Agenda item

10:20

This item provides a report (JHO6) on the key issues for the CCG and will outline current and upcoming areas of work, including the presentation of the Primary Care decision tree. It will also include a verbal update from the Oxford University Hospitals NHS Foundation Trust (OUH) in response to the recent Care Quality Commission (CQC) inspection of operating theatres.

Prior to consideration of this item the Committee was addressed by Didcot Town Councillor Cathy Augustine. She asked the Committee to seek answers on how CCG’s would be affected by the national Long-Term Plan, which, in her view would give considerable powers to a newly created network of joint NHS England and NHS Improvement regional directorates who would report upwards. Alongside this new centralised structure, there would be 44 ‘Integrated Care Systems by April 2019. She asked how transparent and accountable would those new organisations be?  She also asked if, given that each Integrated Care System would be working towards an Integrated Provider Contract, CCGs would only be strategic and not possess commissioning powers? If so, who would have these powers and how would HOSC oversee this?

The Committee considered an update (JHO6) from the Clinical Commissioning Group (CCG) on key issues. It also outlined current and upcoming areas of work, including the work on the primary care decision tree. In addition, Sam Foster, Head Nurse, Oxford University Hospitals NHS Foundation Trust (OUH), attended to give a verbal summary of the action taken in response to a recent Care Quality Commission (CQC) inspection of operating theatres.

The Chairman invited Catherine Mountford, Director of Governance, CCG, Dr Kiren Collison, Clinical Chair, CCG and Sam Foster, Chief Nurse, OUH up to the table.

Catherine Mountford and Dr Collison presented the report JHO6. Catherine Mountford pointed out that, with regard to the GP Practices Procurement Decision Tree, work would continue with this Committee and the public framework as before, but it would also be widened to encompass changes if a contract came to an end. The framework highlighted significant public and patient engagement. The work on the framework with the Primary Care Commissioning Committee would be a very useful and the CCG would ensure that it be made very transparent. It had been tested against some historical decisions. Comments received would be recorded on the flip charts on the wall where the draft version of the decision tree had been placed. Once progressed to a sufficient stage the decision tree would then be digitally produced to make it more accessible. This would not mean it was a static document; it would continue to evolve as learning took place, but the CCG did not want to take the step of producing a digital document (with the time and expense involved), until there was a good level of confidence in the process set out.

Catherine Mountford and Dr Collison gave a brief overview of the vision and main themes of the Long - Term Plan which had been published at the beginning of January. They commented that the CCG was pleased to see how it aligned with the integration of services and how it also addressed health inequalities. Reassurance was given that the Oxfordshire Health system was looking to addressing it with the public via the Oxfordshire Health & Wellbeing Board and this Committee. Under the NHS Plan, the current statutory bodies would remain, together with those providers who were a current statutory body. If any change occurred, then this would originate from the Government and would be discussed with this Committee. With regard to the Integrated Care System (ICS), there needed to be discussions with Buckinghamshire and Berkshire. Dr Collison added that work was ongoing with ICS which was complex, given the many organisations incorporated within it. Work was required with partners to identify the implications within the integration agenda for Oxfordshire.

Prior to questions from the Committee on the above, Sam Foster gave an update on the core service review by the Care Quality Commission (CQC) on OUH, which was the subject of a Section 31 Notice, details of which were on the CQC website. This related to an operating theatre block situated in the older estate on the John Radcliffe site. A refresh of the block had been included in the Trust’s Capital Programme. A refresh Action Plan was currently being drawn up that would ensure that the theatre block was fit for purpose, from a buildings (not surgical) perspective.

A member asked Sam Foster about procedure with the work – and what was being left on the theatre floors? She responded that the Trust planned to do the refurbishment. It was a question of timing and balance of the risk. Some theatres in the block needed to be closed. The CQC was happy for the closure to occur during April this year. She emphasised that the areas in question needed to be refreshed, adding that there had been too much stockpiling of equipment in the theatres and so there was also a plan to maintain the right stock, so that it was available at the right time. In response to a further question about whether the theatres were checked on a regular basis, she stated that OUH had a good record of infection control and surveillance across all of the sites.

