Agenda and minutes

Apologies for absence were received from District Councillors Martin Barrett and Nigel Champken-Woods and from Keith Ruddle.

There were no declarations of interest submitted.

To approve the minutes of the meeting held on 4 February 2016 (JHO3) and to receive information arising from them.

The Minutes of the last meeting held on 4 February 2016 were approved and signed subject to the following amendments:

-       Minute 8/16 ‘Closer to Home – Health & Care Strategy’ – penultimate sentence in paragraph 5, to read as follows (amendments in bold/italics):

‘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?’

-       Minute 12/16 – South Central Ambulance Service NHS Foundation Trust (SCAS) – third sentence, paragraph 2:

‘The Trust was working with the Department of Health to consider how £1m could be reinvested into the service to cover the fines and to address the reasons behind the penalty.’

There were no Matters Arising.

The Chairman had agreed to the following people addressing the Committee. All had requested to speak at the start of the item concerned:

Agenda Item 7 – Councillor Hilary Hibbert-Biles, (Local Member) and Dr Jonathan Moore (Chipping Norton Health Centre);

Agenda Item 8 – Councillor David Nimmo – Smith (Local Member); and Cllr Ian Reissman (Chair, Townlands Steering Group); and

Agenda Item 12 – Councillor Jenny Hannaby (Local Member).

10:20

Stuart Bell, Chief Executive of Oxford Health and Chair of Oxfordshire’s Transformation Board will update the Committee on the development of system-wide Transformation Plans (JHO5).

A Panel attended to update the Committee on the development of system-wide Transformation Plans and also to respond to questions from members of the Committee. It comprised of Stuart Bell, Chief Executive, Oxford Health (OH): Andrew Stevens, Director of Planning & Information, Oxford University Hospitals NHS Foundation Trust (OUFT): Dr Joe McManners, Clinical Chair, Oxfordshire Clinical Commissioning Group (OCCG): and John Jackson, Director of Adult Social Services, Oxfordshire County Council (OCC) and member of the Transformation Board. A presentation was given by Stuart Bell. 

Stuart Bell, responding to a question about whether there was a sufficiency of trained people to provide health care, agreed that there was a need for more trained personnel and support staff, for example, volunteer drivers. He stated the Board’s belief in the importance of creating career structures and the development of apprenticeships. John Jackson added that the practical issues inherent in finding a sufficient workforce to do the job had been recognised at the onset of the Project – and there had been some success in attracting more social care providers into the county – but he had warned that the introduction of the living wage was viewed as a potential problem for the future.

A member asked whether there was sufficient money for the technology required for the project. Stuart Bell responded that much of the technology was about people purchasing their own Health apps to download onto their mobile phone. To this end the Board were working with the Oxford Academic Health Scientists Network on attracting investment into the capability of linking information into the system. He added that the Board was holding discussions with a number of partners and investors in this field with a view to linking into and developing this field. Mr Bell accepted that not everybody accepted new technology, but it was surprising how many older people did – and this acceptance could make the difference between people staying in their own home or having to leave it. An important thread of the project was the concept that care needed to be made much more personal and adapted to people’s own circumstances.

A member of the Committee expressed the view that more work needed to be done in the sphere of sharing information on patients between different healthcare professionals or departments to avoid conflicting, and therefore confusing advice. Dr McManners responded that the system needed to be sufficiently flexible to offer a grade of different interventions to assist patients, adding it was more about partnership between the patient and the professional than patient responsibility. The new proposals allowed the patient to self - report and to observe and take action if required.

A member expressed the view that issues in the national agenda such as the scrapping of nurses’ bursaries by 2020 and the issues currently in the media regarding GPs contracts could all have an impact on the local workforce and attract funding problems in the future. Mr Bell agreed that any issues of this kind could not  ...  view the full minutes text for item 21/16

10.50

Paul Brennan, Oxford University Hospitals Foundation Trust (OUH) and colleagues will give a presentation on the pilot review.

The Chairman welcomed the following representatives from Oxford University Hospitals Foundation Trust (OUH) and Oxfordshire County Council to the meeting:

·         Pau Brennan and Lily O’Connor – OUHFT

·         John Jackson and Karen Fuller   - OCC

Paul Brennan gave a presentation on the pilot to tackle Delayed Transfers of Care (DTOC). He reported, to date, there had been a 30% reduction in delays against an expectation of 25%.

