Agenda and draft minutes

None were received.

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

Cllr Haywood declared his interest in working for the NHS.

To approve the minutes of the meeting held on 23 November 2023 and to receive information arising from them.

The minutes of the committee’s meeting on 23 November 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 Wednesday 10^th January. Requests to speak should be sent to 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 urged the Committee to ensure that the topic of Short Stay Hub Beds in Henley was not lost, and that strong answers needed to be provided to these questions. Accountability was imperative given the lack of consultation regarding this matter.

Cllr Gawrysiak made the following points:

1.    In 2016 the Henley Step Down beds were NHS beds to relieve pressure on the Royal Berks. These were provided by the Oxfordshire Clinical Commissioning Group (OCCG) and were designated as permanent beds replacing the Peppard Ward Beds. The reference for this would be David Smith OCCG and John Howell MP.

2.    In 2021 they were still permanent NHS Beds because a consultation was had by Kate Teroni (OCCG Chief Executive) to remove the 4 RACU beds.

3.    Why had these permanent NHS Chiltern Court Beds been removed without consultation with GP's, patient Groups, RBH, Henley Town Council, Townlands Steering Group, and himself as County Councillor?

4.    If their status had changed from being NHS beds, then it needed to be clarified when this change occurred as well as what consultation took place; including Minutes and Agendas?

5.    These beds had been reduced from 125 to 63 and shortly to 40. Why had this process occurred without consultation and without having a geographical element?

6.    Why was it that South Oxfordshire, Thame, Henley, Wallingford, had no beds at all?

8.    How could it be right to place a vulnerable elderly patient in Banbury some 45 Miles away? Was it expected for elderly family members to catch a bus to see their loved ones?

9.    Cllr Gawrysiak asked for the evidence that the reduction of these beds had been through the proper due process.   

Cllr Gawrysiak emphasised that how could it be right to have a policy that stated that SSHB provision could or should not be predicated on some form of Geography, such that it left South Oxfordshire with no beds. Cllr Gawrysiak questioned as to how it was right to provide beds in Banbury, Chipping Norton, Oxford and Abingdon and not Henley/Thame/Wallingford/South Oxfordshire.

2.    Statement by Janet Waters:

Janet explained that she was chair of the Bell Surgery PPG, and that she also represented the PPGs from the HenleySonNet PCN representing Bell, Hart, Sonning Common and Nettlebed Surgeries. Janet outlined that she was well aware of the history of the provision of Short Stay Hub Beds (SSHBs), having been a member of the Townlands Stakeholder Reference Group which gathered data and information concerning the use of the original 11 beds allocated to the Chiltern Court Care Home.

Janet stated that as representatives of patients in this PCN area, they objected to the closure of the 7 SSHBs provided in Chiltern Court Henley. There had been no communication or consultation before the final decision was taken. They were presented with a final decision that would impact patients in South Oxfordshire adversely. There may had been  ...  view the full minutes text for item 4/23

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

There are three documents attached to this item:

1.    A report (with recommendations from HOSC) submitted to Oxfordshire CAMHS.

2.    A document containing HOSC feedback on the most recent Health and Wellbeing Strategy Document for Oxfordshire.

3.    A letter on Epilepsy Medication which has been made available to National Policymakers (please see more detail on this below).

One matter that was advised to the committee in June last year regarding medicines and epilepsy has since been communicated as a central safety alert CAS-ViewAlert (mhra.gov.uk). A letter has been sent by two leading epilepsy charities, Epilepsy Action and SUDEP Action (Oxfordshire based); to the Neurological Alliance who has made this available to national policy makers. Epilepsy Action, SUDEP Action, and Neurological Alliance have requested that this letter be tabled urgently at Oxfordshire JHOSC because of the deadline for ICB action plans in this matter by 31^st January. And the likely impacts on Oxfordshire patients, clinicians, and NHS management.   

It is RECOMMENDED that the committee delegates this matter to the scrutiny officer and Chair to: 

1. Liaise with the ICB with A view to an update about the ICB response to the alert and required local action plan to date, and consideration of the suggestion by patient charities that a delay is sought to implementation of this measure because of the severe pressures in the NHS and until adequate resources can be made available to local systems. This is based on an understanding of the likely impacts and how best to support clinicians, patients, and managers.

2. Write a letter to the Chair of the Parliamentary Health Scrutiny Committee requesting consideration of scrutiny of the latest safety alert given; the proposed timescales for implementation, the lack of a national impact assessment, or the lack of resources to support the new requirements. 

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

The Committee Chair outlined the following points to update the Committee on developments since the previous meeting:

1.    A report containing recommendations from HOSC had been submitted to Oxfordshire CAMHS.

2.    A document containing feedback collated from HOSC on the most recent Health and Wellbeing Strategy Document for Oxfordshire had been shared with Public Health Officers. It was crucial that HOSC had ongoing engagement with any future delivery plans for the Health and Wellbeing Strategy once these were produced.

