Agenda and minutes

City Councillor Susanna Pressel attended for City Councillor Nadine Bely-Summers and apologies were received from District Councillors David Bretherton and Neil Owen.

Doctor Alan Cohen declared a personal interest on account of him being a trustee of Oxfordshire MIND.

To approve the minutes of the meeting held on 4 April and 31 May 2019 (JHO3(a) and (b)) and to receive information arising from them.

For ease of reference when considering the Matters Arising from the 4 April 2019 meeting, a list of actions is attached at JHO3(c)

The Minutes of the meeting held on 4 April 2019 were signed as a correct record, subject to some very minor corrections which would be rectified.

In relation to Minute 19/19 - ‘Regional PET-CT Scanning Service’ the Chairman referred the meeting to his letter (attached to his Chairman’s Report) in response to Seema Kennedy MP’s, Parliamentary Under Secretary of State for Health and Social Care, Department of Health. Discussion of which would be under Agenda Item 13 ‘Chairman’s Report’.

The Minutes of the special meeting held on 31 May 2019 were approved and agreed as a correct record.

Matter Arising

With regard to Minute 31/19, recommendation (b), the Chairman invited David Walker, Chairman of the Board of Governors, Oxford Health NHS Foundation Trust (OH), to the table, at his request. He referred to the recent announcement of the creation of the Integrated Care System (ICS) for Oxfordshire stating that he hoped that in this climate of collaboration between Local Government and the National Health Service it would proceed successfully. He believed that this would make a real difference for residents. He pointed out that the Board’s role was quite separate to that of this Committee, it being about executive decision making.

Mr Walker added that, as a newly appointed Chairman to the Board, he hoped that the Committee’s future relationship with OH would be amicable, as well as functional, stating both his view that it was regrettable that the Committee had chosen not to acquire the opinion of the CEO prior to making the statement it had.

Councillor Fatemian echoed Mr Walker’s wish that the relationship be amicable, adding that the Committee looked forward to hearing the Board’s formal responses to the statement. He added that the Committee was looking forward to receiving evidence that OH was adhering to the agreed principles of working between HOSC and the NHS, as signed by the CEO himself. He concluded by thanking Mr Walker for his attendance that day. Mr Walker responded that OH would be considering its formal response.

The Chairman had agreed to the following requests to speak at this meeting – all addresses were to be made prior to consideration of the item itself:

-       Agenda Item 7 - Local Health Needs Assessment: OX12

Local Member Councillor Jenny Hannaby

Maggie Swain – Save Wantage Hospital Campaign Group

Terry Knight – Save Wantage Hospital Campaign Group

-       Agenda Item 8 -Oxfordshire Health & Wellbeing Board Annual Report

Councillor Jane Hanna

-       Agenda Item 13 – Chairman’s Report

Liz Peretz – ‘Keep our NHS Public’ Campaign Group

10:15

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

Following consideration of the Forward Plan (JHO5), the Committee AGREED to add the following items to the Plan:

-       The work of the Health Inequalities Commission, to include having a strategy for addressing the outstanding recommendations;

-       To revise the Forward Plan to include the ‘Integrated Care Strategy – Oxfordshire, Buckinghamshire and West Berkshire’ in both the September and November 2019 meetings;

-       Optometry – to include waiting times for cataract operations;

-       Recommendation from Education Scrutiny Committee – Chairman of CAMHS Special Needs Education Board to be invited to attend this Committee.

10:20

This item provides a report on the key issues for the OCCG and outline current and upcoming areas of work. This includes information on a pilot of community palliative care by Sue Ryder (JHO6).

