Agenda and minutes

There were no apologies for absence or substitutions.

There were no declarations of interest.

To approve the minutes of the meetings held on 19 November 2015  and 11        December 2015 (JHO3) to receive information arising from them.

The Minutes of the meeting held on 19 November 2015 were approved and signed as a correct record subject to the following amendment:

-        Minute 113/15 ‘Healthwatch Oxfordshire – Update’ – page 7, paragraph 3, second sentence  - to erase the word ‘own’ and to add ‘home or care’;

The Minutes of the meeting held on 11 December 2015 were approved and signed as a correct record subject to the following amendment:

-       To erase Cllr Nigel Champken-Woods from the list of voting members present at the meeting;

-       Minute 118/15 ‘Rebalancing the Health Social Care System in Oxfordshire; - page 11, paragraph 3, first bullet point - to erase the words ‘Information about how many’

The Chairman had agreed to requests from two members of the public to address the meeting. Both had requested to speak at this item:

Joan Stewart, spoke on behalf of ‘Keep our NHS Public’, in regard to Agenda Item 8 ‘Closer to Home – Health & Care Strategy’. She expressed her concerns about the scale and pace of change associated with the devolution and integrated community care proposals. She added her view that there had not been much public engagement to date, nor stakeholder engagement on the new models of care in Oxfordshire, in the form of discussion or debate. She called for the following:

·         Clarity of clinical evidence base

·         Robust patient and public engagement

·         Clarity of the financial evidence base

She asked the Committee to step up to the challenge and ask the clinicians and finance officers to demonstrate how they intended to engage with the patients and the public.

County Cllr James Mills addressed the meeting in relation to Agenda Item 14 ‘Toolkit’ pointing out that in his view, the revisions made to the proposed toolkit had not gone far enough. He commented that the revisions made had still not addressed the issues of ‘openness, transparency and looking after Oxfordshire residents.’ He pointed out that the meeting between members of HOSC and OCCG representatives to consider the proposed decision by the OCCG to temporarily close the Wenrisc ward at Witney Community Hospital, was sufficiently substantial to require a full public consultation. He added that it was not quorate, in line with the proposed, newly revised ‘Toolkit’, as only two voting members of the Committee had taken the decision. Thus the meeting had not been properly constituted. It was his view that there was a need for more transparency with stakeholders, as specified in scrutiny guidance. Moreover, the Francis Report had advocated that scrutiny should espouse an open and effective channel of communication. The meeting, as he had understood it, had been led by Health providers and had not been dealt with in a sufficiently independent manner by those HOSC members present.

10:10

The Committee’s Forward Plan is attached at JHO5. Members are asked to prioritise items for the next meeting and issues to be scheduled in the future.

Members were asked to prioritise items from their Forward Plan (JHO5) for the next meeting and to consider whether they wanted to add any issues to be considered at future meetings. They AGREED the list following:

Items to be considered at the next meeting:

-       Health Inequalities Commission and Health of Minority Groups

-       Update on Commissioning of Public Health services for Children (aged 0-5 years)

-       Oxford University Hospitals Foundation Trust (OUH) update on implementation of action plan (post inspection), plus achievement against targets

-       Oxfordshire Clinical Commissioning Group (OCCG)  - report on NHS Recruitment  and Retention strategy

-       Quality reports from South Central Ambulance Service (SCAS), OUH and Oxford Health (OH)

-       Southern Health NHS Foundation Trust - monitoring report

-       ‘Rebalancing the System’ update.

Items to be considered at future meetings:

            -           June meeting – a report on health at Bullingdon Prison and                                     Campsfield Detention Centre

10:20

The paper (JHO6) sets out progress made on the implementation of the outcomes based contract (OBC) signed by the Oxfordshire Clinical Commissioning Group (OCCG) on 1 October 2015. It clarifies the scope of the contract, seeks to explain the contracting mechanism and identifies the next steps. The paper will be presented by Ian Bottomley, Head of Mental Health & Joint Commissioning, OCCG.

