Agenda item

10:15

Stuart Bell, Chief Executive of Oxford Health and Chair of Oxfordshire’s Transformation Board, will give a presentation on the development of system-wide Transformation Plans that will cover:

·         The case for health and care transformation in Oxfordshire;

·         Key messages from the Oxfordshire, West Berkshire and Buckinghamshire five year Sustainability & Transformation Plan;

·         Emerging work streams in the Transformation Programme;

·         Plans for public consultation and engagement on the proposed future models of health and care in Oxfordshire.

The Chairman welcomed Stuart Bell, Chief Executive, Oxford Health & Chair of Oxfordshire’s Transformation Board to the meeting. He was accompanied by:

·         Dr Joe McManners, Clinical Chair, Oxfordshire Clinical Commissioning Group (OCCG);

·         Damon Palmer, Transformation Programme Director, OCCG;

·         Dr Barbaria Batty, Dr Shelley Hayles and Dr Kiren Collison, OCCG (leads for the work on Urgent & Emergency care, Planned Care and Maternity, respectively).

Andrew Stevens, Director of Planning & Information, Oxford University Hospitals NHS Foundation Trust (OUT) was also in attendance.

Stuart Bell gave a presentation entitled ‘Health & Care Transformation in Oxfordshire, copies of which were attached to the Addenda for the meeting. Also attached was the ‘Oxfordshire Health & Care Transformation Communications & Engagement Strategy 2016 – 2017.’ He emphasised that there was a need for a proper discussion with stakeholders about how the consultation was to be undertaken before a formal consultation was embarked upon. Moreover, that the OCCG, who represented formal leadership of the Plans, recognised this also. There was also a need to secure the support of NHS England to the Plan, whose role it was to take a clinical view across the whole of the Thames Valley region.

The Chairman noted that the Transformation Programme, as presented in June, was now on the web. Damon Palmer undertook to circulate the web link to members of the Committee.

Following the presentation, members asked a number of questions.

Stuart Bell noted a plea for the consultation to be undertaken in a properly transparent manner, using clear, jargon - free language and any specifics to be clearly bullet-pointed in the final report also. Stuart Bell explained that it was the intention to make clear the options at the outset and the specifics would then follow. He welcomed suggestions on running the consultation and that an impact assessment would be completed. Furthermore, that the engagement of hard-to-reach communities and minority ethnic communities had been considered as a critical part of the consultation process.

A Committee member commented that sufficient transport networks to accessible venues for consultation meetings were also of great importance, particularly in light of reduced bus services. A member also advocated that the Team should go into schools to demonstrate the use of smart phones, particularly for use by young people suffering from mental health problems. To make the consultation more comprehensible to the public, it was suggested that the consultation could include visits to GP/Hospital waiting rooms, where people could be informed of the plans (a very simplified version) and asking for views together with any problems encountered. Specific instances could then be added to the consultation.  Stuart Bell agreed that consultation in waiting rooms and schools had been recognised as a good idea and had been put forward previously.

A member commented that it was paramount that the public understand the need for cultural change, and it was also crucial to bring with it the trust of the public by being open and transparent. Any swell of public opinion needed to be listened to. Mr Bell responded that in his view it would be dishonest to say that all could be achieved, and then to find that it could not be done. Moreover there was therefore a need to be clear at the outset about any constraints and potential consequences of keeping the status quo, adding that a balance would need to be set. Furthermore that planning would be undertaken on the basis of the amount of money available and on the basis of the steer given by the public. He stated that he had already taken on board the Committee’s messages about workforce issues and also about the need for cultural change and due consideration would be given to devoting more emphasis to these issues. Mr Bell added that he saw his role as one of stewardship for the development of services to accord with the needs of the population. It was also his intention that services were to be in the best position for future generations. He felt that now was the opportunity for change in a more strategic way.

A member of the Committee commented that now was the time for local NHS to come up with an exciting vision to tackle the challenges and that particular emphasis was required on prevention and the need to follow healthy lifestyles. Dr McWilliam responded that discussions were being held with GPs about new approaches to their work which would include more telephone consultations, for example, and a more rapid access to diagnostics and assessment. In addition the six locality forums were working up plans for improvement such as practices working together and more staff working across practices.