Diane Hedges, Deputy CEO, Oxfordshire Clinical Commissioning Group (OCCG), attended to present the report JHO6. She highlighted the following:

-       The ‘exciting’ progress made that day in relation to the announcement of the Integrated Care Strategy (ICS) which was a testament to improved working between OCC and Oxfordshire NHS, together with the growing

work with the other Oxfordshire authorities also;

-       The large amount of learning which had taken place around primary care and the need to enlarge its capacity. An active piece of work had taken place in Bicester surgeries were being consolidated into one, in order to offer more services for patients. PML in Banbury were taking an active role in strengthening primary care into a more stable environment, supported by more back office structures. South Oxford Health Centre was another practice who had stepped forward to take on a pilot;

-       The pilot work being undertaken by Sue Ryder around giving care and support to more people in their own homes; and

-       The OCCG had realised a small financial surplus which would be used to improve care service.

The deputy Chairman, Councillor Sean Gaul, local member for Bicester, requested that Bicester councillors be involved in the work that was taking place in that area. In return, Councillors could offer the OCCG clarity on what would help in determining decision making. A member added that, as GPs were retiring from the service, it was vital that Councillors were involved in the decisions going forward. Diane Hedges responded that the Banbury Community Partnership Networks had been involved in the past, with which the OCCG had been very open. She reassured the Committee that talks were currently taking place with councillors and also within the public domain.

A member asked that, in light of the need to recruit more GPs, how robust was the CCG’s forward planning processes? She also made a plea that, when considering sites for the new super-surgery in Bicester, that they be accessible for patients in terms of transport to the site, including cycling routes to it, and for parking availability. Diane Hedges gave her assurances that there would be a very clear set of criteria attached to these plans which would include the input of councillors.

In response to a question asking what contingencies were in place should Sue Ryder, or any other charity involved in the new structure, withdraw? Diane Hedges responded that the ICS was a form of contingency in itself. Thought was currently being given to how integration of the voluntary organisations would be achieved, given the pressures of the increasing workforce challenge. As an example of this, there was a collective group comprising end of life, palliative care workers from OUH who were supporting the consultation which included a proposal for the introduction of certain services. She added that these were different methods of working, and in a more joined - up fashion. She added also that the way organisations were now working, meant more of an understanding for each  ...  view the full minutes text for item 38/19

10:40

To report back on the OCCG and the HOSC Task and Finish Group on the roll out of the Local Health Needs Assessment Framework in OX12 (JHO7).

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

Councillor Jane Hannaby welcomed the Task and Finish Group’s report which she said provided an accurate record of the issue.  She stated that Wantage Community Hospital will soon be closed to inpatients for 3 years.  Given that it will be next spring before proposals can be brought forward it seems likely that it will be closed for 4 years in all.

Cllr Hannaby stated that the Save Wantage Community Hospital (SWCH) Group had worked hard to ensure that the OCCG’s survey reached as many people as possible given the OCCG’s limited resources.  This was despite the SWCH Group’s reservations about the survey, noting that only one question was about the hospital.  She expressed hope that the two groups could work together to solve the problem.

Maggie Swain of the SWCH Group and the Stakeholder Reference Group expressed concern about reports that there would be an emphasis on care in the home rather than in hospital and stressed that both were needed.  A Community Hospital is easy for people to visit patients, whereas people are often more reluctant to visit in the home and loneliness can result.

Volunteer drivers have problems accessing the JR Hospital in Oxford and many JR employees commute from Wantage and would much rather work closer to home.  She also criticised the fact that physiotherapy services were supposed to be up and running but had not yet started.

Terry Knight of the SWCH Group stated that he had been born in the hospital and had received treatment there.  He said that the lack of consultation on the survey was disappointing.  There was talk that nursing homes could be used but it was not clear why they would be more efficient that the hospital.

He also criticised the survey for researching current use and stated that this is not a reliable guide to future need.  There would be 5,000 new families in the area contributing £9 million towards the NHS in taxes.  He asked what had happened to the idea of the money following the patients.  He noted that the Health and Wellbeing Board advocated treatment closer to home but this is not what is happening in reality.

