Agenda and minutes

Councillor Jeanette Matelot attended for Councillor Mike Fox-Davies.

The Chairman took this opportunity to welcome new members Cllr Hilary Hibbert-Biles and Cllr Sean Gaul to the Committee.

Cllr Hilary Hibbert-Biles declared a personal interest in Agenda Item11 – ‘Annual Report of the Director of Public Health 2017/18’ on account of her former office as Cabinet Member for Public Health and Education.

To approve the minutes of the meeting held on 21 June 2018 (JHO3) and to receive information arising from them.

For ease of reference when considering any Matters Arising from the last meeting, an actions list for 21 June 2018 is attached at JHO3 for information.

The Minutes of the last meeting were approved and signed as a correct record subject to the following:

-       Minute 34/18 – ‘Update on implementation of recommendations from the Oxfordshire Health Inequalities Commission’, page 14, paragraph 5, line 3 to add in the words ‘health issues’ after the word ’familiar’;

-       Minute 35/18 – ‘Stroke Rehabilitation’ Services – Pilot Report’ – page 15, paragraph 3, line 1, to add the words ‘along with the local MP’, after ‘Committee’;

-       Minute 36/18 - ‘Transition of Learning Disability Services’ – page 17, paragraph 2, line 7, to delete the word ‘Leader’s’ and to add ‘Leader’.

There were no Matters Arising.

The following requests to speak had been agreed:

-       Cllr Brenda Churchill, speaking as a patient of Cogges Surgery and as Mayor of Witney (Agenda Item 8);

-       Cllr Rosa Bolger, speaking as local Member for Witney East (Agenda Item 8);

-       Julie Mabberley – speaking on behalf of the Wantage Hospital Campaign Group (Agenda Item 9);

-        Councillor Jenny Hannaby, speaking as a local Member for Wantage – Agenda Item 9; and

-       Joan Stewart speaking on behalf of ‘Keep our NHS public (Agenda Item 9).

10:15

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

The Committee gave consideration to the latest Forward Plan, as amended since the last meeting (JHO5).

With regard to the item ‘School Health Nurses’ - this was amended to ‘The impact of school health nurses in primary and secondary schools and future service plans’

A member suggested that the Committee look at the County Council’s response to the Green paper. The Chairman agreed to take this forward to the Planning Group.

10:20

The Committee will consider proposals for the evaluation of action taken following the CQC system review (JHO6).

In April 2018, following a presentation on the progress of work being carried out in response to the CQC Local Area Review, this Committee had asked Oxfordshire System Leaders to develop an evaluation framework to measure how actions taken in response to that review would improve outcomes for people who accessed services.

At the June meeting of HOSC Oxfordshire System Leaders had reported that there was no national framework for measuring the performance of actions plans developed as part of the CQC’s programme of local system reviews. Similarly, the Department of Health & Social Care had not yet developed a performance framework for measuring a health and social care system in its entirety. It was also noted that a number of performance indicators were already being measured and reported on and it was from these that a performance framework would be drawn together.

Also at the June meeting the Committee had received a presentation highlighting some innovative approaches to delivering services, together with an example of how Oxfordshire was learning from best practice elsewhere. The Committee had requested that System Leaders returned to this meeting with some additional examples of how best practice was being incorporated into the work.

The Committee welcomed Louise Patten, Chief Executive, Oxfordshire Clinical Commissioning Group (OCCG); Kate Terroni, Director for Adult Social Services, Oxfordshire County Council (OCC); and James Underhay, Director of Strategy & Communications & Deputy Chief Executive Officer (South Central Ambulance NHS Foundation Trust) to the meeting.