A member asked for reassurance that the people’s voice would be built into all work streams as part of the development, in the form of, for example, access to patient advisory groups. Stuart Bell responded that the key was to ensure that voluntary sector partners were brought into a model of commissioning, adding that if this was successful, it could be lodged in the OTP process.

A Committee member asked if it was felt to be a disadvantage to have to cover such a wide area as BOB (Buckinghamshire, Oxfordshire, Berkshire). Stuart Bell reported that David Smith (OCCG) was giving attention to this.

The Chairman then invited Cllr Nick Carter, OCC Cabinet Member for Local Government, Business, ICT & Customer Services up to the table. He explained that the Chairman of this Committee had asked him to initiate a conversation on the lack of data sharing across systems which were very diverse and separate in character, thus making for much duplication. He asked if there was an ambition for a single and unified IT system, what were the current blockages, and what improvements could one expect to see in the short term. Stuart Bell responded that he was a member of a sub group that had looked into this issue and it had been found that the scale of the task was too large due to the complexity of the systems. Issues such as confidentiality breaches had become apparent. There was, however, a strong ambition to connect the systems together, adding that this came back to the importance of cultural change. When asked by Cllr Carter whether case studies had been undertaken, Stuart Bell stated that they had, using digital scales, adding that the potential was growing along with the growing availability of apps. Mr Bell also stated that he would be happy to engage on this issue outside of the meeting, as it was his belief that there was value to be had in sharing data.

A member asked about the use of agency staff and was reassured that currently there were no problems in this area.

Mr Bell was asked if there were staff specifically allocated to responding to any concerns that staff may have regarding the changes. He responded that there were people assigned to this, but recognised that more could be done in this area. He added that it needed to be carried out in conjunction with information given on the broader picture of the STP and its benefits. Barbara Batty pointed out that there had been a much closer working relationship between staff in the liaison hub and in the community health team. This had the benefit of them feeling more a part of a bigger team. Damon Palmer also added that there was a project team sitting behind the main project team who were looking at workforce recruitment and retention and other issues.  He offered to come back to Committee with a piece of work on this subject.

A member asked if the intention to go live with the consultation on 1 October this year would place a straightjacket on how much money would be available over the next four years, adding that there was much concern that Wantage, Chipping Norton and Henley Hospitals would be operating with less money per head, in light of an increased demand for services. There was thus a need for very clear information on how services would be organised in the localities. Dr McWilliam clarified that there was a need to ensure that the public was given proper choices to consult on and that until the Committee was informed about what it would mean for local hospitals, it would not be a valid consultation. Stuart Bell explained that the size of the pot in relation to expected funding up to 2021 was in the OCCG’s domain and this had already been made public. This was the basis that the Team were already working on. The Chairman confirmed that the Indicative Allocation had been announced and that it was part of the work of the OTP. The Team, however, had not yet reached a position whereby they could publicise their conclusions. She added that to her knowledge, if there was a reliance on 2% efficiency savings, then the gap could not be closed and financial problems and workforce issues would remain. Stuart Bell explained that the aim was that by the time the consultation started, discussions would have taken place and conclusions drawn about the financial consequences of different options. Currently the Team were at the stage of looking at it in terms of components in a system rather than specifically in terms of what could be done. There would be questions of scale and consideration given to what could be moved out to localities. There was also the need to look at all pathways and what would best lend itself in order for patients to receive the best quality of service and to receive value for money.

A member of the Committee commented that it was important to ensure that interim arrangements were shored up, as staff morale appeared low and the system appeared to be losing more staff. There should be a focus made on short term work to support staff within the current system.

On the conclusion of the discussion the Chairman thanked all for attending. In summing up the wishes of the meeting the Committee AGREED that:

(a)  there was a need for separate chapters on proposed services in each locality to be included in the consultation document, as well as the  need/rationale for change, so that the public could consider easily how the consultation impacted on them;

(b)  the need for changes to IT systems be placed firmly on the agenda for consideration; and

(c)  progress reports be submitted to each committee meeting for the foreseeable future on how the Trust was meeting the challenges relating to demographics, workforce and finance.