Councillor Mike Fox-Davies, Chairman of the Task & Finish Group, introduced the group’s report and stated that it was an interim report as they had not fully discharged their duty.  It had become clear around their second or third meeting that the original three-month timeframe was impossible.  He anticipated that actions will be identified by December 2019.

Councillor Fox-Davies stated that he supported the Population Health and Care Needs Framework which was being used for the first time.  There will need to be an evaluation process when completed.  He welcomed the improved transparency and suggested that an extra HOSC meeting may be needed in December to discuss the proposals.

Jo Cogswell, Director of Transformation OCCG and Senior Responsible Officer (SRO) for the  ...  view the full minutes text for item 39/19

11:40

The Annual Report on the activity of the Oxfordshire Health & Wellbeing Board is attached at JHO8 which covers the following:

·         The activity of the Board over the financial year 2018/19 in pursuit of the Health & Wellbeing Strategy.

·         How the Board performed against its aims and objectives during that period, including an overview of performance for all the sub-partnerships of the Board (ie. the Children’s Trust Board, the Integrated Systems Delivery Board, the Joint Management Groups for Adults and the Health Improvement Board).

·         An assessment of how revised governance arrangements are working

·         The Plans for 2019/20.

The Committee is RECOMMENDED to note the content of this report and the systems in place to monitor progress in delivering the Joint Health and Wellbeing Strategy and improving health outcomes for our population.

Prior to discussion on this item Julie Dean read out a statement produced by Councillor Jane Hanna. Her statement related to the Health and Well-being Board’s recent establishment of wider stakeholder involvement through a new Stakeholder Network; and her points were as follows:

-       The paper did not state what considerations under-pinned this recent development and did not give access to published information on any questions the public might have had in relation to the purpose, scope, remit and governance arrangements of the Stakeholder Network; and whether these issues had been scrutinised;

-       There was also the question of whether the Network would be entirely separate from, or related in part, to the new approach to Planning for Population Health & Care Needs, as set out in the paper submitted to this Committee in November 2018. This approach was to be tried first with the population of Wantage and Grove. Indeed the OX12 Stakeholder Reference Group had recently contributed to the work being undertaken by the OX12 Task & Finish Group; and

-       She called for clarity concerning any wider Stakeholder Network, on what it was and how it interfaced with a Population Health and Care Needs Approach, and most especially, any existing Stakeholder Reference Group.

Councillor Ian Hudspeth (Chairman, Oxfordshire Health & Wellbeing Board (HWB), Diane Hedges, Deputy CEO, OCCG, and Lucy Butler (Director for Children’s Services and Interim Director for Adult Social Services) attended for this item.  Councillor Hudspeth thanked the Committee for the opportunity to return to the Committee. He highlighted the following:

-       There had been much change since the last time the Board had reported to Committee, and this had been for the better;

-       The CQC had inspected in 2017 and its findings had given the Board the building blocks to work on, ensuring that the system was looked at as a whole, rather than its key parts;

-       The CQC had paid a follow-up visit in November 2018 and had found that good progress had been made to deliver social care and health benefits to the residents of Oxfordshire;

-       Healthwatch Oxfordshire (HWO) was playing its part in ensuring that the Board received as much information from the voluntary organisations as possible;

-       He made reference to the shadow Integrated Care Board (ICB), which was due to be in place by April 2020 and which would have a complete, system-based approach for residents/patients, particularly in relation to prevention aspects;

-       Success had been achieved in gaining additional funding, amounting to £215m across Oxfordshire in order to build affordable homes. The planning of these was also about the health agenda and £218m had been awarded for infrastructure and cycle facilities in Didcot to encourage a far greater health input, particularly in relation to air quality.

Lucy Butler added that the newly refurbished Board has spent a lot of time considering its priorities and building strong relationships with each other. Much more focus on all age-groups had also been considered to be very important.