Ian Bottomley, Head of Mental Health Services, OCCG presented a report on progress made on implementation of the outcomes based contract (OBC) as signed by the OCCG on 1 October 2015. The report (JHO6) clarified the scope of the contract, explained the contracting mechanism and identified the next steps.

A member of the Committee asked about experience so far in relation to the new contracts. Ian Bottomley explained that OCCG had deliberately opted for a 5 + 2 year contract, as some changes would take time in order to align people to assist in helping patients into work and education. Some of the measures were new and were being developed as the contract developed. Some providers were already moving ahead, for example with the purchase of more intensive support accommodation. The full impact of year 1 would be seen at the end of year.

Mr Bottomley was asked what impact the recent County Council cuts contained in the County Council’s budget would have on the contract. He responded that there would be none, as it had been agreed prior to the recent cuts. However, there could be some implications around services for the homeless, with a significant cross over with services for people with a mental health illness. In his view there was already a reasonably good care pathway, so that help and support could be given by mental health support workers further along the line.

Mr Bottomley was asked what the impact on waiting lists for first entry into the service would be. He explained this was being monitored and the Trust had continued to meet all targets, and there was no waiting list. A national initiative requiring a two week wait for patients experiencing the first onset of psychosis had been put into place, so those patients were coming into the front door very quickly. He added that where there were instances of patients being ‘behind the front door’ these were being addressed. Mr Bottomley, explained that services provided ‘at the front door’ comprised two service contracts, ‘Assessment ‘and ‘Treatment Specification’, which provided four sessions with every patient. The provider would sit with the patient and work out what was needed. This might mean care planning and support, access to work or psychiatric care, all or part thereof. The target also ensured psychological support for the patient, if needed, as soon as possible, as well as access to housing, physical support etc.

Mr Bottomley was asked if the threshold would gradually rise over time if other organisations found it necessary to alter their thresholds due to cuts. He explained that the OCCG had built part of the contract around national measures for mental health. Over many years the ‘Care Plus’ component had stratified patients into those suffering from varying conditions categorised as mild to severe. It was not possible to move from one patient cluster to the other without being in breach of contract.

Mr Bottomley explained that accommodation provision had been organised prior to the new contract  ...  view the full minutes text for item 6/16

10:50

Paul Brennan (Oxford University Hospitals Foundation Trust) will attend to provide an oral update on the rebalancing of health and social care after the discussion at the special meeting of this Committee on 11 December 2015.

Following discussion at the special meeting of this Committee on 11 December 2015, Paul Brennan, Oxford University Hospitals NHS Foundation Trust (OUH) gave a powerpoint presentation updating the Committee on the pilot project to rebalance Health and Social Care. He stressed that the project was not at end until 31 March 2016, and to date, there were no plans to make it permanent. John Jackson, Director of Adult Social Services was also at the table speaking on behalf of the whole system.

Paul Brennan reported the key issues of concern to date. These were:

·         Movements in the workforce as a consequence of the changes were overall in line with projections at this point. However, the numbers of patients needing to be discharged to the reablement service were behind target, due to a reluctance of staff wishing to be transferred;

·         Delayed Transfers of Care (DTOC) performance figures were good during the first few weeks of the project, when the numbers delayed dropped from 150 to 90 – but over the Christmas period the numbers had risen as expected;

·         Section 5 discharge orders were issued over 7 days per week. However, during friday – monday bank holidays there had been no teams able to discharge patients. This problem was continuing;

·         A key challenge was that the number of patients with no home placements was currently at 37.  27 were waiting to go home with domiciliary care and 8 with reablement through the supported hospital discharge service. The total numbers of DTOC was 121 to date;

·         Performance from when this initiative was started was at 85%, and at one point had risen to 90%. As a consequence of delays, this had decreased to 75%.

