Agenda and draft minutes

Apologies had been received from Cllr Nick Leverton and Siama Ahmed, with Cllr Nigel Simpson substituting for Cllr Nick Leverton.

Cllr Hanna declared her interest as working for the health charity SUDEP Action.

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

Cllr Champken-Woods declared his interest as Vice-Chair of Trustees for an Elderly day centre.

Barbara Shaw declared her interest as Chair of Governors at a school, and as Chair of a Heart Charity.

To approve the minutes of the meeting held on 21 September 2023 and to receive information arising from them.

The minutes of the committee’s meeting on 23 September 2023 were assessed for their accuracy.

The Committee AGREED the minutes 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.

To facilitate ‘hybrid’ meetings we are asking that requests to speak or present a petition are submitted by no later than 9am four working days before the meeting i.e., 9am on Friday 17 November. Requests to speak should be sent to omid.nouri@oxfordshire.gov.uk and 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.

The Chair invited the registered speakers to address the Committee.

1.    Statement by Cllr Stefan Gawrysiak

Cllr Gawrysiak highlighted that in December, 7 short stay Hub beds (SSHB) were being removed from Chiltern Court Henley on the Townlands health Campus. This was part of a reduction across the county from 97 SSHB to 63. A further cut to 40 was to happen in April and that this removal by OCC had been done without any consultation with GPs and the local community. These beds were currently fully occupied and were supervised by the Bell and Hart Surgeries.

This meant that the whole of South Oxfordshire was without any SSHB. South Oxfordshire comprises 140,000 residents. These were not Henley beds, these were beds that served postcodes RG9, RG4, OX10, OX9 and OX39.

A frail elderly person, with frail elderly relatives who was discharged from the Royal Berkshire Hospital would be placed in a care homes 20miles and a 2hr Bus journey away. This could not be good for their recovery.

Cllr Gawrysiak highlighted that all local GP’s were against this because the burden would fall on them. Also, it was to be noted:

Ø  that even though they run the service they had not been consulted.

Ø  Henley Town Council, Patient Groups as well as himself (Cllr Gawrysiak) as County Councillor had not been consulted.

Cllr Gawrysiak concluded by asking HOSC to investigate and ask the following questions:

1. The location of the 63 beds shortly to be 40, on a map, so we can see the spread of these SSH Beds?
2. Why had there been no consultation?
3. Where were the frail and elderly discharged from the Royal Berkshire Hospital going to go if they needed extra care?
4. Request from OCC the data that this decision had been based on.

2.    Statement by Henley Town Council Cllr Ian Reissmann:

Cllr Reissmann outlined that he was speaking in his capacity as Chair of the Townlands Steering Group; a community-based committee which invited a wide range of community representatives including 15 Parish Councils from the South of Oxfordshire. The group had also been active for 20 years in the subject of health and social care, and had met a week prior to the HOSC meeting to discuss the closure of the SSHB in Henley. Cllr Reissmann shared Cllr Gawrysiak’s concerns outlined in the previous public statement, and that he was concerned that the determining factor behind the closure of the beds may be cost-driven as opposed to being based on patient need. It also seemed inappropriate that South Oxfordshire, which had a population of 140,000 residents, would have no SSHB. Cllr Reissmann also expressed concern regarding the ways in which the care pathways would work under the proposed reductions of SSHB. The GPs had clarified that they provided the care for the patients occupying the SSHB, and that these beds were fully utilised. Cllr Reissmann added that he had been informed that the beds had only been occupied by patients who experienced delays in  ...  view the full minutes text for item 42/23

Anne Coyle (Corporate Director of Children’s Services); Ansaf Azhar (Corporate Director of Public Health & Community Safety); Daniel Leveson (BOB ICB Place Director, Oxfordshire); Caroline Kelly (Lead Commissioner- Start Well, Oxfordshire Health, Education and Social Care Joint Commissioning across Oxfordshire County Council and the BOB ICB); Donna Husband (Head of Public Health Programmes – Start Well, Public Health & Community Safety Directorate, Oxfordshire County Council); have been invited to present a report with a progress update on Children and Young People’s Emotional Wellbeing and Mental Health.

