Agenda item

12:00

With the recent reorganisation of the Oxfordshire Health & Wellbeing Board in mind, the Committee will ask the following:

·         how effective will the Board be to drive forward health, public health and social care integration?

·         Is there effective governance in place to deliver this?

·         How well is the Health and Wellbeing Board preparing Oxfordshire’s health and care system for greater integration?

A progress report is attached at JHO9.

Prior to consideration of this item and Item 11, the Committee was addressed by Councillor Cathy Augustine, Didcot Town Councillor and Oxfordshire delegate to the national Steering Group of the ‘Keep our NHS Public’ (KONP) campaign and County Councillor Jenny Hannaby.

Councillor Cathy Augustine stated that, in her view, despite the role of this Committee, unscrutinised change was happening now, at a pace, and without adequate public consultation. It was her concern that this made evaluation and scrutiny of the bigger picture for Oxfordshire almost impossible. Instead, the focus was on a loss of services in specific localities, which in her view was an attempt to confuse and distract, without recognition of the cumulative and domino-effect across the county. She added that HOSC was set up as an independence voice and should decide on its own, independent agenda on behalf of patients and residents. It should not fall into line with those bodies it was scrutinising, particularly in three key areas, governance, transparency and consultation.

She expressed her concerns that, in her view, the Health & Wellbeing Board papers contained ‘opaque layers’, which indicated a policy of secrecy behind closed doors, which, in turn made it closed to scrutiny by this Committee. For example, there was alarm that the Integrated System Delivery Board (ISDB), which was the main driver behind the proposed Integrated Care System (ICS), was buried deep within the structure, and, virtually invisible from the scrutiny by elected representatives. Meetings which, in her view determined policy, were in closed session with no public minutes being produced, and there was no democratically elected representative serving on it.

She therefore asked the Committee to examine and challenge this ‘flawed’ governance proposal.

Cllr Jenny Hannaby shared the concerns expressed by the previous speaker in relation to the ISDB stating that there was a real danger of privatisation ‘coming through the back door’. She added that the Joint Management Groups who managed the pooled budgets, only met in public once a year. Transparency and openness was a requirement.

She added her hope that the Health & Wellbeing Board would listen to these concerns. She stated, however, that not all was bad - she was pleased that the Board would be working with the Growth Board in respect of the Healthy Towns initiative as working with the district councils was the way forward.

Dr Kiren Collison, Chair of the OCCG and Vice Chair of the Oxfordshire Health & Wellbeing Board, Kate Terroni, Director of Adult Social Care and Catherine Mountford, Director of Governance, OCCG

Dr Collison stated that this was a good opportunity to explain where the revisions to the Health & Wellbeing Board (HWB) had reached. As was recognised by the CQC last year, and also by the Board itself, the Board was not as valuable as it could have been. A full process review was then undertaken, which began with the engagement and discussion with a wide variety of stakeholders, including the voluntary sector, councillors and the Board members themselves about the way the Board should be going. The outcomes of this was then taken to a special meeting of the Board in May and then to formal approval by the Trust Boards and County Council. It made sense to have more representation by Health on the Board, to represent the whole pathway, from prevention through to hospital care; and thus to give a good mix of views. She added that essentially it was now a new and different Board. There was an awareness that although some groups were not represented on the Board, there was a crucial need to hear their views. It had therefore been decided to create a Reference Group to include representation from the voluntary sector and the care sector, so that nobody was excluded.

Members of the Board had undergone some work to develop and had done so in three facilitated workshops to date to build relationships, how to work together effectively and get a feel for each other’s backgrounds. It was felt that to meet in public was not the best way to go about this as it required a different environment in order to get to know each other and, by use of a storming process, to work out priorities, a vision and finally a full Health & Wellbeing Strategy, which was now open for further comment by the public. The Strategy had been the subject of a large amount of work which followed the residents journey and included cross-cutting themes of prevention and tackling health inequalities throughout.

The four main priorities were:

·         Agreeing a co-ordinated approach to prevention

·         The residents journey through the health and care system

·         To work with the public locality by locality

·         Agreeing plans to tackle the workforce issues.

Kate Terroni stated that the key areas for the new Board was visibility and a ‘joined up’ leadership for Health and Social Care, setting the direction of travel for Health and Social Care services in Oxfordshire, to include the planning and identification of future health social care needs for the county. The ISDB was the ‘engine room’ to start delivering on the direction set by the HWB, adding that it was already doing some valuable work on the workforce. The sub-groups were performance related and would give visibility to the work which the HWB was doing.

