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OXFORD HEALTH OVERVIEW AND SCRUTINY

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					                  UNCONFIRMED MINUTES
                                                                  ITEM JHO3(b)(2)

          OXFORDSHIRE JOINT OVERVIEW & SCRUTINY
                COMMITTEE – 13 JULY 2006

           OXFORD HEALTH OVERVIEW AND SCRUTINY
                     SUB-COMMITTEE
                   Thursday 22nd June 2006
PRESENT: Councillor Tia MacGregor (Chair), Councillors Joseph McManners,
Chris Scanlan and David Williams (Oxford City Council); Councillors Gail Bones and
Nick Carter (Oxfordshire County Council); Terry Quinlan (Vale of the White Horse
District Council) and Ann Tomline (South Oxfordshire District Council).

OFFICERS PRESENT: Julia Woodman (Scrutiny Officer), William Reed and Lois
Stock (Legal and Democratic Services), Nicky Headlam (Neighbourhood Renewal
Business Unit)

ALSO IN ATTENDANCE: Penny Astrop (Director of Primary Integrated Care
Services, Oxford City PCT), Jonathan McWilliam (Director of Public Health –
Oxfordshire), Jackie Wilderspin (Senior Public Health Manager, Oxford City PCT),
Barbara Jeffrey and Mary Judge (Oxford City Patients Forum), Kevin Hayes (Oxford
Radcliffe Hospitals Patients Forum), Alex Barnes (Oxford Radcliffe Hospitals NHS
Trust – ORHT), Dr Anne Edwards (Clinical Director Sexual health Services, Oxford
Radcliffe Hospitals NHS Trust), Alison Westmacott (Acting Head of Primary Care
Services, Oxford City PCT), Roger Edwards (Oxfordshire County Council Health
Overview and Scrutiny Officer) and Cynthia Harper (Acting Lead Clinician, Family
Planning).


1       ELECTION OF CHAIR FOR THE COUNCIL YEAR 2006/2007

      Resolved that Councillor Tia MacGregor be elected as Chair for the Council
year 2006/2007.

2       ELECTION OF VICE CHAIR FOR THE COUNCIL YEAR 2006/2007

      Resolved that Councillor Gail Bones be elected as Vice Chair for the Council
year 2006/2007.

3       APOLOGIES FOR ABSENCE AND SUBSTITUTIONS

        None received.

4       DECLARATIONS OF INTEREST

        Councillors MacGregor and McManners both declared a personal interest in
all items on the agenda as GPs working within the City.



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5       REQUESTS TO ADDRESS THE SUB-COMMITTEE

      Barbara Jeffries (Chair of Oxford City Patient and Public Involvement Forum)
and Alex Barnes (Oxford Radcliffe Hospitals Patient and Public Involvement Forum),
had both requested to speak to the Committee on item 10 – Contraceptive and
Sexual Health Services Update.

      Resolved that they be invited to speak during consideration of agenda item 10
(minute 10 refers).

6.      NOTIFICATION OF URGENT BUSINESS

      The Chair agreed to certify as urgent business a report (previously circulated,
now appended) from the Head of Democratic Services at Oxfordshire County
Council concerning the revision of the Health Scrutiny structure in Oxfordshire. The
reason for urgency was to ensure that the Sub Committee was able to consider this
item before the meeting of the Oxfordshire Leaders’ Group on 29 th June.

      Resolved to consider this report with agenda item 13 - Review of the
2005/2006 Work Programme (minute 13 refers).

7.      MINUTES AND MATTERS ARISING

        Resolved:-

        (1) To confirm the minutes (previously circulated) of the following meetings:-

             (a) 9th March 2006

             (b) Special Meeting (1) 27th April 2006

             (c) Special Meeting (2) 27th April 2006

        (2) To ask the Scrutiny Officer to follow up the item concerning education
            around the causes of cervical cancer referred to in minute 90 (5) of the
            meeting held on 9th March.