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

Anne Coyle (Corporate Director of Children’s Services); Ansaf Azhar (Corporate Director of Public Health & Community Safety); Daniel Leveson (BOB ICB Place Director, Oxfordshire); Caroline Kelly (Lead Commissioner- Start Well, Oxfordshire Health, Education and Social Care Joint Commissioning across Oxfordshire County Council and the BOB ICB); Donna Husband (Head of Public Health Programmes – Start Well, Public Health & Community Safety Directorate, Oxfordshire County Council); had been invited to present a report with a progress update on Children and Young People’s Emotional Wellbeing and Mental Health.

It was highlighted that this item had come to HOSC previously in 2022, where the Committee recommended for urgent prioritisation of funding to support the Children’s Emotional Wellbeing and Mental Health Strategy. This item was therefore an update on the effectiveness of the Strategy and its deliverability in the context of children’s emotional wellbeing and mental health services overall.

The Director of Public Health informed the Committee that this was a system-wide strategy that was launched over 12 months ago, with a view to how there could be improvements to the emotional wellbeing and mental health of Oxfordshire’s young people. It was highlighted that the strategy partly aimed to improve the mental wellbeing of children in a manner that prevented young residents from having to be on CAMHS waiting lists to begin with. Alongside the Children’s directorate, Public Health had conducted a needs assessment to look at the underlying need within the County with respect to children’s emotional wellbeing and mental health. It was explained to the Committee that it was in this context that the strategy was formulated. The strategy contained four key principles which were:

1.    Providing early help and creating supportive environments.

2.    Developing a confident workforce.

3.    Ensuring positive transitions.

4.    Improving access.

The Lead Commissioner for Start Well outlined that there was a digital offer which was currently being tendered, with bids having been received for the new service which was due to start in April 2024. An analysis of the parent course offer was conducted, as well as the use of support groups to understand what was already available, what was working well, and to receive feedback from parents and carers to understand what else could be undertaken in the digital space. There was also work with schools to understand how they operate to support children and young people with their wellbeing and resilience; looking at various frameworks including the I-THRIVE model. The system’s dashboard had also been developed to understand the initiatives that were being worked on now and whether they were making a difference to children, young people, and their families.

The Head of Public Health Programmes for Start Well outlined that Oxfordshire MIND had been commissioned to deliver all-ages Mental Health and Suicide Prevention Training. Training is also very much needs-led in its focus and nature. More bespoke training may also be delivered by the system if that is identified within local communities.

It was also explained to the Committee that in terms of the transitions approach,  ...  view the full minutes text for item 43/23

Vicky Norman (Head of Service Oxfordshire CAMHS & Eating Disorders); Katrina Anderson (Service Director, Oxfordshire, BaNES, Swindon & Wiltshire Mental Health Directorate); Emma Fergusson (Associate Medical Director CAMHS Oxfordshire); have been invited to present a report with data and development updates from Oxfordshire Child and Adolescent Mental Health Services (CAMHS).

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

Vicky Norman (Head of Service Oxfordshire CAMHS & Eating Disorders); Katrina Anderson (Service Director, Oxfordshire, BaNES, Swindon & Wiltshire Mental Health Directorate); Emma Fergusson (Associate Medical Director CAMHS Oxfordshire); had been invited to present a report with data and development updates from Oxfordshire Child and Adolescent Mental Health Services (CAMHS).

The Committee enquired as to whether the cost-of-living crisis had resulted in a decline in the mental health of children and young people, and if so, what role CAMHS was playing in helping to support children and families whose mental health had significantly declined as a result of this crisis. It was explained to the Committee that it was difficult to always identify cause and effect patterns, and therefore it was not straightforward to suggest that the cost-of-living crisis had resulted in a significant decline in children’s mental health. However, there had been a significant rise in the rate of referrals to CAMHS Services, as well as in the acuity of those children who were presenting. The Committee emphasised that the service should keep a close eye on the impacts of the covid-19 pandemic as well as the cost-of-living crisis on children’s mental health and wellbeing. The BOB ICB Place Director added that during the work undertaken as part of the Health and Wellbeing Strategy, the themes of the cost-of-living crisis as well as the covid-19 pandemic resonated in all these contexts. The Executive Director of Healthwatch Oxfordshire also explained that as part of the work undertaken in the context of the public engagement around the Health and Wellbeing Strategy, the cost-of-living was a significant driver. It was heard that the crisis had generated further stresses on working families, which resulted in an increase in parental stress and which would also have a knock-on effect on children’s emotional wellbeing and mental health.

