Agenda and minutes

There were apologies received from City Councillor Jabu Nala-Hartley, District Councillor Sandy Dallimore and Jean Bradlow.

Dr Alan Cohen declared a non-pecuniary interest as a Trustee of Oxfordshire Mind.

To approve the minutes of the meeting held on 25 November 2022 (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).

The minutes of the meeting held on 25 November 2021 were approved and signed as an accurate record.

With regards to the Action List, the Chair noted two updates contained in the agenda published on the previous day for the meeting of Oxfordshire Health & Wellbeing Board on 17 March 2022:

·         The Board will consider a Covid Recovery Plan to take effect from May 2022 onwards.

·         The Pharmacy Needs Assessment has identified a need for improvement in provision in Oxford City and that a new pharmacy could satisfy that need.

Members of the public who wish to speak at this meeting can attend the meeting in person or ‘virtually’ through an online connection.  In line with current Government advice, those attending the meeting in person are asked to consider wearing a face-covering.

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 ‘hybrid’ meetings 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 4 March 2022.  Requests to speak should be sent to colm.ocaomhanaigh@oxfordshire.gov.uk .

If you are speaking ‘virtually’, you may submit 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. Written submissions should be no longer than 1 A4 sheet.

The Chair had agreed to the following request to speak:

Item 8 Community Services Strategy:

Julie Mabberley

10:10

A presentation and reports on Emotional Wellbeing of Children and CAMHS (Child and Adolescent Mental Health Service).

The Committee is RECOMMENDED to endorse the new strategic partnership approach to support children and young people’s emotional wellbeing and mental health in Oxfordshire.

The Committee received

·         a report, as requested, summarising the work completed to date on the development of a shared strategic approach to children and young people’s emotional wellbeing and mental health in Oxfordshire;

·         a presentation on the Emotional Wellbeing of Children and CAMHS (Child and Adolescent Mental Health Service)

·         a briefing paper providing the background information and data.

The presentation was given by Tehmeena Ajmal, Interim Executive Managing Director for Mental Health, Learning Disability and Autism, Oxford Health and Caroline Kelly, Lead Commissioner, OCC / OCCG.

Councillor Liz Brighouse, Cabinet Member for Children, Education and Young People’s Services added that the Children’s Trust Board was also discussing these issues.  She believed that the safest place for a child was in school.  However, the education system was fragmented now with only one maintained secondary school in the county.  Many neuro-diverse young people were not achieving their entitlement of hours in school due to reduced timetables, exclusions, isolation and other reasons.

Tehmeena Ajmal noted that staff were tired after a couple of very difficult years and more staff were needed.  She outlined a number of areas being looked at:

·         the Neuro-developmental conditions pathway where assessment, treatment and support are all offered.

·         the provision of more services online – some young people prefer it and it offers an opportunity to spread the staff base.

·         working with the voluntary sector on in-reach into schools.

·         examining if the outcomes-based contracts for services to 18-65 year olds could be expanded to 16-25 years olds where the offer is not quite right yet.

The Chair noted the tight timeline for engagement and asked if they were satisfied that the stakeholder group included the best possible representation.  Caroline Kelly responded that there had already been engagement on the needs.  They were working with the Council’s engagement team and the list of possible initiatives will go to a stakeholder group to make recommendations.

Caroline Kelly added that the timescales were indicative and they can delay if they feel they need to in order to get sufficient engagement.  The Health & Wellbeing Board had prioritised this strategy to be implemented this year.  She noted that the voluntary and community sector was developing some really innovative services and Oxfordshire was also able to learn through the Integrated Care System what was working in Buckinghamshire and Berkshire.

Asked about additional funding for mental health teams in schools, Caroline Kelly confirmed that additional transformation funding from NHS England was available and that work was in-train on expanding the offer.

Dan Knowles, CEO, Oxfordshire Mind, highlighted some areas in need of focus and investment:

·         the length of wait for an autism assessment

·         the comorbidity of mental health and autism

·         the way in which the pandemic had emphasised inequalities.

