Thames Valley Clinical Senate
Thames Valley Clinical Senate Council Meeting – draft minutes
Tuesday 27th September 2016
Members: (√ attended, D sent a deputy, x sent apologies)
Dr Jane Barrett (Chair) (JB)
Jan Fowler (JF)
√ Director of Nursing
Thames Valley Area Team
Dr Michael Bannon (MB)
Dr Hugh Gillies (HG)
Post Graduate Dean, Health
GP,
Oxfordshire
x
Education Thames Valley
Dr Lindsey Barker (LB)
Medical Director,
Royal Berkshire Hospital
Stuart Bell (SB)
CEO, Oxford Health NHS Trust
John Black (JBl)
Medical Director
SCAS
Paul Brennan (PB)
Oxford University Hospitals
James Drury (JD)
Finance Director, Thames
Valley Area Team
Douglas Findlay (DF)
Lay Member
Prof Gary Ford (GF)
CEO, AHSN
In Attendance
Aarti Chapman (AC)
Asst. Director, TV SCN and
Senate,
Vida Addison
Minutes
x
√
√
Nicola Grimshaw (NG)
Senate Lay Member
x
√
Dr Abid Irfan (AI)
Chair, Newbury & District CG
√
√
x
x
√
√
√
Dr Lise Llewellyn (LL)
Director of Public Health,
Berkshire
Karen Maskell (KM)
Lay Member
Dr Joe McManners (JMc)
Chair, Oxfordshire CCG
Dr Jackie McGlynn (JM)
Medical GP Director
Bracknell & Ascot CCG
Dr Shahed Ahmad (SA)
Medical Director, NHS
England (South Central)
Wendy McClure (WM)
TV Senate Manager
√
√
D
√
√
√
Dr Chris Morris (CM)
GP, East Berkshire
x
Dr Jane O’Grady (JOG)
Director of Public Health
Buckinghamshire
√
David Smith (DS)
Chief Executive, Oxfordshire
CCG
Andrew Stevens (AS)
Director of Planning & Info,
OUH
Dr Emmanuel Umerah (EU)
Deputy Medical Director
Frimley Health
Janet Waters (JW)
Lay Member
David Williams (DW)
Director of Strategy, NHS
Buckinghamshire Healthcare
Prof Margot Gosney (MG)
Deputy Dean, Health
Education Thames Valley
Sula Wiltshire
Deputising for Joe
McManners and David Smith
Phil Yates (PY)
Chair, Clinical Review Team
(Oxfordshire Transformation
Programme)
D
√
x
√
x
x
√
√
√
Apologies
Apologies were received from:
Paul Brennan, Chris Morris, David Williams
Item
Action
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WELCOME AND INTRODUCTIONS
The Chair welcomed everyone to the meeting and congratulated the South Central
Ambulance Service on receiving ‘a good rating’ by the CQC.
CONFLICTS OF INTEREST
None were declared. The Chair acknowledged that a couple of the Council members present
were also part of the Oxfordshire Transformation Team. She advised that she had decided to
allow these members to remain in the meeting when the Oxfordshire proposal was discussed ALL
as it would be very helpful to have their insight. However, she stressed that they would not
be able to participate in any decision making and she asked all members to be alert to
potential conflict. She noted the importance of documenting these conflicts ahead of any
decision making the Senate Council.
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MINUTES of the LAST MEETING
The Minutes of the meeting on 12th of July 2016 were agreed as an accurate record.
The actions from the minutes were reviewed as follows:
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•
•
•
•
•
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HEE input to BOB STP- SB stated that there had been some discussion with the HEE
but that there was a limitation on what the HEE could do. ACTION CLOSED
Buckinghamshire community plan to be shared with Council Members- DW
advised that the paper will be going to the Community Board and could then be
shared with Council Members. DW not present to update
Recruitment of Vice Chair- JB informed Council members that she was still seeking
a Vice Chair. This will need to be further reviewed, carry forward to the next
meeting.
Liaise with Specialised Commissioners regarding cardiology decisions in the
Thames Valley: AC informed the Senate that there had been some contact from
specialised commissioners regarding actions from the previous Senate review but
this had not yet been progressed. The outcome of the Senate PPCI
recommendations is due for review. Action: AC/WM to liaise with specialised
commissioning
Urgent and Emergency care workshop on 28th July, 2016: The invitation had been
circulated. ACTION CLOSED
A sensitivity analysis on Buckinghamshire growth projection to be undertakenJOG informed members that Bucks have just recruited someone who will carry this
out for Bucks Action: JOG to update
WM to proceed with the setting up of the review panel- Clinical Review Panel was
formed and the first review meeting took place on the 5th of September,
2016.ACTION CLOSED
DW
JB
AC/WM
JOG
SENATE WORK PLAN
The work plan was reviewed.
Oxfordshire Stroke reconfiguration: It was agreed that this does not need to be separately
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included on the work plan as it is included in the transformation proposals. It was reported
that ‘blue lights’ have gone direct to the John Radcliffe for many years so the change will only
impact those patients who go directly to the Horton.
East Berkshire Stroke reconfiguration: Specifications have been signed off and
implementation is planned for January ’17. An implementation group will meet next week
JM
and JM will feed back as to whether Senate overview is required.
Action: JM
Vascular: AC informed members that the Vascular proposal had gone through the NHSE Stage
2 review and the HASC without challenges on either the process or the final decision. The
proposal is a significant piece of work and the plan is to come back to the Council in January
to report on the implementation from an operational and patient perspective.
