Agenda and minutes

Venue: County Hall

Contact: Julie Dean Tel: 07393 001089  Email: julie.dean@oxfordshire.gov.uk

Items
No. Item

23/18

ELECTION OF CHAIRMAN

To elect a Chairman for the 2018/19 Council year. Members are advised that the Constitution for the Committee stipulates that the Chairman is to be drawn from the Oxfordshire County Council members of the Joint Committee.

Minutes:

Councillor Arash Fatemian was elected Chairman for the duration of the Council Year 2018/19.

 

 

24/18

ELECTION OF DEPUTY CHAIRMAN

To elect a Deputy Chairman for the 2018/19 Council year. Members are advised that the Constitution stipulates that the Deputy Chairman is to be drawn from the District Councillors serving on the Joint Committee.

Minutes:

Prior to appointing the 2018/19 Deputy Chairman, the Chairman, on behalf of all members of the Committee, led a vote of thanks to the outgoing Deputy Chairman, District Councillor Monica Lovatt, for all her hard work and support during 2017/18.

 

District Councillor Neil Owen was appointed Deputy Chairman of the Committee for the duration of the 2018/19 Council Year.

25/18

Apologies for Absence and Temporary Appointments

Minutes:

Councillor Nick Carter attended for Cllr Kevin Bulmer, District Councillor Phil Chapman for District Councillor Sean Gaul and apologies were received from District Councillor Nigel Champken-Woods and Anne Wilkinson.

 

The Committee recorded its disappointment that South Oxfordshire District Council had not been represented for a number of recent meetings.

26/18

Declarations of Interest - see guidance note on the back page

Minutes:

There were no declarations of interest submitted.

27/18

Minutes pdf icon PDF 210 KB

To approve the minutes of the meeting held on 19 April 2018 (JHO5) and to receive information arising from them.

 

For ease of reference when considering any Matters Arising from the last meeting, an actions list for 19 April 2018 meeting is attached for information.

 

Additional documents:

Minutes:

The Minutes of the last meeting held on 19 April 2018 were approved and signed subject to the following amendments:

 

-       Minute16/18, Care Quality Commission Local System Review - Page 6, paragraph 2, sentence 1 – to delete the words ‘the provision of beds’ and to substitute with ‘any beds were closed’;

-       Minute 17/18, OCCG: Key and Current Issues’ – Page 9, paragraph 2, sentence 2 – to delete the word ‘the’;

-       Minute 20/18, Oxford University Hospitals NHS Foundation Trust (OUH) Quality Account – page 13, penultimate paragraph – delete the words ‘to return to’ and substitute with the ‘email members of the Committee with their priority areas as they were finalised’;

-       Minute 21/18, ‘HOSC and Health ‘Ways of Working Workshop report and draft principles’ – Page 14, penultimate paragraph prior to the resolution – to amend to (amendments in bold italics):

 

Cllr Laura Price then proposed, and Cllr Glynis Phillips seconded, that the Planning Group be held in public session. This was lost by 3 votes to 7. The Chairman then proposed, and was duly seconded, to formally adopt the recommendations contained in the report.

 

Matters Arising

 

The Chairman agreed that issues in relation to Wantage Hospital, which were referred to at the last meeting, could be raised again under Agenda Item 9 – OCCG key and current issues.

 

 

 

 

28/18

Speaking to or Petitioning the Committee

Minutes:

There were no requests to address the Committee or to submit a petition.

29/18

Forward Plan pdf icon PDF 171 KB

10:15

 

The Committee’s Forward Plan is attached at JHO7 for consideration.

