Agenda and minutes

Apologies were received from Councillor Nick Leverton (substituted by Councillor Ian Corkin), City Councillor Jabu Nala-Hartley, District Councillor Jill Bull and Jean Bradlow.

The following non-pecuniary interests were declared:

·       Dr Alan Cohen as a Trustee of Oxfordshire Mind.

·       Councillor Damian Haywood as an employee of Oxford University Hospitals NHS Trust.

·       Councillor Jane Hanna as CEO of SUDEP Action.

To approve the minutes of the meeting held on 10 March 2022 (JHO3) and to receive information arising from them.

The minutes of the meeting held on 10 March 2022 were approved and signed as an accurate record.

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 Wednesday 4 May 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 agreed to the following requests to speak:

Item 7 - BOB-ICB Strategy

Joan Stewart

Item 10 – Healthwatch Report

Marie Walsh

10.05

For the Committee to receive a paper from the Oxfordshire Clinical Commissioning Group on the current position of primary care services.

The Committee considered a paper setting out the key aspects of delivery in the provision of primary care services in Oxfordshire, specifically general practice services.  It included appointment data including the significant contribution that was made to the COVID vaccination programme, and recent patient feedback on accessing GP services.

The following people had been invited to participate in the discussion on this item:

from Oxfordshire Clinical Commissioning Group (OCCG) -

Jo Cogswell, Director of Transformation

Julie Dandridge, Deputy Director of Primary Care

Dr David Chapman, Clinical Chair Oxfordshire CCG and GP in Oxford City

Dr Sam Hart, North Network Clinical Director

from the Local Medical Committee -

Dr Helen Miles, GP at Woodlands Medical Centre

Nargis Khan, Practice Manager Representative.

Jo Cogswell introduced the report.  The feedback included information from Healthwatch as well as an engagement exercise conducted as part of the commissioning contract.

The graph at 3.1 in the report was based on a national data set and unfortunately does not go back far pre-Covid.  The number of appointments face-to-face and virtual were shown.  It should be kept in mind that these levels of work were maintained while the vaccination programme was being rolled out.

Dr David Chapman noted that there had always been a mix of interactions and flexibility in the system with a lot of professionals involved, not just GPs.  Covid accelerated the triage-based system.  GP services never closed during the pandemic – they continued to operate under contingency plans for a major epidemic despite the lack of PPE in the early weeks.

Statistics showed that appointments now were up 10% on 2019.  Primary Care should be congratulated for continuing to deliver services thanks to the hard work of GPs, receptionists, practice nurses and practice managers.  A GP gets about 90% of the necessary information from talking and only about 10% from examination.  Patients were always seen face-to-face if it was necessary.  Many patients liked the new ways.  Opinion polls had indicated that satisfaction levels with Primary Care compared very well with other services.

Dr Helen Miles added appointments were really the tip of the iceberg of GP work.  There were also tests, prescriptions, supervision, training etc.  There was now extra work that was traditionally done elsewhere like tests that used to be done in hospitals.  There were also hours of work spent with the administration of different funding pots.  She also outlined staffing issues.  Negative media was impacting on staff morale and turnover was higher than ever.

Nargis Khan emphasised that if it had not been for the technology now available, practices would have had to close at times.  Fortunately staff self-isolating were able to work from home – patients may not have even been aware of the difficulties practices were facing.

Members thanked those working in Primary Care for their hard work in keeping services going through the pandemic.  However, Members were very disappointed at the lack of information on workforce in the report.  There was nothing on the number of GPs, how that was  ...  view the full minutes text for item 16/22

11.20

For the Committee to receive a report of the Chief Nursing Officer, Oxford University Hospitals FT, on the current position of maternity services. 

12:40 Lunch

The Committee received a report from Sam Foster, Chief Nursing Officer, Oxford University Hospitals Foundation Trust (OUH) on the current position of maternity services.

Members raised a number of questions:

·       If the Trust has been collecting outcomes data to analyse any impact of the suspension of services.

·       If the CQC’s ‘Musts’ have been implemented.

·       If there was a plan to improve the two areas rated Red under the Incentive Scheme.

·       If further information on the Continuity of Carer (CoC) issue could be provided.

·       If any of the health inequality issues that have been identified were impacted by the issues around CoC;  if the teams were working to the recommendations of the MBRRACE Report.

·       If decisions to induce and other issues were discussed with the mother with an opportunity to ask questions before and after the birth and if shortages of health visitors were impacting significantly on the frequency of visits.

