Agenda and minutes

City Councillor Mark Ladbrooke attended in place of City Councillor Susanna Pressel.

The Chairman began the meeting by thanking Katie Read for all her good work as Policy Officer to this Committee and wished her well in her co-ordinating role for scrutiny in the County. He also welcomed her successor, Samantha Shepherd as Policy Officer to this Committee.

He also welcomed new member Dr Alan Cohen as co-optee and District Councillor Neil Owen representing West Oxfordshire District Council.

The following declarations of interest were received:

-       Agenda Item 8 - Banbury Health Centre – Cllrs Arash Fatemian and Mark Cherry declared a personal interest on account of their being regular users of a GP practice in Banbury;

-       Agenda Item 8 – District Cllr Andrew McHugh declared a personal interest on account of his appointment as a short-term locum at West Bar GP surgery, Banbury; together with his involvement in the running of social prescribing in Cherwell up to 2016;

-       Agenda Item 9 – City Cllr Mark Ladbrooke declared a general interest on account of his wife’s employment in the library service at the Warneford Hospital.

To approve the minutes of the meeting held on 14 September 2017            (JHO3) and to receive information arising from them.

The Minutes of the meeting held on 14 September 2017 were approved and signed as a correct record subject to the inclusion within the Chairman’s Report (Minute 50/17) of the formal announcement of Dr Alan Cohen as a co-opted member of the Committee.

With regard to Minute 47/17 - Advice from the Independent Reconfiguration Panel (IRP) (final paragraph) – It was reported that the informal working group would begin its work in the near future despite the imminent change in chief executive of the OCCG.

The Chairman had agreed to the following members of the public addressing the Committee immediately prior to Committee discussion on the item itself:

-       Agenda Item 9 – Sarah Lasenby, speaking as a member of the public

-       Agenda Item 9 – Larry Sanders, speaking as a member of the public

-       Agenda Item 10 – Written statement by Jane Southworth, on behalf of the  Patient Participation Group (PPG), Deer Park Surgery, Witney

10:15

The Committee’s Forward Plan is attached at JHO5 for consideration. Members are asked to note the highlighted items added since the Committee’s work programming meeting on 14 September 2017 and to consider items for prioritisation.

The Committee considered a proposed Forward Plan (JHO5). During the ensuing discussion the Committee added the following:

-       Update on Mental Health services with a particular look at the provision of mental health services to former servicemen; and

-       Musculoskeletal Service – following discussion at the last meeting the Committee requested that a more detailed briefing, including a progress report, be taken to the next meeting in February. Members were asked to submit any further questions for Health to respond to.

10:30

The report (HWO7) contains an update on the Health & Wellbeing Board’s response to the report of the Health Inequalities Commission. The paper includes extracts from a paper presented to the Oxfordshire Health & Wellbeing Board on 9 November 2017 detailing progress against the report’s sixty recommendations. Dr Joe McManners, Chair of the Oxfordshire Clinical Commissioning Group (OCCG) will attend the meeting to present the report..

The Committee had before them a report which had been presented to the 9 November 2017 meeting of the Oxfordshire Health & Wellbeing Board (HWB) detailing progress made against the Health Inequality Commission (HIC) report’s sixty recommendations (JHO6). The County’s Strategic Director of People & Director of Public Health, Dr Jonathan McWilliam, together with Jackie Wilderspin (Public Health Consultant) and Ally Green, OCCG (representing Dr Joe McManners, Clinical Chair, OCCG) attended the meeting to respond to questions.

Dr McWilliam commented on the importance of keeping the topic alive amidst many other competing priorities. The Commission report had produced recommendations which were very specifically targeted at particular organisations and some which were outside of the normal statutory organisations. Furthermore, a key task of the HWB, in its capacity as an advisory partnership, had been to undertake an overview and co-ordinating role to the work of the Commission.