Minutes:

The Committee AGREED to include the following into an updated Forward Plan and to request the Officers to schedule a prioritisation session at the next meeting in September:

 

·         To revisit the MSK Services following the findings of the Working Group (February 2019);

·         Health Inequalities update (in 6 months time);

·         Winter Plan;

·         GP appointments – to include representation from the GP federations; and

·         To prioritise School Health Nurses and the Health Visiting services and the reorganisation of the Oxfordshire Health & Wellbeing Board;

 

30/18

Update on Oxfordshire Winter Plans 2017/18 pdf icon PDF 1 MB

10:20

 

At the time the Oxfordshire Winter Plans were presented to the Committee in November 2017, Members asked to review their subsequent effectiveness. The attached report (JHO8) from the Oxfordshire Clinical Commissioning Group (OCCG) includes information on the success of some of the new initiatives, for example flu jabs for Social Care staff, to learn where the system should be investing in the future.

Additional documents:

Minutes:

 

 

At the time last year’s Oxfordshire Winter Plans were presented to the Committee in November 2017, the Committee asked to review their subsequent effectiveness. Members considered the report JHO8 from the Oxfordshire Clinical Commissioning Group (OCCG) which contained an evaluation of last year’s Plan.

 

The Chairman welcomed OCCG’s Chief Executive, Lou Patten and Chief Operating Officer, Diane Hedges; Karen Fuller, Deputy Director, Adult Services, Oxfordshire County Council (OCC); and Sam Foster, Chief Nurse, together with Sarah Randall, Deputy Director of Clinical Service, Oxford University Hospitals NHS Foundation Trust (OUH), to the meeting. Stewart Bell, Chief Executive, Oxford Health and Dr Kiren Collison, Clinical Chair, CCG joined the Panel to respond to questions later on in the session.

 

Diane Hedges introduced the report JHO8 which covered all angles of the urgent care pathway. Although the focus was on how urgent care supported patients, the report also covered the whole range of options for patients, such as the option to call the 111 service which was supported by clinical advice, the Out Of Hours (OoH) service and the Minor Injuries Units (MIU). It also covered examples of interventions made to try to encourage people not to use the urgent care services, such as the pilot use of the SoS bus in Oxford, the use of the OoH service for patients requiring repeat medication and the use of advice from pharmacy services direct from the 111 service so as not to take up GP time. A wide range of approaches were also being used, such as safe havens for people suffering from mental health illnesses. She stated that the GP Access Fund should increase access to these.

 

Diane Hedges also informed the Committee that, as potentially expected, the 4 hour target for people waiting in Accident & Emergency (A & E) had not been met and the service had been escalated to the highest level. In January/February, when pressures had been felt nationally, operations had been cancelled and Trusts had been requested to re-think their approaches to elective operations. It had been the worst winter in terms of weather nationally with huge numbers of patients waiting to be treated. However, in adversity, alternative solutions had been found to assist in different areas of work, for example, in the approach to home care. Patients had been assessed on an individual basis to enable them to move from their hospital beds more quickly. More care home beds had been bought and the number of community beds had been extended to avoid risk, wastage etc.

 

Lou Patten also highlighted another example of real success which had been the implementation of much tighter assessment systems in hospital and community hospitals, with less duplication, which had resulted in good use of  community hospital beds. Assessments of Delayed Transfers of Care (DToC) patients who had occupied a hospital bed for 7 – 21 days, were linked to the home circumstances of the patient in the first instance, which had resulted in strong progress in this area. OCC had led this work  ...  view the full minutes text for item 30/18

31/18

OCCG key and current issues

11:35

 

OCCG will give an oral update report on key issues and will outline any current and upcoming areas of work.

Minutes:

Lou Patten and Dr Kiren Collison, Chief Executive and Clinical Chair respectively, CCG gave an oral report on the current key issues for OCCG. They were also accompanied by Stuart Bell, Chief Executive, Oxford Health (OH).