Kate, introducing the item, stated that since the CQC inspection, discussions had been underway on how to draw together the Action Plan and how to evaluate it in order to allow its scrutiny; and what proposals to take forward to the newly created Oxfordshire Health & Wellbeing Board on 15 November 2018 to allow the delivery of a new HWB vision. She added that there were many actions which are to be done differently with regard to the pathways, the culture and the narrative of the system. Kate stated that all leaders had worked together and through more joint roles in order to make the experience better for patients and residents of Oxfordshire. Kate stated that although the targets set in the paper presented appeared conservative, these were et centrally and locally. Moreover, the system was working towards a more ambitious progress.

Examples given by the presenters of changes made included:

·         Following a two - day event, a proposal was made to create the first system post, that of a single Winter Director with a single team;

·         For the workforce, best practice had been followed and funding had been awarded to develop a system of care certificates which would be portable across agencies, particularly targeting the under 24’s;

·         The Ambulance Service was working nationally with NHS England, putting together a home delivery plan, which would comprise of therapists who were better equipped to pull together and deliver the best service for patients. This work had been piloted in Reading;

Louise Patten reported that the CQC were returning to Oxfordshire on  ...  view the full minutes text for item 44/18

10:45

The Winter Plan 2017/18 was presented to this Committee in November 2017 and an evaluation considered by this Committee at the last meeting in June 2018.

This report (JHO7), prepared by the Systemwide Winter Planning Group and approved by the Integrated System Delivery Board, follows up on the evaluation regarding the subsequent effectiveness of the Plan, as requested by Committee at its June 2018 meeting.

This item will also outline the Winter Plan for 2018/19 which will include learning from the previous year(s).

The Committee welcomed the following representatives to the meeting:

-       Louise Patten and Diane Hedges, Chief Executive and Chief Operating Officer, Oxfordshire Clinical Commissioning Group (CCG)

-       Tehmeena Ajmal, Winter Director for Oxfordshire, (joint appointment for Oxfordshire health and social care system)

-       Pete McGrane – Acting Clinical Director, Operations Services, Oxford Health NHS Foundation Trust (OH)

-       Ross Comett – Head of Operations, South Central Ambulance Service (SCAS)

-       Kate Terroni, Director for Adult Social Services, Oxfordshire County Council (OCC)

-       Rachel Piri, Lead for Older People Commissioning Mkts, OCC

Diane Hedges gave a presentation on the 2018-19 Oxfordshire System Winter Plan, together with a summary on what worked and what didn’t work in relation to last year’s Plan. She took the opportunity to introduce the newly appointed Urgent Care Director, Tehmeena Ajmal, who worked to the Chief Executives of OUH, OH, OCCG, SCAS, GP Federation and the Director of Adult Services, OCC, co-ordinator of a Team from all these organisations on a demand/capacity dashboard. This would hold information updated on a day to day basis and sometimes on an hour to hour basis, looking at, for example, how many people were waiting to be admitted, or how many were waiting for an ambulance, so that actions could be taken quickly and patients were supported appropriately through the Winter period, enabling them to recover quickly. Following a review of last year’s Plan it had been found that:

·         too much time had been spent on the delayed transfers of care and insufficient attention given to caring for people in their own home;

·         emergency care and Out of Hours did not necessarily co-ordinate or plan ahead on what may be needed on a day to day basis;

·          there was duplication in some areas where three teams were working together – more time with people was required rather than excessive geographical travel.

Tehmeena Ajmal had discussed with Healthwatch Oxfordshire and provider and third sector organisations on how to keep people safe and well and how to work together to ensure there were plans in place for people to receive help when needed, for example for volunteers to go to the shop for the basics, such as milk and bread.

In relation to risks, she added that it was important to ensure that influenza inoculations for front line staff were begun earlier. Also, during inclement weather it was important that each organisation had an instant plan which would ensure that they had sufficient capacity to look after people in their own homes. She was also looking to ensure that nursing staff and therapists could respond quickly when they were needed and with no gaps, by creating overall system plans. There was also a series of projects to best help people to stay at home. Each organisation was asked to identify what could be done with the funding in order to respond to the Winter Plan. This confident style approach enabled the Team to use resources most effectively. She emphasised that hospital beds were  ...  view the full minutes text for item 45/18

11:30

CCG will update the Committee on key issues for the CCG and will outline current and upcoming areas of work. This includes an update on Cogges GP Practice, Witney (JHO8).