The Committee asked what actions were to be taken to alleviate this setback. Mr Brennan responded that the Team had agreed a series of additional measures to bring it back in line. The biggest single issue was the number of patients needing reablement services provided by Oxford Health (OH). The Team had agreed a programme for all staff to work in the OUH, including part-time and bank staff. A staff incentive had been offered in a bid to achieve an additional 1,600 hours per week in February and March. This measure had had a virtual 100% response rate. Current caps on NHS agency staff had been released in order to remove blocks in the flow of the system.

A member asked how OCCG focused on individual patient experience, having heard anecdotal stories of patients being moved a number of times; of families upset; and patients being taken to nursing homes with little attention being given to reablement. Mr Brennan responded that any feedback was being monitored, and an evaluation would be undertaken in order that patient stories could be compiled. No formal complaints had been received from any patients or relatives, to date. A formal evaluation was also to be undertaken.

In response to a Committee member’s comment that District Councils were failing to adapt sufficient homes for  ...  view the full minutes text for item 7/16

11.05

A representative from the Oxfordshire Clinical Commissioning Group and John Jackson will give a presentation on the Strategy. The powerpoint slides are attached at JHO8.

Dr Joe McManners and Rosie Rowe, OCCG and John Jackson, OCC attended the meeting to give a powerpoint presentation on the Closer to Home – Health & Care Strategy (JHO8). The presentation covered the need for implementation, the Model itself and its development, what the changes would mean for 2016/17, its implementation and finally the planned engagement and consultation on the proposals.

A member asked how and when would the public be informed about the changes. Rosie Rowe stated that engagement with the public had begun and a broad model already presented. However, work with the locality forums on the details was planned to take place over the next two months, which would then lead to more formal proposals. Consultation on these would take place in the Spring/Summer of this year.

A member asked if it would be possible for all consultations for this proposed Strategy, the Transformation Strategy, Intermediate Care in the county, Rebalancing of Health & Social Care could all be run together. John Jackson stated that there was a need to set out specific issues which needed to be addressed now, within the context of the emerging Closer to Home Strategy.

John Jackson was asked when the Committee would see a draft of the consultation document. He confirmed that this would be substantial changes and there would be a lengthy consultation. When the proposed Strategy was brought to the Committee, it would effectively be when the consultation would begin. He added that there would be opportunities to ensure issues were flagged up and included within the consultation. He would also set out a scenario of how it would affect different localities.

Dr McManners asked if the Committee wanted engagement with the public to be ‘joined up’ in one local area about everything – or would it want it to be repeated in each locality? The Chairman responded on behalf of the Committee to say that the latter would the most sensible.

A member asked if the future role of the Health & Wellbeing Centres could be considered as part of the Strategy, to include how the existing premises and staff skills could be integrated into working measures. Dr McManners confirmed that the OCCG was looking at local bases for all services, including those of the children’s centres, and was considering whether a pooled budget could assist in supporting these services. John Jackson added that there was a need to see these within the context of devolution. He explained that NHS England was requiring all healthcare systems to provide Sustainability and Transformation Programmes by the end of June this year. He added that this was well timed as work was already underway to introduce integrated locality working.

The Chairman, on behalf of the Committee, thanked Dr McManners, Rosie Rowe and John Jackson for attending.

11:15

Oxford Health FT will present the results of their recent Care Quality Commission (CQC) Comprehensive Inspection Outcome for the Committee’s consideration (JHO9).

Ros Alsted, Director of Nursing, Oxford Health, presented the results of the recent Care Quality Commission (CQC) Comprehensive Inspection Outcome (JHO9).

A committee member asked what was the outcome of the inspection of community hospitals in the county the last time they were inspected? Ros Alsted responded that they had never been inspected by the CQC.

Ros Alsted was asked how the pressures of a significant reduction in beds in Community Hospitals impacted on the report, in particular in respect of Witney Hospital. She responded that the inspection took place at the end of September and at that point Witney Hospital had two wards in operation. There had been no evidence that care outcomes being delivered to patients had reduced.

