Health & Adult Social Care Select Committee - Thursday 7 May 2026, 10:00am

Health & Adult Social Care Select Committee
Thursday, 7th May 2026 at 10:00am

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Start of webcast

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Cllr Shade Adoh

1 Apologies for Absence

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Elizabeth Wheaton - Principal Scrutiny Officer
Cllr Shade Adoh

2 Declarations of Interest

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Cllr Julia Wassell
Cllr Phil Gomm
Cllr Shade Adoh

3 Minutes of the Previous Meeting

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Minutes of Previous Meeting

Cllr Julia Wassell
Elizabeth Wheaton - Principal Scrutiny Officer
Cllr Shade Adoh
Cllr Lesley Clarke OBE
Cllr Shade Adoh

4 Public Questions

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5 Chairman's update

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6 Buckinghamshire Healthcare NHS Trust - key performance and service quality

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BHT 2025-26_HASC 7 May 2026

Raghuv Bhasin
Cllr Shade Adoh
Raghuv Bhasin
Mitchelll Fernandez
Cllr Shade Adoh
Cllr Dominic Pinkney
Raghuv Bhasin
Cllr Dominic Pinkney
Raghuv Bhasin
Cllr Shade Adoh
Mitchelll Fernandez
Cllr Lesley Clarke OBE
Raghuv Bhasin
Cllr Lesley Clarke OBE
Raghuv Bhasin
Cllr Shade Adoh
Mitchelll Fernandez
Jon Evans
Cllr Shade Adoh
Cllr Thomas Hogg
Raghuv Bhasin
Mitchell Fernandez
Cllr Thomas Hogg
Raghuv Bhasin
Cllr Thomas Hogg
Raghuv Bhasin
Cllr Shade Adoh
Mitchell Fernandez
Cllr Shade Adoh
Cllr Phil Gomm
Cllr Shade Adoh
Cllr Frances Kneller
Raghuv Bhasin
Cllr Shade Adoh
Cllr Simon Rouse
Raghuv Bhasin
Jon Evans
Raghuv Bhasin
Cllr Simon Rouse
Cllr Shade Adoh
Raghuv Bhasin
Cllr Shade Adoh
Cllr Alan Sherwell
Raghuv Bhasin
Jon Evans
Cllr Alan Sherwell
Cllr Shade Adoh
Cllr Thomas Hogg
Raghuv Bhasin
Mitchell Fernandez
Raghuv Bhasin
Cllr Shade Adoh
Cllr Thomas Hogg
Jon Evans
Cllr Shade Adoh
Jon Evans
Raghuv Bhasin
Mitchell Fernandez
Cllr Shade Adoh

7 Oxford Health NHS Foundation Trust - refreshed strategy

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HASC Strategy development_7th May_FINAL

Cllr Shade Adoh
Elizabeth Wheaton - Principal Scrutiny Officer
Amelie Bages
Cllr Shade Adoh
Cllr Julia Wassell
Amelie Bages
Cllr Shade Adoh
Amelie Bages
Sam Shepherd
Amelie Bages
Cllr Shade Adoh
Amelie Bages
Cllr Shade Adoh
Cllr Dominic Pinkney
Amelie Bages
Cllr Shade Adoh
Cllr Simon Rouse
Amelie Bages
Sam Shepherd
Cllr Shade Adoh
Cllr Phil Gomm
Amelie Bages
Cllr Shade Adoh
Cllr Thomas Hogg
Amelie Bages
Cllr Shade Adoh
Cllr Julia Wassell
Amelie Bages
Sam Shepherd
Amelie Bages
Cllr Julia Wassell
Amelie Bages
Cllr Shade Adoh
Cllr Lesley Clarke OBE
Amelie Bages
Cllr Lesley Clarke OBE
Amelie Bages
Cllr Shade Adoh
Cllr Frances Kneller
Sam Shepherd
Amelie Bages
Cllr Shade Adoh
Amelie Bages
Sam Shepherd
Cllr Shade Adoh

8 Work programme

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Cllr Lesley Clarke OBE
Cllr Shade Adoh

9 Date of Next Meeting

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Webcast Finished

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Disclaimer: This transcript was automatically generated, so it may contain errors. Please view the webcast to confirm whether the content is accurate.