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

Cllr Brenda Churchill, speaking as a Cogges GP Surgery patient, a member of Cogges Patient Participation Group (PPG) and Mayor of Witney, stated that the closure of the surgery came as a shock and had caused the Town great concern. Whilst they were aware that the circumstances of this closure differed from the Deer Park Surgery closure, the fact remained that there were only two doctors’ surgeries remaining in Witney. These struggled to take on an extra 4,500 patients, with the additional problem of shortness of space. With the extra 7,749 additional patients, she asked how they would cope. Moreover, extra doctors would be required at a time when surgeries were struggling to recruit and in circumstances where a large number of houses were being built. She also pointed out that many of the patients at Cogges lived outside of Witney in South Leigh and in several more of the villages to the east of Witney; asking how would patients travel into Witney to see a doctor when there was no bus service serving those areas.

Cllr Churchill also pointed out that, in her view, if some of the IRP ,recommendations regarding Deer Park patients had been taken on board by the CCG then this situation would not have happened. The recommendation to not preclude opening the Surgery again had not been looked at seriously, and, in her view should have been. As a consequence, she urged the Committee not to allow another surgery to close until such time as fully workable business plans could be seen, to ensure that other practices had the capability of taking the 7,749 patients, plus the new patients. She concluded that, in her view, the CCG’s Locality Plan was not workable and Witney town now needed the OCCG et al to begin to look at what needed to be done to give the people of Witney the patient care they deserved.

Cllr Rosa Bolger, speaking to save Cogges Surgery, stated that Cogges Surgery was essential to Witney and its surrounding villages. She pointed out that this repetition of the Deer Park Surgery closure was no different to the picture emerging nationwide which, to date, had seen the closure or merger of 200 GP practices. She informed the Committee that a community workshop had been convened to ensure that all voices were heard. The community wanted the GPs to remain at Cogges. Cllr Bolger told the Committee that a positive meeting had taken place with the OCCG, who appeared to understand the importance of keeping the surgeries open in the Town. She asked that the Committee continue to scrutinise this matter and to commit to working with the OCCG to retain the surgery, as a steer towards a better solution. In addition to apply pressure to ensure that the highest bidder was intending to retain services at Cogges, to ensure it thrived, rather than be closed. She also  ...  view the full minutes text for item 46/18

12:15

To consider a report (JHO9) from the Clinical Commissioning Group and the Oxford Health Foundation Trust giving an outline framework for working with local communities to review local health needs, current and projected demographics and local assets, to inform service change.

The report includes a timeframe and consultation plan for developing options for the local area that includes Wantage Community Hospital. Please note there will be a number of A3 copies of the Annexes supplied at the meeting for ease of reference.

13:15 - LUNCH

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

Julie Mabberly, speaking on behalf of the Wantage Hospital Campaign Group stated that when she previously addressed the Committee prior to the temporary closure of the hospital in 2016, it had been understood that this closure was subject to statutory consultation. This had not taken place adding that an engagement exercise was not the same as one of consultation. She pointed out:

-       that 650 new homes had been planned for the Wantage area, now the figure stood at 1,000;

-       there was a significant percentage of people aged 65 and over and the local NHS was not making the most of the family and friends asset and resources;

-       the difference in care in community hospitals to that of acute hospitals was that patients were encouraged to leave their beds;

-       it was not understood where the required 142 beds would be situated.