Ros Alsted was asked if there was anything in the capital budget for improvements to the fabric of some of the Warneford Hospital’s buildings. She stated that there was a small recurring capital budget for £5m which could be used to do a small amount of builder’s work, adding that a significant amount of maintenance work was undertaken using this budget. Moreover Trusts were expected to raise their own capital, either via efficiency savings or via loans. She highlighted the new mental health campus in Buckinghamshire, costing £43m, as a major investment in estates, but added that it was usually difficult to raise that amount of investment.

A member asked if discharge planning was sufficiently robust in light of recent fatal incidents in Abingdon and Didcot involving ex patients. Ros Alsted explained that these were rare instances, but when they did occur, rigorous internal and external independent reviews were undertaken by the Trust and by NHS England to discuss the findings and to determine if there were any unforeseen issues. Very structured support was also given in these circumstances. A member asked if the Trust learned from the reviews, to which Ros Alsted directed the Committee’s attention to page 43 of the Agenda papers which cited some good learning which had occurred.

Dr McWilliam noted the ‘outstanding’ CQC result for Children and Young People’s Services. The Chairman also congratulated OH commenting that she had met with the CQC during that week and they had stated that OH were providing Oxfordshire with a very good service which was consistent, robust and well-co-ordinated.

Ros Alsted was thanked for her report and for her attendance.

11:45

Healthwatch Oxfordshire will present a report on their recent activities across Oxfordshire (JHO10).

The Chairman welcomed Carol Moore and Eddie Duller OBE of Healthwatch Oxfordshire (HWO). Prior to consideration of the HWO report (JHO10) the Committee asked that its thanks and best wishes be sent to Rachel Coney, the former Chief Executive of HWO, following her departure to a new post.

In response to a number of questions about the capacity of HWO to look at major issues such as the impact on carers/users of the closure of the Health & Wellbeing Centres, Carol Moore stated that it would be difficult to replicate past work on projects such as this, in light of the coming 30% budgetary cut. She added that HWO would be planning to work differently, possibly with colleagues in the voluntary sector.

The Committee asked Eddie Duller about plans to reorganise, given the funding cut to their budget. He reported that HWO had  begun an internal reorganisation, to be completed by the end of the financial year 2016. Initial plans had been made on the possibility of raising other means of support which could mean that HWO’s impact may not be cut by a third. However, the most expensive events, for example Hearsay! may have to be reconsidered. He added that HWO would ensure that patients were put first as it was required to do.

A member of the Committee asked if HWO was satisfied that carers knew how to find information on support services. Carol Moore explained that feedback given by carers themselves indicated that it was difficult to find the information online, and the online tool did not encourage them to reflect their needs. Work was ongoing to look at this problem.

The Committee encouraged HWO to keep following up on the recommendations their Discharge Project report. Carol Moore responded that most statutory organisations had responded within the required 28 day period, after which the correspondence had been published. She expressed the hope not to have to escalate anything to Healthwatch England, in recognition of the very good relationships established in Oxfordshire.

In response to a question about the publicity on flaws in the data analysis in the Discharge report and whether agreement with the OH and OCCG had been reached, Carol Moore stated that their comments were fair, but had been received too late, meaning that HWO were unable to change the report prior to publication.

A member commented on how powerful the Hearsay! 2015 event had been in attracting so many patients, carers and users to the event. As a result, so much valuable work had come out of it.

Carol Moore was asked about the turnout for the recent voluntary sector conference. She expressed the disappointment of HWO that 70 individuals and groups had registered, but only 30 had attended. Age Concern did not attend. Eddie Duller responded that it was an ideal opportunity, however, to hear the voice of the smaller voluntary groups.

The Chairman, on behalf of the Committee, wished HWO well and congratulated the organisation on their valuable input of views and opinions  ...  view the full minutes text for item 10/16

12:05

The 26 January 2016 Cabinet paper reporting on the results of the consultation and recommending the way Intermediate Care Services will be provided in the future in North Oxfordshire is attached for information at JHO11. An oral update on the outcome of the Cabinet’s decision, together with any points of debate will be given.