AC said that she had found bringing the case to the Senate Council had been very helpful and
thanked the Council for the advice given.
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SENATE TOPIC- OXFORDSHIRE TRANSFORMATION PLAN
The Chair introduced the topic and advised that she had agreed that members from
Oxfordshire should remain in the room as this was not a decision making discussion and she
felt that their input and knowledge would aid the dialogue. All agreed.
PY (Chair for the Clinical Review Team ) gave an overview of the findings of the Clinical Review
Panel which had met on 5th September. He stressed that in carrying out the review, the
Senate should be an independent clinical voice albeit part of the NHSE process and said that
there are 4 questions for consideration:
1. are there unresolved issues?
2. what needs to be done to resolve these?
3. is the evidence base strong enough to support the proposals?
4. are there further levels of assurance, planning and risk mitigation required?
The 5YFV has been agreed as the overall direction of travel of the plan.
DH asked whether the evidence base was all clinical or whether it would include patient
views? PY replied that there would need to be a strong clinical evidence base for the
proposed changes but patient experience is a legitimate evidence piece.
It was noted that the Oxfordshire transformation plan predated the STP but the intentions are
now included within it though the two are not the same. When the STP was reviewed at the
beginning of July it was given a green light to proceed but not without the assurance required
and there will be difficult decisions to be made.
PY informed members that the first clinical review meeting had been held on the 5th of
September 2016 but the panel had been concerned about the lack of detail provided.
Feedback had been given to the CCG to support it to develop the detail required. It was felt
that more time would be required to develop this and so the second meeting planned for the
12th September had been postponed to the 7th November. This would still be within the
timeframe given that the public consultation had been deferred to January.
PY gave a high level summary of the Oxfordshire plans saying that the case for change
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included more ambulatory care, more community based care and more specialised care in the
community. There was a concern about the level of primary care engagement given the
increased role identified for it but the Senate was advised that more events had been planned
for Sep/October. SB said that more engagement had already taken place than was evidenced
in the documentation and this would be addressed in future iterations of the business case.
It had been reported in a media publication that a large practice in Banbury had recently given
notice on its NHS contract and HG gave some background to this which he said was
symptomatic of the pressure facing primary care. The Council agreed that this news put extra
pressure on Oxfordshire to describe where the extra capacity required would be sourced.
There was a discussion about what is being done locally to support primary care and SB
advised that discussions were ongoing with local GP Federations. He said that the solution
would not be to have more primary care personnel but rather draw on the range of skills they
possess.
The Clinical Review
PY gave a brief description of the first day of the clinical review. The panel, with the exception
of LL were drawn from outside the Thames Valley to ensure that there was no conflict of
interest. The day had consisted of a Q&A session with the Oxfordshire Team followed by a
review of submitted documentation.
Overall the panel had felt that the direction of travel was in line with the 5YFV but had
concerns about the following:
• lack of linkage between physical health & mental health
• the impact of the proposals was unclear and it was recommended that this should be
produced as a place based description
• transport analysis had been unavailable and this was important but it was noted that
options for consultation had not been agreed at the time of the review
GF advised that the AHSN had made a specific offer to the STP to improve the uptake of
technology and this would help the Oxfordshire plan as access to shared records would be
essential to deliver the community element of the proposals.
The Council discussed issues raised by the Panel and noted that:
• the current position of the Horton is unsustainable
• the proposal for the MLU at the Horton would be safe provided the risk assessment is
strong though evidence shows that some transfers in labour would still happen and
this needs to be considered
• there needed to be equity of service across Thames Valley
• evidence of capacity at the JR to accommodate additional patients would need to be
provided
• mental health services, although not part of this review, need to be mapped against
the service proposals
• there is more work to do on workforce plans
• the phasing and implementation has not yet been set out
• there needs to be an obvious endorsement from Public Health and the Oxfordshire
County Council
Patient engagement
KM highlighted the need for OCCG to effectively communicate with public & patients as they
feel that they have not been listened to. She advised OCCG to identify and involve the
strategic patient groups who could then support the engagement work.
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Next Steps
The Chair noted that the process to date had been much more complicated than had
originally been set out. AS acknowledged this but said that from the Oxfordshire perspective,
it had been incredibly helpful.
It had been proposed that an extra Council Meeting would be held on the afternoon of the 7th
November in order to provide a decision to OCCG to meet their timescales. Council members
rejected this proposal as it would not allow sufficient time for review or discussion and it was
agreed that the Panel report would be brought back to the Council meeting on the 29th
November for final decision making.
At the meeting on the 29th, the Council asked to be talked through the options and to be
informed as to why the Panel had reached their decisions.
Action: WM to take forward
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SENATE TOPIC- MATERNITY
WM outlined the proposals for the Maternity Event planned for the 22nd November, 2016.
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•
•
•
it would be on the lines of the stakeholder events held in 2015
it would be an invitation event to ensure that the right people were in the room - this
would include user representation
it would use the SCN Maternity Capacity report as the basis but focus on the element
of strategic capacity planning
the intention of the event was to reach consensus on the options to address the
capacity issues
Members discussed the proposal and queried where the responsibility would sit for delivering
the actions following the meeting and what would be the role of the Senate. This would need
careful review at the next meeting but it was noted that this is one of the BOB STP work
streams.
WM
Action: WM to progress
6
STPs – ENGAGING LOCAL PEOPLE
Item 6 deferred due to time constraints.
7
ANY OTHER BUSINESS
None
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Next meeting:
29th November 2016
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