8       OXFORDSHIRE JOINT HEALTH OVERVIEW AND SCRUTINY
        COMMITTEE – 30TH MARCH AND 25TH MAY 2006:“SCRUTINY
        OUTCOMES”

       Resolved to note the contents of the Scrutiny Outcomes document
(previously circulated, now appended) from the Oxfordshire Joint Health Overview
and Scrutiny Committee of 30th March and 25th May 2006

9       NHS DENTAL CONTRACTS – UPDATE

      Alison Westmacott (Acting Head of Primary Care Services – Oxford City PCT)
attended the meeting to update the Sub-Committee on the new dental contracts that
came into force in April 2006. A short briefing paper (previously circulated, now



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appended) from Oxford City PCT was submitted for the Committee’s information. Ms
Westmacott presented the contents of this to the Sub Committee.

        The following additional information was given:-

        (1) The PCT had 34 NHS contracts with individual dentists. It was pointed out
            that a single practice could have 3 dentists each holding a contract, or it
            could have one contract to cover the whole practice.

        (2) There were now only 9 contracts that were being disputed, as opposed to
            the 19 mentioned in the briefing paper. The majority of issues related to
            clauses imposed by the Government, and which were not within the PCT’s
            power to control or amend.

        (3) At present, 4 practices were still accepting NHS patients. This would
            shortly increase to 5.

        (4) Extra funding had been obtained to support the new Dunnock Way
            practice at Blackbird Leys. In the short term, this had gone to an existing
            practice in the area whilst the PCT tenders for a longer-term contract for
            Dunnock Way.

        (5) The recall schedules were being amended. It was anticipated that there
            would be a 5% reduction in activity as a result of it.

        (6) Practices in Headington, Cowley and Kidlington continued to accept NHS
            patients, although far fewer in the north of the City would still do so. Ms
            Westmacott observed that thus far this had not been a problem, since the
            PCT had been able to place people with existing NHS providers. The PCT
            had retained funding from the 2 practices that had rejected the NHS
            contracts, and this could be used to increase access for other practices.
            Ms Westmacott informed the Sub Committee that the PCT had £90,000 to
            invest in better dental access for the Blackbird Leys area

        (7) The Sub Committee expressed some concern that NHS services had
            declined, and that there should be at least 2 more NHS dentists available
            within Oxford. Of concern too was the distance people had to travel to visit
            an NHS dentist in Oxford.

        (8) Out of hours dentistry waiting times had improved. These were now down
            to less than an hour. Urgent cases were required to be treated within 8
            hours within the normal working day.

        Resolved:-

        (1) To ask Alison Westmacott to present an update at the meeting in
            September, and to provide the following information for the Sub
            Committee:-

                 (a) Statistics concerning access to NHS dentistry in Oxford;



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                 (b) Statistics concerning historical access to NHS dentistry in Oxford –
                     had it increased or declined?

                 (c) A map pinpointing the locations of all dental practices within the
                     City that provided NHS treatment;

                 (d) A list, on an area-by-area basis, of dental practices within the City
                     that provide NHS treatment.

10      CONTRACEPTIVE AND SEXUAL HEALTH SERVICES - UPDATE

       Penny Astrop (Director of Primary and Integrated Care, Oxford City PCT)
attended the meeting to present an update concerning the review of the hub and
spoke model for contraceptive and sexual health services; and submitted a
supporting briefing note (previously circulated, now appended). Alex Barnes (Oxford
Radcliffe Hospitals NHS Trust), Dr Anne Edwards (Clinical Director Sexual health
Services), Helen Peggs (Oxford Radcliffe Hospitals NHS Trust) and Jonathan
McWilliam (Director of Public Health – Oxfordshire) were also in attendance for this
item.

       Ms Astrop presented her briefing note to the Sub Committee. She drew the
Sub Committee’s attention to one correction; that the PCT shared the responsibility
for dealing with teenage pregnancy with the County Council, not the City Council.

Introduction.

        (1) It was observed that the PCT had sought to make longer term provision
            for contraceptive and sexual health services on the site of the Radcliffe
            Infirmary, as part of the LIFT project. However, this scheme had failed to
            gain planning permission. As a result of this, the PCT was considering
            other options. It still believed that there was a need for primary health care
            services within the city centre.

        (2) Service use in East Oxford had dropped, but it was felt that this had little
            bearing on teenage pregnancy rates. Of more concern was the 42% drop
            in young people using the family planning service since contraceptive
            advice had been relocated. Numbers for under 16 year olds had picked up
            slightly in the OX1 and OX2 regions, but were still down in the OX4 and
            OX3 areas.

