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Agenda and minutes

Venue: Virtual meeting

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

Link: video link to the meeting oxon.cc/HOSC240920

Items
No. Item

28/20

Apologies for Absence and Temporary Appointments

Minutes:

Councillor Kevin Bulmer attended as a temporary appointment.

 

District Councillor David Bretherton was unable to join the virtual meeting due to technical difficulties.

 

The Chairman welcomed three new members to the Committee:

 

District Councillor Jill Bull, representing West Oxfordshire

District Councillor Kieron Mallon, representing Cherwell

Jean Bradlow, co-opted member, a former Director of Public Health.

 

29/20

Declarations of Interest - see guidance note on the back page

Minutes:

Dr Alan Cohen is a trustee of Oxfordshire Mind.

 

Councillor Alison Rooke is a trustee of Vale House Alzheimer’s Home.

 

Jean Bradlow is a volunteer with Oxford University working on a COVID early alert system.  Her husband is consultant rheumatologist at Royal Berkshire NHS Foundation Trust.

 

District Councillor Jill Bull runs independent services for people with learning disabilities in West Oxfordshire.

 

30/20

Minutes pdf icon PDF 426 KB

To approve the minutes of the meeting held on 25 June 2020 (JHO3a) 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 (JHO3b).

 

Additional documents:

Minutes:

The minutes of the meeting held on 25 June 2020 were approved.

 

On Item 18/20, Forward Plan, Councillor Alison Rooke asked for an update on the Action noted in the final paragraph regarding the Committee’s volume of work.  The Chairman responded that the feedback he received from members indicated a wish to handle the workload within the existing programme of meetings rather than adding extra meetings.  COVID-19 will be a standing item on the agenda as long as it is needed.

 

31/20

Speaking to or Petitioning the Committee

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 Friday 18 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.

 

Minutes:

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

 

Agenda Item 6 – County-wide community services

Julie Mabberley

Councillor Jane Hanna

Councillor Jenny Hannaby

 

Agenda Item 7 - System-wide update on the COVID-19 response and recovery

Liz Peretz

Councillor Jane Hanna

 

Agenda Item 14 – Chairman’s Report

Councillor Jane Hanna

Councillor Jenny Hannaby

 

32/20

Forward Plan pdf icon PDF 236 KB

10:15

 

The Committee’s Forward Plan is attached for consideration.

Minutes:

The Chairman noted that committee members had made the following suggestions for the Forward Plan in advance of the meeting:

 

·         COVID-19: public health messaging targeted at BAME communities and current testing capacity.

·         Waiting times on cancer operations in Oxfordshire including delays due to COVID-19.

 

Councillor Hilary Hibbert-Biles asked that Chipping Norton Hospital be added as an item to be discussed.  She was concerned that more peripheral clinics were going to the health centre which was a private business and that there will not be enough services left to keep the hospital going.  She noted that local people had fought hard to keep it open.

 

It was AGREED to add these items to the plan.

 

33/20

County-wide community services pdf icon PDF 359 KB

10:20

 

A statement from Oxford Health NHS FT on its proposals to progress a strategic development and quality improvement plan for its community services across Oxfordshire (including services at Wantage Community Hospital/OX12).

Minutes:

The Chairman stated that he would take the public speakers after the statement had been read out to give them an opportunity to comment on it.

 

Nick Broughton, Chief Executive of Oxford Health Foundation Trust, read a prepared statement.  He noted that for several years, there have been calls to refresh and update a county-wide approach to community-based care, in order to deliver a vision of more integrated care, closer to home, but, due to various circumstances, attempts to progress this work have been repeatedly frustrated. At the same time, locally-focused work intended to respond to healthcare challenges in parts of the county, such as the OX12 project, have also been delayed. These false starts and recurrent delays have resulted in damage to relationships and an understandable loss of trust from the public, which Oxford Health regrets.