 

Lou Patten reported on the following:

 

-       The CCG was now involved in estates and infrastructure in conjunction with the County and district councils via the Growth Board and meetings related to the Oxford/Cambridge expressway. A fruitful meeting had taken place with West Oxfordshire District Council looking at both planning and infrastructure;

-       She had met with the Deer Park PPG to gain their views on processes and transparency for when the CCG decided the trigger points at which GP practices and GP providers were required to look at how else to provide for a growing population;

-       Work continued with providers to discuss how the plans for winter pressures could be executed, at the same time embedding the CQC work, but also ensuring that services were tailored to localities. Details of how the Government monies must be spent were yet to be worked through and the Committee would be kept updated. She reported that she had informed the regulator that if there was not a similar injection of monies for Social Care, then Oxfordshire would struggle to provide what was required. In response to a comment from a member about the lack of national guidelines on this matter, and if Oxfordshire was to become a pioneering authority in this regard, more money would be required from the DoH, she stated that she had asked for some money to oversee it, to accompany the money the CCG would commit for managerial resource. She added the end result would be a transparent look at how the CCG saw resources and how it was taking forward the market for new GPs.

 

Questions and responses received were as follows:

 

Lou Patten was asked about CCG input into the expressway consultation. She responded that she had heard at the Growth Board that the Police and Ambulance flows would be favoured by very good transport links and intended to query with NHS England how it would affect patient flow. A member informed the Committee that the proposal for the corridor was about to be announced and urged the CCG to consider the time-scale in respect of consultations. Stuart Bell pointed out that one of the most important implications arising from this venture was to consider the more strategic planning of services for Health and their sustainability, for example, for cardiac services.

 

A member asked whether the population planning ought to have a 20/30 year time-frame, rather than a 5 year one adopted by the NHS; a point which had been made as part of the IRP submission in relation to the Deer Park Surgery closure. Lou Patten responded that, in order to conduct a dialogue, planning needed to be about understanding the type of local populations and evidencing their needs. Only then could the physical infrastructure needs be looked  ...  view the full minutes text for item 31/18

32/18

Care Quality Commission (CQC) Local System Review pdf icon PDF 129 KB

12:15

 

Representatives from the Oxfordshire Clinical Commissioning Group, the County Council, Oxford Health Foundation Trust and the Oxford University Hospitals NHS Foundation Trust will report on the following issues (JHO10):

 

·         How ‘innovation’ is being interpreted and used in the Oxfordshire system to address the CQC findings;

·         How learning from best practice is being incorporated into the work in Oxfordshire;

·         The work being undertaken to address the housing and workforce issues within the system; and

·         A proposed evaluation framework for actions arising from the system review to assess the impact on service users and patients, to aid scrutiny by the Committee.

 

13:00 LUNCH

 

Minutes:

 

The Chairman welcomed the following representatives from the CCG, OH, OUH and OCC:

 

-       OUH – Dr Bruno Holthof and Sam Foster – Chief Executive & Chief Nurse

-       OH – Stuart Bell, CBE – Chief Executive

-       CCG – Lou Patten – Chief Executive

-       OCC – Kate Terroni, Director of Adult Services & Helen Sanderson

 

A briefing paper was attached at JHO10 and a presentation was given. The Committee thanked all for the useful paper, particularly because it contained specific examples.

 

Questions from the Committee and responses received were as follows:

 

-       Kate Terroni was asked if there was a clear business case to roll out Amazon Echoes to assist older people living at home. She responded that there was and this was an endeavour to avoid the need for carers for particular tasks;

 

-       Dr Holthof was asked if the AGE UK provision for patients in hospital would be via new monies or would it be via existing contracted services with Age UK. He responded that the Trust would pay and no extra funding would be received for this additional service;

 

-       A member commented that 48% was a useful statistic in relation to keeping people out of hospital and asked what the mortality rate was. Dr Holthof undertook to send a paper for information;

 

-       In response to questions asking who was commissioning the Wellbeing Teams? who was funding the delivery of the service? and who was accountable for the recruitment of outside organisations and development of the service? Kate Terroni responded that OCC was funding the Wellbeing pilot and was accountable for the delivery outcome for the one - year pilot. She added that it demonstrated a new way of working locally and it was her view that it was accompanied by the right values and attitudes.  Moreover, Adult Social Care was to set up some flexible home care services looking at a whole range of options for delivery. She added that the private sector would be encouraged to participate. Performance screening would look at workforce issues and an Officer would be attending a future meeting to present the outcomes and respond to questions;

 