The Committee noted the consultation report of the Director of Adult Services (JHO11) in respect of the future provision of intermediate care in north Oxfordshire; and the decision by Cabinet to implement Model A – the Intermediate Care Unit continues and the full 14 bed service is provided by St John’s Care Trust.

12:25

Representatives from SCAS will attend to provide information about various issues which have arisen recently with regard to the Trust’s performance (JHO12).

Mark Ainsworth, Director of Operations and Richard McDonald, Locality Director for the Thames Valley Region attended the meeting to respond to questions on the latest progress report submitted by the Trust.

Members questioned Mr Ainsworth and Mr McDonald on the recent fines imposed in respect of response rates. Mark Ainsworth responded that within most NHS services there were penalty clauses. The Trust was working with the DoH to consider how £1m could be reinvested into the service to cover the fines and to address the reasons behind the penalty. He added that there was a possibility that the Trust would not incur the full extent of the penalty.

They were asked what impact the decisions made by the localities with regard to patient transport services would have on the finances of the Trust. Mark Ainsworth responded that the Trust had been successful in gaining all patient transport services across the whole of the Thames Valley region. However, it would have to take care in applying the criteria, or it would have to pay costs if it exceeded other providers. It would depend on whether activity levels increased or decreased.

In response to a question about whether outcomes involving delays since 2011 had been publicised at Board level (for example, delays getting patients to Stroke Centres), Mark Ainsworth stated that data had previously been published nationally and was in the public domain. He added that this was a target that all Trusts struggled with nationally and a significant amount of work was being undertaken with contact centres to identify which calls involved stroke to ensure classification as a red response. National reports only required data on the Trust’s performance – but from Monday next week the Trust was due to go live with Electronic Patients Records in Oxfordshire, to enable more data on patients to be seen more quickly.

A member of the Committee asked if data existed in relation to incidents where a crew had missed their targets, particularly where they were 30 miles away from hospital (page 179 of the Agenda papers). Mark Ainsworth explained that there are typically 40 – 50 red calls across the Trust per day, and each required an 8 minute response. The 8 minute response began on the close of the call. A sample of patients outcomes was taken by the control team/and clinicians, and risk scored according to the level of impact experienced. The intention was to look at the process followed, and if identified correctly, to talk to the patient about his/her experience. A member suggested that the question to be asked was what the impact was for the patient. Mr Ainsworth reported that the Trust did not receive data from the hospitals – any data was received after the patient had left hospital. Dr McWilliam explained that nobody would be able to ask such questions as it implied randomised enquiry which was deemed to be not ethical and unknowable.

A member asked if all calls were met with the same standards.  ...  view the full minutes text for item 12/16

12:40

Val Johnson, Partnership Development Manager will present a paper (JHO13) on behalf of the Oxfordshire District Councils which discusses the role of the district councils in relation to health and wellbeing and the current activities that they support in relation to this.

The Committee received a presentation given by Val Johnson, Partnership Officer, Oxford City (JHO13). She was accompanied by District Cllr Anna Badcock, Vice-Chairman, Health Improvement Board and Dr Jonathan McWilliam, Director of Public Health, OCC.

Val Johnson referred to a report commissioned by the Association of District Councils by the Kings Fund, to look at what district councils could provide, particularly at this time of devolution. This report recommended that both the district councils and the Association of District Councils should be much clearer about the impact and measuring impact of added value. It also recommended that District Councils should be actively involved in Health & Wellbeing Boards. She added that in Oxfordshire was lucky in that two district council representatives played a significant role in contribution to discussions, as Chairman and Vice-Chairman of the Health Improvement Board. Cllr Badcock gave her wholehearted support, stating that most of the work of district councils was around public health, a significant part of the work of the Health & Wellbeing Board.