Cllr Shade Adoh - 0:00:03

Again, thank you everybody for letting us this morning.

1 Apologies for Absence

So our personal agenda, apologies for absence and any changes mentioned.

Elizabeth Wheaton - Principal Scrutiny Officer - 0:00:25

Thank you, Chancellor. We have an apologies from Councillor Mabou -Hussain and we have Councillor Mohamed Ayyab here substituting for him.

2 Declarations of Interest

Cllr Shade Adoh - 0:00:34

Thank you very much, Councillor, for substituting. Any declarations of interest from the members? You can run.

Cllr Julia Wassell - 0:00:48

Thank you very much.

Cllr Phil Gomm - 0:01:01

Thank you very much.

Cllr Shade Adoh - 0:01:13

So minutes.

3 Minutes of the Previous Meeting

It's the distractions that I'm on today .ellow

Yes.

That's not a song.

Cllr Julia Wassell - 0:01:28

Yes.

Elizabeth Wheaton - Principal Scrutiny Officer - 0:02:50

So Julia, do you want to add the word then?

Proposed amendment was put forward by Julia wassall and seconded by Councillor Stutchbury to delay

The election of chairman which was voted on and lost

No to delay the election of chairman okay, yeah

Cllr Shade Adoh - 0:03:12

Cllr Lesley Clarke OBE - 0:03:28

On page 11 where it says halfway down before item 10 it says the chairman

thanked the presenter for attending and concluded that and it goes on to say

planned engagement exercises and evidence of more women's health services

being available and accessed within communities. I know that we've got

something on the agenda today but how are you going to take that forward when we want

to listen and hear more about the results of the planned engagement exercises because

I don't think that actually is what we are talking about in the item today.

Cllr Shade Adoh - 0:04:13

That would come through in the next council year when we will be looking at integrated

network neighbourhood services.

So we'll be looking at it, yeah, definitely.

If not for the amendments, do we all agree?

So, actions from the last meeting as well.

On page nine, member visits to the control centre in Bistra.

This will form part of the work programme discussion

for the year ahead.

And on page 10, we see a weight in the cost

of translation services from the ICB.

And on page 11, we see the cost of translation services

The officer will circulate this once received.

And on page 10, maternity services will be considered as part of the work programme for the year ahead.

And we will invite ICB colleagues to attend this.

And on page 11, one of our partners that attended JAMA was looking into the Steering Group membership.

Some members may already have started to receive invites on this.

but please do let our office, our scrutiny officer,

know about it.

4 Public Questions

Agenda item four, which is public questions.

We have received a question below from Mike Etkin,

and this is in relation to item number seven.

This question has been agreed that I will take it

at the start of item seven,

when our Oxford Health colleagues would have joined us by that time. And this will be opportunity for

members of the public, you know, normally to submit the questions which is why we have Mike

5 Chairman's update

Etkin doing this, but we'll be taking that in item seven. Okay, now to Chairman's Update which is agenda

item five. I'd like to update the committee on the following. We had members of Access

to Emergency Care Review Group undertaking several evidence gathering sessions and I

want to thank all the members who, you know, took time out. It was long, long days. It

was really long days, but we learned a lot and so it was really appreciated by our partners

for the ICB, BHT, for the time they've given to us.

So I want to formally say thank you to all our partners

who came and spoke to us candidly.

And to all my colleagues as well who gave

up their time to attend.

We did visit the Audient Treatment Centre

at Wakeham Hospital and we'll be holding a meeting next Tuesday

to discuss the key findings

and develop areas of recommendation.

We plan to have the draught report ready for the first ASK meeting in the new council here.

We have a Buckinghamshire Health Care NHS Trust Quality Account.

As most of you will be aware, the ASK committee will submit a statement for the Trust's

annual quality account.

We are due to receive the draught quality account on the 3rd of June and would need to prepare

the statement by mid -June.

So, all hands on deck, all support will be required.

We're looking for two or three members of the ask to be part of the working group to review the draught account and feedback comments to help inform the ask statement.

So, if I can kindly ask, you know, your support, please do give your names.

We need two to three people.

And I know historically a colleague of ours is always, you know, ready to do it.

