Agenda and minutes

Cllr Ian Corkin attended for Cllr Dr Simon Clarke, Cllr Jenny Hannaby for Cllr Alison Rooke and City Cllr Mark Ladbrooke attended for City Cllr Susanna Pressel. Apologies were received from Dr Alan Cohen, Cllr Monica Lovatt and District Cllr Nigel Champken-Woods.

There were no declarations of interest.

To approve the minutes of the meeting held on  16 November 2017 (JHO3) and to receive information arising from them.

NB. For ease of reference a copy of the actions from the last meeting are attached for information (JHO3a)

The Minutes of the meeting held on 16 November 2017 were approved and signed as a correct record.

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 7 - Jane Southworth and Brenda Churchill - representing Deer Park Patient Participation Group

-       Agenda Item 7 – Yvonne de Burgo – Deer Park Surgery speaking as a member of the public

-       Agenda Item 9 – Anita Higham speaking on behalf of the Oxfordshire Locality Patient Participation Forums - regarding MSK Services.

10:15

The Committee’s Forward Plan is attached at JHO5 for consideration.

The Committee reviewed the latest Forward Plan (JHO5), adding the following:

-       21 June 2018 meeting – to receive a report on the Stroke Rehabilitation pilot as discussed at the September 2017 meeting;

-       21 June 2018 meeting – to receive a report on the transition of Learning Disability services from Southern Health to Oxford Health.

For action

-       Issues of Homelessness to be reported to the Health Improvement Board for action;

-       The Chairman to discuss with the Chairmen of the Health & Wellbeing Board and the Health Improvement Board about how public health issues cross over with this Committee and the most appropriate mechanisms which would give the most effective oversight and scrutiny.

10:30

George Smith, Chairman and Rosalind Pearce, Chief Executive Officer, will be present to report on the views and latest activities from Healthwatch Oxfordshire (JHO6).

The Committee welcomed Professor George Smith, Chairman, and Rosalind Pearce Chief Executive Officer of Healthwatch Oxfordshire (HWO) to present the regular update of issues/activities since the last meeting (JHO6). They highlighted the following from their report:

·         Musculoskeletal services – Healthshare – HWO was aware of the current issues and were meeting with Healthshare that afternoon to raise issues of concern which had been reported;

·         HWO was launching a new website in the style of Trip Adviser which would give HWO direct feedback from the public on every aspect of health and social care. This in turn would serve to flag up areas for HWO to focus its attention; and

·         Three further appointments had been made to the HWO staff roll – one of which was a project officer to work with groups that provided feedback on issues of concern from patients and the public. The aim was to raise the standard of HWO reports by giving a clear focus and to better co-ordinate the stakeholders involved.

Questions from Committee Members and responses received were as follows:

-       In relation to an inquiry as to whether there were any safeguards in place to protect against fake reviews in respect of the new website, Professor Smith responded that HWO was very aware of this and employed a moderative stance. All comments were scrutinised, some of which were better re-directed to the complaints procedure and not placed on the website. This was an opportunity to pick up an issue which had attracted multiple reviews from patients and the public, and to comment back.

-       Professor Smith and Rosalind Pearce were asked if there had, in their opinion, been any recent meaningful engagement with BOB regarding the STP and how HWO were managing to stay with the rapid progress in relation to Accountable Care systems. Rosalind Pearce responded that there had been no public engagement with BOB recently as Louise Patten, the new Chief Executive of the OCCG, had only just taken up her employment. HWO were however keeping a close eye on the situation as things were moving quickly and it was important to exert influence. She added that not all discussion was based on written reports but was verbal and engagement could take place at any time.  HWO was keeping a watching and listening brief in the communities and there were, for example, two forthcoming events taking place in Wantage and Wallingford;

-       With regard to a comment from a member of the Committee regarding the problems being experienced by some users of the new Musculoskeletal Service, Professor Smith stated that HWO was continuing to put pressure on the OCCG and the provider to respond to problems. He stressed the importance of the work being undertaken by the OCCG to put in place more standardised Patient Participation Groups (PPG) across the County - and in turn the work HWO was doing at a locality level with PPGs to help the OCCG to achieve this. This would serve to give a more effective  ...  view the full minutes text for item 6/18

10:45

The item (JHO7) gives feedback on progress made on recommendations made by the Independent Reconfiguration Panel (IRP) to this Committee and the Oxfordshire Clinical Commissioning Group (OCCG). The recommendations emerged following a referral made by this Committee to the Secretary of State relating to the decision by OCCG not to re-procure services at the Deer Park Medical Centre.