The Committee emphasised that there were national challenges around workforce, and queried the steps that had been taken to secure adequate recruitment and retention of staff. The Committee also referred to how the report mentioned attendances at recruitment fairs as well as the offering of relocation packages and incentive payments, and asked how effective these measures had proven thus far, and whether any further measures would be embarked on. The Head of Oxfordshire CAMHS responded that recruitment fairs were held in Belfast, Dublin, and Glasgow; with two nurses from Glasgow expressing a keen interest in relocating. There was also a CAMHS academy pilot to train people to come into CAMHS. The service was being more creative in how it looked for employees and created job roles, and the service was looking to become as needs-led as possible. For instance, it was explained to the Committee that when considering who to employ for the Eating Disorder Service, it may be more appropriate to recruit a more general nurse as opposed to a purely mental health nurse given the physical aspect of eating disorders. In terms of staff retention, it was explained that the service was not performing too badly on  ...  view the full minutes text for item 44/23

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.

There are TWO Key documents attached to this item:

1.    The Letter sent on behalf of HOSC to the Secretary Of State for Health on Dentistry Provision in Oxfordshire.

2.    A document containing a response from the Department of Health to a letter sent on behalf of HOSC on Primary Care within Oxfordshire.

The Chair highlighted the following points in relation to developments that have occurred since the last meeting on 23 September:

The Chair explained that a document was compiled which collated the views of the Committee on the recent Health and Wellbeing Strategy Update. This was shared with the Committee members and was also shared with relevant Public Health Officers.

The Chair referred to the Short Stay Hub Beds in Henley and expressed that the Committee would be closely looking into the reasoning behind the closure of these beds, as well as any other Short Stay Hub Beds within Oxfordshire.

The BOB ICB Place Director explained to the Committee that the closure of the Short Stay Hub Beds was a decision that had already been made, and that these were beds that were wrapped up in the broader Better Care Fund and Winter Plan. The Director of Adult Social Care added that these were not NHS beds, and that they were system beds that flexed up and down within the County, with no requirement to go into consultation when doing so. It was also specified that these were beds that were commissioned by the County Council, and that the closures were a part of the Oxfordshire Way of helping people to be supported in their own homes. It was also explained to the Committee that 17 hub beds were also closed in the North of the County.

The Chair referred to a national Healthwatch report which was published a week prior to the Committee’s meeting, which explained that whilst there was support for being cared for at home, there were some concerns raised in terms of what was heard in surveys from families. The BOB ICB Place Director confirmed that there had been an increase in the amount of hours that the system was dedicating toward delivering care in peoples’ homes, and that there had also been a reduction in the amount of people delayed in hospital beds, with more people being discharged and receiving care at home than in the past. The Committee were therefore informed that the closure of Short Stay Hub Beds had to be seen in the broader context of a Countywide Urgent and Emergency Care programme.

The Committee emphasised that it was pivotal for there to be clear communication behind the reasoning behind the closure of Short Stay Hub Beds as well as details of the alternative services that patients would be expected to receive upon being discharged from hospital. The Executive Director of Healthwatch Oxfordshire also added that whilst this new model of care may be a manifestation of good practice, there was an urgent need for clearer communications with the wider public in relation to this.

The Committee AGREED to the following recommendation:

1.    To hold an item in its extra meeting on 16 January 2024, to look into the reasoning behind the closure of Short Stay Hub Beds, as well as to receive specific and broader insights into the process of discharging and  ...  view the full minutes text for item 45/23

HOSC has received responses to recommendations made as part of the following scrutiny items:

1.    Dentistry Provision in Oxfordshire.

2.    Local Area Partnership SEND.

3.    Oxfordshire Healthy Weight.

4.    Health and Wellbeing Strategy.

HOSC has also received an additional progress update response to the following recommendation made to BOB Integrated Care Board in its November 2022 meeting as part of the Primary Care Item:

Specified roles are filled within the ICB with the primary responsibility to work with District Councils at Place Level to coordinate use of CIL funds held by the ICB and from executed Section 106 funds for Primary Care.

Progress Update Response from BOB ICB: We are delighted to say that we have managed to recruit a Primary Care estates manager who will have a key role in working with Districts in terms of planning for new housing developments.  The successful candidate starts in December 2023.  Unfortunately, recruitment was delayed due to lack of suitable candidates. 