 

The experience of responding to the COVID-19 pandemic has taught some useful lessons in how to improve services in an effective and timely way. Rather than spending a prolonged period on developing another transformation plan that is likely to fail to deliver, they propose to adopt a more rapid approach to service improvement, making small changes with involvement from patients and the public and refining them with ongoing feedback.  They have set themselves an ambitious target to have produced a strategic development and quality improvement plan for community services at the end of this year.

 

Dr Broughton, on behalf of the Trust, apologised for the delays in completing the long-overdue work to upgrade the plumbing systems at Wantage Community Hospital and expressed regret at the long period of time that it has taken to resolve the unsatisfactory situation with the inpatient ward that has been closed at Wantage since 2016.

 

He announced that services were able to restart, including maternity care from the midwife-led unit.  Deliveries will be re-starting in the unit from 1 October. Also a new, local podiatry clinic at the Hospital will open and the school nursing team are also working there, busily organising vaccinations for local school children.

 

However, looking at the output from the application of the health and care needs framework in OX12 and based on the bed occupancy rates in other hospitals, the Trust believes that re-opening the general inpatient ward at Wantage would not be a sustainable plan or the best way to use NHS resources at this time. Instead, they would like to progress new opportunities for developing a wider range of outpatient, community outreach and other daytime services at the Hospital which will be of greater benefit to local residents, such as  mental health services for children and younger people and new ways of providing care for those who are older and frail.

 

He recognised the need for the NHS family to follow a formal process involving local people to deliver this type of change and will work with the clinical commissioners to undertake this as soon as the current restrictions relating to the COVID-19 pandemic allow.

The Trust commits to working with  ...  view the full minutes text for item 33/20

34/20

System-wide update on the COVID-19 response and recovery pdf icon PDF 788 KB

10:40

 

This item will provide a report on the key issues for the Oxfordshire system. Update including:

 

·         Some key learning/changes delivered during the COVID-19 response stage

·         NHS – update on “restart” activity e.g. primary care services

·         Winter planning*, which will include flexibility for a second COVID wave

 

* Report will be circulated in the Addenda.

 

Additional documents:

Minutes:

The Chairman introduced the item stating that, by agreement with the Chief Executives of Oxfordshire County Council and the Oxfordshire Clinical Commissioning Group (OCCG), this will be a standing item on the Committee’s agenda until COVID-19 ceases to be a substantial problem.

 

Liz Peretz, representing Keep Our NHS Public, stated that local test trace isolate and support schemes are necessary if we are to navigate our way through the pandemic. She was much encouraged by comments from the Director of Public Health that we are moving towards a local scheme – run in harmony with the national one.  A number of people such as active, retired staff from the NHS and local authorities want to offer their services as tracers and contactors.  She asked the Committee to ensure that this will happen in Oxfordshire.

 

Councillor Jane Hanna supported the call for local testing.  She believed that the national system was not working with many people in her area of Grove and Wantage unable to access tests.  She had also heard reports of people seeking testing at the Dalton Barracks site mingling due to the absence of signage.  She was also concerned with the lack of engagement with the public and asked what the plan is for engagement, which will become particularly important if there is a second wave or difficulties with supplies of medicines or equipment following Brexit.

 

The Chairman stated that he wished to deal with the Winter Plan separately and concentrate on the overall COVID situation first.

 

COVID-19

Diane Hedges, Chief Operating Officer and Deputy Chief Executive, OCCG, described the plan to restore services to near-normal levels.  With GP services there had been a move away from face-to-face contact and separation of COVID and non-COVID patients.  A lot of work is going on to bring numbers back up towards normal.  There will be a challenge with the increased numbers seeking flu vaccination.

 

Community services have been reopening premises getting people back in safely.  There is a move towards community hospitals providing more support for out-patient services.

 

There has been a lot of new learning across the system most particularly around using digital solutions and the need to improve engagement around inequalities, for example with BAME communities.  The OCCG has laid out an extensive engagement plan to help understand the patient experiences.  Healthwatch has been very helpful in this regard.