The item will cover progress on:

(a)  development of a comprehensive plan for primary care and related services for Witney and its surrounds. OCCG representatives will share the West Oxfordshire Locality Plan with the Committee;

(b)  feedback from the independent review of the OCCG’s process for developing a comprehensive plan for primary care in Witney and its surrounds. This review was commissioned by NHS England and representatives will attend to introduce this item; and

(c)  a review of the relationship between this Committee and Health to ensure it commands public confidence. The Committee will receive feedback from the review and the next steps following a joint HOSC/Health ‘ways of working workshop.

Prior to the discussion of this item the Committee was addressed by the following members of the public:

Brenda Churchill made the following points:

-       She had been unable to find any trace of the content of the IRP report and recommendations in the Witney and its surrounds Locality Plan;

-       The review of Locality Plan patient engagement was misleading. Two meetings had been held in Carterton and Witney and only 125 people had attended them. Some locals had been refused entry as they had failed to book a place at the venue – it was her view that it was an insult to those people who had found it necessary to book a place as they were local residents;

-       It was misleading to call the Plan a review document. She had not been made aware that NHS England had employed people to review the Locality Plan – nobody had approached her about this; and;

-       New houses were in the process of being built now and patients would have to cope with more and more demand for the existing primary care services. She implored the Committee to instruct the OCCG to do as the IRP instructed and refute the plan.

Jane Southworth

-       It was now over a year since the OCCG’s decision to close the Deer Park Surgery and seven months since the IRP had made its recommendations to incorporate patient views into the plan. Nowhere had the Deer Park Health Group been engaged in the co-production of the Plan to address and provide solutions to the current future health needs of the area;

-       She made reference to a personal experience of misdiagnosis by a paramedic and subsequent shambolic access to GP appointments;

-       She asked about a proposal to relocate the Nuffield Health Centre – this had not been debated.

Yvonne de Burgo

-       Had been a patient at Deer Park Surgery and a member of its PPG;

-       As a patient suffering with complex health needs, she had always received good care from Deer Park Surgery;

-       She recounted her recent experiences of patient care at the surgery of which she was now a patient and had found it wanting in a number of areas including a lack of monitoring or follow up care;

-       She expressed her hope that Deer Park would re-open;

-       She was very concerned and stressed about the new housing being built in the area and the resulting numbers of new patients; and

-       In all, the above had caused her great distress and fear that her life could be cut short.

The Chairman welcomed Louise (Lou) Patten, new Chief Executive of the OCCG to the meeting, together with Catherine Mountford and Julie Dandridge, OCCG.

Catherine Mountford, in introducing this item stated that the main focus was about ensuring safe and sustainable primary care in Oxfordshire. The focus that day was on the changing needs and changing population in the West Oxfordshire area.

With regard to progress made on  ...  view the full minutes text for item 7/18

12:00

In light of the recent focus in the press on cancer services at the Churchill Hospital, a report was requested from Health representatives (JHO8) on the provision of services at the Hospital and any actions taken to ensure the resilience of these services.

The role of HOSC in monitoring the provision of Cancer Care at the Churchill going forwards will be discussed.

In light of the recent focus in the press on cancer services at the Churchill Hospital, a report was requested from Health representatives on the provision of services at the Hospital and any actions taken to ensure the resilience of these services. This was attached at JHO8 for consideration.

The Chairman welcomed the following representatives from the OUH to the meeting:

Dr Andy Peniket – Clinical Lead for Haematology

Matt Akid – Head of Communications

John Drew – Director of Improvement & Culture

Matt Akid began by welcoming the approach made by the Committee to establish the facts behind the headlines, expressing his belief that communication was very important to the Service. He explained that the headlines had centred on one part of the patient pathway which was chemotherapy treatments given at day treatment units at the Churchill Hospital and at the Brodie Centre at the Horton Hospital. Almost 100 patients a day received treatment at these centres combined, which was a 10-12% annual increase in patients receiving chemotherapy. People were living longer in Oxfordshire compared to other areas and therefore more treatment was being given in comparison with other areas. The specific challenge was not one of resources, rather it was one of provision of nursing staff to manage the service and how to maintain standards in patient care.

