Agenda and draft minutes

There were none.

Barbera Shaw declared that she was a Patient Safety Partner with Oxford University Hospitals, and a Member of the Board of Healthwatch as a Trustee.

Sylvia Buckingham declared that she was also a Patient Safety Partner with Oxford University Hospitals, and a Trustee for Healthwatch Oxfordshire.

To approve the minutes of the meeting held on 12 September 2024 and to receive information arising from them.

The Committee is recommended to AGREE the minutes as an accurate record having raised any necessary amendments.

The Committee AGREED the minutes as an accurate record for the meeting on 12 September 2024 subject to the following amendment:

• Paragraph 70/24: revise wording to better reflect the discussion on the correspondence to the NHS on the epilepsy item.

The purpose of this item is for the Committee to AGREE to the appointment of a Coopted member.

The Committee is RECOMMENDED to: -

1. NOTE the requirement to fill in two vacant co-opted posts on the Oxfordshire Joint Health Overview Scrutiny Committee (JHOSC) and the work undertaken to fill these posts.

2. AGREE to Sylvia Buckingham’s appointment as a co-opted member of the JHOSC (subject to her completion of the necessary paperwork).

NB This paper is to follow.

The Health Scrutiny Officer explained the recruitment process and requirements for co-optees for the Committee.

The Committee was introduced to the proposed co-optee candidate Sylvia Buckingham.

The Committee NOTED the requirement to fill two vacant co-opted posts and AGREED to appoint Sylvia Buckingham as a co-opted member of the Oxfordshire Joint Health Overview Scrutiny Committee from 21 November 2024.

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 15 November.  Requests to speak should be sent to scrutiny@oxfordshire.gov.uk and omid.nouri@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.

Shaunie Picken addressed the Committee regarding individuals with learning disabilities in Oxfordshire. Mr Picken underscored the significant health disparities faced by this population, noting that they tended to have a substantially shorter life expectancy compared to the general population—men dying approximately 27 years earlier and women 20 years earlier. Mr Picken referenced the ongoing "Health and Happiness Project," which aimed to address these health inequalities, and sought the council's support for this initiative. The speech emphasised the necessity for recognition and action to improve health outcomes for individuals with learning disabilities.

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

There are SEVEN documents attached this item:

1.   A HOSC report containing recommendations from the Committee on Adult and Older Adult Mental Health in Oxfordshire, which was discussed during the 12 September      2024 HOSC meeting.

2.   A HOSC report containing recommendations from the Committee on Winter Planning, which was discussed during the 12 September 2024 HOSC meeting.

3. A HOSC report containing recommendations from the Committee on Medicine Shortages, which was discussed during the 12 September 2024 HOSC meeting.

4. A HOSC report containing recommendations from the Committee on Epilepsy Services, which was discussed during the 12 September 2024 HOSC meeting.

5. A letter on behalf of the Committee sent to Karin Smyth MP, urging for greater resource to be allocated to epilepsy services, and for the suspension the MHRA regulatory updates of 2024 pending an independent national review of the UK's Pregnancy Prevention Programme.

6. A letter on behalf of the Committee sent to NHSE Specialist Commissioning, urging for further funding to be allocated to epilepsy services and for NHSE to escalate to ministers to support the suspension of the MHRA regulatory updates of 2024 pending an independent national review of the UK's Pregnancy Prevention Programme.

7. A letter on behalf of the Committee sent to Layla Moran MP, requesting the Health and Social Care Parliamentary Select Committee to embark on thorough and ongoing scrutiny of the Pregnancy Prevention Programme.

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

Taken following the maternity services item.

A Working Group meeting was held on community health hubs with Oxford Health NHS Foundation Trust.

Significant work had been done following the last Committee meeting regarding the epilepsy item, with positive responses expected from NHS England specialist commissioning.

A meeting with Oxfordshire MPs was held to brief them on the ICB proposed restructure and seek their support for a call-in from the Secretary of State.

