Agenda item

11:40

The Annual Report on the activity of the Oxfordshire Health & Wellbeing Board is attached at JHO8 which covers the following:

·         The activity of the Board over the financial year 2018/19 in pursuit of the Health & Wellbeing Strategy.

·         How the Board performed against its aims and objectives during that period, including an overview of performance for all the sub-partnerships of the Board (ie. the Children’s Trust Board, the Integrated Systems Delivery Board, the Joint Management Groups for Adults and the Health Improvement Board).

·         An assessment of how revised governance arrangements are working

·         The Plans for 2019/20.

The Committee is RECOMMENDED to note the content of this report and the systems in place to monitor progress in delivering the Joint Health and Wellbeing Strategy and improving health outcomes for our population.

Prior to discussion on this item Julie Dean read out a statement produced by Councillor Jane Hanna. Her statement related to the Health and Well-being Board’s recent establishment of wider stakeholder involvement through a new Stakeholder Network; and her points were as follows:

-       The paper did not state what considerations under-pinned this recent development and did not give access to published information on any questions the public might have had in relation to the purpose, scope, remit and governance arrangements of the Stakeholder Network; and whether these issues had been scrutinised;

-       There was also the question of whether the Network would be entirely separate from, or related in part, to the new approach to Planning for Population Health & Care Needs, as set out in the paper submitted to this Committee in November 2018. This approach was to be tried first with the population of Wantage and Grove. Indeed the OX12 Stakeholder Reference Group had recently contributed to the work being undertaken by the OX12 Task & Finish Group; and

-       She called for clarity concerning any wider Stakeholder Network, on what it was and how it interfaced with a Population Health and Care Needs Approach, and most especially, any existing Stakeholder Reference Group.

Councillor Ian Hudspeth (Chairman, Oxfordshire Health & Wellbeing Board (HWB), Diane Hedges, Deputy CEO, OCCG, and Lucy Butler (Director for Children’s Services and Interim Director for Adult Social Services) attended for this item.  Councillor Hudspeth thanked the Committee for the opportunity to return to the Committee. He highlighted the following:

-       There had been much change since the last time the Board had reported to Committee, and this had been for the better;

-       The CQC had inspected in 2017 and its findings had given the Board the building blocks to work on, ensuring that the system was looked at as a whole, rather than its key parts;

-       The CQC had paid a follow-up visit in November 2018 and had found that good progress had been made to deliver social care and health benefits to the residents of Oxfordshire;

-       Healthwatch Oxfordshire (HWO) was playing its part in ensuring that the Board received as much information from the voluntary organisations as possible;

-       He made reference to the shadow Integrated Care Board (ICB), which was due to be in place by April 2020 and which would have a complete, system-based approach for residents/patients, particularly in relation to prevention aspects;

-       Success had been achieved in gaining additional funding, amounting to £215m across Oxfordshire in order to build affordable homes. The planning of these was also about the health agenda and £218m had been awarded for infrastructure and cycle facilities in Didcot to encourage a far greater health input, particularly in relation to air quality.

Lucy Butler added that the newly refurbished Board has spent a lot of time considering its priorities and building strong relationships with each other. Much more focus on all age-groups had also been considered to be very important.

Diane Hedges added that the inclusion of NHS providers was also considered to be very important to ensure integration. That way, benefits could be realised for commissioning, together with learning and knowledge. A whole new thinking had gone into how to get the best out of commissioning and providing – and this had strengthened the approach.

Questions and comments from the Committee were as follows:

A member of the committee enquired why there had been no performance information provided on what the HWB was doing about the areas with red flags against them. Lucy Butler informed the Committee that performance information was soon to be upgraded in relation to how it was monitored. Thought was to be given to the reasons behind what was driving it, and then, for it to be rigorously monitored as a system. She gave the example of concerns around the CAMHS (Children & Adolescent Mental Health Services) waiting list and the linkage behind the reasons why children were on a child protection plan. There were often a multitude of reasons behind why they were on the Plan – there could be mental health issues, domestic abuse, problems with parenting etc.

In response to a question regarding the lack of data on homelessness, Councillor Hudspeth undertook to bring this back to the Committee. He explained that all district councils and OCC did the account, but figures were somewhat skewed as homeless people tended to gravitate to the City where the facilities were. He added that the Board was working with all of the district councils on a Homelessness Strategy, and this was also being addressed by the Oxfordshire Councils Leaders’ Group.

With regard to the matter of how the committee would be scrutinising the ICS, the Chairman reported that the committee had previously agreed to seek training on this and now that it was a post-election period, the officers were looking at dates to do so. There had been concerns aired previously at this committee about how much power that HOSC would have, realistically, to carry out scrutiny, given its bigger footprint. Diane Hedges explained that thought had been given to how the different scrutiny committees could work together; and out of this, a suggestion had been made. Each of the three scrutiny committees would work with a specialist commissioner on a particular range of scrutiny. She added that those working with ICS would be interested to hear from each committee on how it may work. Lucy Butler added that Integrated Care Partnerships would be specialised across all of the three areas (Oxfordshire, Buckinghamshire and West Berkshire) – and this HOSC needed to think about how it would like to interact with the wider work beyond Oxfordshire also. Councillor Hudspeth stated that he accepted HOSC’s concerns and that training would be provided, adding that there would be a significant amount of hard work taking place, the vast majority of which would be on the actual structures in Oxfordshire. If one looked at the long-term plan it was about having accountability – previously democratic accountability had not been present.