He added that the challenges faced by the Trust in relation to the recruitment and retention of staff were substantial.  More money had been put into this area but there were still problems in recruiting. Despite this the number of complaints had fallen and standards of care had continued to be very good.

He outlined the innovative work being undertaken to increase the capacity of chemotherapy services which included:

-       Improved training to aid staff retention;

-       Weekly interviews for staff using social media for recruitment campaigns;

-       Working hard at the standards of service to attract staff.

Dr Peniket highlighted the efforts taken by the oncology consultants in seeking constructive comments and ideas about alternative ways of giving palliative care in a bid to maintain services; given the premise that how one responded to cancer care was not an exact science. Matt Akid added that in this instance the email in question which asked for comments and ideas was leaked and the Times newspaper had led with a headline ‘hospital cuts to cancer care due to lack of staff’. A statement had then been issued to the Times stating that this headline was untrue, no decision had been yet been made and explaining that the aim of the email was not to cut services, that no changes to treatment had been made and the Trust’s priority was to its patients. He agreed that whilst the issue needed to be aired, the impact of the headline was damaging and upsetting to patients. The Trust’s clinical head of service, Dr Hobbs, had spoken to the media reassuring patients and the public of this, stating that the area of challenge was in nurse  ...  view the full minutes text for item 8/18

12:45

The Chairman’s report is attached at JHO9. It includes answers to Committee members’ questions regarding Musculoskeletal Services (MSK) and an update on Banbury Health Centre.

LUNCH 13:30

Prior to discussion of this item the Committee was addressed by Anita Higham OBE, Chair of the North Oxfordshire Locality Forum, on the subject of Physiotherapy as part of Musculoskeletal Services. She also spoke on behalf of the North East, City, West Oxfordshire, South West and South East Locality Forums.

She stated that across Oxfordshire, all six Locality Forum Chairs were receiving concerns expressed by many patients who were experiencing a significant and serious breakdown in the provision by Healthshare for their physiotherapy and muscoskeletal needs.  Healthshare was contracted to provide services for GPs in primary care and patient self-referrals.

She pointed out the view that although there were examples of good services, these were overtaken by serious administrative and organisational difficulties which had led to enormous frustration. Patients had experienced extensive discomfort and further pain due to a lack of treatment long after they had been referred.

OCCG had previously had quite separate contracts with the OUH and OH to the usual physiotherapy for MSK or neurological issues following in-patient procedures.

She asserted that Healthshare had inherited a very considerable backlog of untreated patients from the previous contract holders for GPs and self- referrals and had made seemingly very little improvement in managing this. Locations for patient appointments were also not within acceptable travelling distances from their homes.

The locality forums believed that this was a problem of inadequately challenged and poorly monitored performance against contract by the OCCG. They requested the Committee to seek answers to these matters by requesting an update from the OCCG on publicly-funded Healthshare’s progress against their contractual requirements. 

The Chairman proposed, and the Committee AGREED the establishment of a Task & Finish Group to look at questions of the performance of MSK services, to include the expressions of concern received by the Committee in respect of the above.

Cllr Jenny Hannaby, local member for Wantage, expressed her concern that the physiotherapy department had ceased to operate from Wantage Hospital. Instead people were being allocated to premises in Faringdon, to which there were no bus services. She had recently been informed that people could also go to Witney and Wallingford community hospitals to access these services. She stated that only the maternity facility remained at Wantage and was concerned for the Hospital’s future. The Chairman noted these comments and referred them to the Task & Finish Group for further examination.

Cllr McHugh reported that he had received correspondence from a number of GPs regarding MSK services stating that now the administration had improved, letters of referral had been received by patients. He added however that the time - period for referrals for scans was unacceptable and that the referral form itself were too complex. These issues were also referred to the Task & Finish Group.

The Committee AGREED the following recommendations (made as part of agenda item JHO7);

(a)  develop working principles that could be signed up to by this Committee and Health colleagues

(b)  amend the change process to introduce a staged approach with different  ...  view the full minutes text for item 9/18