Responses to recommendations on adult and older adult mental health had been received and circulated to Committee members.

The Committee NOTED the chair’s update.

A verbal update will be provided to the committee on the BOB ICB restructure by Stephen Chandler, OCC Executive Director (People), on current discussions around the BOB ICB restructure. The Committee will also be provided with the letter sent to the Secretary of State and is recommended to CONFIRM its support for the submission.

NB This report is to follow.

The Committee was provided with a verbal update on the BOB ICB operating model from Stephen Chandler, Oxfordshire County Council (OCC) Executive Director for People. The Committee was also provided with the letter that was sent to the Secretary of State in September to request a call-in in relation to the ICB’s changes to its operating model.

The Executive Director noted that the ICB board had considered feedback from stakeholders, including the HOSC and Oxfordshire partners. The ICB decided not to proceed with the centralisation of the urgent care director role and agreed to local oversight of certain budgets.

There was a commitment to appoint an Oxfordshire-funded place-based convener, though discussions continued regarding the role's delegated authority. The importance of maintaining the integrated approach at place, was emphasised, and the positive outcomes it had delivered for Oxfordshire highlighted. The Committee expressed concerns about transparency and the need for the ICB to provide more information to the public and the HOSC.

The Committee CONFIRMED its support for the call-in request.

Derys Pragnell (Consultant in Public Health, Oxfordshire County Council) has been invited to present a report providing an update on the work undertaken by Oxfordshire County Council and its partners to promote healthy weight amongst Oxfordshire residents.

Please note: The report submitted for this item includes input from the BOB Integrated Care Board so as to take account of the NHS’s work around healthy weight in Oxfordshire.

There are FOUR documents attached to this item:

1. The main report.

2. Appendix 1: Recommendations from Healthy Weight Health Needs Assessment 

3. Appendix 2: Whole systems approach to healthy weight action plan 23/24

4. Appendix 3: Oxfordshire WSA To excess weight: Work undertaken or in progress update 2024 

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

Derys Pragnell, Consultant in Public Health, was invited to present a report providing an update on the work undertaken by Oxfordshire County Council and its partners to promote healthy weight amongst Oxfordshire residents. Ansaf Azhar (OCC Director of Public Health), Claire Gray (Public Health Practitioner), Angela Jessop (Personalised Care Lead BOB ICB), and Alicia Siraj (Head of Health Promotion, Health Prevention, and Personalised Care BOB ICB) also attended to answer the Committee’s questions.

The OCC Director of Public Health and Consultant in Public Health introduced the Oxfordshire Healthy Weight report. Post-COVID-19, addressing excess weight was crucial owing to its links with long-term conditions such as type 2 diabetes. A whole system approach involving all organisations across the County Council was needed. Rising obesity rates both nationally and locally necessitated changes in the food environment and sedentary habits. A four-pillar approach was introduced, emphasising that no single intervention would suffice. Local data showed robust information on children but less information on adults, highlighting higher weights among children in some areas compared to the national average.

Angela Jessop, a Tier 3 weight management lead at the ICB, explained the weight management tier system. Tier 2 services were for individuals with lower BMIs and included programs such as Slimming World and online support. Tier 3 services were for those who had not successfully lost weight in Tier 2 and targeted people with higher BMIs and those considering surgery. This tier adopted a multidisciplinary approach including dietetics, psychological support, and physical activity, with programs typically lasting around 12 months. Oxfordshire residents could access face-to-face services at Luton and Dunstable Hospital and a remote service available across the Buckinghamshire, Oxfordshire, and Berkshire West (BOB) geography, which supported non-English speakers and those with learning disabilities or low health literacy. The program included access to weight loss medications, aiming for 60% of patients to lose 5% of their weight within six months. Tier 4 services were for patients who may opt for surgery after Tier 3. At the time, Oxford University Hospitals NHS Foundation Trust (OUH) was not accepting new referrals, so patients were directed to Luton and Dunstable Hospital or the Royal Berkshire Hospital. In 2023-24, approximately 25 patients from Oxfordshire underwent Tier 4 surgery.

