Agenda and minutes

Apologies for absence were received from District Councillor Nigel Champken-Woods and Cllr Jenny Hannaby attended in place of Cllr Alison Rooke.

District Cllr Ian Corkin attended and took part in the Committee as a representative from Cherwell District Council but not in a voting capacity, as the vacancy had not been filled formally as yet.

There were no declarations of interest.

To approve the minutes of the meeting held on 30 June  2016 (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 30 June 2016 were approved and signed subject  to:

-        Minute 38/16 - references made on pages 6 and 7 to the STP (Sustainability & Transformation Programme) being amended to TP (Oxfordshire’s) Transformation Programme;

-       Minute 39/16 – page 8, paragraph 2, final sentence – to amend the sentence to read ‘However, they would have been assessed prior to their release’.

Matters Arising

-       Minute 38/16 – it was confirmed that Damon Palmer had circulated the Transformation Programme web link to members of the Committee;

-       Minute 38/16 – final summing up, page 7 – confirmation was given by Stuart Bell that the Committee’s request for separate chapters on proposed services in each locality to be included in the consultation document would be actioned. Also , in relation to the need for changes to IT systems to be placed firmly on the agenda for consideration, David Smith, OCCG, confirmed that he had invited Cllr Nick Carter to a meeting to discuss the matter;

-       Minute 39/16 – Councillor Pressel undertook to specify the areas of interest in relation to performance data on healthcare in prisons and IRCs in order to inform the request for further information.

The Chairman had agreed to the following speakers, all of whom would make their address at the start of Agenda Item 8:

Representative for Victoria Prentis MP, Catharine Gammie

Keith Strangwood, ‘Keep the Horton General’

Cllr Lawrie Stratford, Bicester resident

Cllr John Christie, Local Member

10:10

A draft Forward Plan is attached for consideration (JHO5).

The Committee had the draft Forward Plan before them for consideration (JHO5).

The Chairman advised that a report on the allocation, contracting and provision of District Nurses across Oxfordshire would be presented to the November meeting.

10:15

Representatives from the Transformation Board will update the Committee on the following:

·         Consultation process, timetable and sign-off schedule

·         Feedback from the pre-engagement phase

·         The Sustainability and Transformation Plan itself

The Chairman welcomed Stewart Bell, Oxford Health (OH); David Smith, Dr Joe McManners and Damon Palmer, Oxfordshire Clinical Commissioning Group (OCCG) attended for this item.

Stuart Bell gave a presentation  -  the objectives for which were to:

-       summarise the key messages from the public conversation regarding the case for change in transforming health and care in Oxfordshire and the emerging models of care;

-       give a summary of the key messages from the public conversation;

-       primary care development;

-       to seek views to help inform the thinking and development of plans as part of the ongoing process of engagement.

Mr Bell pointed out that one of the key messages from the public pre-consultation was that there needed to be an interconnection between all services so that any questions relating to other services could be raised and may engender more useful work.

David Smith reported that there would be a delay in launching the consultation It was currently anticipated that the new date was early January 2017. He added that the Clinical Senate and NHS England had to sign it off primarily. He also stated that the earliest a final decision could be made was May 2017 and the implementation period would be up to 5 years.

Stuart Bell confirmed that transport matters were high on the public’s list of priorities.

The Committee asked to receive a summary of information given out at all the roadshows, as it was a useful method of informing their constituents.

Damon Palmer confirmed that the next stakeholders meeting would be on 22 September. The Chairman confirmed that she would attend this event and relay any information to all members of the Committee.

Members of the Committee urged Health representatives to give more information on the ongoing remedial work that was currently underway, for example in relation to the closure of certain GP surgeries. More flesh was needed on the bones, for example what criteria was being used to determine which were to close. Mr Bell responded that access to services was a major factor being considered. He added that the Deer Park surgery, Witney was a slightly different situation in that the provider was proposing a difference in quality. He added that the issue was how do small practices continue to make ends meet in the plans for the future integration of primary care with the hospital sector and the community services. GPs and PML were looking at the whole primary solution trying to work it out for the whole population. With regard to a question about provisions being made to transfer patients to other surgeries, the current plan was to expand other practices to enable them to take on more patients. He stressed that patient support was the key issue. In answer to a question about the sustainability of care provision via primary care providers, David Smith responded that this came back to the importance of getting as much right before the consultation began. He added that lessons learned from elsewhere had  ...  view the full minutes text for item 49/16

11:00

Representative (s) from the relevant organisations will attend the meeting to give details on the end of pilot review (JHO7).

