Agenda and draft minutes

Apologies had been received from Cllr Paul Barrow, with Cllr Diana Lugova substituting.

Apologies had also been received from Barbara Shaw.

Cllr Damian Haywood declared that he had a contract of work with the NHS.

The Chair declared that she had a contract of work with SUDEP Action.

Cllr Jenny Hannaby declared that she was Chair of the Wantage Town Council Health Committee.

To approve the minutes of the meetings held on 08 June and 30 June 2023 and to receive information arising from them.

The minutes of the committee’s meetings on 8 June and 30 June were assessed for their accuracy.

Cllr Katharine Keats-Rohan cited a correction as to the nature of her declaration of interest.

The Chair cited a correction to page 17 in relation to the extraordinary meeting held on 30 June, suggesting an amendment to include the point relating to whether notice will be provided on if the power to refer matters was to be removed by the Secretary Of State.

The Committee AGREED the minutes subject to the proposed corrections.

Liz Brighouse (Cabinet Member for Children, Education and Young People’s Services) and Anne Coyle (Director of Children’s Services) have been invited to present the most recent Local Area Partnership SEND Report, with a particular focus on the Health and Wellbeing implications on Children.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

The following were invited to respond to the Committee’s questions concerning the recently published Local Area Partnership SEND Report; Liz Leffman (Leader of the Council), Liz Brighouse (Deputy Leader and Cabinet Member for Children, Education and Young People’s Services), Anne Coyle (Interim Director of Children’s Services), Stephen Chandler (Executive director – People, Transformation and Performance), Rachel Corser (Chief Nursing Officer- BOB ICB), Daniel Leveson (Place Director Oxfordshire – BOB ICB), and Victoria Baran (Deputy Director, Adult Social Care).

The Chair explained that this report came against the backdrop of the Cabinet having considered the Education Commission report on Tuesday the same week; and that HOSC were looking at this particular SEND report that had highlighted significant concerns and systemic failures in SEND provision for Children. The Chair confirmed that the Committee had also had sight of a statement that was released on the BOB Integrated Care Board’s website, which included statements from many representatives of the senior leadership of the Local Area Partnership who were also present during this meeting.

The Committee emphasised that whilst the report highlighted challenges in the Local Area Partnership, it also highlighted some positive aspects of the partnership that were indeed working well.

The Chair also reiterated that in terms of the format of scrutiny for this SEND report, this Committee would scrutinise this report’s findings with as much a focus as possible on the health and wellbeing of children, and that the People and Overview Scrutiny Committee would scrutinise this report separately at a future date. It was emphasised that both scrutiny committees had a remit over certain aspects of SEND issues, and that it must be ensured that this discussion was centred around the implications on the Health of Children.

The Committee AGREED it would hold off from issuing any recommendations until the People and Overview Scrutiny Committee had had an opportunity to scrutinise the OFSTED report. Upon both committees having scrutinised the report, the Chairs, Vice-Chairs, and officers of both committees would meet and agree on a separate list of recommendations from each committee that did not conflict with each other.

The Chair invited the registered speakers to address the Committee.

1.    Statement by Terez Moore:

Terez Moore began by stating that the battle for their children has been hard and lengthy with no end of distress. Nothing she had ever experienced when fighting for her children had been centred on them and their needs. The County Council and health system could improve on trying to put children first. Terez gives an example of behavioural incidents and experiences of her child at school that she felt were not appropriately addressed or dealt with; with the head teacher refusing to accept her child’s diagnoses. She then expressed the traumatic nature of her child’s experiences with suicidal thoughts and stated that she felt there was a lack of support for her child and that their voices were not being heard strongly enough. The school refused to apply for an EHCP assessment for her child,  ...  view the full minutes text for item 29/23

Cllr Oconnor (Cabinet Member for Public Health and Inequalities), Derys Pragnell (Consultant in Public Health), and David Munday (Consultant in Public Health) have been invited to present a report on Oxfordshire Healthy Weight, with a focus on tackling Obesity with the County.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

The following were invited to respond to the Committee’s questions in relation to the Oxfordshire Healthy Weight Report; David Munday (Consultant in Public Health), Dery’s Pragnell (Consultant in Public Health), and Cllr Michael OConnor (then Cabinet Member for Public Health and Inequalities).

The Committee stated that this item’s purpose was to examine the work undertaken to help promote Healthy Weight within the county, and that it would also be looking at the Whole Systems Approach to tackling excess weight. It was also emphasised that the timing of this item was crucial given that excess weight affected many residents and families, and that it was crucial for there to be plans in place to support residents well as their families in this regard.

