Agenda and minutes

To elect a Deputy Chairman for 2020/21. Members are advised that the Constitution stipulates that the Deputy Chairman is to be drawn from the District Councillors serving on the Joint Committee.

The Chairman welcomed participants to the virtual meeting.  He explained that in the event of a vote being required it would be carried out by roll call.

The Chairman on behalf of the Committee thanked all of those who went to work or volunteered in order to keep everybody safe during the Covid-19 crisis.

On the election of a Deputy Chairman, City Councillor Nadine Bely-Summers was nominated by District Councillor Paul Barrow and seconded by Councillor Laura Price.

Councillor Bely-Summers was elected Deputy Chairman for 2020/21.

Apologies were received from District Councillor Sean Gaul.

The Chairman noted that Councillor Mike Fox-Davies was stepping down from the Committee.  Councillor Charles Mathew was a temporary appointment for this meeting.

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

To approve the minutes of the meeting held on 6 February 2020 (JHO4a) 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 (JHO4b).

The minutes of the meeting on 6 February 2020 were approved.

This meeting will be held virtually in order to conform with current guidelines regarding social distancing. Normally requests to speak at this public meeting are required by 9 am on the day preceding the published date of the meeting. However, during the current situation and to facilitate these new arrangements we are asking that requests to speak are submitted by no later than 9am four working days before the meeting i.e. 9 am on 22 June 2020. Requests to speak should be sent to colm.ocaomhanaigh@oxfordshire.gov.uk  together with a written statement of your presentation to ensure that if the technology fails then your views can still be taken into account. A written copy of your statement can be provided no later than 9 am 2 working days before the meeting.

Where a meeting is held virtually and the addressee is unable to participate virtually their written submission will be accepted.

Written submissions should be no longer than 1 A4 sheet.

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

Agenda Item 6 – Forward Plan

Councillor Jane Hanna

Agenda Item 7 – Covid-19 Response

Liz Peretz

Councillor Jane Hanna

Agenda Item 8 – Oxford Clinical Commissioning Group

Julie Mabberley

Councillor Jenny Hannaby

Councillor Jane Hanna

Agenda Item 9 – Proposed changes for health scrutiny

Councillor Jane Hanna

10:15

The Committee’s Forward Plan (JHO6) is attached for consideration.

Councillor Jane Hanna asked the Committee to consider having more regular meetings given the increase in demands on the system in the wake of Covid-19.  The long-term implications are not clear yet – at local, county, regional or national level.  She said that, while the numbers of people involved are high, it was important to remember the individuals and their families behind the statistics.  She hoped that the Committee would look into variations in the statistics across the districts as well as the high rates in care homes.

The Chairman noted the very full agenda for this meeting following the postponement of the April meeting and that the volume of work is only going to increase.  It was agreed to discuss the way forward outside the meeting (ACTION).

10:20

An overview of the approach and impact of the virus on health services and health partners.

Liz Peretz, Oxon Keep Our NHS Public, advocated local testing as the best approach to tackling the spread of Covid-19.  She said that such schemes had worked in Durham and Sheffield and were advocated by the World Health Organisation.  She believed that local GPs, hospital trusts and the universities were ready to step up and provide such a service and she called on the local leadership to back this approach.

Councillor Jane Hanna stated that communities were anxious as the lockdown eases.  The questions surround how hotspots will be identified, how the return to work and school will be handled and if hospitals will be using risk assessments for vulnerable workers.  Test and trace will be crucial and she asked if all the necessary data was available in a timely way to make it work.

Yvonne Rees, Chief Executive, introduced the item.  She stated that the update reflected the fact that the country was still in the response stage and was now slowly transitioning to the recovery stage – however it should be recognised this stage would be as, if not more, challenging than the preceding months. She emphasised that Oxfordshire has responded to the crisis as a system - with all partners working together putting our residents’ and patients’ wellbeing at the heart of our activity.

Sam Foster, Chief Nursing Officer at Oxford University Hospitals Trust, on behalf of Chief Executive Dr Bruno Holthof, started the presentation.  She outlined a patient story and the impact on staff when the system had to double, and double again, its capacity.  Patients were nervous about being in hospital, as were their relatives who sometimes came in to seek their discharge.

Supplying PPE was very challenging.  The hospitals operated under the national response framework as is still the case.

Dr Ben Riley, Managing Director of Community Services at Oxford Health, described the two big challenges facing services: they had to establish new services to handle Covid-19 while at the same time reconfiguring all other services and premises.  At the start there were no guidelines and the thinking evolved day by day.