This item will also give information on the next steps, including:

·         Detail of the timescales for implementation and consultation

·         The impact of the proposals on patients and the public

·         The impact of the proposals on adult social care, community services and on GPs.

The Chairman welcomed the following representatives who were attending the meeting in order to give details on the end of the pilot review and to give information on the next steps:

Paul Brennan – Director of Clinical Services, Oxford University Hospitals Foundation Trust (OUH)

Lily O’Connor – Divisional Head of Nursing and Governance & Liaison, Hub Manager, OUH

Karen Fuller  - Adult Social Care Service Manager, City and Hospitals, Oxfordshire County Council

Dr James Price - Divisional Director for Medicine & Clinical Lead for Gerontology, OUH

Paul Brennan gave a brief overview of the information contained in the report JHO7 about the review of the pilot. He concluded by stating that the Hub was now in operation using 55 beds – a reduction from 150 beds at the start of the pilot. He added that patient feedback had been good overall, particularly as people were being moved out of a busy acute ward to a different environment.

Mr Brennan agreed to provide the Committee with the key performance indicators which had been used to monitor during the evaluation.

A member asked from which areas were the staff recruited. Mr Brennan reported that 70% were targeted from retail with an attractive package, including a good wage, full-time work for those who wanted it, access to a full NHS Pension Scheme, possible access to a nurse’s induction programme or development into the Healthcare system.

In response to a question, Paul Brennan reported that the 55 patients still in hub beds were there for further assessment and work with the family. The beds were used as though they were community beds and were not classed as delayed transfers of care as they were not in the acute sector. Lily O’Connor explained that many patients in community hospitals were there for rehabilitation reasons and were not categorised as delays. She added that it normally took a long time to work out their long-term care, requiring talks with the patients themselves and with their families. Paul Brennan further explained that the pathway had been changed for patients in acute beds, so that before they became a delay, they were moved out and placed in intermediate care beds. A member commented that it was difficult to tell where the 476 patients cited in the report had been placed. Paul Brennan explained that one third had been placed with nursing or care homes, one third had gone home and one third had either died or been readmitted to hospital. Karen Fuller further explained that social workers worked very closely with community colleagues to ensure that patients were moved out and negotiated into homes. Their presence in the Hub put Social Care in a position to ensure that the market was managed well. Paul Brennan added further that when the audit of the first 150 patients had been undertaken there had been no expectations as to where they would be placed.

In response to a question, Paul Brennan reported that the total number of delated transfers of care was currently  ...  view the full minutes text for item 50/16

12:00

As requested by the Committee, representatives from the Oxfordshire Clinical Commissioning Group (OCCG) and the Oxfordshire University Hospitals NHS Foundation Trust (OUH) will attend the meeting to give an update on the situation with the Obstetrics Unit at the Horton Hospital. This includes records of engagement with key stakeholders, including patients and staff at the Unit (JHO8).

Background information is also attached at JHO8 including a letter from Victoria Prentis MP to the OUH and the response; and a job description for a Trust Doctor in Obstetrics and Gynaecology.

LUNCH  - 13:30

Prior to consideration of this item, the Committee was addressed by the following speakers:

Catharine Gammie – speaking in behalf of Victoria Prentis MP

Firstly the decision to suspend obstetric services at the Horton Hospital was made with no consultation at all. Victoria Prentis’s staff were made aware of the OUH’s plans at a meeting of the Horton on 20 July. It was thought that the object of the meeting was to discuss the Transformation Plan proposals affecting maternity provision at the Hospital and Victoria could not attend the meeting. At no point did anybody forewarn her of the imminent announcement relating to the temporary closure of obstetrician provision. The Trust’s decision affects not only her constituents in North Oxfordshire, but those beyond her own Parliamentary constituency boundary, for example, the Cotswold Birthing Centre in David Cameron’s former constituency transfers 50% of emergency closures to the Horton. Yet at no point did the Trust inform them of their plans.

