Agenda and minutes

The Chairman welcomed the new GP Representative Dr Kerrin Masterman, White Horse Medical Practice, who will share the position with Dr Michelle Brennan, The Hart Surgery.

Apologies were received from Dr Nick Broughton (Dr Ben Riley substituting), Councillor Steve Harrod, Dr Bruno Holthof, Dr James Kent (Diane Hedges substituting), Tracey Rees (Rosalind Pearce substituting) and Yvonne Rees.

There were no declarations of interest.

To approve the Note of Decisions of the meeting held on 1 October 2020 (HWB5) and to receive information arising from them.

The notes of the meeting held on 1 October 2020 were approved.

2:05pm

Verbal update from the Director for Public Health.

Ansaf Azhar, Director for Public Health, gave a verbal update.  Oxfordshire remained in Tier 2 although neighbouring counties Berks and Bucks had moved to Tier 3 so there was no room for complacency.

The figures showed a dramatic drop in the first week affected by the recent lockdown but it did not last as the numbers began to rise again after that.  It was now getting to the point that elective surgeries were being cancelled in the South East region.  It was predicted that the next peak of cases would come in mid-January and hospitals were preparing for that.

Even though the rules had been relaxed to allow families to get together for Christmas everybody still needed to use their judgement and keep contacts to a minimum.

The vaccines and tests will still be effective with the new variant but it was thought to be more easily transmitted and might be behind the recent increases in the South East.

2:15

Updates from the Oxfordshire Clinical Commissioning Group on the Buckinghamshire, Oxfordshire & Berkshire West Integrated Care System and the COVID-19 Phase 3 Recovery.

Diane Hedges, Chief Operating Officer and Deputy Chief Executive, Oxfordshire Clinical Commissioning Group, summarised the report and updated the Board on the COVID-19 vaccine.

The vaccine programme was unlike anything seen before.  Vaccinations had started at the Churchill Hospital with people from care homes.  The second phase saw three centres established in Abingdon, Chipping Norton and Henley.  The next phase will operate through general practices.  A central location for mass vaccination will start in January.

The programme was following national guidelines in terms of prioritisation.  She asked everyone to emphasise that people will be called for their vaccine when it is their turn.

Dr Kerrin Masterman added that, while the practices were really enthusiastic about the vaccine, there was concern at the likely impact on day-to-day services.

Stephen Chandler reported on feedback from care home staff who really appreciated that they had been prioritised and recognised.

Councillor Lawrie Stratford asked if it was known how many people were not registered with a GP and consequently would not be called for the vaccine.  The Chairman agreed to seek the answer to that after the meeting.  Dr Collison emphasised that the vaccine was open to everyone though it may be more difficult to get in touch with people who were not registered.

Rosalind Pearce, Chief Executive, Healthwatch Oxfordshire, asked how people were contacted if they did not have a mobile phone.  Dr Masterson responded that GPs were making individual phone calls to landlines where necessary.  He added that he was only aware of 10 people turning down a vaccine out of about 1,000 offered so far.

Rosalind Pearce also emphasised the importance of local communications.  There were indications that the uptake of the vaccine might be lower in certain communities due to rumours circulating.  She hoped that the lessons from the first wave of the virus would be learned which demonstrated the importance of working through communities.

The Chairman welcomed the additional funding provided for Mental Health services which are likely to be under pressure following the lockdowns.

2:35

The purpose of the paper (HWB8) is to outline the proposed establishment of a new Joint Commissioning Executive (initially in shadow form) to provide the necessary oversight and accountability for the recently created Transformed Joint Commissioning Function across Health, Education and Social Care (HESC) for Oxfordshire. It is important to note that the establishment of the JCE is subject to final agreement through the OCCG Governance Structure.