Mark Stone, Chief Executive of South and Vale District Councils, added that it was important to recognise the amazing response from the community and voluntary sector.  The councils on their own could not have responded to all of the needs.

Yvonne Rees emphasised that the system had been agile and recognised and implemented on-going learning during the crisis - this is normal practice but much can be taken forward and will inform the ‘new normal’.

Stephen Chandler, Corporate Director for Adult Services, described how partnership working was structured.  There was a care homes cell with a dedicated contact route.  They captured the views of care providers and the Care Alliance.  They were able to respond to the challenges of PPE and work on post-discharge services to avoid re-admission.

Ansaf Azhar, Corporate Director of Public Health, presenting data on the pandemic emphasised that this was a snapshot and the situation changed constantly.  ...  view the full minutes text for item 19/20

11:50

This paper (JHO8) aims to provide the Oxfordshire Joint Health and Overview Scrutiny Committee with an update on:

·         BOB ICS

·         OX12 Project

·         Merger of Horsefair Surgery and Banbury Health Centre

·         Windrush Branch Surgery

·         OCCG Annual Report

Julie Mabberley stated that residents of OX12 were disappointed that since the HOSC meeting in January nothing has been done to take account of their request that the report from the OX12 project be withdrawn or to progress the project to review the future of beds in Wantage Hospital.  She recognised that the Covid-19 pandemic has meant that priorities have had to change but believed that if the in-patient facilities had been open it would have helped ease congestion at the acute hospitals.

The Committee needed to ensure that health and care needs in the area are provided locally and effectively using all local facilities including the Hospital, the Health Centre and the Day Care Centre going forward.  The Horton has been given a local HOSC and she asked if OX12 could have the same.

The Chairman responded that the reason the Horton had its own HOSC was because the patient flow statistics showed that it serviced a significant number of residents from different local authority areas.

Councillor Jenny Hannaby stated that she didn’t understand the conclusion of the consultation process that Wantage can access excellent care facilities.  Wantage is expanding and the local plan will bring more development.

She suggested that it was time for a new strategy on community hospitals, looking at them in a different way – perhaps with a community board working alongside.  She hoped that the new CEO of Oxford Health would take a new approach to Wantage Hospital.

She was disappointed that the suggestion of using the hospital for Covid testing was not taken up.  The beds need to be opened first and then look at the services that can be delivered.

The Chairman responded that the decisions on the location of test centres were taken nationally.

Councillor Jane Hanna speaking as a local member and member of the Task & Finish Group stated that Covid-19 had highlighted the importance of local communities.  It was very disappointing for the community to see in the report that the OX12 work had been effectively dropped.

The community accepted that Covid-19 has changed everything but they are ready to engage with proposals going forward.  They have had no response to their position that the OX12 report was not fit for purpose.  She supported the recommendations of the Task and Finish Group and would welcome engagement on the way forward.

Dr James Kent, the new Chief Executive of the OCCG, introduced himself to the Committee and outlined his background and experience.  Being new in the role he had yet to meet all of the stakeholders but he could see how Covid-19 had strengthened joint working across Oxfordshire.

Councillor Mark Cherry stated that he was taken aback at the suddenness of the announcement of the proposed closure of the Bradley Arcade branch surgery.  He was well aware of the work being undertaken on the Ruscote ward by the Director for Public Health and the provision of new facilities but to lose an asset like this surgery was an intolerable retrograde  ...  view the full minutes text for item 20/20

12:45

This report gives information on the activity and development of the Oxfordshire Health and Wellbeing Board in 2019-20.

Councillor Ian Hudspeth, Chairman of the Board, introduced the report.  He noted that the March meeting of the Board had to be cancelled to allow health staff to focus on the Covid-19 crisis.

Apart from the formal meetings, the Board had a number of workshops including one with the Growth Board – housing being a key area with relevance to wellbeing.

There were four main areas of work: the Integrated Care System, Primary Care Networks, the Care Quality Action Plan and the Prevention Framework.

Dr Alan Cohen and Barbara Shaw asked how the Board scrutinises red and amber ratings in the performance reports.  They asked if trends were analysed and how did it feed into sharing improvement and their forward plan.

Councillor Hudspeth responded that their reviews took consideration of trends.  How the Board can take things forward depends on the organisations with responsibility.  He would take the challenge back to the Board and ensure that their scrutiny of performance reports is clear.

The Chairman undertook to write to the Board on this matter (ACTION).

Councillor Hilary Hibbert-Biles noted that performance reports are also scrutinised by the Performance Scrutiny Committee.  She also expressed the view that there were too few elected councillors on the Board.  She felt that it needed to be more balanced.