Diane Hedges added that  ...  view the full minutes text for item 40/19

12:20

A report is attached on progress made against the recommendations of the MSK Task & Finish Group. This Group reported in February 2019) (JHO9).

12:45 - LUNCH

Diane Hedges, Chief Operating Officer and Deputy Chief Executive, OCCG, introduced the progress report which was requested at the February HOSC meeting when the Task and Finish Group presented a comprehensive list of recommendations.  The Group was led by Councillor Monica Lovatt.  MSK services receive over 5,000 referrals per month across Oxfordshire.  Generally, the level of concern amongst patients has been reduced.

Members of the Committee raised the following issues:

·         Dr Alan Cohen noted that several recommendations included the need to get a clinical review, for example - have long waits led to clinical harm?  Also, three of the 8 KPIs have no data since September 2018.  He also queried what the Clinical Governance Committee feedback was over the use of the EQ5D. He wished to see evidence that the Committee had considered this. The data should not just be about performance management. It should be about improving care. Diane Hedges stated that there was nowclinical overview in the system with GP triaging. Diane Hedges AGREED to sharing the notes of the meetings where the recommendations on clinical governance had been considered. Diane Hedges also responded on the KPI’s and stated that due to the provision of additional resources, the KPI's have been lengthened and adjusted.  The CCG have looked at what is reasonable to measure and asked the provider to meet those adjusted KPI’s. Diane Hedges AGREED to provide a full set of the revised KPI’s.

·         Councillor Laura Price noted that NHS physiotherapists have benefited from increased pay under Agenda for Change funded by central government and asked if InHealth staff were not receiving the same benefits.  She noted the low number of complaints and wondered if it is clear to people how to complain. It had been reported to her that people in Witney had been told that they cannot have an appointment. Diane Hedges responded to say that she was not aware of any lag or issue with physiotherapists not receiving their uplifts in line with NHS rises, but she AGREED to look in to it and report back to the committee. Diane also AGREED to investigate to make sure patients were not being told they could not have an appointment in Witney.

·         Barbara Shaw asked how the KPIs will be improved for those caught in the delay whose health has suffered as a result.  She also queried the extent to which the CCG are tackling the trust of the service with GPs reporting that they are not referring to Healthshare.  Diane Hedges recognised that the change-over to a new provider was difficult, but it was helpful to look forward now, which the CCG were doing with GP training events with Healthshare.

·         Councillor Alison Rooke asked when the physiotherapist service in Wantage would be up and running. Diane Hedges reported that this would be by the end of July.

The Chairman stated that the committee still had some concerns around the performance of MSK services and would like a report back to its September meeting.

13:30

The Committee will scrutinise the issues surrounding GP appointments and action being taken by the OCCG and GP Federations (JHO10). It will cover:

·         Contracting for GP Services in Oxfordshire.

·         Extended hours GP appointments – commissioning provision. Availability and uptake of extended hours appointments.

Dr Ed Cao-Bianco, Locality Clinical Director, OCCG; Jo Cogswell, Director of Transformation, OCCG; and Julie Dandridge, Deputy Director and Head of Primary Care & Localities, OCCG attended for this item.

Dr Cao - Bianco introduced the report highlighting the following points:

-       There were 70 appointments per 1,000 patients in a week;

-       Difficulties experienced in the training of GPs;

-       There was a variety of ways that patients could interact with GPs, including telephone and on-line appointments, where patients could complete medical questionnaires and receive a response the same day;

-       E - consult – one of the online consultation platforms via a private provider. The first wave of 10 practices had signed up to this. There had been a slow uptake as Oxfordshire had one of the most aged populations in the country. However, the patients who had used it had found it both easy to use and speedy;

-       A member commented that his surgery did not offer online appointments but offered a morning walk-in service. This had resulted in long waits for patients. It had given the impression that the surgery was managing its booking service rather than conducting a good customer service for its patients. Dr Cao-Bianco responded that there had been challenges with regard to what people needed, whether that was a health care assistant, a mental healthcare worker, or a clinical pharmacist etc. He added that a survey had recently been undertaken on all Oxfordshire GP practices, and it had been found that out of all of the practices in the county, 56 had operated a receptionist triage service. The vast majority operated appointment booking or telephone triage offering appointments afterwards. Not many offered a walk-in system where patients waited to see a doctor, adding a proviso that this could be due to workforce pressures.

