Agenda and minutes

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Contact: Colm Ó Caomhánaigh, Tel 07393 001096  Email: colm.ocaomhanaigh@oxfordshire.gov.uk

Items
No. Item

61/19

Apologies for Absence and Temporary Appointments

Minutes:

Apologies were received from District Councillor Neil Owen, Councillor Hilary Hibbert-Biles (Councillor Liam Walker substituting) and Councillor Alison Rooke (Councillor Jane Hanna substituting).

 

62/19

Declarations of Interest - see guidance note on the back page

Minutes:

Dr Alan Cohen declared a personal interest as a Trustee of Oxfordshire Mind.

 

63/19

Minutes pdf icon PDF 425 KB

To approve the minutes of the meeting held on 19 September 2019 and to receive information arising from them.

 

For ease of reference when considering the Matters Arising from the minutes, a list of actions is attached at the end of the minutes.

 

Additional documents:

Minutes:

The minutes of the meeting on 19 September 2019 were approved and signed with one amendment as follows:

 

Item 52/10, on Agenda Page 5 -

Delete the bullet points:

“publishing risk assessments”

and

“The risk assessments …”

 

And insert before “Members of the Committee asked about”

 

“Councillor Jane Hanna asked if the risk assessments that support the statement of no significant risk can be published.  Louise Patten responded that the risk assessments are subject to Freedom of Information requests anyway so she was happy to AGREE to publish them.  She also AGREED to find out if they include issues raised in Operation Yellowhammer.”

 

64/19

Speaking to or Petitioning the Committee

Minutes:

The Chairman had agreed to the following requests to speak at this meeting:

 

Agenda Item 6 Oxfordshire Clinical Commissioning Group Update

Clive Hill

 

Agenda Item 7 Future arrangements for NHS commissioning

Joan Stewart, Oxfordshire Keep Our NHS Public

Charlotte Bird, Keep The Horton General

 

Agenda Item 9 CAMHS

Helen Evans

 

65/19

Forward Plan pdf icon PDF 313 KB

10.15

 

The Committee’s Forward Plan is attached for consideration.

 

Minutes:

The Chairman explained that the item on Mental Health which was supposed to be on the agenda for this meeting and on the agenda for the November meeting of the Performance Scrutiny Committee was not ready.  It will now come to the January meeting of Performance Scrutiny Committee and the February meeting of this Committee.  This will cause problems since elements of the contract have budget implications and this timing will not now fit in with the budget process.  The Chairmen of the Committees have made their displeasure at this clear.

 

Councillor Jane Hanna suggested that the Committee should consider risk assessments on Brexit planning across the system.  It was AGREED to ask officers to address Brexit issues in future reports.

66/19

Oxfordshire Clinical Commissioning Group Update pdf icon PDF 147 KB

10.20

 

This item will provide a report on the key issues for the CCG and outline current and upcoming areas of work. Including an update on Chipping Norton First Aid Unit and the CCG Annual Reports.

Minutes:

Clive Hill stated that he did not see why the award-winning Chipping Norton First Aid Unit (FAU) needed to be moved into the GP surgery.  He asked that if it was not a cost problem, if paramedics will not take on primary care work, if the FAU will be commissioned separately and operate independently and if patient records can be accessed in the hospital, why does the FAU need to be moved to the GP surgery?  He said that he understood that the SCAS paramedics could be used to help less qualified surgery staff.

 

He asked the committee to instruct OCCG to either cancel the proposed change or conduct a full public consultation before any change is implemented.  People see the proposed move as a major backward step and a significant downgrade of the Community Hospital based services.  In addition, this change must not be forced through in a hurry because after the General Election there will be a new Government and policies could well change.

 

Louise Pattern, CEO, responded that NHS national guidance in 2017 stated that everything must be either an urgent treatment centre or primary care.  OCCG did not want to lose the FAU which was working well so asked for more time to consider the options.

 

Being a reactive service there can be a lot of down time but by placing paramedics with other clinicians there can be a better utilisation of staff.  The FAU will not be under the GP practice.  It will be commissioned separately but will not operate in a silo.  She AGREED to come back and report on the benefits.

 

Councillor Laura Price questioned if the decision made sense being taken in isolation from the community hospital issue.  Louise Patten replied that the FAU has to be part of the primary care hub.  Services in Chipping Norton are a wider issue which could include consideration of digital solutions.

 

Barbara Shaw asked if medics were overstretched and their mental health was being considered.  Louise Patten said that paramedics were often the most stressed staff but that opportunities to work on something different can be helpful.  Staff were in favour of working together.  They had felt isolated.  Councillor Nadine Bely-Summers asked if there were records of the staff feedback.  Louise Patten AGREED that she would see what was available to share.

 

Councillor Jane Hanna asked when there would be a strategy for community hospitals.  Clarity was needed around community beds especially in areas of expanding population such as OX12.