He noted that funding for mental health services in Oxfordshire has historically been below average and this was an issue in need of scrutiny.  The voluntary sector shared the same workforce issues as the statutory services.  What the sector does well was in providing non-clinical, person-centred, strengths-based,  ...  view the full minutes text for item 5/22

11.30

Updates on Elective Recovery Plans and BOB ICS Workforce and People Strategy

The Committee had received updates on

·       Elective Recovery Plans,

·       Midwifery Led Units,

·       BOB-ICS Workforce and People Strategy and

·       Re-opening of Temporarily Closed Specialties.

Sara Randall, Chief Operating Officer at Oxford University Hospitals, confirmed that the remaining specialties had reopened and they continued to work within BOB-ICS to manage the very long waiting lists.

Dr Alan Cohen asked for details of the waiting times for reopened specialties – in particular ENT and Ophthalmology – and how they were handling what must be an enormous surge of referrals.

Sara Randall responded that the overall waiting times were in the information pack but she could supply the specific information on those two.  She confirmed that there would not be any patients waiting more than two years by the end of March and the numbers waiting more than a year had been steadily reducing.  They had task and finish groups working on solutions across the BOB-ICS to ensure patients were seen in a timely way.  Advice and guidance was being provided to GPs.

Councillor Freddie van Mierlo asked if there was now a two tier system with those who can afford it going to the private sector and others having to wait.  He asked how many patients were leaving the waiting lists to be seen by the private sector.

Sara Randall responded that she could only speak for the NHS but referrals were being prioritised by urgency.  She would know how many people left waiting lists but would not necessarily know where they went.  She offered to get whatever information was available on that.

Councillor Nick Leverton gave an example where he had received a prompt service from an independent provider paid for by the NHS.  Sara Randall agreed it was an example of effective cooperation with the independent sector.

The Chair asked when the Committee could see the recovery plan currently being developed.  Sara Randall replied that there was an elective care board working on the issues on behalf of the ICS.  She would ask them to advise on when that would be ready to be seen by the Committee.

The Chair asked for more information on the reasoning for the temporary closures of some local maternity units and the levels of absences through sickness.  Sara Randall reported that the closures were being reviewed on a weekly basis.  It was due to safety concerns around staffing levels during the latest Covid surge.  It was a problem across the region and the country.  Overall the numbers out with Covid had reduced from a high of 600 to around 200.  She did not have figures for maternity but would get them for the Committee.

Councillor Damian Haywood asked about nursing recruitment rates. Sara Randall stated that international recruitment was going well but there were some particular areas of shortage.  She agreed to get data on that.

James Scott, People Strategy Programme Director, BOB-ICS, summarised the ICS People Plan that includes five programmes and multiple projects such as  recruitment, retention, apprenticeships and evaluation.

Councillor Damian Haywood  ...  view the full minutes text for item 6/22

12:35

An update on the development of BOB ICS / ICB.

The Committee received an update on development of the Integrated Care System and Integrated Care Board.  Catherine Mountford, Director of Governance, Oxfordshire Clinical Commissioning Group, summarised the report emphasising that many aspects were still subject to change as the legislation was still going through parliament.  The final guidance was expected early April with the system aimed to function from 1 July.

Members noted the new positions to be appointed and national reports of management consultants being engaged to work on elements of ICS’s and asked if this was introducing another layer of administration and costs.

Catherine Mountford responded that it was not expected that the running costs of the ICB (the new NHS statutory body) would be larger than the combined costs currently for the three separate organisations.  A number of the positions were required under the legislation.  Consultants were providing advice on governance which was helpful.  Any such contracts were subject to NHS approval and had to be within the budget envelope.

Dr Alan Cohen noted that there was to be engagement around local determination and asked who made the final decisions on that.  He also asked why there was no mention of scrutiny in the draft constitution.

Catherine Mountford responded that there were currently a Chief Executive designate and Chair designate who would make those decisions subject to approval by NHS England.  They would expect to have a review of Board membership within the first year.  The draft constitution used the NHSE template and there was a reference in that to compliance with local authority scrutiny arrangements but without any detail on that. 