A member commented that it was her view that the data submitted masked what was actually taking place on the ground. There were long waits for same day appointments, following triage, for up to 3 hours. She added that this was not a good patient experience and proved very difficult for patients suffering from long-term conditions – adding also that a patient might have to wait 5 weeks to see a doctor who had an oversight of their condition. Julie Dandridge responded that data had been collected on a national basis, not at practice level. Moreover, data from patient surveys was used and detail collected allowed the OCCG to target where patient satisfaction was not ideal. She agreed that the problem with patient surveys was that many people had not experienced anything better than waiting for 3 hours. However, PCNs were already seeing patients coming together to exchange information – and PCNs should solve this with the sharing of practices. With regard to those patients waiting a long time with long-term conditions, Julie Dandridge added that, for those patients where continuity of care was not important was where single and group consultations with specialist nurses helped (for patient asthma  ...  view the full minutes text for item 42/19

14:15

The Committee will scrutinise the issues surrounding the local GP Federation landscape across Oxfordshire (JHO11). It will cover:

·         What are the Federation funding arrangements?

·         What are the Federation governance arrangements for public transparency and accountability?

·         How is the quality and effectiveness of Federation-delivered services understood? How successful are they meeting those performance and quality standards for residents across Oxfordshire?

·         What are the challenges and opportunities for Federations in Oxfordshire?.

The following representatives of the GP Federations attended the meeting to present their reports and respond to questions:

·         Dr Ben Riley and Dr Louise Bradbury from OxFed

·         Derek Sprague, CEO, Abingdon Federation

·         Andrew Elphick, CEO, PML

·         Dr Ed Capo-Bianco, SEOx

Andrew Ephick recognised that delivery of Integrated Care is critical.  It acts as a glue between practices and facilitates more consistent provision. The Oxford Care Alliance are willing participants though not formally constituted yet.  They deal with primary care and community services.

The federations have sought to engage where any practices were in crisis.  Their policy is to support individual practices first, then look at working with neighbouring practices and to step in only if all that fails.

Asked about Patient Care Networks (PCNs), Dr Ben Riley said that they would be particularly beneficial for those with frailty or multiple issues.  He said that it has been the federations’ experience that practices at the scale of 30 to 50,000 patients work well.  At that scale 19 PCNs would be needed in Oxfordshire.  The networks could better share resources such as IT, communications, appointments, GDPR knowledge and facilitate team systems, career development, disease prevention and health promotion.  They will be able to think more about the community needs.

An Oxfordshire training network has been set up to help improve failing practices and address workforce issues such as when a partner is retiring.

The federations have funding for a mentoring scheme to help improve efficiency in practices.  There is a risk of greater access issues for PCNs in rural areas.  Despite Oxfordshire being relatively attractive, the county has only 85% of the GPs it needs.

Dr Louise Bradbury described how networked practices can provide additional roles such as social prescribing, clinical pharmacists and paramedics.  These have been well received by practices and patients.  The whole team can learn from each other.

OxFed has seconded paramedics to offer home visits where they can assess and sometimes make decisions or discuss the next steps with the GP. They can make a big difference to GPs’ lives but it is not clear yet if it will help with availability of appointments.

Derek Sprague warned that paramedics are a scarce resource as they are sought by the acute sector as well.

Councillor Hilary Hibbert-Biles expressed concern about competition for paramedics with the ambulance service.  They are also used as first-aid units outside normal hours.

Andrew Elphick responded that they are training their own paramedics as well.  Individual paramedics look for different work experiences.