Challenges highlighted in the presentation were:

·         Workforce recruitment and retention – some staff tended to find a combination of high cost housing, the cost of living, transport movement around the City a disincentive and move away;

·         The 4 hour standard in Accident & Emergency – reaching the desired level of 70% was moving in the right direction, but not as quickly as was hoped;

·         Re-ablement care was still posing a challenge, demand being greater than capacity;

·         Readmissions had been higher than expected.

Lily O’Connor  gave a flavour of how the Hub staff (comprising Occupational Health, Physiotherapy, Social Workers, Contracting, Financial Assessment, Nursing staff, Administration, Medical staff) were working interactively – and were meeting on a formal basis once a week. The Hub was staffed at weekends by nursing staff and Oxford Health Medical Assessment staff. She reported also that there had been a number of readmissions at the start of the project. However, as the Hub had gained in confidence, communication with the Care Homes had improved, and many patients had either been placed in Homes close to their own homes, or been given rehabilitation enabling them to go back home with reduced packages of care.

Karen Fuller spoke of issues which were being dealt with by staff at the Hub, including assistance with obtaining legal power of attorney consent. From an Adult Social Care point of view, there had been a number of key benefits to working at the Hub, such as staff being able to conduct daily tele-conferences to discuss clients, to which key organisations would contribute. This enabled the flow of patients to be managed better. There were good, positive outcomes owing to a robust multi-disciplinary team assessment. Intensive rehabilitation, in conjunction with social workers, enabled patient pathways to change. There was also good communication between organisations which enabled staff to focus resources to the most appropriate point.

In response to a question, it was confirmed that there had been a sufficient number therapists recruited.

In response to a question about funding of the project, John Jackson reported that funding had been via the OCCG, who were currently looking at continuing the project beyond April 2016 at a reduced level.

A member asked how nursing staff in care homes coped with patients with very complex conditions. Lily O’Connor explained that Hub staff went out to homes to support this category of patient when required, and worked alongside staff. There was also a care home support service who worked with other staff in the Home to aid the management of such conditions on a long term basis. Any problems with patients’ medication  ...  view the full minutes text for item 22/16

11.20

John Jackson, Director of Adult Social Services, OCC will provide an implementation update on the Henry Cornish Centre, Chipping Norton following the report to the September 2015 Committee (JHO7).

Prior to consideration of this item, the Committee was addressed by Cllr Hilary Hibbert-Biles, in her capacity as Local Member for Chipping Norton, and Dr Jonathan Moore, GP at the Chipping Norton Health Centre. The major points of their addresses were as follows:

Cllr Hilary Hibbert-Biles

·         The 2011 contract had made clear that the beds were defined as ‘sub-acute’ intermediate care status. The change constitutes a down-grade;

·         In her view, this Committee had not supported the residents of Chipping Norton in relation to this issue;

·         Nursing staff did not wish to TUPE over to the Orders of St. John;

·         There was concern that the Unit was not accepting referrals for people who had known clinical needs during the transition. This constituted a waste.

Cllr Hibbert-Biles called for the Committee to consider this as a substantial change in service, consultation for which had not occurred, and asked that it refer it to the Secretary of State for Health as a consequence. She also called for the Unit to be included in the forthcoming community hospital review.

Dr Jonathan Moore

·         Expressed his appreciation for the large investment made in 2011 when the old hospital centre had closed down. The Hospital now had a Maternity Unit, a Minor Injuries Unit, Physiotherapy services, Outpatients and X ray facilities.. To complement these facilities, a sub-acute unit had always been expected and it had been disappointing to GP staff, in particular to a new GP with an interest in hospital care, to find that the Community Hospital had been downgraded without sufficient consultation;

·         There had always been a need for sub-acute beds and there had been no alternative model of care provided; and

·         The numbers of beds were shrinking and as a result there was an inadequate background provision of care in the community.

The Committee had before them a briefing on the implementation of the new arrangements at the Henry Cornish Care Centre ICU. On 26 January 2016, the County Council’s Cabinet had approved Option A for the ICU which involved the ICU continuing, the full 14 bed service being provided by the Orders of St John Care Trust (OSJCT). The paper addressed the staffing issues, including the TUPE transferred staff, implications for service users and the plan moving forward.