The Chair noted that there was some anxiety around the situation where the ICB was going to be an NHS body dealing with social care.  Questions remained about how the local authorities were to be involved and how the cultural differences would be addressed.  There was also a lot of concern that many of the meetings were not to be held in public.  She asked if there was still scope to deal with these issues.

Catherine Mountford welcomed the points being raised.  She said that it was clear that care will remain managed at Place with local input.

Stephen Chandler, Chief Executive, Oxfordshire County Council, responded that he recognised and understood the concerns being expressed.  He believed that the Committee should look, not just at how the Board would work, but also how the local structures will operate.  He was aware of a recent report that was critical of the NHS culture but he had seen no evidence of it in the people he had dealt with on the ICS.

Councillor Freddie van Mierlo asked to focus on how services were going to change for the people of Oxfordshire.  He gave the example of differing policies on In Vitro Fertilization across the three counties and asked how that would be resolved.

Diane Hedges responded that work would have to be done to identify the differences in services across the region.  The priorities committee would  ...  view the full minutes text for item 7/22

12:55

An update on the development of the Oxfordshire Community Services Strategy.

The Committee had before it a paper providing a brief update on the Oxfordshire Community Services Strategy which proposed a way of working with members of JHOSC, the public and other key stakeholders to ensure engagement was as effective as possible.

Before considering the report, the Chair had agreed to a request to speak on this item:

Julie Mabberley welcomed the appointment of Helen Shute as Programme Director and hoped that this will enable a detailed timeline to be produced for the Strategy.  She asked for more information about the way that this project will be scrutinised by HOSC and repeated a number of questions that she said had not yet been answered:

·       More clarity was needed on what the Strategy was intended to do.

·       While it was anticipated new services for mental health in Wantage could see a potential 300 people a month being assessed, it wasn’t clear if this will be 300 in Wantage or across Oxfordshire.

·       If birthing does not reopen in March when does this become a “substantial change” subject to public consultation?

·       How will the changes taking place in the direction and content of the strategy affect the future of in-patient beds at Wantage?

·       Was a minor injuries unit in the hospital being considered?

Helen Shute, newly appointed Programme Director, Community Services Strategy, Oxford Health, summarised the Strategy as providing the people of Oxfordshire with the right care at the right time in the right places supported by the right resources.  She planned to put in a programme structure to make it clearer what they intend to do and the progress they are making along the way.  She would provide timescales once she had scoped what was required.

On an issue such as a minor injuries unit, they will look at the county as a whole, the needs and what is currently available and other issues such as transport, parking etc.  They will also consider what care can be delivered at home given new technologies available.

Dr Ben Riley, Executive Director, Primary, Community and Dental Care, Oxford Health, added that the principles of the strategy, which were updated following the public engagement work last year, had been adopted by the Health and Wellbeing Board in December.  There were a large number of proposals being considered.

The pilots at Wantage were going well – notably Ophthalmic and Audiology Services and a wide range of mental health services.  Most people using those services were from the south west of the county.  Oxford University Hospitals, the provider of the Birthing Unit at the Hospital, had indicated that they hoped to reopen this service within a few weeks.  219 responses have been received on the new out-patient services and they will have been evaluated by the time HOSC Members visit the hospital in May.

The Chair reported that she had already arranged to meet with Helen Shute to discuss the lessons to be learned from the previous experience of the OX12 Task and Finish Group.

District Councillor Paul Barrow  ...  view the full minutes text for item 8/22

13:35

Reports:

·         the Cumulative COVID-19 Impact in Oxfordshire 2020 & 2021

·         the Oxfordshire COVID-19 Vaccination Programme

The Committee received a presentation on the cumulative impact of Covid-19 through 2020 and 2021 and an update on the vaccination programme.

Ansaf Azhar, Director of Public Health, summarised the current position which was that we were now moving into the recovery phase in which we needed to learn to live with Covid.  There was still a need to move cautiously and consider how to protect the vulnerable against current and future threats.