Dr Louise Bradbury stated that all parties are talking to each other – they share the same set of patients – and ensure that resources are apportioned as appropriate.  Being able to assess needs across networks enables better decision-making.

Dr Keith Ruddle expressed concern that a rush towards new arrangements will take over without any health improvement.  There were pay-offs in scale but disadvantages at a local level too.  He said that everyone needed to work with the communities on this.

Dr Ben  ...  view the full minutes text for item 43/19

15:00

Healthwatch Oxfordshire will report on the views gathered on health care in Oxfordshire (JHO12).

Rosalind Pearce, Executive Director, Healthwatch Oxfordshire invited questions on her report.  Asked about the proposed series of network meetings for the Health and Wellbeing Board which include the voluntary sector she responded with the following points:

·         It could be an unwieldy approach but as each meeting will be themed not all organisations will attend all meetings.

·         The first one will be key – the Health and Wellbeing Board (HWB) must demonstrate that it is listening.  The Board identified the themes.

·         It had been said that the Board was closed to the voluntary sector and Healthwatch tried to be a voice for the sector, being close to it, but it can’t really be.

·         It will take about 18 months to know if it has been successful.

·         Healthwatch has standing items on the HWB agenda.

·         The HWB and HOSC do coordinate but their independence must be respected.

The Chairman stated that the HWB coordinates with the HOSC Forward Plan and suggested to come back and present on the progress with the voluntary sector forum for the HWB in three meetings time..

Rosalind Pearce reported that Healthwatch had carried out 24 reviews between November 2018 and May 2019.  Problems included long wait times and difficulty in making a formal complaint.

Healthwatch is still calling for a community hospital strategy.  They are observing developments in OX12 through the stakeholder group and have watched relationships become more collaborative, largely down to the approach taken by the Chair.

15.10

The Chairman’s report is attached at JHO16 to include an update on health and social care liaison.

Prior to consideration of this item the Committee was addressed by Liz Peretz a representative of Keep our NHS Public Campaign Group (KONP).

She urged the Committee to continue the fight to insist that whilst the referral of the PET-CT scanner procurement process to the Secretary of State for Health was being processed, that NHS England do not sign the contract with InHealth. She thanked the Chairman for his clear reply on behalf of the Committee to the undersecretary Seema Kennedy’s which was a clear refusal to accept her response.

She stated that it was helpful for the public to note the Committee’s argument that NHSE’s ‘improper’ process was a threat to all HOSC’s, not just to Oxfordshire. Further, that in proposed service changes covering several authorities, NHSE should have requested a wider HOSC for all the relevant patient populations. She pointed out that the legal remit of HOSC covered not just the service changes but had responsibility to ‘review or scrutinise any matter relating to the planning, provision and operation of health services in Oxfordshire’; adding that ‘the very strong clinical advice to HOSC was unequivocal that NHSE’s plans regarding the PET scanners at the Churchill Hospital would result in a qualitative reduction in the service offered to patients’.

She called for the original process, the route to preferred bidder status, to be re-run.

Finally, KONP felt that it had been very wrong of the Secretary of State to treat the only legal democratic voice for the people of Oxfordshire, ie. HOSC, with the contempt shown in the letters. She added that no HOSC took its responsibilities lightly, and the decision taken by Oxfordshire was on appropriate grounds. KONP wanted the retain the excellent clinicians at OUH.

The Chairman agreed that the Committee had set out the clear legal arguments in the letter, to which the DoH had committed to send out their latest response by the end of June. He added that there may be a need to call a special meeting in July to consider other potential actions.

On the conclusion of the discussion, the Committee AGREED to request the Chairman to:

(a)  send out another letter to DoH asking them not to sign the contract until the process had run its course;

(b)  write to OUH to request an update on the partnership talks which the Trust was engaged in; and

(c)  to note the Chairman’s report JHO13.