3.    The Chair and Health Scrutiny Officer had met with the SCAS Chief Governance Officer to commission a paper for the February HOSC meeting, on an update on the Ambulance Service’s Care Quality Commission (CQC) improvement Journey.

4.    The Chair and Health Scrutiny Officer had met with Karen Fuller (Adult Social Care Director) to discuss the reasoning behind the closure of Short Stay Hub Beds in Henley, as well as to understand how this sat in the broader context of providing support to people who left hospital within their own homes.

5.      An updated matter that was advised to the Committee in June last year regarding medicines and epilepsy had since been communicated as a central safety alert CAS-ViewAlert (mhra.gov.uk). A letter had been sent by two leading epilepsy charities, Epilepsy Action and SUDEP Action (Oxfordshire based); to the Neurological Alliance who had made this available to national policy makers. Epilepsy Action, SUDEP Action, and Neurological Alliance had requested that this letter be tabled urgently at Oxfordshire JHOSC because of the deadline for ICB action plans in this matter by 31^st January; and the likely impacts on Oxfordshire patients, clinicians, and NHS management. A letter was also tabled from Professor Marian Knight (University of Oxford) in support and the Chair stated that she had received serious concerns from Oxfordshire clinicians. A question was raised about concerns of medicine shortages for anti-seizure medications and it was also raised that the medicine is used for mental health as well as for epilepsy. 

The Committee AGREED to DELEGATE this matter to the scrutiny officer and Chair to: 

1. Liaise with the ICB with a view to an update regarding the ICB response to the alert and required local action plan to date, and consideration of the suggestion by patient charities that a delay is sought to implementation of this measure because of the severe pressures in the NHS and until adequate resources could be made available to local systems. This was based on an understanding of the likely impacts and how best to support clinicians, patients, and managers.

2. Write a letter to the Chair of the Parliamentary Health Scrutiny Committee requesting consideration of scrutiny of the latest safety alert given; the proposed timescales for implementation, the lack of a national impact assessment, or the lack of resources to support the new requirements. 

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 the final co-produced report providing details on both the outcomes of the Public Engagement Exercise around Wantage Community Hospital, as well as on the final offer as to which specific services will be provided at the Hospital following the closure of the in-patient beds in 2016.

Based on the feedback of the HOSC Substantial Change Working Group (to be provided verbally during the meeting on January 16^th), the Committee will be required to AGREE on:

1.    Whether or not to declare the closure of beds at Wantage Community Hospital as a Substantial Change, and,

2.    Whether or not to refer to the Secretary of State for Health and Social Care the matter of the closure of beds at Wantage Community Hospital.

PLEASE NOTE the following:

The Committee’s Substantial Change Working Group will be meeting on Friday 12th January, where it will be making its final decision on what it will be recommending to the wider HOSC on 16th January. The reasoning behind the Working Group meeting being scheduled at a date that is close to the formal HOSC meeting on the 16th is due to the fact that it is pivotal that the Working Group and the wider HOSC take the outcomes of the Wantage Town Council Health Committee Public Meeting on 11^th January into account prior to making a formal decision on whether or not to; refer this matter to the secretary of state and as to whether or not to declare the closure of the in-patient beds at Wantage Community Hospital as a Substantial Change.

The following documents are attached to this item:

1.    A report by the Health Scrutiny Officer, outlining the context and explanations as to what it is the Committee will be required to decide on during this item.

2.    The final co-produced report on Wantage Community Hospital outlining the outcome of the Public Engagement Exercise and the next steps and recommendations.

3.    A list of appendices including; a list of outpatient services delivered at Wantage Community Hospital, the HOSC History of the hospital, a Map of Community hospital inpatient locations, and a statement of support from Oxfordshire County Council on the recommendations being proposed as to how to configure the future services at Wantage Community Hospital.

4.    A report by Verve, the independent facilitator used for supporting the Public Engagement Exercise.

5.    A letter of support from the Chief Executive of Oxford University Hospitals NHS Foundation Trust on the recommendations being proposed as to how to configure the future services at Wantage Community Hospital.

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); had been invited to present the final co-produced report providing details on both the outcomes of the Public Engagement Exercise around Wantage Community Hospital, as well as on the final offer as to which specific services would be provided at the Hospital following the closure of the in-patient beds in 2016.

It was highlighted that the Committee had received a written report from the Health Scrutiny Officer, which provided some context as well as clarity over the process around the decision that the Committee were required to make during this item.

The Committee Chair explained that the members of the Substantial Change Working Group (Cllr Hanna, Cllr Barrow, Cllr Champken-Woods, and Cllr Hayward) had considerations as well as provisional recommendations which were to be shared verbally with the Committee by herself.