·       If there was data to compare with national figures on stillbirths, complications and trauma.

·       If there had been a response to the CQC report that had highlighted the lack of quiet rooms.

·       If CQC visits were unannounced and if their report contained any surprises.

·       If there was a prospect of the service moving from “requires improvement” grading to “good”.

·       If the communications and engagement around the temporary closures at Wantage and Chipping Norton were satisfactory.  If there was a timeline for reopening and if population growth trends were being taken into account.

·       Where the main shortages were in staffing.

·       If there was a problem with midwives having to endure poor living conditions

Sam Foster responded as follows:

·       The Trust was required to produce a quality impact assessment and review all of the alternatives – their pros and cons – which they were in the process of doing.  They had established that six patients were affected but they had been able to maintain one-to-one maternity care through this period.

·       The audits around the ‘Musts’ have given assurance that those improvements were in place.

·       On the Incentive Scheme issues, electronic notes were ensuring 100% compliance on point 6.  Point 8 related to training which encountered difficulties under Covid when front-line care had to be prioritised nationally.  However, they were on track to ensure compliance.

·       A national report (Ockenden final report ) had recommended pausing the Continuity of Care model due to a recognition that it could compromise safe staffing under the current workforce restraints.

·       The Lotus Team was focussed on health inequality and vulnerability issues and the Trust was continuing to invest in that team.  That team had the expertise to deal with the recommendations of the MBRRACE Report.

·       The decision to induce will always be a clinical decision.  The service could do better on providing information and will work with patients, families and Healthwatch to see how they can improve.

·       The service was working towards providing a dashboard and benchmarks.

·       The fabric of buildings could be an obstacle to providing bereavement areas and capital funding was needed.  However,  ...  view the full minutes text for item 17/22

13:45

To receive an update on the progress of actions arising from previous Committee meetings. 

The Committee considered the update on the progress on actions arising from previous Committee meetings.

Helen Mitchell, Scrutiny Officer, asked the Committee to endorse the completed actions with the exception of the items relating to Admissions to Care Homes which Members wish to discuss under the Chair’s Report.  This was agreed.

Action: Consider the issue of the convergence of service offer across BOB under the Committee’s work programme.

14:00

To receive an update from the Chair of The Committee on work progressed in between meetings and future issues. 

The Committee considered the update from the Chair of the Committee on work progressed in between meetings and future issues.

Helen Mitchell, Scrutiny Officer, drew Committee Members’ attention to paragraph 13 on the recent High Court judgement that the discharge of untested Covid-19 patients to care homes was unlawful.  This Committee had already called for a local review of the discharges to care homes and may wish to consider asking for that to take place sooner rather than later given the High Court judgement.

Members of the Committee noted that there was an Oxfordshire resident involved in the High Court case.  Families wanted answers but there was no indication when a national review would take place.  They agreed with the suggestion that Oxfordshire partners should look at having a local review.  Such a review might be able to identify differences of approach between care homes for example.

Ansaf Azhar, Director for Public Health, was concerned that a local review would not provide a sufficiently large sample size to produce solid conclusions.  Unless there was a belief that there was something different happened in Oxfordshire, it would be better to wait for the national public enquiry which would give better conclusions.

Stephen Chandler, Interim Chief Executive, added that another problem was that there was no testing regime in place in the period in question which would make it difficult to identify causes.  The Government was currently working on the terms of reference for the national review but it seemed unlikely that they would move to interviewing witnesses even within the next year.  He agreed to take the suggestion of a local review to the NHS partners.

The Committee agreed to accept the Interim Chief Executive’s offer to consult with system partners about what could be done locally and come back to the June meeting with their response.

Councillor Paul Barrow asked for an update on including system partners in scrutiny training.  Helen Mitchell responded that a programme of training was in development with the Centre for Governance and Scrutiny and system partners will be included.

Dr Alan Cohen questioned whether the action on providing information on winter access funds had been completed as there was only a small amount of information provided.  Helen Mitchell agreed to include it in the planned workshop.

The Committee also noted that the latest update from Oxford University Hospitals was that the John Radcliffe appeared to be under severe pressure. 

Action:

The Chair will ask for more information as there appeared to be a lack of public awareness that the impact of the pandemic was still being felt.

13:15

(Buckinghamshire, Oxfordshire, Berkshire West Integrated Care Board)

To receive an initial draft.

The Committee considered a draft engagement strategy from the Buckinghamshire, Oxfordshire, Berkshire West Integrated Care Board.