Hopefully we'll still do it, but you know, we need two more people to join in or three if

You know, our colleague is not going to do it. So please do let Liz know

your

Availability to help with this because this is where we can ask questions we can dig deeper

To you know in supporting our partners to get the work done properly

Mount Vernon Cancer Centre.

Buckinghamshire Council has two seats on this committee.

It's a joint health overview and scrutiny committee

to review the proposed service change to relocate the service

from Mount Vernon to the Watford General Hospital site.

There has been public consultation on this,

which ended in January.

and there is a Mount Vernon meeting to review the feedback and agree next steps.

This is on the 16th of June. I think I have asked this before that we want

people to please attend and my special request would be to members who actually

you know located nearer that end of the of our County. It would be good to have

people from that end to attend this meeting on the 16th of June. So please kindly let

the officer know if you're able to do it. It would not be good if we don't have somebody

or two people to attend this meeting. So it would be good to, I'm looking to all this

side for somebody, two people to do that. So thank you for that. Right, to the business

of the day, which is agenda item six.

6 Buckinghamshire Healthcare NHS Trust - key performance and service quality

This is Buckinghamshire Healthcare NHS Trust,

looking at key performance and service quality.

So I'd like to welcome yourselves,

and I know you gave us some of your time

the last three weeks, four weeks.

Yeah, so thank you.

Please do say extend our greetings and gratitude

to your colleagues as well.

And this is to ask you to, you know, introduce yourselves,

provide a brief summary of the key points from the slides

that you have submitted for the agenda.

And for us, it's an opportunity for us to review

and evaluate your, you know, not your PhD's performance

over the last year and to hear by your key areas of focus for 2026 -2027, including financial

performance and the major investments in the States.

So it's an opportunity for us to be able to hear, ask questions and then see what happens.

The committee also will hear from the deputy chief nurse about the NHS quality accounts.

We'll submit annual statements to BHC Quality Act Council.

This item is set up for the purpose of statutory reports

and what can or cannot be included.

So please do introduce yourself, your role,

and then it's over to you.

Great, so if we do introductions first,

Raghuv Bhasin - 0:12:04

and I'll just speak for a couple of minutes

and then really open it up for questions

because we've tried to put as much as possible into the pack.

So I'm Raghav Basin, Chief Executive of Bux Healthcare.

Good morning, everyone.

I'm John Evans, the Chief Finance Officer

at Buck's Healthcare.

Good morning, everyone.

Mitchell Fernandez, Deputy Chief Nurse at BHP.

So, as I said, we won't go through the slides

in deep much detail.

I'll just speak for a couple of minutes and then sort

of really keen to have a conversation and answer

questions from council colleagues.

So, 25, 26, a few things that particularly mark it out.

So there's a significant focus on agreeing on new strategy,

which we launched in the summer.

That's very much in line with the Buckinghamshire Health

and Wellbeing Strategy.

And we started to take steps to deliver that ambition

for helping people to live healthier,

more independent lives.

So a big focus on prevention, working in neighbourhoods,

moving services out of the trust into close to people's homes.

We've also clearly had quite a lot to do on the performance side and reducing our

waiting lists and delivering reductions in corridor care. In parallel we've had a

challenged financial position as it is in the whole NHS and wider economy. We

were able to hit our financial plan yet again and we had our biggest ever

capital investment at 75 million pounds.

So big upgrades on the states on digital with a lot more to come in the coming

years and we've continued our focus on having a great environment for our

colleagues to work in and that was recognised in National Staff Survey.

So I won't say much more than that really keen to get questions and thoughts

and yeah over to council colleagues.

Cllr Shade Adoh - 0:14:05

Sorry.

Whilst recognising that not all services can be included in the quality accounts, the progress

in increasing the service that's hospital at home is, you know, it's like there's not

much progress in that.

You know, last year the quality account mentioned that this service would be expanded to 160.

And you know, when we're looking at caring for people closer to home, surely the key

ambition for the NHS would be to have this service linked to this feature in the quality

account for this year.

So how are we managing that?

I mean, it's a bit disappointing, but I can see why.

Raghuv Bhasin - 0:15:10

Yes, at Hospital at Home, that's where we support people with hospital level care in their own homes.

So we've grown to about 180, what we call beds, virtual beds for Hospital at Home.