The Chair highlighted that the Committee had received acceptances for and responses to its previously made recommendations. The Committee was pleased that most of the recommendations had been accepted. Acceptances and responses were provided to recommendations made around the following items/areas:

1.    Dentistry Provision in Oxfordshire.

2.    Local Area Partnership SEND.

3.    Oxfordshire Healthy Weight.

4.    Health and Wellbeing Strategy.

The Committee had also received an additional progress update response to a recommendation made to the BOB Integrated Care Board in its November 2022 meeting as part of the Primary Care Item. This called for specified roles to be created within the ICB to work alongside District Councils to coordinate the use of CIL funds held by the ICB and from executed Section 106 funds for Primary Care. The ICB clarified that a new post would be in place in the ICB by December 2023 to work on the above.

The Committee NOTED the responses to, as well as the progress made toward implementing the recommendations it had made previously.

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.

The Executive Director of Healthwatch Oxfordshire expressed the following points to the Committee:

1.    The Committee were informed about the reports on community research which stemmed from the emerging community research network that was developing in Oxfordshire. Healthwatch Oxfordshire undertook interviews with both system partners and communities as part of this. The Committee were informed that within the reports developed by Healthwatch, important lessons had emerged for all system partners who were looking into how to better engage with seldom heard communities. Healthwatch had also heard a lot from community members regarding a sense of research fatigue. Community members felt bombarded by services which sought their views and which expressed a commitment to work with them, but did not notice any action or a strong sense that services were building on previous work or research that had taken place.

2.    In support of the upcoming Primary Care Strategy, Healthwatch were holding a webinar with the BOB ICB Place Director to speak to members of the public about the strategy with the ICB.

3.    The Committee were informed about the footcare report which highlighted the public concerns relating to basic footcare not being provided through the NHS, with residents having to resort to private means of treatment.

4.    Earwax removal was another area explored by Healthwatch. Previously, residents would usually receive earwax removal treatments form their GP, which was no longer a service that was available. There was a concern around whether residents would have to seek private earwax removal treatments prior to accessing some of the services for hearing support.

The Committee NOTED the report by Healthwatch Oxfordshire, and thanked Healthwatch for its contributions.

Daniel Leveson (BOB ICB Place Director, Oxfordshire) has been invited to present a report with an update on the Oxfordshire Place-Based Partnership.

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

Daniel Leveson (BOB ICB Place Director, Oxfordshire) had been invited to present a report with an update on the Oxfordshire Place-Based Partnership.

The following points were explained to the Committee in relation to the Place-Based Partnership.

1.    The Partnership struggled with the governance around it, as it did not have formal delegated authority from the ICB. There had been ongoing discussions as to whether or not authority would be delegated, but that national guidance outlined that the engine room of integration should be Place. The Partnership had also been running for approximately a year.

2.    The Partnership was developing well, and the Place Director brought the leadership of the Partnership together.

3.    A wide array of organisations and stakeholders were represented in the Partnership including the County Council, General Practice, the City and District Councils, the Chief Executives of Oxford Health Foundation Trust and Oxford University Hospitals Foundation Trust, Healthwatch Oxfordshire, and Voluntary Sector Representatives.

4.    The ICB Place Director’s role was focused on identifying individuals and populations that would benefit from joined-up care.

5.    The Partnership focused on bringing resources together for improving outcomes for residents.

6.    The Committee were also informed that the Partnership focused on the following priority areas/populations:

Ø  Children and Young People: including school readiness, SEND, children and young people’s emotional health and wellbeing.

Ø  Adult and Older Adult Mental Health and Wellbeing: including the adult and older adult mental health, those with Learning Disabilities and neurodiversity.

Ø  People with Urgent Care Needs: including children, adults and older adults with multiple illnesses and frailty.

Ø  Health Inequalities and Prevention: including the promotion of healthy lifestyles, working with communities and taking into account the role of anchor institutes and major employers.

The Committee queried the steps that the Partnership were taking to establish strong relationships, both amongst its core membership as well as with wider partners. It was responded that Partnership working was going well, and that the Partnership took basic measures including having meetings in-person. There was a clear set of priorities that the Partnership was collaboratively working towards. A maturity matrix was also adopted, and the Partnership would routinely refer back to this to determine its overall direction of travel. It was emphasised to the Committee that good relationships formed the basis of this Partnership at a fundamental level.