Due to difficulties in recruiting staff in the west Oxfordshire area, a transition plan had been put in place that involved staffing the ICU with a combination of transferred nursing staff and Health Care Assistants, agency nursing staff and OSJCT care staff. All community and urgent care services would be available as usual during the transition period and there would continue to be medical and therapy cover available to the Unit at the same level as currently provided. The transition plan would focus on providing the service to those predominantly with rehabilitation needs. The service would therefore not be accepting referrals of people during the transition period who had known clinical needs, as it was essential that safe care was provided. The timescale for achieving  ...  view the full minutes text for item 23/16

11.50

A representative from the Oxfordshire Clinical Commissioning Group and a member of the Townlands Stakeholder Reference Group will give an update on progress (JHO8).

Prior to consideration of this item the Committee received an address by Cllr Ian Reissman of the Townlands Steering Group, and by Cllr David Nimmo-Smith, local member.

Cllr Ian Reissman

Cllr Reissman began by congratulating all who had been involved in work on the new Townlands Hospital, saying that it was a major achievement in securing local delivery of these much needed services. He expressed the concern, however, of the Townlands Steering Group that the OCCG decision, which was made in September 2015, not to provide the beds as originally planned but to operate the Ambulatory Care Model, had not been shared with the Group sufficiently to provide reassurance that the health needs of patients who had been using the bedded service in the Peppard ward were being met. Cllr Reissman commented also that he believed that the closure of beds would lead to higher DTOC statistics. He stated that the community were keen to see an effective process of monitoring and scrutiny of the new model of care. He added that the paper presented by the OCCG to this Committee provided an overview of many of the key issues but asked that the Committee ensure that details were provided by the OCCG in the following areas:

·         Details and location of the Integrated Locality Team which would be based at Townlands as key components of the RACU and the Multidisciplinary Team;

·         Provision of a clear plan for the Rapid Access Clinical Unit (RACU) including the opening dates and staffing arrangements;

·         Evidence that home care packages were available both now and when the RACU opened with the inevitable increased demand;

·         Details of the operation of the beds leased from the Care Home including levels and qualifications of staffing, co-location of the beds and spot purchasing arrangements;

·         Provision of a clear, specific, measurable set of Key Performance Indicators to include an explanation of how these had been arrived at , and the dialogue with the community; and

·         To request the OCCG to engage properly with the Townlands Stakeholder Resource Group (TSRG) and co-operate with the OCCG to reconfigure the TSRG and have clear and constructive Terms of Reference. The CCG was asked to respond to the proposals and adopt as many of the proposed Terms of Reference as possible.

Cllr David Nimmo-Smith

Cllr Nimmo-Smith supported the comments made by the previous speaker address. He too congratulated all involved in getting the new hospital opened and looked forward to the care home opening soon. He hoped that the Henley experience would be taken into account as plans were developed, and consultations held, as part of the County’s Transformation Plan, which in turn fitted into the national health agenda.

He stressed that the new facilities were, in his view, a great improvement, but the OCCG report accompanying this Agenda gave the impression that all teething problems had been resolved. He pointed out that this was not the case, the community required answers to their questions about integration with Adult Social Care and home care  ...  view the full minutes text for item 24/16

12:10

There will be an update on Healthwatch Oxfordshire activities (JHO9).

LUNCH

Eddie Duller, Chair of Healthwatch Oxfordshire (HWO), was invited up to the table to deliver his update on the activities of HWO. He reported that the restructuring of the organisation was now complete and HWO were relocating during the following month. He also stated that they may be able to continue the Hearsay! programme later in the year.

A member suggested that the NHS response to HWO’s recommendation (a) on the Discharge Report which stated that ‘the discharge summary was being redesigned with input from clinical staff including GPs, pharmacists’ should also include summaries from carers and patients.

A Committee member asked for more information in the section on ‘what we have heard’, page 37, mental health services – first bullet point – ‘widespread concerns have been expressed about how difficult it is for people to access mental health services when needed in a timely and effective manner. They report seeing increasingly unwell people who are turned away from services as the threshold to access mental health services rises ever higher.’ Mr Duller agreed to send more information with regard to this.

Members asked if it would be possible for HWO to be a little less anecdotal and to give more concrete evidential information, It was agreed, however, that it was useful for the Committee to see a picture emerging from the community of any problems .Mr Duller agreed to this.

Mr Duller was thanked for the report.