-       Kate Terroni was asked if OCC would be supporting the ongoing work to gain recognition for the inclusion of care workers into the definition of key workers. She responded that there was a need to work up a definition of key workers and would come back to Committee on this issue if required;

 

-       Kate Terroni was asked if the potential partnership agreement with Cherwell DC might address the need for housing and recruitment of staff workers. She responded that Lou Patten and herself had met the previous day and had agreed that there was a potential to look at housing at local level, which could be quite exciting if the opportunity arose;

 

-       In response to a question about how home care scheduling worked for self-funders, she reported that there was a very active and vibrant domiciliary provider market with whom  ...  view the full minutes text for item 32/18

33/18

Healthwatch Oxfordshire pdf icon PDF 133 KB

13:45

 

Rosalind Pearce, Chief Executive Officer will be present to report on the views and latest activities of Healthwatch Oxfordshire (JHO11). She will present a short video which has been co-produced by the Luther Street Medical Practice Patient Participation Group (PPG), Healthwatch Oxfordshire and the Luther Street Medical Practice staff on the work of the PPG of the Medical Centre.

 

 

 

Minutes:

Rosalind Pearce, Chief Executive Officer, Healthwatch Oxfordshire (HWO) attended to present the HWO update (JHO11). She also presented a short video which had been co-produced by the Luther Street Medical Practice Patient Participation Group (PPG), how the Luther Street Medical Practice staff, on the work of the Medical Centre’s PPG. She stated HWO was working well with the PPG and that this was an example of the PPG going to where the patients were rather than the other way around. The Committee thanked her for bringing the video to the Committee’s notice.

 

In response to concern expressed by a member that 40% of children were known to have tooth decay by the age of 5 and the need to target this in areas of deprivation, Rosalind Pearce responded that a HWO report was due for publication at the end of July which included a survey of care homes on dentistry provision for their residents. She added that in her view this was a classic area of joint responsibility for the Public Health and NHS areas. She also added her agreement of the importance of dental care beginning at a very early age.

 

A Committee member informed the Committee that there had been much concern expressed at a recent voluntary sector forum she had attended; and also expressed in discussion on the streets of Wantage, about the temporary loss of community care bed facilities at Wantage Hospital following its temporary closure 2 years ago.

 

A member supported the different approaches/interventions being taken in relation to people’s health and wellbeing, such as the Health Checks project which targeted young men. Ros Pearce agreed that if HWO had not undertaken this it would not have reached these men in the normal manner. She also expressed the hope that others would learn from this approach taken by HWO.

 

Ros Pearce was thanked for her report.

 

34/18

Update on implementation of recommendations from the Oxfordshire Health Inequalities Commission pdf icon PDF 412 KB

14:00

 

A request was made on 16 November 2017 that progress be reported to this Committee every 6 months to ensure Health Inequalities remains a priority. A report is attached which will review progress of the Health & Wellbeing Board with the Health Improvement Commission’s recommendations (JHO12).

Minutes:

In response to a request made by this Committee for progress on the review from the Oxfordshire Health Inequalities Commission to be reported every 6 months to ensure that health inequalities remained a priority, an update report was attached at JHO12. Dr Kiren Collison, Clinical Chair of the OCCG and Vice – Chair of the Health & Wellbeing Board, and a member of the Implementation Group which she also chaired, joined Dr McWilliam and Jackie Wilderspin, Public Health, OCC at the table.

 

Dr McWilliam introduced the item giving a brief overview of the process, reminding the Committee that the recommendations had no force of statute and some were very broad about society as a whole. Jackie Wilderspin spoke to the report highlighting the following key issues:

 

-       A multi-agency group met quarterly which included membership from the district councils, OCC, OCCG and other bodies to consider how and who would take forward the recommendations of the Commission;

-       Six priority areas had been highlighted and there was now a basket of indicators on ‘Oxfordshire Insight’’

-       Little progress had been made on the setting up of the Innovation Fund as groups did not wish to duplicate what was already in existence;

-       A workshop had been held to look at the reasons why benefits were not taken up, the outcomes of which would be taken to the Implementation Group to take forward;

-       Good work had taken place on social prescribing which was OCCG led;

-       Physical activity issues had been targeted and OXBAR had agreed to take them forward;

-       A specific initiative on prevention issues had been taken on by the Oxford City Locality Group, working with Mental Health; and

-       The Implementation Group was due to meet in July and wold be focusing on the list of recommendations, where progress had not yet been made.