 

Ansaf Azhar, Corporate Director for Public Health, outlined the current situation.  The numbers of cases are rising across Europe.  In Oxfordshire the Health Protection Board, involving all partners, meets weekly.  There is also a surveillance unit analysing data on a daily basis, giving an early warning of problems.  It also provides a dashboard where the public can see the number of cases at a district level.

 

There have been two areas of concern: East Oxford in July and more recently among young people.  These were tackled by expediting testing through local mobile units.

 

He recognised the frustration with availability of testing.  He is working with the BOB  ...  view the full minutes text for item 34/20

35/20

COVID-19 research pdf icon PDF 595 KB

12:00

 

Oxford researchers have been at the forefront of national and global efforts to tackle the COVID-19 pandemic, with many high profile trials and studies being led by Oxford researchers.

 

This briefing paper focuses on some of the key COVID-19 research being carried out in Oxford.

Minutes:

As the representatives of Oxford University Hospital had to leave soon to attend a board meeting, it was AGREED to take the report as read and move on to Agenda Item 10.

 

36/20

Routine referrals pdf icon PDF 453 KB

12:30

 

The reinstatement of routine referrals to OUH services following the COVID-19 lockdown. Including:

 

·         Overview of the approach to re-starting referrals

·         Information on specialties where patients are being seen and treated elsewhere and how this is being communicated to GPs and patients

·         When OUH expect to be able to accept referrals for these specialities

·         LMC representative to attend to share views from primary care.

 

Minutes:

Dr Raman Nijjar, Chairman of the Oxfordshire Local Medical Committee shared the views from GPs on the restart and recovery of routine appointments at Oxford University Hospitals (OUH).  He noted that NHSE had asked, about five months ago, that all services be reinstated but this had not happened in Oxfordshire.  Patient care was deteriorating as a result of routine referrals not taking place.  He believed that patients were not being prioritised as they were in neighbouring counties.

 

Dr Nijjar had raised it with OCCG and had a meeting with them but OUH were unable to attend.  At that meeting he said that services needed to resume by the end of July or mid-August but seeing no movement on this, he decided to go to the press.  He was aware of a number of case studies of appalling care.  GPs were doing their best with limited tools but they could not refer to a number of services.

 

Lisa Glynn, Interim Director of Clinical Services, OUH, stated that referrals were open for cancer and other services had started to reopen but capacity was restricted.  Unfortunately for a number of services this had been particularly problematic.  They were monitoring the volume of patients and the timeline from referral to booking and when that goes below 12 weeks they could look at reopening the waiting list.  This would be expected to happen between now and February/March.  They were working across BOB (Bucks, Oxon, Berks West) to improve availability and working with the independent sector too.  Urgent patients were being prioritised.

 

Dr Bruno Holthof, Chief Executive, OUH, added that they were serving patients across the Thames Valley area with a population of 3 million.  Patients who were clinically urgent could always be referred.  If there was a second wave of COVID-19, he did not expect that services would close but they would have to readjust.

 

Barbara Shaw stated that, even pre-COVID, women had to go out of county for routine gynaecological referrals.  She understood there were recruitment issues and asked if this was expected to continue.  The report suggested that some patients were having to wait 52 weeks.

 

Lisa Glynn responded that there was a community service in place now with patients requiring acute services being referred to OUH.  They restarted a few weeks ago.  There had been improvements in recruitment and some short term support had been provided.  In the gynaecologic oncology sub-specialty there had been recruitment advances as well as partnering with private general gynaecologist services in Berkshire which had brought about improvement.

 

Dr Alan Cohen asked if the capacity was restricted by space or personnel and if local sites could be used.  Lisa Glynn replied that both were an issue.  They were using space from local providers but there were a limited number of consultants and they needed to use them most efficiently. They were looking at using weekends and evenings to reduce the backlog.