        (3) The Radcliffe Infirmary was scheduled to close at the end of December
            2006. The PCT needed to decide how best to relocate a complex health
            service. In the short term a home was needed quickly – perhaps at the
            John Radcliffe or Churchill hospitals in Headington. The long term home
            was a topic for further debate.

        (4) The John Radcliffe hospital was the main acute care provider, and there
            was provision there for genitourinary medicine (GUM) and Family




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             Planning (FP) primary care. The decision concerning the future home of
             these services would be made within the next week.

        (5) There was a need to ask patients how they wished to access sexual
            health services. The PCT wished to work with the Sub Committee on this.
            This would not be a formal consultation, but it would be a case of asking
            people what they wanted so that an informed decision could be made.

Public Speaking.

      Barbara Jeffrey and Mary Judge (Oxford City Patients Forum), Kevin Hayes
(Oxford Radcliffe Hospitals Patients Forum) addressed the Sub Committee, and
made the following key points:-

        (1) Concern was raised about the levels of HIV and Sexually Transmitted
            Infections (STI) within the Thames Valley region. The PCT had a target to
            see concerned patients within 48 hours, but the patients’ forums did not
            believe that it could achieve this.

        (2) It appeared that PCTs from Buckinghamshire, Berkshire and Milton
            Keynes had submitted bids for extra funding to develop their sexual health
            services, but that Oxford City PCT had not. There was some anxiety that
            the PCT might be missing out on valuable funding, and that it needed to
            develop of more coherent vision of sexual health services for the City.

        (3) It was observed that the two key considerations when setting up GUM and
            FP services were easy access to the services, and dignity and discretion
            for the patient.

        (4) The Oxford City Patients Forum wrote to the PCT in July 2005, during
            public consultation on the LIFT project, to point out that they believed that
            consideration of GUM and FP services within this scheme to be
            insufficient. They had major concerns about the relocation of these
            services, particularly the removal of the GUM service from the Radcliffe
            Infirmary site. As a result, they would like public consultation to take place
            now.

        (5) The Oxford City Patients Forum felt that it would be beneficial if Family
            Planning nurses could be trained to provide first stage GUM services.
            They would be very concerned if the FP budget was cut. Raglan House
            was the most popular outreach clinic, and it made sense to locate the FP
            hub at this site.

PCT and ORHT response to public speaking

        (1) Attendance rates for GUM patients were in line with national statistics.
            60% of patients were seen within 48 hours of requiring an appointment.
            The PCT was aware of the need to improve these figures and had
            submitted a bid for funding for capital works to facilitate this. There was a




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             need to make the best use of the accommodation available. Meeting the
             48-hour target was a priority.

        (2) The PCT intended to make a bid for further funding when it was known
            where the GUM and FP services would be located. It was desirable to find
            the right site for them. It was not too late to do this. There were 2 hubs,
            one for GUM services and one for FP services; and it was for the former
            that the additional funding was being sought.

        (3) It was pointed out that the GUM service had a countywide base, whereas
            the PCT saw the FP hub being based in East Oxford, with satellite clinics
            elsewhere. The latter did not require laboratory or hospital services,
            whereas the former did. The two services could be approached in different
            ways.

        (4) Where FP was concerned, it was believed that the greatest area of need
            was in East Oxford. Residents from the OX4 and OX3 regions were far
            less likely to go into the city centre for this service, so the relocation of the
            FP service to East Oxford was a good move for them.

        (5) GUM needed generous accommodation. It needed a location that was fit
            for the purpose. It wished to target specific needs, and it wished to target
            male patients in particular. Above all, the PCT felt there was a need for
            convergent FP and GUM services.

        Resolved:-

        (1) To support the suggested short term move to either the John Radcliffe or
            Churchill Hospital;

        (2) To ask that the PCT noted the Sub Committee’s reservations concerning
            the need for further consultation on a permanent move;

        (3) To express support for some sort of public consultation, of the S11 type;

        (4) To ask that a meeting between the PCT, the Sub Committee and the two
            Patients Forums be convened, at which the proposed consultation could
            be discussed;

        (5) To note that all GP practices within the City needed to be informed of the
            impending move, and to ask that this be done;

        (6) To ask the PCT to advise the Sub Committee on the type of publicity
            produced to facilitate (5) above.