The Health and Wellbeing Board is RECOMMENDED to

a)               note the proposed review of the Section 75 Legal Agreement between Oxfordshire County Council (OCC) and Oxfordshire Clinical Commissioning Group (OCCG) which governs the arrangements covering the Better Care Fund (BCF) and Adults with Care and Support Needs Pooled Budgets (ACSN) and the current Joint Management Groups (JMGs). (please see attached)

b)              approve the adoption of the new Joint Commissioning Executive (JCE), which has been developed to provide oversight and accountability for the recently transformed commissioning arrangements for Health, Education and Social Care (HESC) across OCC and OCCG.  The transformed HESC Commissioning arrangements are laid out in this report and will be in place by the 1^st March 2021.

Stephen Chandler summarised the report on behalf of the County Council.  He welcomed the opportunities for working together across health, education and social care.  The procedures, which still required approval from the Oxfordshire Clinical Commissioning Group (OCCG), sought to avoid blame and maximise the effect of funding available.

Diane Hedges, Chief Operating Officer and Deputy Chief Executive, OCCG, added that complacency may have crept in when there were big pooled budgets but there was a great enthusiasm with this more holistic approach.

Ansaf Azhar, Director for Public Health, had found it a refreshing experience.  The focus was now on outcomes.  It was all about building relationships and trust.  He also now had a much better understanding of the other roles and areas of activity.

Councillor Lawrie Stratford welcomed the development.  He praised the leadership that had brought this about and added that staff across the County Council appreciated the benefits of this kind of cooperation.

The Chairman proposed the recommendations to the meeting.

RESOLVED: to

a)            note the proposed review of the Section 75 Legal Agreement between Oxfordshire County Council (OCC) and Oxfordshire Clinical Commissioning Group (OCCG) which governs the arrangements covering the Better Care Fund (BCF) and Adults with Care and Support Needs Pooled Budgets (ACSN) and the current Joint Management Groups (JMGs);

b)            approve the adoption of the new Joint Commissioning Executive (JCE), which has been developed to provide oversight and accountability for the recently transformed commissioning arrangements for Health, Education and Social Care (HESC) across OCC and OCCG. The transformed HESC Commissioning arrangements are laid out in this report and will be in place by the 1st March 2021.

2:55

The Growth Board partnership wishes to consider in a positive, open and transparent way what the ambition for Oxfordshire should look like and how it can be achieved.  It has developed a Strategic Vision for Oxfordshire, which seeks to set out the shared ambitions of local councils and key organisations including those in the health and care system.   The Vision focusses on social, economic and environmental well-being and prioritises climate change. It is centred on people's well-being, with Oxfordshire a place where current and future generations thrive. The Draft Vision is intended to be the start of a conversation with our communities to build consensus around a common set of goals for Oxfordshire, strengthening and improving the Vision.

The Health & Wellbeing Board is RECOMMENDED to request that its members provide feedback on the draft Strategic Vision for Oxfordshire which has been developed by the Oxfordshire Growth Board.

Andrew Down, Director, Oxfordshire Growth Board, introduced the strategic vision which he said came a critical point in the development of the Oxford Cambridge Arc and the Oxfordshire Plan for 2050.  There was also a lot of emphasis now on healthy place shaping and a shift of momentum on climate change as well as an opportunity to be seized in the wake of the pandemic.

There were seven draft outcomes listed on Agenda Page 41 and feedback was sought on these and all aspects of the vision by 3 January 2021.  A final draft will go to the Growth Board on 22 March 2021 for approval.

Councillor Andrew McHugh noted Guiding Principle 8 on Agenda Page 50 “We will expect high quality development” and asked how to get from that to requiring high quality development. 

Andrew Down agreed that there was a need to lobby central government to raise building standards.  He noted that with the UK climate change targets for 2050 local government should be pushing an open door regarding zero or negative carbon standards.

Councillor McHugh also asked if the County should be looking to get ahead of the curve in requiring net biodiversity gain from developers, as Cherwell District Council already does, in anticipation of the coming Environmental Bill which will seek improvements in this area.

Andrew Down responded that a new county-wide nature partnership was being formed and it was hoped to see progress on bio-diversity soon.

Councillor Lawrie Stratford welcomed the report but emphasised the importance of getting the communications right to emphasise the positive aspects of growth.

The Chairman encouraged everybody to respond to the consultation, including endorsing aspects that they agree with.  He looked forward to a joint meeting of this Board with the Growth Board which was being arranged for February 2021.