 

Dr Collison commented that Health Inequalities should form a part of every workstream within Health and Social Care stating that there was a significant amount of work to do in relation to recognising its importance.  She undertook to provide further information to members of the Committee in relation to recommendation 48 relating to the gathering of information on race.

 

When asked about how Health Inequalities for people suffering from mental health illness was being addressed, Dr McWilliam responded that this was included across the board, along with those for people with a learning disability (recommendation 39).

 

A member asked why the Commission did not address recommendations that related to the link between housing and health inequality, for example, to work more closely with housing associations in order to improve inequalities. Jackie Wilderspin stated that the report was a product of the evidence the Commission had taken from local data sources and responses received – and the links with housing had not been included in the report. Dr McWilliam added that Health had been a missing piece in local planning. However, its role was now much to the fore and was about to enter  ...  view the full minutes text for item 34/18

35/18

Stroke Rehabilitation Services - Pilot Report pdf icon PDF 238 KB

14:45

 

Oxford Health will report back on the performance, outcomes and next steps following the Stroke Rehabilitation Services Pilot. It includes information on the plans to provide intensive care at home, on the County Council therapy services, and the plans for expanding the ESD services. It also seeks further evidence about issues about the Services highlighted by Healthwatch Oxfordshire (JHO13).

Minutes:

Stuart Bell, Chief Executive, Oxford Health, presented a report (JHO13) which reported back on performance, outcomes and the next steps following the Stroke Rehabilitation Services pilot. He stated that the move had taken place in February from Witney to the Abingdon site. Since then it had been found that the length of stay had reduced which meant that patients were able to go home more quickly.

 

Attending alongside Mr Bell was Dr Robbie Dedi, Deputy Medical Director, OH and Sara Bolton, Allied Health Professions Lead, OH.

 

Cllr Rooke reported that some members of the Committee had made a very interesting visit to the Stroke Unit and had found the staff to be very engaged in their work. Questions asked and responses received were as follows:

 

In response to questions from members regarding a recent Healthwatch Oxfordshire report which had stated that a number of patients at Abingdon were waiting for a discharge package for occupational therapy and physiotherapy; and 70 patients were waiting for assessment, Sara Bolton stated that therapy was provided on the Unit and exercises were also given for patients to do at home on leaving the Unit. She added her awareness that there were waiting times in the Community Therapy service, stating that the Team would provide more information to the Committee on this subject.

 

In relation to a question asking at what point did a patient begin to deteriorate without physiotherapy, Sara Bolton stated that it depended upon the individual’s treatment plan. If a patient required therapy immediately following discharge then it would follow through as a seamless process. Sometimes hospital patients were given extra therapy. Dr Dedi added also that even without therapy, the level of functioning deteriorated the longer a person was in a hospital bed. Therefore, getting these patients home would improve their situation.

 

In response to a question about whether there had been input from families /carers regarding the travel aspect of the move, Dr Dedi stated that there had been no specific complaints or consistent carer feedback regarding the transfer. The patients were made aware of the benefits of co-locating which were that they would be better cared for and would be moved back to their home more quickly.

 

A member asked about the costs of recruiting nursing staff. Sara Bolton responded that the Trust continued to have a very active recruitment process which had been extended to embed agency staff further into the Team. This, however, was not a long - term plan. Also, in response to a question about how many staff had left the service as a result of the transfer, how many had transferred and how many had returned, Sara Bolton stated that she did not have the current details with her of who had left the service. However, four support workers had discussed a transfer to Abingdon which would create a good Team.