Cllr Hannaby, local member for Wantage, spoke of the ‘invisibility’ of Wantage Hospital stating her view that the ‘new plan’ presented to Committee would not be implemented quickly. She called for a comprehensive online consultation plan to which the public could give their comments. It was her view that, had legionella not broken out, the situation would not be as it was currently. She stated her belief that the OCCG had taken this as an opportunity to close the hospital, commenting that Wantage Hospital was a vibrant hospital which had served the community well. The Hospital also gave employment to a large number of people in the area. She urged the Committee to help the people of Wantage in their campaign to keep it open until such time as the health provision was decided for the area. She asked for equal treatment with other towns in Oxfordshire, expressing her fear that this kind of proposed engagement for the county would begin to split communities and one town against the other. Furthermore, it was her belief that the Hospital needed to be open to assist with the winter pressures. She concluded by stating that if the consultation was not open and transparent, it would be unsuccessful.

Joan Stewart, speaking on behalf of ‘Keep our NHS P,ublic’ campaign commented that at first glance, the framework suggested a gentle move towards approval. However, it was her view that beyond the window dressing, the intention was still the same which was to mask underfunding and the provision of few hospital beds. She added that in the past there would have been a consultation, but this review was not in the same vein. She asked if the proposed options would be deliverable. She pointed out that an audit of the community hospitals had already been carried out in 2016, and, in her view, the primary care locality plans were already in motion and underway. She asked where was the interconnection of the community hospitals, warning that a domino effect could ensue alongside greater fragmentation,  ...  view the full minutes text for item 47/18

13:45

Rosalind Pearce, Chief Executive Officer, Healthwatch Oxfordshire (HWO) will be present to report on the views gathered by HWO and its latest activities (JHO10).

Rosalind Pearce, Chief Executive Officer, Healthwatch Oxfordshire (HWO), reported the views gathered from members of the public and the latest activities of HWO (JHO10.)

She reported that she was pleased to see Health and Social Care working together in a closer way and its impact on DTOC statistics.

Cllr Lovatt reported that the Committee’s Task & Finish Group had met the previous week and had valued the information received from Healthwatch Oxfordshire on the patient experience of the Healthshare and MSK service. The Group would be publishing its recommendations in due course. Cllr Pressel made reference to the evaluation of the survey on breastfeeding support, to which she had had an involvement, together with the literature for the public to be found in GP and dentists surgeries. This had revealed that NHS England would be looking to produce information sharing leaflets.

When asked about the outcomes of the workshop on dentistry, Rosalind Pearce reported that NHS England had not been able to send anybody to the meeting; and there had also been limited availability of other NHS representatives who had been scheduled to attend. The meeting had focused mostly on carers and dental services in care homes. She added that HWO had worked with the local dental network on how recent toolkits could be re-designed. It was hoped that, in six months’ time, there would be a beneficial outcome for patients.

The Committee AGREED to thank Rosalind Pearce for the report and for her attendance.

13:55

An Annual Report is a statutory duty of each Director of Public Health and it is a duty of the County Council to publish this report.

The Director of Public Health, Dr Jonathan McWilliam will present his independent Annual Report for 2017/18 (JHO11). Members of the Committee are asked to receive the report and consider the key issues which it would like to see taken forward in the year ahead.

The Director of Public Health, Dr Jonathan McWilliam, presented his independent Annual Report for 2017/18 (JHO11). The Committee was asked to receive the report and to consider any key issues which it would like to see taken forward in the year ahead.

Dr McWilliam highlighted the following for 2017/18:

-       There had been good signs of organisations such as health, housing and planning working together to highlight solutions to be worked for together. For example, the work undertaken with residents in Barton and Bicester;

-       Many indicators had seen an improvement, such as those for smoking (though there was a need to maintain an oversight in particular on smoking amongst manual workers);

-       Positive work was ongoing with mental wellbeing, for example, good work was taking place by school health nurses and work with the military and veterans;

-       Infectious diseases were doing well, but there was a need to be on our guard for any new infections.