3:20

The OSAB is required by statute to report annually on the work of the Board and of its partners, assessing the position of the partnerships in relation to the safeguarding adults at risk within Oxfordshire.

The report outlines how the Safeguarding Adults Board works, the outcomes of the Annual Safeguarding Self-assessment, the deaths of adults with learning disabilities, the safeguarding training offered by the Board, the statistics around the abuse and neglect reported within Oxfordshire and what the priorities are for 2020-21.

The Health & Wellbeing Board is RECOMMENDED to

a)               note that the adult safeguarding partnership is working across Oxfordshire and the work undertaken by the Board and its partners.

b)              note the priorities for 2020-21.

This item was deferred to the next meeting as the Independent Chair of the OSAB was unable to connect to the meeting due to technical problems.

3:40

The OSCB Annual Report sets out the challenges of the ongoing demand on the system with neglect being a key feature; the need to keep children safe in full-time education and the contextual safeguarding risks that exist for children outside of their home environment. The report acknowledges that, as ‘system issues’, they will need ‘system leaders’ e.g. political leaders, headteachers, senior managers to bring a collective focus on them to deliver change.  The report also highlights a number of examples of good practice including the increase in support to families at an early stage; the multi-agency practice guides following case review and audits; the escalation of safeguarding issues to board level and the safeguarding training of approximately 10,000 local practitioners.

The Board is RECOMMENDED to note the report.

Derek Benson, Independent Chair of the Oxfordshire Safeguarding Children Board, introduced the report.  He emphasised that he had been appointed to the position in November whereas the report covered the year up to the end of March 2020.  For that reason, credit for all of the work that went into the report was due to his predecessor, Richard Simpson, and his colleagues.

He welcomed the unique partnership involving senior officers of the County, Thames Valley Police and health partners.  Work on child exploitation has been widened to include such as criminal exploitation.  Other areas of progress included early help and emphasising the importance of full time education.

There was a conference held where the voice of the child was central but there is still work to be done on this as well on the area of neglect which is all too common.  There had been worrying increases in knife crime and domestic abuse, the latter particularly of concern during the lockdown.  While the mental health services for children and adolescents were of the highest standard, there was still a challenge in getting timely access.

Tan Lee, Strategic Partnerships Safeguarding Manager, added that this had been a particularly challenging year but that all agencies were working closely together to identify the risks and opportunities and that the strong partnership was increasing effectiveness and definitely making a difference.

Councillor Lawrie Stratford made the point that important aspects of attendance at school were the friendships and social interaction involved.  During the lockdown children were saying how much they missed their friends.  He welcomed the emphasis on attendance at school in the report.

Diane Hedges asked what the Board could do to help.  Derek Benson responded that at this early stage for him, he felt the most important considerations were how to communicate to ensure a broad dialogue on children’s safeguarding issues.

The Chairman thanked the former Chair, Richard Simpson, and his team for the report and reiterated the offer of support from the Board.

4:00

At the Oxfordshire Joint Health Oversight and Scrutiny Committee (JHOSC) meeting in September 2020, Dr Nick Broughton and Dr Ben Riley explained to the committee how Oxford Health Foundation Trust (OHFT) would be commencing the development of a Strategic Development and Quality Improvement Plan for the Community Services the Trust provides in Oxfordshire, in partnership with Oxfordshire Clinical Commissioning Group (OCCG) and other stakeholders.

This paper provides a short update on the progress of this work for the Oxfordshire Health and Wellbeing Board.

Dr Ben Riley, Managing Director, Oxford Health NHS Foundation Trust, summarised the update on work that is currently underway.  They started by reviewing all of the information available from stakeholder engagements and strategies produced over the last five years and were considering how to apply these to community services operated by the Trust across the County.

He outlined two pieces of working going on in parallel: firstly, the development of a community strategy with a full system view including all partners and secondly, developing service plans in local areas – in particular for the OX12 area which had been waiting a long time for a plan for the closed in-patient beds at Wantage Community Hospital.