The Chair reminded the Committee that 31 January 2024 was the date that formal powers of referral to the Secretary of State by HOSCs were to be removed by the government, and that this had influenced the necessary timing of this extra meeting and the intensity of work; including the public meetings that had been held in the lead up to the HOSC meeting. 

The Oxford Health (OH) Executive Director of Primary Care and Community Services explained that the Public Engagement Exercise had represented an intense piece of work over the last 6 months, and it presented a fantastic opportunity to engage with local representatives and members of the stakeholder group to determine a secure future for Wantage Community Hospital. It was explained to the committee that the coproduction with the local stakeholder reference group had shared various different sources of information and types of data available on the health needs of the population (including the Joint Strategic Needs Assessment as well as service data) that supported the findings in the report.

The Committee were informed of the importance of the local community’s engagement in the exercise and its stakeholder engagement events, and how the NHS had taken the views of the local community seriously and that these had influenced the recommendations.

The OH Executive Director of Primary Care and community Services also reiterated the three scenarios as to how the hospital’s future ground floor services that were presented to the community during the engagement exercise, and explained that there were some key principles that would be used to guide the decision as to the future services. Such principles included a consideration that the community wanted clarity about a secure future for the community Hospital and that it was imperative for there to be sustainability around the future services that would be agreed and delivered.

It was explained to the Committee that the recommendation that was ultimately proposed in  ...  view the full minutes text for item 6/23

Karen Fuller (Director, Adult Social Care) and Ian Bottomley (Lead Commissioner, Age Well); have been invited to present a report on the Oxfordshire Way and the support provided to people leaving hospital.

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

Karen Fuller (Director, Adult Social Care) and Ian Bottomley (Lead Commissioner, Age Well); have been invited to present a report on the Oxfordshire Way and the support provided to people leaving hospital.

The Chair highlighted that the purpose of this item was to receive an update on the support for people leaving Hospital and the Oxfordshire Way. It was emphasised that upon commissioning the paper for this item, the Committee sought an outline as to the kind of support that residents could receive upon being discharged from hospital, and to look at this in the context of the Discharge to Assess (D2A) Process and the Oxfordshire Way.

The Chair also specified that key attention should be placed on the rationale behind prioritising care at home, and any National Directives and Nationally set Targets around this; and that it was also important for the Committee to understand how effectively the D2A process was working, and how it met people’s healthcare needs.

The Lead Commissioner for Age-Well informed the Committee that Oxfordshire was on a journey to improve how the system helped people leaving hospital. Oxfordshire needed to ensure that 95% of people leaving hospital returned to their usual place of residence. Oxfordshire was focused on getting people home and had rolled out a Home First D2A to achieve this. It was more possible to move to this approach due to operational and commissioning improvements that had been made, and the Home First D2A was better for Oxfordshire’s residents.

The Committee were informed that Oxfordshire also utilised short-term bed options each winter to increase flow out of hospital and to keep A&E moving, leading to the short stay hub model. Short-term beds created a further step in the onward journey, and they needed social work, therapy and medical cover to each bed. Most of the people in those beds eventually went home (over 70% of people in short stay hub beds). Oxfordshire was required to get 95% of people directly home from hospital; however the current achievement was 91-92%. There had been an improvement to the flow home through reablement, where 78% of people were now discharged without requiring any further care. In order to get to the 95% target, there was a need to support 15-20 people from bed-based to home-based pathways. The learning from the discharge to assess pilots indicates that only 33% of people waiting in beds for long-term care actually required that care. Getting people home first was therefore in line with national policy; the right thing to do for residents in line with the Oxfordshire Way; and was now possible because of changes that had been made in the Oxfordshire system.

The Committee were also informed about the Transfer of Care Hub in the hospital; which allocated patients to the appropriate discharge pathway, anticipated and pre-empted any barriers to discharge, and promoted a discharge to assess approach.

In regards to the Home First D2A model, there had been extended reablement through national Additional Discharge  ...  view the full minutes text for item 7/23

HOSC has received Acceptances and Responses to each of the FOUR Recommendations made by the Committee during its item on Winter Planning in its meeting on 21 September 2023.

The Committee is recommended to NOTE the responses.

The Chair outlined that the Committee had received acceptances and responses to each of the 4 Recommendations made by the Committee during its item on Winter Planning in its meeting on 21 September 2023.

The Committee NOTED the responses.

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

The Chair and Health Scrutiny Officer provided a brief outline of the items to be held in the remainder of the Committee’s meetings in the 2023-2024 civic year.

The Health Scrutiny Officer informed the Committee that the ICB’s Primary Care Strategy would be scrutinised by BOB HOSC, whilst this Committee would examine GP and Dentistry Provision at Place-level within Oxfordshire.

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.