Sam Foster reassured the Committee that patients were being risk assessed against those risks associated with the refurbishment, which was due to start on 1 April.  The logistics associated with moving patients was a serious undertaking – and it was important to the Trust that the patients were treated in-house.

Questions from members of the Committee, and responses received, were as follows:

-       How would the additional £25bn by 2023/24 be phased and would it be phased equally? Catherine Mountford responded that information had been received on this, and CCG would be allocated just over £43m, of which £20.56 would be for 2019/20. Some of the £43m would include money for pay awards. She undertook to circulate to the Committee what was known of the allocation;

-       When would the Long-Term Plan be available for scrutiny? Catherine Mountford stated that a report would be taken to the next meeting of this Committee on 4 April. The Chairman asked that it be presented in plain English and clearly labelled;

-       Given the many different patient pathways, how far are you away from discussion with the local authorities? Catherine Mountford stated that discussions were underway with regard to how to address data sharing with the different health providers. She added that the Clinical Commissioning Policies were on the CCG site for information on which procedures and treatments the CCG would not fund, or fund against set criteria for eligibility. The link could be shared with Committee members. There was also a national list. There had to be evidence of clinical cost effectiveness which for Oxfordshire, the Thames Valley Priorities Committee assessed and determined. She was asked to circulate the list of procedures and treatments not funded by the CCG to Committee members, highlighting what had changed and to inform the Committee of any additions to the list each time;

-       A member commented that whilst the workshop looking at the Primary Care Decision Tree had thrown forth some innovative solutions, some participants had some concerns. She asked if the Committee would be able to look at the finalised proposals? Catherine Mountford stated that she was happy to discuss with the Committee about how it wanted to comment. The proposal was to share the decision tree with the CCGs and NHS England and the more it was shown and tested through, the better it would be. The aim was to get it professionally produced, so that there was an electronic version, whilst still remaining a working document, in order to give members of the Committee the opportunity to see it as a whole. She offered to leave the only draft with the Committee for a few weeks to look at it. The Chairman declined but thanked her for the offer, commenting that the Committee felt that it could work with the framework, but warned against being ‘wedded to it’ and not to rush it;

-       With regard to the Vasectomy survey, a member thanked the CCG for undertaking it, but asked for assurance that there were no plans in place to cease female sterilisation. She asked if OCC had been consulted on the plans, expressing a concern that there would be potential knock-on effects to the County Council’s budgets. Catherine Mountford informed the Committee that the CCG was currently in an engagement period, which included engagement with Public Health in relation to the impact on services. A decision had not yet been taken, as there was a need to look at it fully. With regard to female sterilisation, which was not normally funded, the proposals were in line with those of other CCGs, in that there were more cost-effective ways of providing the service. She undertook to highlight this service when sending the links through of procedures and treatments not funded by the CCG;

-       A member asked if there was a backlog in patients needing the vasectomy service and had the service caught up with seeing new patients? Catherine Mountford responded that new referrals were not being seen because it would take the service until the end of the contract to do so;

-       A member asked how the decision to suspend all bariatric surgery referrals and clinics whilst the study on pathways was underway, impacted on OCC obesity services etc; and was the CCG consulting with OCC? Catherine Mountford responded that there were workforce shortages in this area causing pressures for those working with patients pre and post surgical. The CCG was working with OUH to find a short - term solution for those patients awaiting surgery. Work was ongoing with other Health authorities in the Thames Valley region on what a future service could look like, given the limited availability of clinicians, as it was a small service.  She added that no decision had been made on a permanent change to date. She accepted that the temporary change in service should not be prolonged;

-       In response to a question relating to the results of the Children & Adolescents Mental Health services (CAMHS) bid, Catherine Mountford reported that Oxfordshire had been successfully awarded £5.4m in extra funding until 2021 to bring services into all primary and secondary schools within Oxford City, where there was the highest need. A development plan was being worked up.

The Committee thanked all for the update and for their attendance