Members expressed concerns about the link between arthritis and obesity. They wanted to know what support was provided for individuals with both conditions. Officers explained that General Practitioners (GPs) were proactive in recognising the link between excess weight and arthritis. They often recommended lifestyle changes and referred patients to Tier 2 and Tier 3 weight management services to help manage weight and improve arthritis symptoms.

Healthy Weight Services worked closely with long-term condition groups to raise awareness about the importance of weight management in managing arthritis. They provided tailored support to help individuals with arthritis adopt healthier lifestyles. The Move Together Program specifically targeted individuals with long-term conditions, including arthritis. It aimed to improve mobility, reduce falls, and decrease the number of GP appointments. The program had shown positive outcomes,  ...  view the full minutes text for item 80/24

Veronica Barry (Executive Director, Healthwatch Oxfordshire) and Katharine Howell (Senor Research and projects officer, Healthwatch Oxfordshire) have been invited to present a report on a Healthwatch Oxfordshire project on 'People's Experiences of Leaving Hospital in Oxfordshire'.

There are TWO key reports attached to this item:

1. A general Healthwatch Oxfordshire Update Report.

2. The report produced by Healthwatch Oxfordshire on peoples’ experiences of leaving hospital.

The Committee is invited to consider the Healthwatch Oxfordshire reports and NOTE them having raised any questions arising Barry (Executive Direc Veronica Barry (Executive Director, Healthwatch Oxfordshire) and Katharine Howell (Senor Research and projects officer, Healthwatch Oxfordshire) have been invited to present a report on a Healthwatch Oxfordshire project on 'People's Experiences of Leaving Hospital in Oxfordshire'.

Veronica Barry (Executive Director: Healthwatch Oxfordshire) and Katharine Howell (Senior Research and Projects officer: Healthwatch Oxfordshire) were invited to present a report on a Healthwatch Oxfordshire project on 'People's Experiences of Leaving Hospital in Oxfordshire'. Karen Fuller (OCC Director of Adult Social Care) and Victoria Baran (OCC Deputy Director of Adult Social Care), were also present to answer the Committee’s questions.

The Senior Research and Projects Officer introduced the Healthwatch update on people’s experiences of leaving hospital in Oxfordshire. The project involved collaboration with various system partners, including OUH, Oxford Health NHS Foundation Trust (OH), Age UK Oxfordshire, Carers Oxfordshire, and patient groups. The focus was on understanding people's concerns about the new model of moving people out of hospitals and bringing support closer to home. The aim was to incorporate patient voices into the development and response to these changes.

The Committee had made six recommendations in January 2024 around ensuring adequate support for people leaving hospital, which were acknowledged as having a mixed picture of progress. One of the key recommendations was the creation of a discharge leaflet, which was now in the final stages of production and expected to be available soon. The Director of Adult Social Care mentioned that the recommendations from January were in progress, with a focus on improving communication and engagement with the community. The leaflet had been co-produced with residents and patients to ensure it was accessible and meaningful.

The Committee was assured they would receive a written update in January 2025 on the progress of the previous recommendations.

Officers noted the improvements in reablement. The rate of full independence after reablement was 57% in 2021, below the national average of 77%. It rose to 76% in 2023-2024 and was now about 72.5%. Overall, 85.3% of people benefited from reablement, including those with reduced care needs. This improvement showed the effectiveness of the discharge to assess process.

Members requested an update of recruitment and retention, and whether the service was on target in this area. Officers acknowledged that there was currently good availability of care providers in the market, with very few people waiting over 48 hours for a discharge to assess package. The main challenges were not related to care availability but to other factors such as organising equipment for home or coordinating with informal carers.

Concerns were raised about the potential impact of national insurance changes on care providers, but it was noted that the Council had given above-inflation increases to care providers and pays above the national living wage.