The Committee enquired as to the degree to which transparency was at the heart of how the partnership operated, and whether there were any challenges in this area of transparency. It was responded that the Partnership somewhat relied on trust, and that trust was not always easily measurable. It was also explained to the Committee that the current system in which the Partnership operated did not necessarily enable the Partnership to exercise transparency very well, as the regulatory system had not kept up with this. But there were incremental changes within the system that were necessary, including a stronger understanding of risk and a practice of risk-sharing.

The Committee queried if any reassurances could be  ...  view the full minutes text for item 48/23

Daniel Leveson (BOB ICB Place Director, Oxfordshire); Lucy Fenton (Transformation Lead – Primary, Community & Dental Care

Oxford Health NHS Foundation Trust); Susannah Butt (Transformation Director-Primary, Community and Dental Care, Oxford Health NHS Foundation Trust); Dr Ben Riley (Executive Managing Director- Primary, Community and Dental Care, Oxford Health NHS Foundation Trust); have been invited to present a report providing an update on the Public Engagement Exercise around Wantage Community Hospital.

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

N.B A report detailing the recommendations of the HOSC Substantial Change Working Group is to follow and to be published as an addendum. The Committee is invited to consider this report on the Public Engagement Exercise around the future of the Hospital, and is recommended to AGREE to the following recommendations made by the Working Group:

1.    Defer the decision as to whether the closure of beds at Wantage Community Hospital constitutes a Substantial Change.

2.    Defer the decision on whether to refer to the Secretary of State for Health and Social Care the matter of the closure of beds at Wantage Community Hospital.

3.    Agree an extra HOSC meeting to be scheduled in mid-January to make a final determination as to whether to make a referral to the Secretary of State is necessary in relation to the removal of beds at Wantage Community Hospital, and as to whether declare the removal of the beds as a Substantial Change.

Daniel Leveson (BOB ICB Place Director, Oxfordshire); Lucy Fenton (Transformation Lead – Primary, Community & Dental Care OH NHS Foundation Trust); Susannah Butt (Transformation Director-Primary, Community and Dental Care, Oxford Health NHS Foundation Trust); Dr Ben Riley (Executive Managing Director- Primary, Community and Dental Care, Oxford Health NHS Foundation Trust); were invited to present a report providing an update on the Public Engagement Exercise around Wantage Community Hospital.

The Committee emphasised that it was crucial that they were aware of the progress made as part of the public engagement exercise around the future services to be delivered at Wantage Community Hospital, as well as for there to be clarity on the degree to which adequate co-production had been at the heart of determining how future services at the hospital would be configured following the closure of the inpatient-beds some years ago.

The Committee sought reassurance on the degree to which viable offers were being made as to the future of the hospital’s services. It was raised and discussed that the HOSC Substantial Change Working Group had been involved in close and continuous scrutiny of the public engagement exercise, and that the working group had held monthly check-ins with Oxford Health and the ICB to be kept up to date with as well as to discuss the exercise. The Working Group had also produced a report with its own recommendations to HOSC, which had been published as an addenda to the original agenda for this meeting.

The Committee thanked Oxford Health as well as the ICB for their efforts around the co-production exercise on the hospital’s future, and outlined that this was the closest that the system had ever been previously in helping to determine which services should be delivered on the ground floor of the hospital following the closure of the inpatient beds. The Committee also thanked all stakeholder groups which also partook in the exercise.

It was also discussed that the survey that was distributed as part of the exercise had come to an end, and that verve (the independent facilitator of the exercise) were in the process of collating the findings.

It was also raised that there were three scenarios as to how future services could be delivered on the ground floor of the hospital, and that these scenarios were discussed as part of the public engagement exercise, which included:

1.    Clinic based services (tests, treatment and therapy) for planned care appointments.

2.    Community inpatient beds and the alternatives when care in people’s own homes was not possible.

3.    Urgent care (minor injury, illness and mental health issues) access needs on the same day.

The BOB ICB Place Director explained to the Committee that the NHS understood and appreciated that the community in Wantage wanted clarity on the future of the hospital’s services since the closure of the inpatient beds, and that they wished to see a resolution. It was also highlighted to the Committee that immense time, effort and resource was invested into the public engagement exercise in  ...  view the full minutes text for item 49/23

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 AGREED the proposed work programme for the upcoming meetings throughout the remainder of the 2023/24 civic year.

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

The Committee NOTED the progress made against agreed actions and recommendations.