 

Louise Patten described how some community hospitals are part of a network such as for stroke rehabilitation.  Some have specialisms.  But local services out of hospital need to be considered as well as social care.  One third of beds are social care funded.

 

Members agreed that they were not ready to agree that the re-location of Chipping Norton FAU is not a “substantial change”.  The Chairman asked that the toolkit be revised to take account of the wider issue of the viability of the Community  ...  view the full minutes text for item 66/19

67/19

Future arrangements for NHS commissioning pdf icon PDF 257 KB

10.50

 

This paper aims to provide the Oxfordshire Joint Health and Overview Scrutiny Committee with an overview of future commissioning arrangements across Buckinghamshire, Oxfordshire and Berkshire West (BOB) and seeks feedback on the proposals.

Additional documents:

Minutes:

Joan Stewart of Oxfordshire Keep Our NHS Public urged the Committee to insist on a formal public consultation on the proposed merger of Clinical Commissioning Groups.  She maintained that it was more than just streamlining.  It was being designed for key stakeholders.  There were concerns that a more remote CCG would be more difficult to hold to account.  The merger is not inevitable – GPs have stopped similar mergers elsewhere.  She circulated a letter from the NHSE to her local MP on the matter.

 

Charlotte Bird of Keep The Horton General stated that the proposed merger would make things more difficult for the ‘Banburyshire’ area.  Although Banbury is the second largest town in Oxfordshire its hospital services have been whittled away.  Thirty three percent of those attending live outside Oxfordshire – mostly in Northants and Warwickshire.  Her group has already found it very difficult to get early communication with OCCG and OUH on proposals and this will be even more difficult in the proposed BOB footprint.  Most BOB members will not have visited Banbury – it will be an afterthought.  The commuter areas in the south of the region will be prioritised.

 

Surveys about the next five years' services were put on the CCG's and OUH's websites but no information whatsoever was given to the Banbury local newspaper despite requests.  She asked that the Committee insist that these organisations keep the Banbury press fully informed and to ensure that Keep The Horton General is fully involved in BOB CCG planning and that the needs and geography of Banburyshire are fully considered in future strategy.

 

The Chairman noted that there was no mention of scrutiny in the report or the presentation.  This was one of the Committee’s main concerns.

 

Louise Patten, CEO OCCG, gave a presentation on the BOB CCG engagement.  She said that there was already joint commissioning on ambulance services, for example, because that was the most effective level.  The Integrated Care Partnership is the key part.  There are no plans to change services - it’s about managing commissioning.

 

The experience of the Horton HOSC involving a number of counties has been useful.  Banbury will be the next area for health and social care planning which will involve the Horton and stakeholders.  She would welcome the way it will broaden the discussion beyond acute services.

 

The CCGs are member organisations and GP practices will vote in each one.  The NHS could impose a decision, but they would be mindful of the size of majority in the CCGs.

 

Ansaf Azhar, Corporate Director of Public Health, added that there has been a lot of integration of services at a local level.  There is an emphasis on prevention across the spectrum which should have positive impact on demand for services.

 

The Chairman added that there was a meeting of HOSC Chairs in the BOB area, Councillor Mike Fox-Davies attended for him.  They have asked for guidance from the Secretary of State whether scrutiny of BOB will be at the BOB level  ...  view the full minutes text for item 67/19

68/19

Health Inequalities Commission Implementation Group Update report pdf icon PDF 386 KB

11.35

 

This report will focus on furthering the prevention agenda and reporting on good practice in some new projects funded through the Innovation Fund which was set up in response to recommendation from the Health Inequalities Commission.

 

This report also includes information on the strategic direction being proposed by Ansaf Azhar, the Director of Public Health for Oxfordshire.

Minutes:

Ansaf Azhar, Corporate Director of Public Health, introduced the report.  Kiren Collison, Clinical Chair OCCG, gave a presentation to demonstrate how theory can be brought to reality.

 

Ansaf Azhar stated that while most indicators are green across the county, when you look at local areas some reds show up.  The plan is to apply the approach in these areas first and then apply elsewhere.  He believes that preventative work can be quite powerful.

 

Councillor Mark Cherry asked if the Council had a response to the very sad County Lines case featured recently in a Channel 4 programme.  Officers said that the case showed how you cannot just look at a geographical level.  They recognised that there are real problems with social isolation.  They will make sure that the learning from this case is applied across the system.

 

District Councillor Sean Gaul noted that the list of deprived areas has not changed much since 2016.  He asked was there a specific ambition to change this.  Ansaf Azhar responded that they will analyse the impact in areas but that they also need to engage with councillors and stakeholders to get community insights.

 

City Councillor Nadine Bely-Summers asked how prevention was working with the NHS when the reality is that they have to ration care.  Kiren Collison responded that resources were finite and decisions on who to treat follow guidelines based on analysis of outcomes.