Secondly, no effort has been made to engage with clinicians or the public. There is considerable bad faith locally and this is exacerbated by a total lack of engagement. The consultants feel excluded and do the Banbury GPs, many of whose patients would now have to decide whether to give birth in the midwife-led unit or to make the 90 minute journey to the JR Hospital. Together the GPs wrote to the Trust in advance of the Extraordinary Board Meeting to express their opposition to the proposals. Their letter expressed many of the concerns they expressed to the Independent Reconfiguration Panel in 2008 ie. safety, sustainability and the reduction in access to base health care and choice for their patients.

Thirdly, the decision to suspend obstetric services is not evidence based. Despite asking to see the risk assessments on many occasions, it was not until this Committee’s Agenda was published was there one in the public domain. She has grave concerns, that without controls and contingency plans, there were a number of ‘high risks’ on the register, including the timeliness of the transfer of patients; the impact on the JR Hospital’s maternity service and the retention of staff. Whilst she recognised that without sufficient obstetricians the service was not safe, the transference of mothers who had encountered complications during or post-labour when that transfer would take at least 45 minutes in an ambulance, not taking account of loading and de-loading the patient was extremely worrying.

In conclusion she expressed her fear that lives would be lost and urged this Committee to do everything in its power to intervene and hold the Trust to account. He understood that when there was an emergency, there could not be a statutory consultation process, but the decision needed real scrutiny. She asked the Committee to refer the Trust’s actions to the Independent Referral Panel as a matter of urgency and at the same time to ensure that the Trust remained under pressure to recruit, either by being more creative with the advert and job  ...  view the full minutes text for item 51/16

14:00

The Director of Public Health will present his Annual Report to the Committee (JHO9). The Committee will be asked to consider the key issues which it would like to take forward in the year ahead.

The Committee had before them the Director of Public Health’s Annual Report (JHO9). Members were asked to consider the key issues which they would like to take forward in the year ahead.

Dr McWilliam was congratulated on a very interesting, easy to read and comprehensive report.

In relation to alcohol related hospital admissions and illness, Dr McWilliam was asked what was in place to educate the public in relation to the dangers of alcohol. He responded that Public Health Officers addressed it to the best of their ability, it was also part of the schools’ curriculum and part of the school nurses remit. He added however that drinking rates among young people were falling, along with teenage pregnancy numbers, but both needed to be kept under surveillance. Public Health advocated a growth in referrals, but also a good and timely service. The key element of the new service which had been put in place was that of outreach for people in psychological distress. School health nurses also dealt with mental health problems and help was on hand for children suffering from stress. However, it was his view that services were still not dealing with this aspect quickly enough and there was a need for him to keep a watching brief.

Dr McWilliam was asked to expand on what services were in place for children aged 15 – 19, in light of the recent surge in mental health issues experienced by this age group. He reported that the Care Quality Commission had highlighted the matter of increases in waiting list times and assessment at first appointment. The Chief Medical Officer had highlighted a more stressful lifestyle as the cause for this and had advised young people to come forward earlier in life if they were experiencing problems. He added that the Child & Adolescent Mental Health Service (CAMHS) provided access to school counsellors and school nurses had been invited to attend a conference on alcoholism which was held every two years. He also added that he had been very pleased with the outcomes of the alcohol prevention project when Oxfordshire Fire Service had been involved.

At the request of the Committee, Dr McWilliam gave a flavour of the areas in which Public Health had been involved over the last year. This included:

·         A breast feeding project in Brighton with an aim to increase support in areas where there was a low uptake.

·         A person had been employed to telephone primary care patients with the aim of encouraging them to take up their health check.

·         School nurses were keen to know what outcomes they should meet and were thinking of a way to use these to target help where it was needed most.

·         Pegasus Theatre had staged some excellent plays on Health issues.

A Committee member asked about Health services and transport (in the face of reduced bus subsidies) for older people in villages in light of the closure of some GP practices. Dr McWilliam agreed that there big issues for Public Health  ...  view the full minutes text for item 52/16

14:30

An update report on Healthwatch Oxfordshire activities is attached at JHO10.