The presentation looked at the direct impact and, at future meetings, the Committee would be welcome to consider the indirect impacts on health and care services and then the wider impacts on employment, education and mental wellbeing, once further work had been completed to more fully understand these.  David Munday, Consultant on Public Health, gave the presentation.

The Chair asked officers to address the concerns raised in emails from members of the public who were vulnerable and not feeling safe since the main Covid restrictions had been lifted.

Ansaf Azhar emphasised that the priority was still to protect the vulnerable and he had reiterated this in statements.  Since the vaccine roll-out there has been no evidence that Covid is any worse than other respiratory illnesses.  In January there had been no excess deaths despite the surge in Covid infections.

However, he urged everyone to continue the good practices developed during the pandemic – wearing face masks in crowded settings, keeping distance etc.  A lot had been learnt about dealing with infectious disease that needed to be embedded in the culture in order to protect the vulnerable.  New national policies were coming to address this.

Ansaf Azhar assured the committee that acute services and care services were still observing all the Covid precautions such as face masks.

Councillor Imade Edosomwan asked if vaccine certificates were required for health staff as he had heard reports of staff being asked to produce them.

Ansaf Azhar responded that it was not mandatory for health and care staff to be vaccinated.   The position was that they were all strongly encouraged to get vaccinated.

Karen Fuller, Interim Corporate Director for Adult Services, confirmed that vaccination had been a condition of employment for social care staff and they had worked with staff to achieve near 100% compliance.  The government had changed policy on that so it was no longer mandatory.

Councillor Damian Haywood asked about staff who had been removed from post due to this requirement and if they had been re-employed since the requirement had been dropped.

Karen Fuller responded that this was down to the individual employer.  At the County Council the small number of staff involved had been re-deployed to other posts that did not require vaccination.

Barbara Shaw asked if there was information on the impact of long-Covid on health services.  David Munday responded that research was still in progress on diagnosing long-Covid and the needs of patients as a result.  The NHS was providing support and perhaps they could be asked to present at a future meeting on this.  ...  view the full minutes text for item 9/22

14:05

The Committee is RECOMMENDED to

a)               Note the report;

b)              Agree the actions within. 

Members accepted the Chair’s Report and agreed the actions within it.

14:20

A report on the views gathered on health care in Oxfordshire by Healthwatch.

The Committee received a report from Healthwatch on views from the public on health and care issues.  This included a report on a survey of GP practices.  The Chair invited Glyn Alcock, Healthwatch Researcher, to summarise the report.

Glyn Alcock stated that the report was based on over 700 responses to the survey.  They found that most people were contacting their GP practice by telephone.  There was a lot of frustration at long waits.  Some people found the call back facility useful but it was not suitable for people who were at work for example and unable to take a call back at an unspecified time.

Online facilities like eConsult and the NHS App were useful alternatives to phoning for some basic functions such as repeat prescriptions but could be cumbersome to use.  The feedback indicated that people were very happy with the service received once they got through – the problem for many was long waits and in some cases people gave up.

The report was sent to GP practice managers after publication and much of the response from them was about the limits on their clinical capacity.

The Chair added that practices had also made the point to her that they had no choice in eConsult and there was a lesson there in the importance of codesign.

Councillor Damian Haywood asked if the Committee should invite NHS England to come to a meeting as they were responsible for issues such as eConsult, not the Clinical Commissioning Group.

Helen Mitchell, Scrutiny Officer, reported that she had been in touch with NHS E/I in relation to the vaccination programme and they had indicated that they would be happy to attend as long as there was clarity around what they were expected to address.  They had a clear role in relation to Primary Care and it would be reasonable to invite them to the Committee on that issue.

Councillor Nick Leverton stressed the importance of discussing dentistry which was becoming more urgent.  The Chair noted that it was among the items for consideration for the Committee’s Work Programme for the next Council Year 2022/23.

Rosalind Pearce, Executive Director, Healthwatch, asked that the BOB-ICS report be rewritten to explain the acronyms as it would be mostly unintelligible to members of the public.

Action:

To support the discussion on 10 May, an appropriate officer from NHS E/I will be invited to attend to discuss primary care challenges and opportunities.