The Committee noted how pregnant women faced an increased risk of excess weight, and enquired about the support that was available for women both during and after pregnancy (including with breastfeeding) to help avoid this. The point was also raised regarding whether there was sufficient awareness of, as well as support for women diagnosed with gestational diabetes to help them manage this condition, particularly through early diabetes testing. The Committee also emphasised and asked about the importance of guiding children on chewing their food adequately and on eating more healthily, as well as spacing out the intervals between food consumption into specific meal and snack periods.

It was responded to the Committee that a needs assessment was carried out that was published earlier this year, which also looked at everything that could be done in terms of best practice, what was currently happening, as well as the latest guidance around early years, pregnancy, breastfeeding, weaning, and fussy eating, and that these were focused areas of work that were currently being looked at; with considerations being made as to what actions were required in these areas so as to contribute to healthy weight overall. It was also stated that licences were put to support people working in early years settings. The Consultants in Public Health emphasised that if support for healthy eating started early, particularly in terms of promoting a healthy balanced diet, then individuals who received this support would be more likely to perpetuate these eating habits later on in their lives in the long run. There was also work being undertaken with early years settings, including a survey which was conducted to understand what might support people in early years settings; both to help with food in these settings as well as to help parents. It was also emphasised to the Committee that there was a Whole Systems Approach to promoting healthy weight, and that it was pivotal for healthy weight to be maintained during pregnancy, as this could also have a positive effect on the weight of the child in question later on. Therefore, the essence of the Whole Systems Approach was to cover the entire life course.

It was also highlighted to the Committee that unhealthy weight could often manifest within more disadvantaged communities,  ...  view the full minutes text for item 30/23

Members of the public who wish to speak at this meeting can attend the meeting in person or ‘virtually’ through an online connection.

NB Owing to the fact the incorrect details were originally posted, if you wish to register to speak please do so by 2pm on 20 September by contacting scrutiny@oxfordshire.gov.uk

If you are speaking ‘virtually’, you may submit a written statement of your presentation to ensure that your views are taken into account. A written copy of your statement can be provided no later than 9am 2 working days before the meeting. Written submissions should be no longer than 1 A4 sheet.

Cllr Bethia Thomas submitted the following statement regarding the lack of NHS Dentistry services in the Faringdon area, with reference to the process through which NHS dentistry services were ceased by dental practices.

“I am here after the recent announcement that Faringdon’s dental practice in my division, has closed its doors to all NHS patients. The closure came as a shock to many as it came with very little warning – the statement that recently appeared on their website reads: “Regrettably, our NHS services will end on 30 September 2023. We have explored all available options to carry on providing NHS services, but unfortunately these have been exhausted, and we now have no alternative but to hand back our contract and stop providing NHS services as of 30th September 2023.”

Obviously this has caused great concern to my residents as it is the only practice in Faringdon serving the town and many of the outlying villages in the Western Vale. Many people wrote to us with their concern, and we had to explain that while we have no direct control in this matter, we would do our best to address the situation and find out if anything could be done to restore services locally.

And this is where I have to make a confession, as I realised how little I knew about the nature of NHS Dental provision and who is responsible for it. Initially I wrote to our MP David Johnston as I automatically assumed it is due to national policy and out of local control – incidentally he did get back to us and said he would meet with the practice, though I am still unclear what this action would achieve. Once this approach had been exhausted, I committed to asking a question of the Cabinet Member for Public Health at last week’s full council meeting in county hall. It is clear from his answer that nationally, dental services are in crisis. Over 90% of dental practices are not accepting new patients. The British Dental Association estimated in August last year that after a decade of ‘savage’ cuts, an additional £880 million a year would be needed to restore funding to 2010 levels. This is, of course, shocking, and while I think that it would take a radical change in direction in government funding to redress this situation, and more than a single MP of any colour could do, it did at least vindicate my decision to write to our local member. So, what can be done locally? The county recognises the importance of oral health to our overall wellbeing and is doing what it can to improve provision through its informal influence.

I know that this committee has already looked at this matter in April, summarising the problems with dentistry services in Oxfordshire. It noted that numerous practices are terminating their NHS contracts and explained the arrangements that are supposed to be put in place to try to find local practices to cover this loss temporarily and  ...  view the full minutes text for item 31/23

Cllr Hanna will provide a verbal update on relevant issues since the last meeting.

The Committee is recommended to NOTE the Chair’s update having raised any relevant questions.

The Chair referred back to the theme of NHS dentistry access as emphasised in Cllr Bethia Thomas’s aforementioned statement, specifying that this was a significant area of focus for the Committee. The Chair also proceeded to highlight the following points:

1.    The Committee had been hearing more about the difficulties that residents were experiencing with NHS dentistry access.