It was hoped to have a proposed process for discussion with partners as well as some pilots for an expanded range of services in early 2021.

In the short term an initial service development framework will be put for discussion at the Oxfordshire Joint Health Overview and Scrutiny Committee in February which will set out an initial vision, ambition and set of priorities for the service.

Quality improvement programme pilots were being considered for the evolving area networks for the north, south and city which will link the city and district councils with the Primary Care Networks and community services.

Councillor Lawrie Stratford welcomed the commitment to resolving the Wantage situation as a priority.  As a champion of his own local hospital, he could understand the feelings of local people on his issue.

The Chairman noted how the voluntary sector had come to the fore during the pandemic and emphasised the need to enhance that.  Also, new more efficient ways of working had been introduced which need to be embraced.  He hoped that Wantage could be a pilot for new ways of working.

Dr Riley added that the work in the area of reablement provided in people’s homes had really accelerated during the pandemic as alternatives to in-patient care had really taken off.

The Chairman welcomed the success of the Aging Well programme and such benefits that technology had brought forward.

4:10

Report on views of health care gathered by Healthwatch Oxfordshire.

Rosalind Pearce, Chief Executive, wanted to emphasise that despite the difficulties imposed by the pandemic, they were still working to listen to people’s views on health and social care and while everybody had to use the digital route, they had managed to keep personal contact.

She noted that some things worked well virtually but some things did not.  Not everybody had access to the internet or smart phones and they should not forget the importance of face-to-face.  This needed to be considered in the redesign of systems.

She warned against the overuse of terminology such as ‘Place’ and ‘BOB’, saying that they often needed to be explained to members of the public and there was a need to ensure consistent definitions.

Dr Kiren Collison asked if there were any insights into possible different attitudes to the COVID-19 vaccine in different communities and if there were any specific examples of digital exclusion and if solutions to those problems were being developed.

Rosalind Pearce responded that it was probably too early to say about the vaccine.  There were indications that a certain number of people were worried about it but they may not be receiving accurate information on it. 

Healthwatch was hosting a meeting of chairs of Patient Participation Groups with the OCCG to get more feedback on that.  Also, in the new year they will seek feedback, especially from BAME (Black, Asian and Minority Ethnic) communities given the difficulties that they had in the first wave and the fact that these communities are more adversely affected by the virus.

With regard to digital problems, they were aware that some people were receiving text messages and did not know how to respond or did not have a smart phone which was often required to respond.

Councillor Andrew McHugh gave an example where volunteers in the Banbury area were delivering medications to those who were otherwise being digitally excluded from access during the lockdowns.

4:20

To monitor progress on agreed outcome measures.

Ansaf Azhar summarised the report for the second quarter of the year.  It was the first report that was picking up the effect of COVID-19 especially in regard to preventative measures such as immunisation and health checks.  Most of these services had resumed now and it was hoped to see an improvement.  He commended the efforts of those who have been involved.  However, there will undoubtedly be long-term impacts from the reduction in preventative measures so it was important to minimise the periods during which these were stood down.

Councillor Andrew McHugh noted that in the figures for measure 3.18 the overall figure does not match the area rates listed.  Ansaf Azhar agreed that that needed to be corrected.

Diane Hedges noted that this meeting had already discussed most of the issues which had red flags and felt reassured that the Board was dealing with the right issues at a strategic level.  The Chairman stated that he was comfortable with the red flags as long as there was an action plan to address them.  The red flags indicated that the measures were appropriately challenging.

4:30

To receive updates from partnership boards including details of performance

issues rated red or amber in the performance report (above).

Reports from:

·         Children’s Trust (HWB16a)

·         Better Care Fund Joint Management Group (HWB16b)

·         Adults with Support and Care needs Joint Management Group (HWB16c)

·         Health Improvement Board (HWB16d)

Stephen Chandler noted that the Joint Management Groups will be subsumed into the Joint Commissioning Executives in the next financial year.

The Chairman acknowledged that it had been a very challenging year for everyone but the Oxfordshire system was working well and he thanked everybody for all the work across the system.