Catherine Mountford stated that the Board had recognised that there was a need to take a wider view of transparency with patients and the public. The core of this work was the development of working together, responding to what was heard from the public and showing its commitment to that. This had been shown, for example, with the Older People’s Strategy. It had heard that the public wanted services to be joined up and its structure was a reflection of this. She pointed out that the CCG had held its Board meeting on this day and at this venue, as it recognised the importance of working with other organisations on how to meet health and care needs.

Questions and responses received from members were as follows:

-        In response to a question about the earlier suggestions that the private workshop meetings meant that the HWB was secretive, Dr Collison stated that the Board was multi-agency in its membership and it was felt that there was a need to get to know each other properly in order that they could work together effectively. She added that there was no mystery intended, in that they needed to go through a process of storming in order to move forward. Catherine Mountford pointed out that the HWB itself was still meeting in public and Board members required more time to get to know each other on top of the public meetings;

-       A member asked if the panel saw any room for more democratic representation on the ISDB and the Joint Management Groups in light of some public concern that there was unscrutinised change taking place at quite a pace? – Kate Terroni responded that the JMG (Better Care Fund) was chaired by Cllr Lawrie Stratford and met in public once a year. The two pooled budgets were managed by the JMGs and oversaw a spend of £350m. They looked at how to achieve the most efficiency out of contracts and they were therefore bound by commercial regulations. There were regular quarterly reports to the HWB for public scrutiny. The ISDB was newly formed and settling in in terms of its membership. Conversations were only just taking place in relation to its clinical voice. There was an awareness that there needed a little more thought to how to respond to the transparency/visibility of papers. The Committee was asked for its views on this issue. The Chairman requested members of the Committee to circulate any views via himself on this issue him in good time and prior to the next meeting in February. In terms of the concerns expressed regarding democratically elected membership of the HWB, Catherine Mountford commented that this had been signed off by the County Council. This would, however, be kept under review. She added that if there were any particular issues, this would be brought to the Committee and the Trust Board, as was the usual practice. The principle and approach of the new Board was to think together about how the NHS and Social Care was commissioned, provided and aligned and to work together to achieve the best results. For example, to work together on winter pressures to ensure that primary, acute and social care services were all working together for the patients and the public in an integrated way. Dr Collison added that the NHS 10 - year Plan was due out in December and it will provide great potential for looking at best practice across the country;

-       In response to a question regarding a wish expressed by the voluntary sector to be involved in the integration of Health and Social Care on the HWB as provider, Dr Collison informed the Committee that following the discussions on the review there had been agreement that there was a vital need for a reference group in order that views from the voluntary sector and other stakeholder groups could be fed in. Kate Terroni added that there was a concern if all stakeholder groups were represented on the HWB it would become too unwieldy. This was a system for all voices to come to the table – it would be the subject of review if it was felt this was needed;

-       In response to a question about the meaning of the term ‘commissioner-provider collaborative’, Kate Terroni explained that this was an area where people worked together at a local level to deliver services, for example, mental health services work involved working with the provider plus voluntary providers. The ISDB had a number of workstreams, for example, IT/ Estate/provider and commissioner collaborative. She added that more work was required in relation to this aspect, for example on how to bring together providers and how to share information with each other;

-       In response to a question about how to resolve the tension of using this very radical methodology and listening to what the public considered to be important and gaining their trust and a meaningful inclusivity, Catherine Mountford commented that it was her understanding that the Committee’s concerns in relation to the ISDB was not just about the meetings themselves, it was more about how the Board would work when listening to the public’s concerns. Dr Collison added her understanding also that it was not just about being evidence driven, it was about how the public perceived services. It was the job of the Board to bring these aspects together and to show the results of this;

-       A member expressed concern about the democratic accountability on the Board, and the fact that elected members had not been approached when the new Board was in its embryonic form for discussion and views. Councillors had their ear to the ground and received any worries the public had - Kate Terroni stated that the Board needed challenge from the Committee on delivery and outcomes – and if this proved to be of concern, then changes could be made to its membership on review.

At the conclusion of the question and answer session, the Panel was thanked for their attendance and it was AGREED:

(a)  to request the officers to take back to the HWB the comments from HOSC on the make-up of the Board and its transparency and request a response on these;

(b)  that members of the Committee send their questions and comments on the Strategy as soon as possible and to request the officers to send a collective set of questions and comments to the Board for clarification; and

(c)  to add the CQC follow -up report to the special meeting of  HWB on 29 January 2019 to the Agenda for this Committee on the 7 February 2019 meeting of this Committee.