13.15

Representatives from the Oxfordshire Clinical Commissioning Group (OCCG), Oxfordshire County Council (OCC) and Southern Health Foundation Trust will provide an update on Learning Disability Care in Oxfordshire.

A joint report prepared by OCC and OCCG is attached at JHO10. A presentation on the report will also be given.

An update including annexes from Southern Health is also attached at JHO10.

The Chairman welcomed:

Ian Winter CBE – Independent Chair, Transforming Care Partnership Board;

Ian Bottomley – Head of Mental Health Services & Joint Commissioning – Oxfordshire Clinical Commissioning Group (OCCG)

Sula Wiltshire – Director of Quality & Chief Nurse – OCCG

Helen Ward – Senior Quality Manager, OCCG

Lesley Stevens – Medical Director, Southern Health NHS Financial Trust (SH)

Kate Terroni – Deputy Director for Adult Social Care (Joint Commissioning) – Oxfordshire County Council

Ian Winter CBE addressed the meeting prior to the presentation. It was his view that successive governments had often failed in their quest to find a successful strategy for Learning Disability policy over the years. However, the latest Transformation Care Plan was a positive initiative in that it did not separate patients across the age ranges or by condition. He spoke about the importance of the Transforming Care Plan being underpinned by the Transforming Care Partnership Board. One of the issues for Oxfordshire was about the successful transfer of services to other providers. The role of the Board was to ensure the safe and effective transfer and transformation of services by means of challenge, championing and collaboration. He hoped the Committee would reach some level of confidence in the action that was being taken.

Kate Terroni and Ian Bottomley then gave a presentation on the current arrangement with Southern Health and how the transition to other providers would be managed. Ian Bottomley referred members to Appendix 1 ‘Oxfordshire’s Health & Social Care Transformation Plans’ which was set out in the Addenda to the Committee.

A member asked if the general community health services, as health care providers, would have the appropriate expertise to deal with people with conditions such as autism. Ian Bottomley responded that resources were already in place to provide a service, in the form of the existing contract which would be rolled over. He stated that there was no imposed solution – all had to be fully engaged and inform the OCCG of general risks and of financial risks. Moreover, the OCCG needed to be satisfied that providers were able to do the job. The contract was already provided by the existing community services located at the John Radcliffe Hospital. Here there was a good liaison service in place for people with a learning disability because staff and ward teams had a familiarity with the patients.

In response to a question asking how would intelligence be collected in order to access data, Ian Bottomley stated that the OCCG’s working approach would be to identify the outcomes for meeting the health needs for a person with autism or a learning disability, and then to monitor how well the patient had done against those outcomes. Moreover, there was also a need to monitor how well the OCCG was picking up this condition generally, by asking the question of how the organisation might assess whether somebody had got autism. Sula Wiltshire explained further that the commission had made recommendations in relation to the investigation of deaths. She explained that  ...  view the full minutes text for item 26/16

14:15

Healthcare providers publishing Quality Accounts have a legal duty to send their Quality Account to the local HOSC. Representatives from Oxford University Hospitals Foundation Trust (OUH) and Oxford Health Foundation Trust will present an overview of their Quality Priorities for 2016/17.

In light of the timing of their Board meetings and of this Committee, full quality account reports are not available at the time of the Agenda publication.

The full report of the OUH will be available in the next few days and will be circulated separately to members of the Committee. It will also be uploaded onto the website when received.

A summary briefing from Oxford Health providing an indication of the Trust’s priorities and objectives to be contained in the report is attached at JHO11.

Oxford Health Financial Trust (OH)

The Chairman welcomed Ros Alsted, Director of Nursing & Clinical Standards and Jane Kershaw, Acting Head of Quality & Safety, Oxford Health Financial Trust (OH).

The Committee had before them a summary version of the Quality report. A finalised, detailed report had been circulated to members that day. Ros Alsted reported that the summary had focused on prioritisations. She pointed out that representatives had recently attended Committee to discuss the findings from the Care Quality Commission (CQC). Eleven were evaluated as good, one was outstanding and four required improvement.

Jane Kershaw reported that the Trust had identified for priority areas in 2015/16 and were also keeping the same ones for next year. The four priority areas were as set out in the report.