Members were curious as to the working relationship between the Council and Healthwatch, and whether there was good communication between the two bodies with regular meetings.

Officers highlighted that there was a good working relationship with Healthwatch, with ongoing engagement and collaboration throughout the process. Officers from Healthwatch had been actively involved in meetings and discussions, providing feedback and insights as they progressed. The report and recommendations from Healthwatch were based on continuous communication and collaboration with the Council and  ...  view the full minutes text for item 81/24

Oxford University Hospitals NHS Foundation Trust has been invited to present a report on the current state of Maternity Services in Oxfordshire.

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

Oxford University Hospitals NHS Foundation Trust were invited to present a report on the current state of Maternity Services in Oxfordshire. Yvonne Chrisley (OUH Chief Nurse), Rachel Corser (Chief Nursing Officer for BOB ICB), Dan Leveson (Place Director for Oxfordshire: BOB ICB), and Veronica Barry (Executive Director: Healthwatch Oxfordshire) attended to answer questions form the Committee on the report.

Members requested that Officers provide further details on the new training programmes and staff participation, as mentioned in section 1.1 of the report. It was responded that the Trust had implemented new training initiatives for obstetricians and midwives, including the Peaches programme and PROMPT training. The Peaches programme aimed to recognise and prevent third and fourth-degree tears, while PROMPT focused on enhancing teamwork and coordination between medical professionals and midwives. Staff participation in these training programmes was regularly monitored and reported to the Trust board, with approximately 90% of staff having completed the training at any given time. These programmes had proven effective, as evidenced by lower-than-national-average birth injury rates.

Oxfordshire's birth injuries were generally below national rates, which was positive. Efforts continued to minimise these injuries further. Notably, therapeutic cooling rates for infants over 37 weeks had reduced to 0.07, beating the national target of 0.1 to 0.3, thanks to significant interventions. OUH maternity services handled complex cases, and maintaining low injury rates demonstrated the high quality and safety of care.

The Committee questioned why the number of patients accessing the birth reflection service was projected to be significantly higher in 2025. The higher projection was attributed to increased awareness of birth trauma among women and the service itself. The growth was seen as a positive indicator of timely interventions and greater awareness among women and families. Although there was not a direct link to COVID, the pandemic created an environment of isolation for women and families, possibly raising awareness and intervention needs as restrictions eased. The pandemic was further noted to have had a wide-ranging impact on health services, including potential interruptions in training.

The process of identifying and addressing risk was questioned, with members curious as to whether there was a standardised and consistent approach. Officers highlighted that the Trust had implemented a digitalised system through an electronic patient record (EPR) called Badger Net. This system ensured that risk assessments were both available and accessible to staff and mothers. A monthly audit program monitored compliance, and gaps were addressed with timely interventions. The digital system enabled quick audits and interventions, ensuring a standardised and consistent approach to addressing identified risks.

Members inquired about the mental health support provided for both pregnant mothers and fathers affected by mental health challenges. Officers discussed several aspects of mental health support.

The Trust had bereavement suites and specially trained staff to assist families experiencing stillbirth. These suites provided a family environment where families could spend time with their baby and access counselling services. There was a dedicated trauma midwife and a service ensuring timely interventions for those who had experienced birth trauma.  ...  view the full minutes text for item 82/24

To AGREE the Committee’s proposed work programme for its upcoming meetings.

The work programme until January was discussed, with a planned meeting to discuss future items, including member suggestions and input from My Life My Choice.

The Committee AGREED that the Health Scrutiny Officer will work with the Director of Adult Social Care to commission an update in the January 2025 meeting on the previously issued HOSC recommendations for supporting people leaving hospital.

It was NOTED that the timing for the Director of Public Health's annual report was uncertain and could be moved to April.

Future items suggested included social prescribing and school nurses, focusing on effective provision and data sharing across the county.

The Committee AGREED to the forward work plan subject to the amendments outlined above.

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

The Committee NOTED the action and recommendation tracker.