In response to a comment from a member that it was important to think about the actual structures first before work took place on governance and accountability, to avoid HOSC’s disempowerment; Councillor Hudspeth reassured the committee that local determination would feature in a part of it, and there would be a far better system approach. However, regionally, specialist areas needed thought and to be taken into consideration. The Chairman commented that it would be important to ensure that processes were put in place to tackle early challenges. That way, surprises could be avoided.

Rosalind Pearce, CEO, HWO was invited up to the table at this point for the consideration of the setting up of the Stakeholder Reference Network. A member asked where the information was on the move away from the Stakeholder Reference Group (SRG) to the Network? Councillor Hudspeth explained that he and Dr Kiren Collison (Deputy Chair, HWB) had approached all the voluntary organisations to discuss the matter of engagement and to explain that the HWB would have too many representatives on it if all representatives were to be present; and it would also serve to make decision making process too complex. He added that engagement with the voluntary organisations (which had been a CQC action point) would be taking place via a Stakeholder Reference Network (SRN) instead.

In response to a question asking if there was a difference between the SRG and the SRN, Rosalind Pearce explained that the proposal was to move away from having exclusive voluntary group around the table and to take a network approach. She added that HWO would be holding 3 or 4 events a year, all holding particular interest to voluntary organisations, at which a themed discussion would take place. The outcomes of the themed discussion would then be reported back to HWB. She explained that it would also be about going out to people who did not necessarily have any involvement, to obtain their views, for example, the faith groups. This was a much broader approach than the SRG and would glean a great depth of knowledge about what happens within the population, and their views.

In response to a question asking what PCN’s were, Rosalind Pearce reported that they were patient groups working together and being involved collectively. She added that HWO were very concerned that PPG’s needed an effective group network, where they could be actively involved, rather than operating at individual GP level. Jo Cogswell stated that the CCG was leading on some of the work on PCN’s around the county and this would be picked up at Agenda Item 11.

In response to a question about the sufficiency of provision for autism, Lucy Butler stated that she had already picked this up and was working on it.

Councillor Ian Hudspeth, responding to a question regarding affordable housing for social/health workers, explained that this would come under the recently successful £60m Growth Deal which been made, hopefully on a rolling basis. The money would be used to reinvest elsewhere, not just in Oxfordshire. He stated that it had to be used sensibly and good transport networks would be required, including the inclusion of walking and cycle routes.

Dr Ruddle commented that he had attended the last meeting of the revised HWB and it was his view that it had been a very good meeting, discussion being in an engaged, open and honest manner.  It was his view also that the issues of joining up prevention, PCNs etc were nowhere near being real and needed to be made top priority. In relation to the performance report he commented on the following:

-       the most significant CQC issue was to reduce admissions to hospital – and this needed to be included within the report. It was agreed that this would be included;

-       the DToC measures had not been mentioned within the targets;

-       the parking problem at the John Radcliffe Hospital should be a performance measure of whole system working. It was the most significant issue for all residents in accessing hospital services and was truly a cross-cutting issue.

Councillor Hudspeth commented that complacency was not wanted and challenge required. He agreed that the DToC figures, although they had improved considerably since the previous report, should still be reduced further.

Dr Ruddle added the following:

-       targets with a green rating were more concerning that those with a red rating, in that the latter had an action plan behind them. One should ask ‘is the target too low?’;

-       with regard to the parking problems at the John Radcliffe Hospital – he would have liked to see access to Headington via a better connectivity, perhaps by bus lanes to the A40. He would like to see parking allocations linked to the appointment system. A solution for this had to be found with the devolving of services locally, adding that ICS could be a solution as clinics could be situated elsewhere rather than at the John Radcliffe Hospital.

In response to a question asking why some district councils were not represented on the Board – and why couldn’t at least one local representative from each District Council be given a place, the Chairman stated that consideration had already been given to this issue – and it had been scrutinised by this Committee in November 2018. He added however that this Committee still had concerns with regard to the democratic responsibility on the Board and requested the Board to consider shifting the balance again to ensure that the majority of voting lay with democratic members (to at least 51%). Councillor Hudspeth AGREED to take this matter back to the Board.

Responses to various questions and comments from members of the Committee were as follows:

-       The report that the prevention framework was coming to fruition was welcomed;

-       In response to a question asking where the strategic aim was to tackle inequalities, Councillor Hudspeth responded that given there was a ten year difference in life expectancy across the county, an agreed aim was to reduce the gap by 2040 and to measure progress towards it;

-       Could the performance targets be made more ambitious?

At the conclusion of this discussion, the Committee thanked Councillor Hudspeth, Diane Hedges and Lucy Butler for their attendance.

The Committee AGREED the following: to

(a)  bring a report back to this Committee on work that was being undertaken by the county’s leaders on homelessness;

(b)  request the HWB to consider again increasing the district council representation on the Board to allow one representative from each to sit on the Board, to ensure that the majority of voting lay with democratic members;

(c)  request the Board to consider making some of the targets a little more ambitious - and to include more detail on actions in relation to red targets; and

(d)  request more information on the legal aspect of the Integrated Care Board/Strategy from the Director of Law & Govenrnance at OCC.