A Committee member asked about the problems being experienced both nationally and locally regarding the recruitment of nursing staff. Jane Kershaw responded that the overall majority of staff in lower paid work were not clinical members of staff. She added that that there were multifactoral reasons why the problems were unique to Oxfordshire, such as high property and rental costs, but the Trust remained very focused in trying to attract people into the workforce. It had achieved relative success, particularly in respect of the recruitment of nursing staff. She added that in one year’s time the bursary system would change, but any problems would not emerge for 4 years. In the meantime, efforts were being made to recruit and retain staff by working together to ensure career pathways were in place, for example. This was an important priority for the Quality account.

The Committee AGREED to note the priorities and objectives proposed for the Quality Account in 2016/17.

Oxford University Hospitals Foundation Trust (OUH)

The Chairman welcomed Dr Tony Berendt, Director of Quality, and Claire Dollery, Deputy Director of Quality, OUH.

Dr Berendt gave his apologies for the full Quality report arriving too late to be despatched with the papers for this meeting, but stated that he was pleased to be given the opportunity to discuss the report.

Dr Berendt, during his report to Committee, commented that discharges to GP care had more than doubled. He also stated that the work put into the DTOC programme could not have taken place without all the input that Health and Social Care colleagues had put into the system.

He reported that a public engagement event, to which both governors and staff had attended, had been held on the Quality account, when an overview of the previous year’s account and a reflection on outcomes had taken place. A session had also been held on intended priorities for the coming year. The Trust was doing a piece of work on improving the discharge process as part of DTOC work. Part of this was to empower patients and families to ask the right questions. He added that he would be happy to give an update in progress. He undertook to let the Committee know of future patient  ...  view the full minutes text for item 27/16

14.45

The Chairman will update the Committee on meetings attended since the last Committee.

Prior to discussion, the Committee were addressed by local member, Cllr Jenny Hannaby, in relation to the report of the confidential meeting held with representatives from Oxford Health with regard to Wantage Community Hospital on 14 April. The report informed the Committee of a briefing meeting attended by 10 members of the Committee regarding the imminent closure of Wantage Community Hospital on safety grounds, given the persistent recurrence of legionella in the hot water system of the hospital. This was being treated and there was no immediate risk to health. However, the treatment was not a long term solution and the whole system required re-plumbing in order to permanently eradicate the risk. The purpose of the confidential meeting was for Oxford Health to ask this Committee whether the proposed extension of the temporary closure of Wantage Hospital (to allow public consultation outcomes to shape the nature of capital works undertaken) constituted a substantial variation or not.  The outcome of the meeting was that HOSC members recognised the closure of Wantage Hospital as a substantial change in service and noted the commitment by OCCG, OH and other organisations to a full Transformation consultation later this year.

Cllr Jenny Hannaby

Cllr Jenny Hannaby began her address by regretting that local members had not been invited to the confidential meeting with HOSC members. However, she had attended a briefing yesterday, in her capacity as local member. She stated that on making inquiries about the issues prior to the briefing, she had been informed that the hospital would close for 2 weeks, and later told it would be closed for 3 months. The staff had been very shocked when given the full facts. She added that this was the third time in 10 years that she had attended meetings to defend the hospital against closure. She informed the Committee that the problem had been prevalent for 4 years. It had been flushed out in the past and maintenance work had taken place. Friends of Wantage Hospital had given donations for some of this work. She reported that there had been 63 babies born this year at hospital, adding her view that OH should have corrected the problem permanently if it was a danger to patients. She further commented that purdah prevented a consultation on the closure which would have enabled members of the public to have their say. She requested the Committee to encourage OH to do a temporary closure of the hospital until a consultation was held – and to support the fight against permanent closure.

The Chairman responded to Cllr Hannaby on behalf of the Committee stating that, following their meeting with OH on 14 April, members were of the view that a proposal to close the Hospital permanently would constitute a substantial change of service and would require a full public consultation. Members had recognised the Legionella made it unsafe for the health of patients and therefore needed to be flushed out. She added that they were informed that the temporary  ...  view the full minutes text for item 28/16

A draft Forward Plan is attached for consideration (JHO13).

The Committee considered the draft Forward Plan.

With regard to a possible review into private nursing care homes, John Jackson advised that the Committee ask for a quality and monitoring report on private care homes.

It was AGREED that the Forward Plan be agreed and that patient transport and parking to hospital sites be reviewed.

The Committee is briefed on the following (JHO14):

·         Commissioning of Public Health Services for Children (0-5) - Update

The briefing report was noted.