Jackie Wilderspin introduced the paper and responded to questions from members. The Committee welcomed the report recommendations and views, comments and questions from members were as follows:

·         The usefulness of this work in breaking the silos apparent between organisations was very good. However, this type of work did not fit with planning timeframes and the measurement of performance. For example, BME women needed additional obstetric intervention in childbirth – was this taken into account with the proposals to close the obstetric services at the Horton General Hospital? Dr McWilliam responded that there was no need to wait for implementation of the proposals, organisations were welcome to act on them themselves;

·         With regard to the need to carefully monitor food banks, in light of the Council’s removal of funding to support homeless shelters, a member asked if the need for food banks was increasing and wasn’t there a need to understand their use, rather than just mapping and monitoring? Jackie Wilderspin responded that work was still ongoing in relation to their use and a report back on food bank activity had been requested;

·         The decision to form an Innovation Fund was good but this might not meet the greatest need in some geographic areas. How robust was the strategy to conduct this? Dr McWilliam commented in response to this on the need to adopt three main approaches simultaneously. The greatest was the goal of adopting long term strategies for which funding was required both to spark and keep county-wide interest and to drive the Health Inequalities programme through. The short-term work was necessary to keep the programme rolling and action going via specialist interest and strategic drive. Health Inequalities were driven by population need, not where there were initiatives;

·         The Joint Strategic Needs Assessment (JSNA) and all other policies were in danger of allocation to those who shouted the loudest? Jackie Wilderspin stated that the Commission had formed its report on representations from communities at meetings and objective data from the independent Director of Public Health’s independent report and the JSNA. Dr McWilliam encouraged a request from the Committee to see the assessment criteria to see which  ...  view the full minutes text for item 56/17

11:10

The attached regular report (HWO6) from Professor George Smith, Chairman of Healthwatch Oxfordshire (HWO) and Rosalind Pearce, Executive Director updates the Committee on the activities of HWO since the last meeting and gives the views from residents/patients on particular issues. The report itself is that which was presented to the Oxfordshire Health & Wellbeing Board on 9 November. Professor Smith and Rosalind Pearce will give an oral report on matters pertinent to this Committee which have arisen since the last report to this Committee.

The Committee welcomed Rosalind Pearce, Chief Executive Officer, Healthwatch Oxfordshire (HWO) to present the regular update of issues/activities since the last meeting (JHO5). She offered her Chairman, Professor Smith’s apologies as he had been delayed. Rosalind Pearce highlighted the following:

·         There would be a stall on Stroke Awareness at Thame Market on 28 November. She reported that despite the usual practice of working with HWO Buckinghamshire, unfortunately they would be unable to join in on this occasion. Cllr Champken - Woods thanked her for arranging this as it was at the request of the Committee. She added that a stall was also planned in a town in the Vale of White Horse area in April next year;

·         A key recommendation coming out of the recent Forum meeting was that the Oxfordshire Health & Wellbeing Board (HWB) needed to have better ways of engaging with the voluntary sector. Dr McWilliam responded that this had been taken on board and a review of HWB Board governance was taking place. This matter would be on the HWB Agenda for the next Board meeting on 22 March 2018;

·         HWO would be facilitating a meeting to establish a project fund in January 2018 to enable research on Health Inequalities.

Questions and responses received from the Committee were as follows:

-       In response to a question about whether issues had been raised with HWO about the restricting of day services, Rosalind Pearce stated that people had contacted HWO post change. Many were unhappy that they were unable to access services that they would have to travel further to. Age UK had been doing a significant amount of work in the community with the people affected, as had HWO following their concern about social isolation amongst older people. She added that HWO was planning to try to understand the longer-term impact of this and then to embark on a piece of work starting in September 2018, for report in February 2019;

-       Rosalind Pearce was asked if there had been any work done by HWO on waiting times for GP practices, as this tended to increase numbers attending Accident & Emergency departments. She stated that HWO had found that people were not happy if people had to wait for longer than one week and there was significant dissatisfaction after two weeks. It was the view of HWO that there was a need to re-educate the public in order to change the way they booked appointments. For example, to encourage them to book a further appointment on their way out from an appointment, if appropriate, or to encourage them to see an alternative doctor sooner rather than later with their preferred one. Nowadays patients could see the practice nurse or the local pharmacist depending on the problem. She added also that now there was a GP service operating in the acute hospital;

-       In response to a question about what HWO planned to tackle next, she stated that HWO had a rolling annual plan in place. She added that HWO  ...  view the full minutes text for item 57/17

11:25

Information is sought by the Committee from the Oxfordshire Clinical Commissioning Group (OCCG) on its plans for future changes and consultation for Banbury Health Centre. In particular information on the challenges, priorities and approach will be sought, including the proposed new model of care in Banbury. The Committee will seek information on how the changes in Banbury relate to the broader context for primary care in the North Locality and on the areas of focus for the OCCG’s consultation plan.