11      HEALTH TRAINERS UPDATE

      Jackie Wilderspin (Senior Public Health Manager, Oxford City PCT) attended
the meeting to provide a further update on the progress of this scheme. The original



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report presented at the meeting on 9th March (previously circulated, now appended)
and a progress report from the PCT (previously circulated, now appended) was also
submitted.

        The following additional information was presented:-

        (1) 5 part-time trainers (just over three full-time equivalents) had been
            recruited, and they should start work on July 5th. The first three weeks
            would be devoted to training. There would be ongoing training and
            supervision after that.

        (2) It was intended that each trainer would build a portfolio of evidence of his
            or her competence, along with a record of training completed. It might be
            that they would receive a nationally recognised qualification, but this was
            still being investigated.

        (3) Deprived areas of the City would be targeted. Evidence would be collected
            from clients, and a fuller evaluation of the scheme was planned for
            January 2007.

        (4) Funding was not guaranteed after the end of March 2007, but the PCT felt
            that the project would be worth running for nine months. Some funding
            had been received from the South East Regional Development Agency

        (5) It was intended that each client should have contact with a trainer for 3
            months only, to try to avoid waiting lists, and to allow the trainers to see as
            many people as possible. There was room for some flexibility.

        (6) GPs would refer people to the trainers, however these would not be
            people who were chronically unwell. People reaching their targets – such
            as giving up smoking - would be one measure of success.

        (7) The Sub Committee felt that this was a positive project that deserved
            support.

      Resolved to ask the Executive Board of Oxford City Council if it could make
funding available to help support the Health Trainers Scheme.

12      OXFORD HEALTH PARTNERSHIP

      Nicky Headlam (Social Inclusion Team Leader Neighbourhood Renewal,
Oxford City Council) attended the meeting to present an oral update on the
partnerships role, structure & activities to the Committee

       She explained that the Oxford Healthy Communities Partnership comprised
the Strategic Director of Housing, Health and Community and his team from Oxford
City Council, along with the Director of Public Health and his team from Oxford City
Primary Care Trust. They met quarterly and worked to support community focused
health projects. An invitation was extended to the Sub Committee to nominate a




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delegate to attend further meetings. Ms Headlam was willing to add the members of
the Sub Committee to the circulation list for this group.

      Resolved that Councillor McManners would represent the Sub Committee at
meetings of the Oxford Health Partnership in future.

13      REVIEW OF THE 2005/2006 WORK PROGRAMME

2005/2006 Work Programme.

       The Strategy and Review Business Manager submitted a report (previously
circulated, now appended), which presented a progress report and update on
agenda items considered by the Oxford City Health Overview and Scrutiny Sub-
Committee during the 2005/2006 work programme.

        Resolved:-

        (1) To select a work programme for 2006/2007 that could be delivered within
            5 meetings (given that it was felt that there were too many extra meetings
            last year);

        (2) To select a work programme that balanced the three elements of scrutiny
            – pre-decision scrutiny, performance monitoring and review, and to avoid
            taking reports for noting;

        (3) To aim to have no more than 4 or 5 substantial items on each agenda, to
            allow for focussed and in depth scrutiny, and to ensure that agendas were
            balanced;

        (4) To monitor the number of vacant seats and substitutions. The Committee
            dates and start times had been set for 2006/2007 (Thursdays at 2.30pm),
            but they could be changed if a number of Members found it difficult to
            attend at the set time;

        (5) To examine scrutiny performance information in 6 months time to evaluate
            progress.

Future of Health Scrutiny in Oxford.

       The Sub Committee considered as urgent business a report from the Head of
Democratic Services at Oxfordshire County Council concerning the future of Health
Scrutiny in Oxford (minute 6 refers).

       This item was due to be discussed at the Oxfordshire Leaders’ Meeting on
29th June. A recommendation would be placed before the Joint Committee on 13 th
July, with the final decision being made by Oxfordshire County Council at its meeting
on 12th September. The current recommendation was that all Health Scrutiny Sub
Committees should be dissolved. The County Council Health Scrutiny Committee,
which would be co-terminous with the single countywide PCT, would carry out all the
work in future.