 

Dr Holthof stated that they were having a lot of non-attenders.  There was good uptake of  ...  view the full minutes text for item 36/20

37/20

Proposed changes for health scrutiny

13:30

 

To consider proposals for scrutiny of issues at a BOB-wide level (Bucks, Oxon, Berks West).

 

Minutes:

This item had been deferred.

 

38/20

Healthwatch Report pdf icon PDF 287 KB

14:00

 

Report on views of health care gathered by Healthwatch Oxfordshire.

 

Minutes:

Rosalind Pearce, Chief Executive, Healthwatch Oxfordshire, introduced the report, giving apologies for Tracey Rees, Chair, who was not well.

 

She noted that Healthwatch were presenting a report to the Health and Wellbeing Board the following week on nine surveys they conducted related to COVID-19.  It was AGREED to circulate that report to members of the Committee.

 

Healthwatch is talking with OCCG and other services on engagement around the impact of COVID-19 on primary and secondary services.  They are particularly concerned about alternatives for those who cannot, or do not wish to, use digital options. They believe that the NHS should be considering what travel support they give to people who choose to take up referrals out of county.

 

With regard to referrals, she understood that the position was that GPs can refer, it’s just that for some services the only referrals available are out-of-county.  She called on the hospitals and GPs to work together to solve these problems.

 

She supported earlier comments regarding the negative impact of banning visits to care homes on both patients and families.  She believed that, given the measures taken on infection control and the prioritisation of testing for keyworkers, it should be possible to allow visits.  She hoped that the Council would ensure that care homes complied with the advice on this.

 

Their feedback from heads of care homes was that one felt under pressure to take transfers from hospital and one said that they closed their doors to transfers.  The Chairman urged her to pass on any information about care homes to the Director for Adult Services.

 

Healthwatch have heard that it is possible to access private dental health but not NHS services.  They are taking this matter to the NHS Commissioner.

 

Healthwatch are recruiting two positions to work with the BAME communities and develop innovative methods of outreach. 

 

City Councillor Nadine Bely-Summers asked about the difficulties being experienced by some Patient Participation Groups (PPGs) and the situation regarding BOB-ICS (Bucks, Oxon, Berks West Integrated Care System).

 

Rosalind Pearce reported that some PPGs are finding it difficult to re-engage with GPs and some are not functioning fully due to individuals isolating. This is also a challenge for Primary Care Networks (PCNs) who have a responsibility to engage more widely.  Healthwatch is talking to OCCG to see how they can help and to PPGs about how they can support re-engagement with GPs.

 

District Councillor Jill Bull said that she was hearing reports of problems with dosetted medication.  Rosalind Pearce responded that she had not heard of any problems but any information should be passed on to her.  She was aware of problems with small pharmacies closing and was keeping that monitored.

 

Barbara Shaw called for support for PPGs to engage at PCN level.  They no longer get support from the CCG and there is a legal obligation on PCNs to engage with the local communities.

 

Rosalind Pearce responded that Healthwatch have a resource to support PPGs and have been brokering meetings with practices.  The picture  ...  view the full minutes text for item 38/20

39/20

Chairman’s Report pdf icon PDF 198 KB

14:10

 

To include an update on OX12, co-opted members and communications.

 

Additional documents:

Minutes:

Councillor Jenny Hannaby spoke regarding the letter from the Chairman on the OX12 report.  If the inpatient beds are closed at Wantage Hospital then people, including many elderly people, will have to travel 30 miles and be more remote from family and friends leading to a risk of depression.  She warned that other community hospitals may follow if they close Wantage.  She believed that Oxford Health and the OCCG were not paying attention to the democratic wishes of local people.  She thanked the Chairman for keeping this issue on the agenda for so long.

 

The Chairman responded that the position appeared to be that Oxford Health does not currently see the business case for keeping the inpatient beds but that they are open to exploring it further.