Cllr Pressel highlighted a number of issues and Dr McWilliam responded as follows:

-       Healthy new towns – how are we spreading the learning? Dr McWilliam responded that Public Health was taking part in discussions in relation to this;

-       The need to integrate health issues into local planning? – Dr McWilliam stated that organisations were doing much better in relation to this as compared to ten years ago, though this still needed to be monitored;

-       The lack of support for breastfeeding mothers in the communities, some baby cafes were struggling – Dr McWilliam commented that the amount of support for this was unknown;

-       Health inequalities needed to feature prominently in all strategies – how was it monitored?  Dr McWilliam stated that more targets could always  be produced, but all strategies had inequalities written into them and this was being worked on at the moment by the Health Inequalities Commission;

-       How can this Committee lobby the Government for a minimum price for alcohol and a watershed in advertising fast food to be set at 9pm? Dr McWilliam stated that in his view the Government was doing well in tightening the screening of obesity using non-legislative means and there was an increasing gradual awareness amongst the population;

-       How to survey and target the pockets of areas in Oxfordshire where oral health was poor – does it go far enough? – Dr McWilliam agreed that the national survey of oral health in children did not reach wide enough;

-       STI’s, are very high in Oxford - how do the statistics compare with comparable cities? – Dr McWilliam responded that Oxford was comparable with similar cities and urban areas;

-       Dementia statistics had risen over the last 10 years. It was understood the Oxford City figures were lower, are they increasing at a different rate?  - Dr McWilliam responded that it was too complicated to draw conclusions as it involved different lifestyles;

-       When would staff be recruited to the Healthy Living Team? – Dr McWilliam stated he was not aware  ...  view the full minutes text for item 49/18

14:25

The report (JHO12) includes:

·         The Business Case for longer-term changes following the Stroke Rehabilitation Services pilot; and

·         An evaluation of the pilot to include data and analysis to show the impact on staff and patient outcomes (including detailed patient feedback)

The Committee welcomed Dominic Hardisty, Oxford Health, and Sara Bolton, OUH to the meeting.

Dominic Hardisty gave a summary of the report JHO12 stating that:

-       All the evidence had been very positive and looking at patient flow outcomes had been found to be the correct way forward;

-       There were problems with staffing, particularly with nurses. OH were trying to resolve this, using agency nurses for the present; and

-       It was their view that this change of service constituted a substantive change.

Dominic Hardisty was asked how many patients there were from outside the southern part of the county. He responded that he did not have this data to hand but would circulate this. He added that what was required was the best possible care and if this required travel for some patients for approximately 20-25 days then it had been found that they willingly undertook this.

He was also asked how it fitted in with the wider locality plan for West Oxfordshire and were the general purpose beds open at the same time? He responded that the Stroke pathway did not stray into premises of local services and it was a countywide provision.

The Committee AGREED (unanimously):

(a)  to thank Dominic Hardisty and Sara Bolton for the report and for their attendance; and

(b)  that the indications from the pilot had been good and that this service be accepted as a substantive change and it should continue in its present form.

.

14:55

The Chairman’s report is attached at JHO13. It includes an update on health and social care liaison and the MSK Task Group.

The Committee had before them the Chairman’s report (JHO13).

Cllr Monica Lovatt gave a report on the MSK Task & Finish Group which had now met three times. The first meeting was to hear the views of patients, GPs, HWO and the Local Medical Council. The second to hear clinician’s views and the third to hear the view of the previous provider.

Attendees were asked to share their views of the new service, how they had experienced any differences from the former service, what worked well and was there any room for improvement. She added that the Group now needed to digest what they had heard and to draw together the evidence. It would then be publicised as part of the Chairman’s report to the February meeting. She thanked her colleagues on the Task & Finish Group and Sam Shepherd, Policy Officer, stating her view that the Group had set the framework and guidelines for future Task & Finish Groups.

The Chairman thanked Cllr Lovatt for the report agreeing that this was a very good and encouraging example for future Groups to follow.

The Committee AGREED to receive the Chairman’s report.