key areas evaluated at ISIS, three were rated ‘requires Improvement’ and ‘there was insufficient staff on duty to support people and meet their needs.’

Mr Hill added that the Action Group was aware that OCC had to make budget savings, but ISIS could not be the model just because it was the cheapest. They advocated instead that OCC return the commissioning of the beds to the CCG so that commissioning could fully take into account the overall impact on Oxfordshire healthcare. He added that apart from Banbury, Chipping Norton and the surrounding villages were the largest centres of population in the north of the county and that a fully functioning Community Hospital in this rural area was essential.

Mr Hill commented that the Committee could not have an overview because the wider impact of the OCC plan had not been properly evaluated and there was no integrated approach to Oxfordshire’s hospital healthcare in this proposal. He therefore urged the Committee to take a further reflection and realise that a fair and open consultation could not now take place.

David Smith, Chief Executive, OCCG, Cllr Mrs Judith Heathcoat, Cabinet Member for Adult Social Care, and John Jackson, Director for Adult Social Services (OCC) & Director of Strategy & Transformation (OCCG) attended for this item. Mr Jackson explained that meetings had been held with key organisations, ie OCC, OCCG, Oxford Health (OH), Oxford University Hospitals NHS Foundation Trust (OUHFT), Healthwatch Oxfordshire (HWO) and the Chipping Norton Action Group, adding that OUHT and OH had made it clear at their meetings that it would not be possible to continue the current arrangement for Intermediate Care to be provided through a bed-based service at Chipping Norton. Thus there was  ...  view the full minutes text for item 102/15

11:10

In February 2014, the Committee requested that an update report on services at the Horton Hospital, Banbury, be provided to the Committee in the following year.

The attached report (JHO8):

·         Provides a general update on the Trust – wide developments as they have impacted on the Horton.

·         Describes developments at the Horton General Hospital over the last 12 – 18 months.

·         Summarises other issues considered by the Community Partnership Network.

·         Identifies priorities for the Horton General Hospital.

A draft of the report was considered by the County Council’s Locality meeting in July. The Group commented as follows:

‘Members were pleased to have been informed and consulted and pleased that the issues had been set out so transparently. They expressed a wish that this level of communication should continue. They were generally supportive of the strategy, but recognised that there would be a continuing demand to keep a 24/7 accident and emergency and the CT scanner.’

Andrew Stevens, Oxford University Hospitals NHS Trust, will attend for this item.

In February 2014 the Committee had requested that a progress report on services at the Horton General Hospital, Banbury be provided to the Committee during this year. A report was now before the Committee (JHO8).

The Committee were advised that the report JHO8 had been considered by the County Council’s Locality meeting in July, 2015 and it had commented as follows:

‘Members were pleased to have been informed and consulted and pleased that the issues had been set out so transparently. They expressed a wish that this level of communication should continue. They were generally supportive of the strategy, but recognised that there would be a continuing demand to keep a 24/7 accident and emergency and the CT scanner.’

Andrew Stevens, OUHFT, introduced the report.

In relation to paragraph 2.6 (page 29 in the Agenda) of the report, Mr Stevens reported that Steve Candler, elected public governor for the Northamptonshire and Warwickshire catchment area served by the Horton General had stepped down and Blake Stimpson had been newly elected in his place.

In response to comments from a local member from the Committee about concerns expressed by members of the public with regard to changes in staffing at the Day Centre, Mr Stevens commented that the community had been fully involved in development plans and that the Trust were in the process of perfecting when was the right time to let people know of any changes as they occurred.

Another local member for Banbury commended the Trust for its engagement with the community and asked that progress in this area be maintained.

The Committee AGREED to welcome the report and expressed a hope that other changes proposed for the County would be developed in a similar fashion.

11:20

Rachel Coney, Chief Executive of Healthwatch Oxfordshire (HWO) will give an update on recent projects (JHO9). Also attached at JHO9 is HWO’s report entitled ‘Improving Discharges from Hospital in Oxfordshire.’

Rachel Coney and Eddie Duller OBE, Chief Executive and Chairman, respectively, of Healthwatch Oxfordshire (HWO) attended to give an update on recent projects (JHO9). This included a report entitled ‘Improving Discharges from Hospital in Oxfordshire.’   

The Committee took the ‘Improving Discharges from Hospital in Oxfordshire’ report first, commenting that it was a ‘sound’ piece of work and welcoming the fact that 80% of those interviewed were satisfied with their discharge.  Eddie Duller introduced the report and handed over to Rachel Coney to respond to questions from the Committee.  Rachel Coney explained that there was a sample size of respondents, though they had exceeded their target for the number of people they had spoken to and HWO were delighted with the level of co-operation from the communities and from providers. Agreement to the methodology had been sought from the start.

A Committee member commented that he had been involved in a scrutiny review about DTOC (Delayed Transfers of Care) 9 years ago and one of the recommendations was that Social Care should have equal access to patient notes alongside the medical practitioners. Rachel Coney responded that great strides had since been made with the interaction between both parties, and clear plans and policies were now in place. There were only a few glitches in the system remaining and the report recommended some small changes which would assist with patient experience and care as they proceed through the discharge process.

Members asked if problems with the transport system had been raised and whether respondents had felt reticent about complaining in case there were consequences in relation to their care. Rachel Coney responded that these issues did not feature much in this particular project and the question of timing and manner of transport home and of complaints, were far more the subject of concern in the dignity report. 

With reference to the question of whether GP’s were told of the imminent discharge of their patients, Rachel Coney responded that GPs did like to be informed as they were responsible, alongside nursing staff, for the coordination of their patient’s care. She added that this was an issue to be taken up with the OCCG in due course.

Rachel Coney was asked why so many of the respondents wished to discuss their discharge from the JR Hospital, to which she replied that the majority of people who responded online wished to cite the OUHT facilities. She added that volunteers had talked also to patients in other hospitals and in the community hospitals. 

The Chairman then invited Paul Brennan, (speaking on behalf of OUHFT, OCCG and OCC) and Yvonne Taylor, Oxford Health, up to the table for their comments in relation to the report. In respect of Committee members’ queries, Paul Brennan made the following observations:

-       The electronic patient record could be operated online and was backed up every 30 minutes. Business continuity arrangements were in place should the system go down;

-       The hospital and social care were fully integrated, both parties had access  ...  view the full minutes text for item 104/15

11:55

Attached is an update which has been produced by the Clinical Commissioning Group (JHO10).

John Jackson was invited to introduce a progress report on the Better Care Fund programme (JHO10).

Mr Jackson was asked if there would be more detailed discussions on primary care going forward at the end of the process. He responded that a five year forward view on primary care had been circulated which gave a number of options and possible models going forward, one of which was the idea of whether the acute sector could enter into an alliance contract with Oxford Health and OUHT for older people’s services in the communities. Practical issues around processes were also to be considered with the user in mind, such as the use of the NHS number.

Members thanked Mr Jackson for his attendance and AGREED to note the report and looked forward to further reports on proposals for primary care coming forward to the Committee for scrutiny.

12:15

This will be an opportunity for Committee members to review the key issues for the Committee for the coming year and to identify priorities for consideration at future meetings (JHO11).

Members of the Committee reviewed the current Forward Plan (JHO11) for the coming year.