We're looking at other areas to expand into, so I was with our cardiology team earlier in the week,

and they're looking at additional pathways you can bring to Hospital at Home.

But I suppose one of the reasons we haven't emphasised that in particular is it's just one part of a much bigger agenda to move care into the community.

So we are, for example, this year we've launched what we call proactive frailty clinics.

So we're inviting colleagues, sorry, patients in with GPs to give people an M .O .T. and address some of their needs to try and maintain their independence for longer.

We've got a remote monitoring programme, so people are monitored in their own homes,

not because they need hospital -level care, but because they have potential risk

of deterioration, and we're increasingly trying to increase the level of specialist input

into our community hospitals and into our communities.

We're doing some work on gynaecology at the moment to try and reduce the length of weights

for patients coming into the hospital

and giving opportunity to get earlier treatment.

So I think Hospital at Home was a really big focus.

I think we're now at the level we think is appropriate,

but it is a much bigger part, is one part

of a much bigger programme.

And we can, Mitchell, I think particularly pull

out something in quality about that.

That's helpful, Mitchell.

Thank you very much, Raghu.

Mitchelll Fernandez - 0:16:50

Yeah, so I had a conversation with Liz, and I already,

I just acknowledge that we've taken on board your comments from the last year quality account the

Latest layout of our quality account for 26. 25 26 will include the hospital at home update for that

So some of your comments will be included

I do acknowledge that the quality account needs to be user friendly and be you know, not too lengthy

But most of your comments all your comments on that last year will be taken on board and hospital at home is one of them

So we will get

Thank you very much.

Cllr Shade Adoh - 0:17:21

So, Chancellor Picnich.

Thank you, Chair.

Thank you everyone for coming in this morning.

Much appreciated.

Great for all the information.

I had a comment that looking at the year ahead in particular,

there's not very much mention of working with the voluntary

and community sector, which I have asked questions

of before just with that.

Cllr Dominic Pinkney - 0:17:44

But my question is, on page 19, there's a bit

about working with primary care to tackle health inequalities.

I was wondering if you could explain a bit more about what

that looks like and why only primary care mentioned,

I appreciate it's only a slide, but what about all

the other people and organisations

that could be involved, particularly

the voluntary sector, public health,

adult social care, et cetera.

Yes, so really a good point.

Raghuv Bhasin - 0:18:10

So we actually met as a Buckinghamshire Voluntary Care

sector partnership board which the council support. So I attended that with

George Gabriel on the lead GPs and Craig McTargill from the council just last

week to talk about how we better work with the voluntary sector in a more

strategic way. So we are very keen to be able to support a different type of

relationship with the voluntary sector so less of a paternalistic can you fix our

problems and more of a how do we support the voluntary sector to do what it's best at,

recognising that you need to take a new form of commissioning and you need to take a new

approach because some things don't fit into neat boxes which the voluntary sector provides.

That's the conversation we're trying to have at the moment.

And just earlier this week, we agreed as part of our funding 2627, putting 100 ,000 pounds

into reducing social isolation,

working with the voluntary sector to do that.

And so we're gonna be working with Heart of Bucks,

the community foundation, to develop models

to work with the voluntary sector

about how best to do that.

So it's definitely a key part of what we do.

The question I kind of posed to voluntary sector colleagues

was tell us how best to work with you.

Like, we shouldn't tell you,

and so there's a bit of work that the colleagues are gonna do

about how best to engage with them,

because it's very difficult for us as an organisation

to engage with 2 ,500 voluntary sector organisations.

So we need to think through that.

And the reduction in health and quality.

So we are particularly working with primary care colleagues,

but as you say, it counts for Pinky.

It's with the local voluntary sector.

It's with Oxford Health.

It's with the council as well.

So we're quite targeted in our focus around opportunity

bucks ward.

So we've just had community health and well -being workers

starting in Aylesbury and Wickham,

starting their work there.

We've got some diabetes work that's just about to go live in Wickham and Aylesbury as well.

So there's quite a lot we need to do, particularly in those areas of deprivation,

recognising those are the only areas of inequality over the coming months and years.

And we're really proud. One of our objectives last year was to reduce the waiting time difference for people in opportunity bucks.

between the non -obligatory bucks,

so there was a six -day waiting time difference

at the start of the year on average.