The Committee had before them the report (JHO10)  by Healthwatch Oxfordshire (HWO). Tracy Rees, Vice-Chair of the HWO Board attended in place of the Chairman, Eddie Dyer whilst he was on leave. She was accompanied by the new Executive Director, Rosalind Pearce, who had only just taken up her post. Rosalind Pearce explained that initially she intended to follow the current programme, but was working with the Board on it. She added that although the overarching Policy would not change, it was intended that there would be an increased HWO presence in different parts of the county with a view to meeting and listening to the views of the patients and public. She also intended to develop the current reporting mechanism with agencies of the third sector and stated that she would like to be more proactive with HWO’s ‘enter and view’ role, in order to gain a clearer idea of issues and to aid horizon scanning.

There was a discussion on the study being undertaken by HWO on Minor Injuries Units (MIU) and what equipment was available to them. Rosalind Pearce commented that it was the view of HWO that MIU’s needed to promote more information about what services could be offered at these sites and agreed to follow it up. Tracy Rees added that the primary focus would be on the Abingdon MIU, as its situation and issues were mainly similar at all the sites around Oxfordshire.

A member suggested that HWO and HOSC might work together utilising the roles each had. As an example, it was suggested that as Oxfordshire had a new contract for school nurse provision, it would be helpful if HWO could talk with some young people who had experience of the service in order to produce some feedback for the future scrutiny of this service by the Committee. Rosalind Pearce commented that HWO were keen to work with young people, and were already doing some work in schools. She undertook to let the Committee know what could be done at the next meeting.

A member commented how effective and helpful HWO had been when contributing to the pre-consultation engagement meetings on the Transformation Plan. Rosalind Pearce responded that high on HWO’s agenda was to work actively with the OCCG on this, sharing knowledge on the engagement process, but at the same time maintaining their independence. She added that there was to be a HWO/Voluntary Sector conference towards the end of January to ensure that these organisations get a voice in the engagement process. Tracy Rees flagged up the need for information to be in plain English, to provide translations and for there to be good information on the website, to ensure people had all the tools to enable them to make up their own minds.

The Chairman thanked Rosalind Pearce and Tracy Reese for their attendance at the meeting.

14:40

Attached at JHO11 is the report produced by the Chairman updating the Committee on meetings she has attended since the last meeting and the letters sent and received on behalf of the Committee.

The Chairman introduced her latest report (JHO11). She highlighted the report on the closure of the North Bicester Surgery and the action taken by the Committee. This entailed asking the OCCG to complete a Toolkit assessment, in order to glean the information required, and then meeting with the Patient Participation Group (PPG) attached to the surgery, local councillors and OCCG representatives to hear the issues.

Katie Read, Policy & Partnership Officer, asked the Committee if this approach could be established as a process to be followed with similar issues in the future. Dr McWilliam pointed out the GPs were a commercial enterprise and the process was more about ensuring that NHS England had the processes in place to deal with issues around surgery closures. He questioned whether the Toolkit process added anything to the process of patient care.

Katie Read clarified that elements of the Toolkit assessment, which were normally initiated by Health organisations if they were unsure as to whether a change in service was substantial or not, could be used to find out how many people would be affected by a change in service, for example, so that this could inform similar issues as they emerged.

Some members of the Committee suggested that important messages around changes in Health care from NHS England and the OCCG were not being communicated sufficiently well enough. For example, residents were not aware that once they had re-registered with another surgery, following the imminent closure of a surgery, they could not attend their previous one. Local Councillors had distributed letters to residents in their local areas in Bicester, reminding them that they must register with another practice.

The Chairman informed members that the Committee’s visit to the Hub was to be arranged shortly.

The Committee is briefed on the following (JHO12):

·         Healthcare & Justice Commissioning for Prisons and IRC in Oxford – Deaths in Custody April 2013 – July 2016.

The Committee was briefed on ‘Healthcare & Justice Commissioning for Prisons and IRC in Oxford – Deaths in Custody’  - as requested at the previous meeting (JHO12).

At the request of the Committee, Katie Read undertook to seek information on what issues caused the deaths in custody and what the Service were doing to reduce suicides, and to circulated this information to all members of the Committee.