 

 The Chairman requested at this point that representatives returned to a future meeting once the evaluation pilots had been completed, adding that the  ...  view the full minutes text for item 35/18

36/18

Transition of Learning Disability Services pdf icon PDF 348 KB

15:30

 

The OCCG will give an update the Committee on the transition of Learning Disability services from Southern Health to Oxford Health which took place in July 2017 (JHO14).

 

 

Minutes:

Following the transfer of specialist learning disability health services from Southern Health Foundation Trust to Oxford Health in July 2017, Sula Wiltshire, the OCCG’s Director of Quality and Lead Nurse attended to present an overview report (JHO14) of the transition which included a consideration of whether lessons had been learned. She was supported by Chris Walkling, Senior Commissioning Manager for Mental Health at the CCG and the co-chairs of the Oxfordshire Transforming Care Partnership Board, Gail Hanrahan (Oxfordshire Family Support Network) and Paul Scarrott (My Life My Choice).

 

She introduced the report by stating that the OCCG had undertaken this piece of work at the request of this Committee, its focus being on quality and safety from the users and carers’ perspective. She informed the Committee that this had been very much a shared piece of work with Southern Health, Oxford Health and ‘My Life My Choice’.

 

Paul Scarrott informed the Committee that he had sat on the Board during its consideration of the transition and its view was that the transition had gone smoothly, with no staffing problems encountered. The Oxfordshire Family Partnership Network had been successfully embedded within the process which had involved families and users in the process. It had also co-chaired the Board. The Network had been part of the whole of the process, for example, viewing and commenting on, if necessary, letters to families prior to despatch. This had been very good from the Network’s perspective.

 

The Chairman stated that this information was very reassuring and positive, asking if Oxfordshire was the only place who had experienced this level of involvement. Gail Hanrahan explained that this had been a difficult process to be a part of initially, given the mistrust from families following Conor Sparrowhawk’s death. She added that it had been a risk of reputation for their organisations to be a part of the process. She added however that there would always be a mistrust of the NHS, given the recent Leader’s report and the Mazar’s review. A benefit had been the learning for the NHS that the involvement of families was required when changes were made to a service. As a result of this involvement there was now more trust in the process and knowledge that the views and input of families were required to create a more level playing field.

 

A Committee member thanked Gail Hanrahan and Paul Scarrott, on behalf of the Committee stating that there was a need for more of this method of involvement within the NHS when difficult changes were proposed. Sula Wiltshire was asked if there had been any interaction the ongoing health inequality work within the County. She responded that, as a result of the Mazar’s report, a joint report had been undertaken between the OCCG and OCC’s Safeguarding Adult Board. As a result, a sub-committee had been created reviewing mortality and morbidity. This had been set-up prior to the formal requirement to look at it. She reiterated the importance of learning lessons. For example, it  ...  view the full minutes text for item 36/18

37/18

Chairman’s Report pdf icon PDF 160 KB

16:15

 

The Chairman’s report is attached (JHO15).

Minutes:

The Chairman addressed his report (JHO15).

 

At the request of the Committee he undertook to:

 

(a)          raise formally with South Oxfordshire District Council the question of representation at this Committee;

(b)          include in future reports a correspondence record; and

(c)           circulate the Task & Finish Group report on MSK services to all members of the Committee. He took this opportunity to thank the three members of the Group for their valuable work. These were Dr Cohen, Cllr Monica Lovatt and Cllr Laura Price.

 

It was AGREED to receive the Chairman’s report.

 

 

 

38/18

Dates of Future Meetings

Here are the dates of future meetings of this Committee for your diaries:

 

All take place on a Thursday and start at 10am (with a pre-meet at 9:15am):

 

20 September 2018

29 November 2018

7 February 2019

4 April 2019

20 June 2019

19 September 2019

21 November 2019

6 February 2020

Minutes:

The dates of future meetings are as follows:

 

(All to take place on a Thursday to begin at 10am, with a pre-meet at 9:15am for members of the Committee only)

 

20 September 2018

29 November 2018

7 February 2019

4 April 2019

20 June 2019

19 September 2019

21 November 2019

6 February 2020