That's now down to one day.

So we're gonna get that down to zero

and potentially go beyond that, as it were.

So it is front and centre

for what we're trying to do as an organisation.

Thank you.

Just one quick comment back.

That was much appreciated and sort of sounds so good.

Cllr Dominic Pinkney - 0:20:53

Also wanted to flag that obviously within working

in the voluntary community sector,

volunteering itself is a important subset and I noticed that Sir Jim Mackey, the NHS England CEO,

this week was talking about the fact that volunteering should be in terms of achieving

the 10 -year plan should be considered at the beginning and not considered an afterthought.

So it would be great to see in future more things around volunteering and the voluntary community sector.

Raghuv Bhasin - 0:21:19

Yeah, I completely agree. So we have over 500 volunteers in the trust who are sort of a vital

part of our team. I think one of the things we were keen to do is explore with Community

impact box and I'm meeting the council chief executive later today about how we

can sort of grow that even further and tap into the huge amount of engagement

that we have in the county and I think particularly as we start to spread out

services more broadly into the county so working with volunteers from the local

community is going to be really crucial.

Cllr Shade Adoh - 0:21:52

Mitchelll Fernandez - 0:21:56

Probably just to flabage that because I really value the volunteers and one of the services

that we cover is Chaplaincy.

So in terms of Chaplaincy, we have around 50 plus volunteers that have been ongoing

for the last two years and compared to other organisations, we only have a few that's been

substantive but the majority of them are volunteers working different, you know, religious beliefs

and that covers our staff and also the patients, and we always acknowledge them.

Councillor Clark.

Cllr Lesley Clarke OBE - 0:22:25

Thank you, Chairman. Several questions on your paper.

We were very pleased to see the purchase of QVR, saving it for the people of High Wycombe,

that's really good. It's in the ward I represent and I'm really pleased that we're keeping that.

Knowing that you're looking at the huge potential of neighbourhood hubs and you are obviously very aware how difficult it is for doctors to get appointments with doctors and therefore get into seeing you in the hospital, how do you see the neighbourhood hubs actually helping it, helping people?

In particular those that are left behind when it comes to IT

because they're not on

any social media

27 % of the people in High Wycombe are not on social media, which is quite high. The majority of them are elderly people

How do we ensure that they are looked after and kept up with the flow?

document which is interesting to read. You've got a national staff survey. What about your

local staff survey? What does that actually say and what does that actually prove that

you understand? Because national surveys are not what we're really wanting. We want to

know what your local staff do. Then on your financial delivery, you are very pleased that

you've made an efficiency of 37 .9 million pounds.

Does that get ploughed back into the local service?

Or is it because you get to 31st of March

and has to go back to government?

And that would be, and then you then say further down

on that page, page 25, you actually then say

you've made further 38 .9 million efficiency.

So overall you've made really nearly 80 million pounds

worth of efficiency. Where are you putting that money? What are you doing with it? And

on page 27 you've got the following publication of our Trust Green Plan. Further down you

say we have eliminated use of death fluorine. Sorry I can't see that. Thank you very much.

Reduced nitrous oxide, which is good to hear in theatres, and introduced digital pathway

to cut unnecessary travel. Surely that's a bit of an oxymoron isn't it? If you're in the theatre

you won't be able to stop travel because you have to actually be in the theatre. You can't do that

from home can you? That's a question and then the last bullet point on that page is that we work

with partners to develop plans for QVR. Who are your partners that you're developing those plans?

Thank you.

Cool. Thank you very much.

Raghuv Bhasin - 0:25:32

So if I try and cover a few of those, and then I'll pass to John to talk about some of the financial side of how it works.

So I think we missed a comma on digital pathways.

So reduce nitrous oxide in theatres, comma, and introduce digital pathways.

So it's not digital pathways into theatres, it's digital pathways.

The staff survey results, so it's a national staff survey, but those are our local results.

So what you're showing is how we compare to national.

We also run our own surveys, quarterly surveys as well,

which largely match the sort of key findings

in the national staff survey.

So we are seen as a good employer, supportive of colleagues,

but we've got issues around race

and religious discrimination that we need to tackle.