The following reports from the OCCG are attached:

-        Delivering Primary Care at scale in Banbury (JHO8)

-        Consultation Plan – Banbury Health Centre (JHO8)

Information was sought by the Committee from the OCCG on its plans for future changes and consultation for Banbury Health Centre. The following reports from the OCCG were considered:

-       Delivering primary Care at scale in Banbury (JHO8)

-       Consultation Plan – Banbury Health Centre (JHO8)

The meeting was attending by the following representatives:

-       Julie Dandridge, Ally Green and Dr Paul Park – OCCG

-       Paul Roblin – Local Medical Council

A powerpoint presentation was given by Ally Green and Julie Dandridge on proposals for the practice.

Ally Green stated that the OCCG had learned from experience, had engaged with patients already via the PPG. They had also talked to members of the Community Partnership Network and shared the draft plans to consult online. The OCCG had also listened to feedback and had revised their consultation plans and options accordingly. Ally Greene that the CCG had wanted to engage with HOSC early about the way it intended to consult.

The Chairman thanked Ally Green and Julie Dandridge for the presentations. He pointed out that the 8am – 8pm offered by the Centre was the result of a unique contract set up in 2009 as a Darzi Health Centre and it was a facility which was very much welcomed by patients. He began the discussion by asking why was it necessary to move away from these compelling characteristics when it had served the community so well?

Dr Park stated that he was one of the founding GPs of the Centre and had judged it to be a good place to work and gave good primary care service to patients. The question to be considered now was how the opening hours could be retained alongside the expansion of services in north Oxfordshire giving capacity in Banbury to treat unregistered patients, give coverage by the Neighbourhood Access Hub, plus a GP Out of Hours service. In addition, how to take north Oxfordshire forward in terms of health inequality issues with the catchment area containing two clusters with deprivation of illness, disease, cancer and stroke.

Responses to questions from the Committee were as follows:

-       Would Windrush and the drop-in centre at Bradley Arcade shops be included in the consultation? – Julie Dandridge responded that Woodlands and West Bar surgeries would be integrated in an innovative piece of work creating a pathway for other practices to join in. She added that each practice was the GPs own business and each must agree the right way for their practice. However, proposals would allow individuals to join together to decide how to provide services. Dr Park pointed out that Bradley Arcade was a branch surgery of Windrush Surgery.

-       In response to a report about a certain amount of scepticism amongst the public that the Banbury Health Centre would be closed and the need for new GPs and trainees in the area, Dr Park agreed that there was a need for training practices and larger practices could encompass this;

-       A local member of the  ...  view the full minutes text for item 58/17

13:20

In light of the recent focus in the press on Accident & Emergency waiting times and winter resilience, a report has been requested from Health representatives on the system’s preparedness for increased activity during the winter period, particularly in the context of the Delayed Transfers of Care (DTOC) figures and the impact of ward closures at the John Radcliffe Hospital (JHO9).

The Chief Operating Officer of the OCCG, Diane Hedges, will attend the Committee meeting to provide an update on the Winter Plan including the urgent performance and communications activity to support the plan.

Prior to consideration of this item, the Committee heard addresses given by Sarah Lasenby and Larry Sanders.

Sarah Lasenby expressed her general concern about winter care, believing that the present NHS systems were denying patients their health requirements. She made the following specific comments:

-       Earlier this year Accident & Emergency had found itself so stretched it had introduced GP triage in hospitals. In her view, beds had been taken away before the outcomes of the changes had been evaluated in the knowledge that there were staff resourcing problems;

-       In her view the ambulatory units were working very well and it was a good scheme. Innovation was good but not when patients were being put into side corridors on trolleys because there were no beds for them; and

-       She expressed her concern regarding the proposed transfer of services from the Horton Hospital to Witney.