A Committee member agreed that the district councils’ contribution to health & wellbeing was impressive, but patchy. She gave an example of the homelessness pathway, where little work had been undertaken outside of the City. She asked what could be done to ensure that every agency was contributing what it could for its residents. Val Johnson stated that District Councils worked together to recognise the needs within Oxfordshire and to ensure the evidence base for it.  District Councils recognised the importance of working together to get the most from limited resources that were available, not merely inviting other agencies to do the work. Moreover, the housing teams worked hard to prevent homelessness in the first place. Much of the contribution work was unseen.

A view expressed by some members of the Committee was that district councils needed to acknowledge the need to keep the multi-agency pathway alive. A possibility could be that the district councils could look collectively funding housing associations for adaptations to prevent falls in the home, for example.

Dr McWilliam reported that housing and homelessness care was under the remit of the Health Improvement Board and currently there was a strong strand of work being undertaken on bringing key partners together. He added that this one issue should not detract from the wide range of work the district councils were engaged in.

The Committee took a view that, in the future, if the topic of obesity featured in the Committee’s forward plan, it would be helpful to consider the role of district councils in relation to this. This could include a breakdown of what services are provided and commissioned and stating funding provision.

Cllr Badcock commented that it would be easier to look at the budget breakdown of the Council’s themselves in relation to food safety, environmental health etc, which prevented people coming through the NHS system.

A Committee member commented on the need to understand the prospect of devolution and where it was expected that the district councils would  ...  view the full minutes text for item 13/16

13:00

Officers will present the revised toolkit to the Committee, highlighting the changes made and the rationale behind these (JHO14).

The Committee is asked to note the report and to approve the updated toolkit.

The Committee had before them the revised version of the Toolkit for approval (JHO14).

Members of the Committee, on considering Cllr Mills’ comments and the proposed Toolkit document commented that:

·         Hannah Iqbal had undertaken significant best practice research into how substantial change is assessed in other areas. She had also considered Cllr Mills’ comments and it was this process of extensive research that had caused the delay in the final proposed document coming to Committee. The Chairman had also engaged with the healthcare organisations and various providers in order to promote the Toolkit framework;

·        The point of the Toolkit was not to enact public consultation with local members and other stakeholders at this stage, that would come later. It was to give some guidance or a steer to the healthcare organisations, through an early dialogue not performed in the public domain, to consider whether public consultation would be required and therefore whether the HOSC needed to know about it formally. There were no constitutional aspects to it and it did not constitute even an informal meeting. However, with Cllr Mills comments in mind, it was agreed that there be a quorum at these discussions, as required at meetings of HOSC, and that a written note of the discussion be submitted to the next meeting of the Committee;

·         The onus was on the healthcare organisations to seek the Committee’s opinion, not the other way round. If the Committee had concerns about whether a proposal should be the subject of a public consultation, and it had not been the subject of early dialogue, then it would insist that it be submitted to the next HOSC meeting to be considered in the public domain. It was important also to note that members of HOSC attending a toolkit meeting were not required to give a steer. It could be decided to take it to the next meeting of HOSC.  It should be noted that a healthcare organisation could, if particular rules and regulations (as stated in the Act) were satisfied around emergency procedure, evoke immediate action on a proposal without public consultation.

The Committee agreed, subject to the following two amendments to the Toolkit document, to approve the Toolkit for future use:

·         Paragraph 1, second bullet point down, last sentence should take out the word ‘sensitivity’ to read (change in bold italics) – ‘No substitutes will be permitted given the knowledge base required of issues to be discussed.’

·         B. Assessment criteria – last one – addition of the words ‘risks and’ so that it reads (change in bold italics): ‘Risk: What mitigations are in place to reduce any potential risks and negative impacts of the proposed change?’

1:20

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

The Chairman gave an oral update of meetings she had attended since the last meeting.

The Committee will meet at 10am in County Hall on the following dates:

21 April 2016

30 June 2016

15 September 2016

17 November 2016

2 February 2017

The Committee noted the dates of future meetings:

21 April 2016

30 June 2016

15 September 2016

17 November 2016

2 February 2017