And that is we just about to finalise our people

and culture strategy, which we're going to publish

at the start of next month and there's a lot of work in that to try and build on

the things we do really well around looking after our colleagues and

supporting our colleagues but also address some of those issues of

discrimination and give people the skills as we go through into quite a

changed world. On Queen Victoria Road, so we've been working over the past

nine months with local GPs in particular but also Oxford Health and voluntary

sector and council to think about a Wickham solution to some of these state issues.

And we are building on that group and expanding that further.

I mean, if people want to be part of those conversations, we're very happy to do that.

I think it's already three or four times oversubscribed in Victoria Road by the amount of people who

sort of grabbed me and say, can I have some space?

So we need to go through a process about working that through.

So our vision is really it's kind of a health and care campus.

So Citizens' Advice Bureau and a domestic abuse charity are currently there.

It'd be brilliant if they could stay.

Other charities on board, Oxford Health Services, I was speaking to Bucks Minds who run Safe

Havens.

They like to put services there together with our services and GP services and opportunity

for health tech and innovation to come in and so a real campus type feel to benefit

the people of Wickham and also look at economic regeneration of that area as well.

And we kind of see ourselves as the able to facilitate some of that given our scale and

size so very keen to be part have conversations and one of the ways we'll improve access is

by bringing our services together.

There's quite a lot of duplication between our services

with GPs in particular, so bring those together.

As I said, we're trying to work with GPs

to get better triage systems,

and so people can be seen,

not have to wait for a long time on waiting lists

when they can be seen by a GP with a special interest

who's able to access a specialist condition more readily.

That's not how the system currently works.

And I think the new estate would give us a big benefit to unlock some of that.

And then on the digital exclusion challenge, so yeah, we are very aware of that.

I'd say two things.

So not being on social media doesn't mean you're digitally illiterate.

So I think my dad isn't on social media, he's 75, he's pretty digitally literate, he runs

a business on his phone.

So I think we need to sort of think through,

we have an antiquated way of engaging with people

in the NHS.

I was, if we think about the rest of our lives

and what we do in terms of running the rest of our lives

online, that's where we need to move to.

And actually we're quite far behind in this country,

in lots of other countries about how you use technologies.

I think there's quite a lot we can do.

What that will do is reduce a large amount of the workload

to dealing with 80, 90 % of patients,

so we can actually focus much more

on the 10 or 15 patients who need,

who choose not to, aren't able to use

those kinds of modes of interaction.

So I'm very much of a,

we should be segmenting our patients

into different ways of engagement with them,

so that we can better target resources

are those people who can't use digital platforms

or who need greater navigation or greater allowance

for their circumstances to be able to access services.

But at the moment, we can't see the wood from the trees

because our systems are not as modern as they could be.

And so one of our big programmes this year

is digitising and using artificial intelligence

to change that quite fundamentally.

But should I pass over to John to?

Hello, please.

Yeah.

Cllr Lesley Clarke OBE - 0:30:36

There are 75 ,000 people in High Wycombe. If 27 % of those are not on social media

and you're saying you're going to renew the way that we deal with digitisation

you're still excluding them and you actually made reference to your father

who wasn't an IT literate. Quite a few of us are perhaps not as literate on IT as

we'd like to be but how do you see engaging with those people who get

really concerned about not being able to get through to their doctor or getting

through to the hospital to make an appointment. How do you see that in

the future? Particularly when you're told, oh you should have made an appointment

for this when last week you didn't have to and next week you'll probably find

that you have to get back to where you started from. How do you actually see

that right at the top of the tree filtering down to everybody so that

they're included because at the moment,

elderly feel absolutely out of it,

that they're not even considered.

And it's the elderly that need this extra care

that we're talking about.

And how do we ensure that they are actually seen

as an important part of the structure

that you're trying to put into place?

That's amazing.

Yeah, so I think, so sorry.

So I think I slightly challenged the premise

Raghuv Bhasin - 0:32:00

of if you're not on social media,

that doesn't mean you're digitally literate.

So, and I think a lot,

the example of my dad is he's not on social media,

but he's digitally literate,

because he's made a choice.

And so I think we need to think about

what does digital literacy mean or not?

Because quite a few of the systems

are relatively straightforward digitally.

Now that isn't to say there's a large number of people

who are excluded if we take certain routes.