Councillor Hudspeth responded that the membership of the Board had been reviewed about 18 months ago.  There were certain regulations in law about membership and voting rights.  He added that the Cabinet Member for Public Health is also on the Board.

The Chairman thanked him and the Committee noted the report.

13:45

The presentation reports on progress against Quality Priorities 19/20 and Priorities for 20/21.

Anny Sykes, Deputy Chief Medical Officer, presented the report on behalf of Meghan Pandit, CMO.

Councillor Laura Price asked for an explanation of the difference between extended LoS (Length of Stay) and Delayed Transfers of Care (DToC).  She also asked if there were any learning points from the Covid-19 crisis that might help resolve the long-standing problems with reablement.

Anny Sykes responded that an extended LoS could be for a medical reason or it could be a DToC.  The Covid-19 experience showed the value of a system-wide approach and they need to examine that and see how it can be applied in a non-pandemic situation.

City Councillor Nadine Bely-Summers asked what measures are in place to ensure the wellbeing and mental health of staff.  Anny Sykes responded that this was already a priority before Covid.  There is a wellbeing group and wellbeing leads in each department.  Also through Project Wingman space can be provided to talk away from the pressures of the hospital.

Dr Alan Cohen noted that there was a lot of evidence that mental health patients received poorer physical health care than others.  Anny Sykes responded that the way in which mental health services were being delivered had changed a lot in recent months and agreed that this is something that needed to be looked at.

14:00

This will be a presentation on progress against stated priorities from Oxford Health Foundation Trust.

Jane Kershaw, Head of Quality Governance, introduced the report.  Marie Crofts, Chief Nurse, described the focus for this year and shared progress against the quality objectives set out for 2019/20.

Councillor Laura Price noted that mental health patients frequently complain about the buildings and how they impact negatively on their health.  She had also received a complaint about a patient being unable to choose the gender of a person assigned to a suicide watch.  Finally, she expressed the view that it is not clear how people should complain or give feedback.

Marie Crofts agreed that the condition of buildings can be a problem.  The Warneford Hospital is over 200 years old and probably the oldest inpatient mental health building in the country.  It has been raised regionally and at national level.  In the meantime they are trying to incrementally improve the existing buildings.

The Chairman asked that written replies be sent for the other two questions (ACTION).

14:15

This item will cover:

·         The history which led to the Oxford Vaccine Group to lead the trials

·         Information on the vaccine trials

·         How Oxfordshire residents benefit from these (both now and in the future)

·         How HOSC can help and support the work in future.

Professor Andrew Pollard of the Oxford Vaccine Group gave a presentation on the development of Covid-19 vaccines both in Oxford and internationally.  He stated that it is estimate that 5 to 7% of the population in the UK have been infected.  It would take years of social distancing to manage the spread in the rest of the population.  It is not viable to keep that up so it is essential that a vaccine be found.

There are 13 vaccines at the human-testing phase – taking a range of different approaches.  Normally vaccine development takes 10 years but a number of the processes are being run in parallel to streamline the development.  When a vaccine is available there will need to be decisions made on who to prioritize.

City Councillor Nadine Bely-Summers asked if the fact that Covid-19 has had a greater impact on BAME communities has informed any part of the vaccine strategy.  Professor Pollard responded that it has been a major part of the thinking globally that the vaccine should be equally available to developing countries.

The Chairman asked if there were any problems recruiting for vaccine trials in the Oxford area.  Professor Pollard stated that they recruited across the Thames Valley area and so have no difficulty given its large population.

Barbara Shaw asked if the vaccines being developed worked by boosting the immune system and where that leaves people who have a compromised immune system.

Professor Pollard agreed that vaccines work less well for people who have compromised immune systems but they are protected by ensuring that people around them are immunised.

Councillor Hilary Hibbert-Biles asked if the Covid-19 vaccine might be mixed in with the annual flu vaccine in the long term.  Professor Pollard responded that it is not yet known if people will need repeat vaccinations for Covid. The flu virus changes all the time but the evidence so far suggested that Covid does not vary that much.  He added that it was too early to say when vaccines might be available.  Covid-19 had proven to be highly unpredictable so far.

15:00

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

Rosalind Pearce, Executive Director, introduced the report and invited questions.

The Chairman asked her to outline Healthwatch’s involvement in Covid-19 and in particular the survey of care homes.

Councillor Laura Price asked about unheard communities.  A high proportion of care home workers would be from the BAME communities most heavily affected by the pandemic and home care workers are not well unionised.

Councillor Hilary Hibbert-Biles noted the suggested involvement of the Health Inequalities Commission and asked had that not concluded its work.