2.    The Committee had looked into dentistry provision in Oxfordshire as a formal scrutiny item earlier this year, and committed to following this up with an additional update.

3.    As per an Action from the Committee’s dentistry item held in April 2023, the Chair would hold a meeting with the relevant Cabinet Member to discuss the challenges around NHS dentistry in more depth, and to provide feedback from the Committee’s understandings and works around the area of dentistry provision.

4.    The Committee should continue to pursue a recommendation it previously made to NHS England and the ICB regarding the prospect of utilising underspends in Oxfordshire creatively so as to help provide improvements to dentistry services.

The BOB ICB Place Director for Oxfordshire highlighted that an innovative approach to utilising funding differently had recently been launched, which was to possibly manifest into the new flexible commissioning model adopted by the ICB.

The Chair emphasised that where Dentistry deserts did exist, it would be useful to consider investments of any potential underspends into these areas to ensure continuity of access to NHS dentistry services for local residents.

The Chair also referred to an issue highlighted by Healthwatch Oxfordshire, which related to websites for NHS dentistry services needing to be updated.

The Chair also enquired as to whether there was any process that allowed for the ICB to know with sufficient notice in advance that a dental practice would reduce NHS services, as doing so may enable the ICB to adopt measures to reduce the prospect of more NHS dentistry deserts emerging throughout the County. It was AGREED with the Committee that the BOB ICB Place Director will provide some further information on this to the Committee.

The Chair then pertained to the co-production exercise that was occurring within the Wantage and Grove area in relation to the closure of the community beds at Wantage Community Hospital. The Chair reiterated that the Committee would receive a formal update on this in its meeting in November 2023, and referred to how this was an ongoing co-production journey, with the Committee’s Wantage Community Hospital Working Group having received monthly check-ins from the ICB and Oxford Health around the nature and effectiveness of the co-production exercise.

The Chair stated that the ICB and Oxford Health requested an extra two weeks for the public engagement exercise, and the community’s representatives were pleased with this. The Chair also expressed that her and the Scrutiny Officer were happy for the additional two weeks to be added to the engagement exercise as it was felt that the quality of the co-production, which should be the most crucial outcome, was not to  ...  view the full minutes text for item 32/23

Veronica Barry, Executive Director of Healthwatch Oxfordshire will present the Healthwatch update report. The Committee is invited to consider the report and NOTE it having raised any questions arising from the contents.

Veronica Barry (Executive Director HWO) was invited to summarise the report.

The Executive Director of HWO made the following points:

1.    HWO had contributed to the work invested into updating the Health and Wellbeing Strategy for Oxfordshire.

2.    HWO had heard about residents struggling to find a dental practice that was willing to take on NHS patients.

3.    It was still not clear how patients could access the supplementary service, but the pathways for this remained unclear. Further clarity on this would be highly useful so as to help HWO in signposting patients.

The Committee reiterated the importance of greater transparency and information sharing and urged the ICB’s Place Director to try to follow this up within the NHS. The ICB Place Director lauded HWO’s work and contributions toward the Health and Wellbeing Strategy as well as the recent work around the Primary Care Strategy.

Cllr Oconnor (Cabinet Member for Public Health and Inequalities) and David Munday (Consultant in Public Health) have been invited to present a report on the Oxfordshire Health and Wellbeing Strategy Update.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

The following were invited to respond to the Committee’s questions in relation to the Health and Wellbeing Strategy Update; Cllr Liz Leffman (Leader of the Council and Chair of Health & Wellbeing Board), David Munday (Consultant in Public Health), Cllr O Connor (Cabinet Member for Public Health and Inequalities), Daniel Leveson (BOB ICB Place Director for Oxfordshire), and Veronica Barry (Executive Director, Healthwatch Oxfordshire).

The Committee outlined that this item was looking at the work undertaken by key actors and partners within the Oxfordshire system to update the strategy, and understood that the report received was not the official strategy document, but provided an outline of the work being put into updating the strategy.

The Committee urged to have site of a draft of the strategy document prior to its ratification at the health and wellbeing board in December this year; so as to allow for an opportunity to provide feedback on the draft.

The Leader explained that the strategy was a product of a joint production of many system partners; including the ICB, the County Council, the District Councils, and Healthwatch Oxfordshire.  In essence, this was a system strategy and not an OCC strategy. The strategy was not looking at the nature of clinical services, but focused on the building blocs of health, and how this played out at the place level. The strategy was about focusing on a few key priorities as opposed to everything and anything related to health. The strategy also aimed to provide equity across the board.

The lead OCC Public Health Consultant working on the strategy also explained the following points:

1.    A lot had changed since the publication of the last Health and Wellbeing Strategy.

2.    The occurrence of the Covid-19 pandemic had a significant impact on public health overall.

3.    The cost-of-living crisis had also emerged since the previous version of the strategy, with significant implications on health and wellbeing.