And I think I'd say two things to that.

So one, at the moment, we are treating everyone the same.

So that means those people who are excluded

are in a queue with everyone else.

So what we want to do is people like me,

who are very happy doing it all online,

can be taken by that service.

That frees up a more personal service

for those people who need it.

And two, as part of all this work,

we're engaging patients with a wide range of backgrounds

and needs into designing these services.

There's no point designing a service for patients to use

if patients are involved.

So our transformation programmes have got patients involved

in testing some of the models,

testing what will work for people.

But yeah, my underlying premise,

which you might not agree with,

is we do this in most of the rest of our lives,

quite a lot of us.

We need to move to that world, but have a very clear focus on those people.

This doesn't suit because we are here for everyone, but we can only have that focus

unless we, whilst by digitising for everyone else.

But just, should I bring John on the financial questions?

Before you do the finance.

Cllr Shade Adoh - 0:33:44

So, I agree with you.

Not everybody is on social media.

There are other online ways of making contact with the world.

And are you working with the voluntary service?

You have a patient group.

So through that, you're able to capture means of reaching out to those who are not on social media.

for, you know, what are the means, what are you hearing for residents on how, which are

the ways or platforms are they engaging with information or services that you're providing?

Mitchelll Fernandez - 0:34:29

Thank you, Chair. So, we do have patient partners, a patient participation or patient group that

they're all, you know, represented a wide variety. And in every digital that we do,

we always put it forward for, you know, for, you know,

for conversation to make sure that nobody's left behind.

So one thing probably I can give you an example is one

of our service, shall we say, dermatology.

So if you get a number of phone calls that have been swamped

by, you know, by not using digital, our admin people,

our clinicians could hardly, you know,

keep up with the number of volumes.

We introduce a patient portal where some of those colleagues

or some of those patients that can do digital appointment.

So 80 % go digitally and because of that the only 20 % be able to be managed by our technician or our admin to have a

Conversation so it's not only about digital

But we're using as well that you know the letters to follow up so that make sure that everybody's included

So the digital just there's a tool for it to help us manage it as I said it improves our

Conversation with the methodology because 80 to 90 percent go digital and 10 percent or 20 percent can be assisted through our admin and conversation

Joe?

Jon Evans - 0:35:38

Thank you, Chair.

So I think the questions were broadly,

we've referred to quite a significant amount of money.

I'm gonna round it to about 40 million pounds per year

around efficiency.

Kind of what is that?

What does that mean?

And what does that kind of look like

in terms of kind of funding back into services

or going back to the centre?

So that number is a kind of function

of about two or three things.

It's probably important I kind of describe that.

So as an NHS trust, we receive the majority of our funding to deliver NHS services and it comes through two routes.

We get paid for some elements of care, predominantly kind of elective or planned care, based on the levels of activity that we deliver.

So there's a national price, we get paid that activity times price.

And then there's a chunk of other activity, predominantly unplanned or non -elective and community care, where we're given a block or a fixed amount of money.

Every year, nationally, they apply what's called an efficiency to that.

So those prices get dropped for 25, 26 and for 26, 27.

That's by 2%.

So all other things being equal, the amount of money we're paid to deliver

services gets cut and we have to find that money.

That's part of that 40 million.

We also have been receiving as the vast majority of the NHS has as we kind of exit, continue to exit from the financial arrangements put in place during the COVID pandemic,

kind of additional what's called kind of top up money to help us get to break even.

And year on year that also has been dropped. So last year we lost £10 million, moving into £26, £27 we lose another £10 million.

and that's basically all of that money then gone,

like kind of additional top -up money.

So I've got a kind of loss

because the prices that I'm paid are dropped,

i .e. I need to deliver the same,

but the price per piece of activity is dropped.

That gives me a amount of money to find.

And then because of the fixed amount of money that we get

is being cut year on year,

it's pretty much being cut as much as it can do now.

For 26, 27, I need to find that money.

We also make a decision year on year

to invest in new services.

so they will cost us more money.

So we have to find that money from somewhere.

And we also make a decision in any other given year

where we have particular services that are fragile,

where we require additional money or investment or support

because of quality concerns or because of safety.