Larry Sanders commented that he respected the work that was going on into innovations in the NHS, the outcomes of which held many interesting ideas. However, reading between the lines he believed it could not work and crises could happen. This was due to the lack of Government funding and the worsening of the manpower situation with shortages of social care workers and GPs. He believed that it was the responsibility of elected members and various professionals working in the services to speak out; the latter having a dual responsibility to patients and the public, as they were the people who knew the most. He made reference to the bed shortages in the UK being the second worst ratio in its European group. He also stated that in his view the lack of future sustainability of the Health system in Oxfordshire was based on constant reductions of beds which amounted to 300 lost. Moreover, it was his view that there had been no attempt to measure the problem of unplanned admissions or re-admissions, due to premature discharges. He made a plea therefore for people to speak out about their concerns, particularly those who had inside knowledge; and to look at the issues affecting the issues that arise, an example of this being unplanned admissions.

The Chairman welcomed the following representatives to the meeting:

-       Diane Hedges – OCCG

-       Dominic Hardisty – Oxford Health

-       Richard McDonald and Dr John Black – South Central Ambulance Service

-       Benedict Leigh – Adult Social Care, OCC

The above representatives commented on the issues important to their organisation prior to questioning from the Committee, with reference to report JHO9.

Diane Hedges stated that there was a need to be realistic, the simple opening of more beds being not straightforward. She pointed out the following:

·         that the John Radcliffe Hospital was also a specialist centre which meant that demand was even higher than elsewhere. Thus, diversion to Southampton or London hospitals to service specialist demand would be required;

·         significant workforce issues and the ensuing patient safety issues meant that beds could not be opened even though it was desired.  ...  view the full minutes text for item 59/17

14:10

The Chairman’s report is attached at JHO10.

Prior to consideration of this item, a statement produced by Jane Southworth on behalf of Deer Park Medical Centre Patient Participation Group (PPG), was read out by the Committee Officer, Julie Dean in her absence.

The statement made the following points:

·         The Deer Park PPG felt duty bound to again voice their objections to the failure by the OCCG to properly implement the recommendations of the Independent Reconfiguration Panel (IRP). It was their view that the work the OCCG was currently undertaking on the wider Locality plan for West Oxfordshire (related to Phase 2 of the Oxfordshire Transformation Plan), had nothing to do with the plan envisaged by the IRP, following the referral of the of the closure of the Centre to the Secretary of State. This was to produce a separate plan for primary care in Witney and its surrounds;

·         The need to produce a separate plan for primary care in Witney and its surrounds, in accordance with the IRP report, was highlighted by this Committee at its 14 September 2017 meeting, the Chairman requesting the OCCG to produce a plan or ‘roadmap’ of the actions it was taking and timeframes, which would be a separate piece of work from the detailed locality work. The Committee had agreed to the setting up of a working group to do this. She asked if the working group had met;

·         The PPG called upon the Committee to enforce the OCCG’s duty to implement the IRP’s recommendations fully and correctly. Despite the OCCG representative assuring the Committee that they would do it as a separate piece of work, it had not happened. She pointed out that the OCCG had been recommended by the IRP that the public and patients be ‘at the heart’ of this project ‘in assessing current and future health needs, understanding what the options are and co-producing the solutions’. The public and patients of Witney had not been involved in producing this plan, to date, within the six-month timeframe as envisaged by the IRP. Furthermore, the PPG remained concerned that no independent person had been appointed to oversee and review the OCCG’s compliance with the IRP plan;

·         OCCG had declined to meet with the Deer Park PPG to enable it to share their proposals for the reconvening of GP services at or near the Deer Park Medical Centre. The IRP had recommended that this possibility should not be precluded;

·         She also made reference in the statement to the two locality planning workshops held recently in Witney and Carterton which the PPG would not regard as ‘public open events’. People were required to pre-book and as a result of it being fully booked, some people had been turned away. There was also a change of both venues, causing confusion. The ‘round table’ format of both events was not agreed with the patient forum groups with no patient group input as to its format; and

·         She stated that in her view there was public mistrust of the OCCG and public dissatisfaction with  ...  view the full minutes text for item 60/17

The Committee’s attention is drawn to the following document which is for information only:

-        A briefing on changes to the provision of musculoskeletal services in Oxfordshire (JHO11).

Noted.