4.    The way the strategy was formulated was that it was an objective plan, built out of the Joint Strategic Needs Assessment (JSNA).

5.    The Strategy also drew in the voices and experiences of residents and how they felt about the priorities around Health and Wellbeing.

6.    The Integrated Care System’s strategy also informed the wider Health and Wellbeing Strategy for Oxfordshire.

It was also emphasised to the Committee that data had been drawn into the strategy, which indicated the following:

1.    There was an ageing population in Oxfordshire.

2.    There had been an increase in people living with long-term conditions.

3.    There were more challenges with children being able to learn age 5.

4.    There were unequal impacts relating to Healthy Weight

5.    Challenges around loneliness had also increased.

In regards to the public engagement exercises, the Committee was also informed that with Healthwatch Oxfordshire’s lead, 1100 residents were consulted with questions around what helped their health and wellbeing, what hindered their health and wellbeing, and what was important to them. It was also emphasised that the residents spoken to were those  ...  view the full minutes text for item 34/23

Dan Leveson (BOB ICB – Place Director, Oxfordshire), Lily O’ Connor (BOB ICB Programme Director Urgent and Emergency Care for Oxfordshire), Dr Ben Riley (Executive Managing Director- Primary, Community and Dental Care at OH), Lisa Glynn (Director of Clinical Services OUHFT), and Victoria Baran (Deputy Director of Adult Social Care), have been invited to present a report on Winter Preparedness.

The Chair welcomed the following invitees; Dan Leveson (BOB ICB – Place Director, Oxfordshire), Lily O’ Connor (BOB ICB Programme Director Urgent and Emergency Care for Oxfordshire), Dr Ben Riley (Executive Managing Director- Primary, Community and Dental Care at OH), Lisa Glynn (Director of Clinical Services OUHFT), and Victoria Baran (Deputy Director of Adult Social Care) to present a report and answer questions on readiness to respond to the increased demands on the health and social care systems over the winter period. .

The ICB Programme Director for Urgent and Emergency Care (Lily O’ Connor) summarised the following points to the committee:

1.    There had been immense work with all Primary Care partners to develop a more integrated approach with additional resources added to help them manage frail or complex individuals in their own homes.

2.    There was an OPEL (Operational Pressures Escalation Levels) framework and process that is utilised to assess whether existing demand is being met, with scorings from 1 to 4. The ICB was working with SCAS, Oxford Health, Oxford University Hospitals and the local patient transport service as part of this OPEL framework process.

The following points were also provided by the Executive Managing Director- Primary, Community and Dental Care at Oxford Health (Ben Reily):

1.    There was a need to simplify the complexity for people to understand the services available to them.

2.    Prevention was a key principle, to preclude surges of demand, both within the winter as well as in other seasonal periods.

3.    Community services were being pulled together to ensure that there was one single team to call when patients require help, who could then arrange the appropriate response and prevent patients being passed around; this work was a key element of the projects around the single point of access.

4.    There needed to be clarity regarding the right place to go when needing to be seen by a professional. People were finding it difficult to access care, walking into different services such as a minor injuries unit or Accident and Emergency, only to be informed that they have to go elsewhere for help after having waiting for several hours.

5.    It was important that there were staffing resilience measures, and it might be necessary to think about how to pool and organise staffing on a wider scale to avoid abrupt closures of services caused by staff absences. 

In referring to the development of a support structure to integrate local community services, the shape and nature of the resultant services was queried, particularly how they would operate at a community level.

The point was made that it was important for transparency that HOSC and the public knew which areas tended to be rated OPEL 3 or 4 and were thus under greatest pressure. More information on where the greatest risks lay within the system was requested.

The ICB Programme Director for Urgent and Emergency Care explained that SCAS were declaring OPEL 4, and could declare this during the evenings and during the  ...  view the full minutes text for item 35/23

Following the decision of Jean Bradlow to resign from her position as a co-opted member of the Committee, Tom Hudson, Scrutiny Manager, will present a report outlining suggested next steps. The Committee will be asked to AGREE those next steps.

NB This item is to follow.

The Chair asked the Committee to NOTE the resignation of Jean Bradlow as a member of the Committee, and thanked Jean for her contributions to the Committee’s work.

To agree the Committee’s work programme for the upcoming meetings throughout the remainder of the 2023/24 civic year, having raised any questions.

The Committee NOTED the Forward Work Plan.

The Committee is recommended to NOTE the progress made against agreed actions and recommendations having raised any questions.

The Committee NOTED the Actions and Recommendations Tracker.