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        Resolved:-

        (1) That the Oxford Health Overview and Scrutiny Sub Committee was
            opposed to this change, given that:

             (a) Little notice of the proposed change had been given to the Sub
                 Committees;

             (b) Only one option was under consideration;

             (c) It appeared that there had been little involvement of County Councillors
                 during the exploration of this item;

             (d) The present Joint Committee had a very full agenda, and there was
                 doubt that it would be able to cope with the additional work placed
                 before it as a result of the dissolution of the Sub Committees.

        (2) To ask the Scrutiny Officer to prepare a written response to the report
            from Oxfordshire County Council, to be circulated to all political group
            leaders at the City Council, and by Councillors Bones, Carter, Quinlan and
            Tomline to their respective groups;

        (3) To ask the Scrutiny Officer to arrange a special meeting of the Chairs and
            Vice Chairs of all the Sub Committees prior to the County Council meeting
            on 12th September in order to formulate a single response;

        (4) To ask Democratic Services to re-arrange the next meeting of the Oxford
            Health Overview and Scrutiny Sub Committee for 2.30pm on Monday 11th
            September.

14      WORK PROGRAMME 2006 – 2007

       The Strategy and Review Business Manager submitted a report (previously
circulated, now appended) from which the Sub Committee was asked to form its
work programmes for the coming year.

        Resolved:-

        (1) That owing to the uncertainly about the future of this Committee it would
            not be possible to start a review immediately;

        (2) To ask the Scrutiny Officer to prepare a short summary on each of the
            following topics which would be presented at the Sub Committee meeting
            on 11th September. Should the Sub Committee be dissolved, the above
            topics could be referred to the Joint Committee for a task and finish
            group:-

                 (a) Mental Health Services and access to counselling;




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                 (b) Health and Housing, including homelessness;

                 (c) Physical activity.

        (3) To select the following areas of study as Committee Enquiries, which
            would remain on the work programme for the Joint Committee to take
            forward should the Sub Committee be dissolved:-

                 (a) Access to GUM services (percentage of patients seen within 48
                     hours);

                 (b) Sexual Health Strategy;

                 (c) Re-siting of GUM and FP core services;

                 (d) Oxford Radcliffe Hospital trust – move from the Radcliffe Infirmary
                     to the John Radcliffe site;’

        (4) To agree that Chair and Vice Chair could rationalise the choices made by
            the Committee into agenda schedules.

15      ALCOHOL MISUSE REVIEW REPORT – RESPONSE TO
        RECOMMENDATIONS

        The Scrutiny Officer gave a brief update to the Sub Committee.

        The report of the review group was submitted to the Sub Committee on 27 th
April. The summary of findings and the list of report recommendations, and the
response of Oxford City PCT to the recommendations (previously circulated, now
appended) were circulated to the Committee for information.

      The Alcohol Misuse Review Report was submitted to the Oxfordshire Joint
Health Overview and Scrutiny Committee on 25th May 2006, and would be
presented at the County Council Cabinet in July or September.

       The Oxford PCT had endorsed the majority of the recommendations
contained within the review report, but lacked the funding to put them into practice.
No response had been received from the Oxford Drugs and Alcohol Action Team. A
sub group working with the Crime and Disorder Partnership planned to look at
various drug and alcohol misuse issues.

       The Oxfordshire County Council Community Safety Scrutiny Committee has
also requested a presentation of the findings of this review to be made at its next
meeting on 3rd July. Members of this Committee wished to consider the wider
community safety ramifications of the report.

        Resolved to note the position.

16      DATES OF FUTURE MEETINGS




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        Resolved to note the following meeting dates:-

        Monday 11th September 2006 (re-arranged meeting date)
        Thursday 30th November 2006 (to be confirmed)
        Thursday 8th February 2007 (to be confirmed)
        Thursday 26th April 2007 (to be confirmed)

17      CONFIDENTIAL MATTERS

        There were no confidential matters.



The meeting began at 2.30pm and ended at 5.45pm.




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