 

Barbara Shaw asked about hidden deprivation especially in the GRT and rural communities.  Kiren Collison accepted that there can be pockets that do not show up in the data.  PCNs can have a role in identifying local needs.  The NHS is investing in local data analysis but this is at an early stage.

 

Councillor Laura Price welcomed the presentation but asked how the strategy could be pursued properly given the current “grant-pot” culture.  Kiren Collison accepted that, even though great work is being done, it is piecemeal and sustainability is a concern.  That is why a strategic view is needed.  The next stage is to prioritise and then allocate resources.

 

Ansaf Azhar stated that this was raising the profile of tackling inequality and will also help reduce demand. The healthcare challenges are not just about new houses.

 

The Chairman thanked officers for the report and looked forward to hearing more in the annual report of the Director of Public Health in February.

 

69/19

CAMHS pdf icon PDF 142 KB

12.20

 

This paper aims to provide the Oxfordshire Joint Health and Overview Scrutiny Committee with a progress report on implementing Mental Health Support Teams (MHSTs) in Oxfordshire schools. It will also explain how the new MHSTs fit within the overall Children and Adolescent Mental Health Service (CAMHS) provided by Oxford health NHS Foundation Trust.

 

The paper also updates on progress with the Oxfordshire four week wait pilot, funded by NHS England.

Minutes:

Helen Evans described her son’s story in order to put a face on the report.  He was one year waiting for an assessment and was eventually diagnosed with autism.  An urgent referral in April which should have taken 7 days, actually took 3 months.  Staff are overloaded, often have not had time to read notes and the information can be wrong.

 

Every day her son hits and hurts those around him.  He doesn’t want to hurt them. He desperately wants help. Six months after the urgent referral he has only just been observed at school.  Hundreds of other children and their families are going through the same ordeal.  They are being failed by CAMHS.

 

The following officers addressed points raised by the public speaker and Members of the Committee:

 

Sarah Breton, Head of Children’s Commissioning

Debbie Richards, Managing Director, Oxford Health

Dr Andrew Valentine, Deputy Locality Clinical Director, OCCG

 

Officers acknowledged that the case was very difficult to hear and highlighted the challenges the service is facing.  Recruitment is a national issue, it’s not just a problem about money.  They are further developing recruitment options from the third sector.  The service is in the middle of a transformation to a multi-agency approach to include colleagues in education.

 

Councillor John Howson noted that an Educational Scrutiny Committee Working Group had looked at school attendance problems and concluded that the most common reasons were illness and medical appointments.  A lot of it was related to mental health, compounded by the problems with CAMHS waiting.  He asked if the £5.4m government grant will help reduce waiting time.

 

Sarah Breton stated that the extra funding will provide four pilot Mental Health Support Teams, two in Oxford City and one each for Banbury and Bicester.  There will be 8 persons per team covering 8,000 students.  Each school will appoint an MH lead.

 

OCCG has been selected for a pilot to reduce waiting times for CAMHS.  The pilots will be monitored quarterly and will be part of the national evaluation.  The teams will be able to see more students but also in a more timely way.

 

City Councillor Nadine Bely-Summers asked if online support from a private provider is an appropriate service for autism.  Officers responded that it works across the UK and is well evaluated and evidence-based.  It is not the only option available but users have found it helpful and it is available outside normal work hours.  Those waiting longest are prioritised.  There is strong clinical governance in place.  Feedback indicates that members of some minority ethnic groups find it is more acceptable.

 

Councillor Laura Price asked why the new teams will be managed by Response, why it is easier to do this through the third sector and if the public sector can be made more attractive.  Officers responded that the third sector has a huge resource of skills and experience different from conventional services.  A proportion become NHS workers and the Council promotes apprenticeships.  The arrangements include clinical supervision and mentoring.

 

Councillor Price  ...  view the full minutes text for item 69/19

70/19

Healthwatch Oxfordshire pdf icon PDF 464 KB

13.00

 

A report on the views of health care gathered by Healthwatch.

 

Minutes:

Rosalind Pearce, Chief Executive, summarised the Healthwatch report.  On CAMHS there is concern about the sustainability of the pilots and that the wider population will still be subject to Oxfordshire’s budget issues.

 

Healthwatch will respond to the engagement process on BOB particularly on the questions of scrutiny and accountability.  They are currently a non-voting member of OCCG but do not know how it will work with BOB.

 

The Oxfordshire Wellbeing Network has had its first meeting with over 100 participants including parish councils.  Eleven members of the Health and Wellbeing Board were present.  The main issues that came up were isolation, transport, access and information.

 

71/19

Chairman’s Report pdf icon PDF 316 KB

13.10

 

The Chairman’s report for November 2019 is attached.

Additional documents:

Minutes:

Dr Alan Cohen noted a Radio 4 News report on increased numbers of S136s.  He would like mental health services to address this at the February meeting.