Before discussing the draft strategy, the Chair had agreed to a request to speak:

Joan Stewart, Keep Our NHS Public, stated that the engagement strategy had to be seen in the context of the wider strategy for BOB.  The Board’s strategy stated that it had to support those most in need.  She believed that this entailed rationing services according to the limited funding from central government.

She noted that the head of Healthwatch England had resigned in protest at the reduction in resources available to it.  She also believed that the Board members were being appointed for their financial expertise and none had been brought on to oversee the engagement strategy.

Joan Stewart described the strategy as tokenistic and believed that it would not achieve any meaningful public involvement where the real decisions were made - at Board level.

The Chair described the strategy as deeply disappointing as was the fact that the Committee had only heard about it recently.  She asked for comments to be submitted to the scrutiny officer by Friday 13 May in order to prepare a draft response by 18 May.

The BOB-ICB had not provided a speaker for this item but Catherine Mountford, Director of Governance for the Integrated Care Board, had sent a statement to be read out.

“One of the NHSE requirements for Integrated Care Boards (ICBs) is to develop a strategy for working with people and communities in line with the published guidance available here.  Following some early discussion with the five Healthwatches across Buckinghamshire, Oxfordshire and Berkshire West (BOB), lead governors and the VCSE alliance we have developed an initial draft for BOB ICB’s strategy for engaging with people and communities.  This was submitted to NHSE and published on our engagement site just before Easter.  It has now been more widely circulated/communicated and we welcome comments on it. For context it is a very general and high level draft strategy about an approach for ways in which the new ICB can work with people and communities across the geography.   This would guide our approach for individual projects and service reviews.

Any comments received by Wednesday 18 May will inform the next iteration of the strategy to be considered by the BOB Integrated Care System (ICS) Development Board and then submitted to NHSE. A final version will not be ratified until the first ICB Board meeting on 1 July. Comments received by 17 June can be used to inform the draft that will be submitted to the ICB Board.”

Asked if she had been in contact with the Chairs of the other Health scrutiny committees in the BOB area, the Chair confirmed that she had been and they had been equally surprised.  She believed that the document was a very early indication of the culture and priorities of the ICB.  Success depended on strength at Place between local government and health partners along with effective  ...  view the full minutes text for item 20/22

14:15

To receive a report of Healthwatch Oxfordshire. 

The Committee had received a report from Healthwatch Oxfordshire on its feedback from members of the public and its recent reports.

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

Marie Walsh, representing Didcot Against Austerity, expressed concern that the pace of growth around Didcot was not being matched by the provision of health facilities.  Her organisation’s initial petition was to call for the provision of a Minor Injuries Unit but other issues came up as they engaged with people – particularly access to GPs and NHS dentists and waiting times for treatment of mental health issues.

A recent public meeting itemised specific needs such as a health centre and GP hub for Great Western Park and a pharmacy for Ladygrove.  There were also problems identifying who to contact about each issue.  The group would be very happy to meet individually with any Members of the Committee who could help.

Rosalind Pearce, Executive Director, Healthwatch introduced the report which she said was in a different format focussed on Healthwatch Oxfordshire reports relating to accessing GP services over the past 12 months.  She offered some observations on the issues that had come up throughout this Committee meeting:

·       The majority of people were very supportive of the care they get from the system once they are in it but the problem was with access in the first place.

·       Many complained of long waits for an answer on the phone only to be told there were no appointments available.

·       Dentistry was high on the list of access complaints.

·       Healthwatch will have a report on access to pharmacies in six to eight weeks.

·       Could the lack of uptake of the fourth vaccine be related to having fewer volunteers available?

·       Not every surgery or every area was experiencing problems with access and it was necessary to identify those that had the biggest problems.

·       In relation to reviewing transfers to care homes, the collection of ‘data’ needed to include the views of people.

·       Healthwatch has had meetings on the BOB-ICB engagement plan.  They have been quite clear that it will not work unless it has resources, a local focus and involvement by the public.

In response to questions from Members:

·       The earwax removal service, free to those over 55, was advertised on the Healthwatch website and others but there was still more work to be done on getting the message out to ensure GPs refer people.

·       They have had discussions with OCCG on the idea of having a consistent website for all GP practices.  In the meantime, it would be important for practices to learn from the best sites.

·       Relying on family members to interpret has always been problematic.  Some people prefer to use family members but the offer of an interpreter must be made.  The service was free to GPs and members of the public and, as a result of a Healthwatch report and follow-up action by OCCG, pharmacies now have access to this service, although not all seemed to  ...  view the full minutes text for item 21/22