Councillor Nadine Bely-Summers stated that she had received representations from care workers who may be reluctant to come forward with criticism for fear of losing their jobs.  She said that Public Health England and the Care Quality Commission must have had a role to play in the shortage of PPE and testing.

Councillor Jeanette Matelot expressed concern that it sometimes appeared that care homes were being targeted for criticism.  As Covid-19 most heavily affected the elderly and people with underlying conditions it was not a surprise that it would be a big problem for care homes.  She was satisfied that they did their best.

Rosaline Pearce responded that Healthwatch does not attempt to represent others as such but they feed back everything that they hear and try to get the voices that are normally unheard.

Examinations of the timelines show that efforts to support care homes were generally one month behind everything else.  She asked where the Integrated Care System was at the start.  It seemed that care homes were left to local health authorities to deal with.

Healthwatch had been focussing on social care this year before Covid-19 appeared.  They are determined to get back out there as soon as they can and talk to paid carers in care homes and private homes.  There is also a need to hear the voices of unpaid carers.

While the Health Inequalities Commission had completed its business there is a group that has the task of carrying out the recommendations and this crisis has shown the need to complete that work.

It is naturally a concern when a lot of people die but she felt that care homes did their best and they got huge support from local communities.

Ansaf Azhar added that the recommendations of the Health Inequalities Commission have gone to the Health Improvement Board.  The emphasis on health inequality is being renewed through the Joint Strategic Needs Assessment report and the ward profiles focusing on the 10 most deprived areas of the county.

The Chairman thanked Rosalind Pearce for her report and asked that the care homes report be circulated to the Committee when it becomes available (ACTION).

12:15

This paper (JHO9) outlines proposed changes to the health scrutiny arrangements in Oxfordshire for consideration by the Oxfordshire Joint Health Overview and Scrutiny Committee (HOSC). The changes seek to ensure health scrutiny is appropriate and effective according to the scale and geography concerned.

Councillor Jane Hanna asked the Committee not to delegate scrutiny powers to the regional level at this time.  She noted that this was the first HOSC meeting since Covid-19 had changed everything.  The proposal was to delegate 20% of business to the BOB level (Buckinghamshire, Oxfordshire, Berkshire West) She added that the experience of the OX12 project had shown how critical local involvement was.

The Chairman responded that 20% was just an estimate of the amount of scrutiny business that might be carried out at the BOB level in response only to a statutory consultation.  He reminded the Committee that the OCC’s final decision on the BOB HOSC matter was for Full Council and this Committee was being asked to support the idea.

Councillor Laura Price proposed that the recommendation be amended to ensure that this Committee sees the Terms of Reference before they are finalised.  She noted that it was possible for Oxfordshire members of a BOB scrutiny committee to be outvoted.  She cited the example of a proposal on the PET CT scanners which benefitted Berks and Bucks but was a setback for Oxfordshire.

Councillor Alison Rooke noted that the BOB scrutiny committee would only meet when needed and asked who would decide that.  Currently the City and Districts are represented on this Oxfordshire Joint HOSC but she wondered would they not be concerned about being left out of the BOB level decision-making.

Glenn Watson, Principal Governance Officer, responded that the proposed BOB HOSC had a limited role as a mandatory joint committee.  It would only be needed when there was a consultation at the BOB level.  The proposals being drawn up were to be a basis to negotiate with the other HOSCs who will have their own views.  He was happy to draw up the Terms of Reference and bring them back to the Committee so that Members could see more detail before agreeing.

Dr Alan Cohen commented that there needed to be clear examples as to the kind of issues that would be dealt with at the BOB level.  Paragraph 26 a) could be interpreted as including all primary care but presumably it was mainly high-tech areas that would be envisaged.

Barbara Shaw asked if there should be lay representatives as there are on this Committee.  She also suggested that perhaps it should only meet when all of the constituent HOSCs were agreed.

The Chairman responded that it should be clear that primary care remains with the local HOSCs.  The only issue in recent years that covered the BOB area was the PET CT scanners.  He agreed that greater clarity was needed on the mechanism for calling meetings – perhaps a toolkit for the Chairs to use.

The Chairman proposed to have separate votes on the proposals for Horton HOSC and BOB HOSC.  Recommendations 3 a) and 4c) were agreed.

The following amended recommendations on BOB HOSC were adopted with one Member opposed:

3b) The introduction of a new Health Overview and Scrutiny Committee to scrutinise  ...  view the full minutes text for item 26/20

15:10

This report (JHO16) includes an update on the impact of Covid-19.

The report was noted.

The Chairman stated that he will give serious consideration to the suggestion of separating out the Covid-19 issues from more general issues.