I think in particular areas, we've invested quite heavily

last year and this year in maternity

to ensure that we're able to continue to provide

safe, nationally recognised standards of maternity care and maternity staffing.

We are investing in our estates teams because of the challenges that we've got around maintaining,

keeping safe and developing, you see from our side of our capital programme, kind of

investment in the estate and a number of other areas that we focus on.

So we've got a kind of, we're having the money coming into us cut and then we're investing

in new services on top and that gives us a chunk of money that we need to find

through efficiency to be able to pay for that. So those numbers that were quoted

as I say I'm going to round to 40 million we need to make sure or ensure

that our services operate more efficiently or effectively i .e. cost

about 40 million pounds less to run so that we can cover the fact the amount

or being paid has dropped, and so that we can invest in new services.

And that's where that 40 million pound comes from.

If we didn't do that, we would post a deficit or we'd post a loss, kind of equivalent to

that amount of money.

So that's the amount of money that we need to make our trust operate more effectively

or efficiently or cost less to run to be able to balance the books or to deliver breakeven.

We were able to do that for 25, 26, and the ask for 26, 27 is about the same scale, hence

why those numbers are about the same. Does that make sense? No, we don't give it

back. It's taken from us at the beginning of the year and then we have

to save it throughout the year to be able to balance the books. Thank you.

Cllr Shade Adoh - 0:40:00

That's well explained. Thank you. That is well explained and I think because we all have, most

people have views on what is pain, what is not pain, does it go back, does it get kept,

how else is it reimbursed into the system for patient care.

So that was really my next thing.

Thank you.

Councillor Hogg.

I've sent in multiple Freedom of Information requests to the Trust on various different

Cllr Thomas Hogg - 0:40:34

items, one of which is on maternity care because of course CQC in 2023 came back and said it

that it needed improvement, that area.

Firstly, I'd like to congratulate,

based on the return of data

in the Freedom of Information request,

on the clear improvements to maternity.

There was, however, one thing that came back in the FOI

that was concerning, which was the increased sickness

of midwives.

And the CQC report was saying in 2023 that midwives were already stretched, causing illness,

causing a lack of care.

And so I'm interested to understand that that situation seems to have got worse, what's

going on.

Secondly, there is something that the NHS looks at that measures called never events.

I've never heard of these before, but I started researching.

These are things that should never happen, like surgery in the wrong place, keeping a

scalpel in a patient after surgery, or putting the wrong thing in a drip.

Now if you look through all of the different trusts, generally in a year you'll be seeing

one or maybe two of these never events.

But for Buckinghamshire, we were looking at five, five events that should never happen,

that really genuinely should never happen.

So I would like to start my scrutiny on those two questions, please.

Raghuv Bhasin - 0:42:19

Yes, if I come in and start, I might bring in Mitchell.

So yeah, you're right to focus on, and thank you for the kind words about maternity, so

there's been a lot of focus to improve the service.

So the sickness in maternity is something we spend quite a lot of time trying to understand

and unpicked because it's in multiple different factors.

So one is very much that colleagues were feeling stretched

and stressed.

And as John articulated, we put in quite a lot of investment

to meet the national staffing standards to try

and address some of those issues.

That is slightly countermanded by there is increasing complexity

of the ladies coming in and the births that we're having

to put in place.

So there are, an average birth now is a much more complex

thing than it was 10 years ago.

And so that comes with multiple complications

and additional stresses on colleagues there

that we're working through and upskilling colleagues as well.

The third thing is the environment

that maternity is in at the moment.

So nationally with all of the investigations,

There's a big focus on Oxford as well at the moment.

So speaking to colleagues, midwifery colleagues

in our maternity units,

it doesn't feel great to be a midwife at the moment.

So their own personal resilience

to stress or sickness is reduced

compared to where it might have been a few years ago

for all those reasons.

So what we're doing about it

is we've got a very good occupational health

and wellbeing team who are working alongside

the head of midwifery and director midwifery,

holding what we call health summits to understand

and unpack the sickness issues in detail

and try and work through the various things we can do

to reduce that sickness, because it is an issue

that we need to continue to focus on.

Yes, those never events should never happen, as you say.

We undertake hundreds of thousands of procedures a year,

so there will always be some things that do go wrong

and we need to learn from, Mitchell can talk through

sort of the process by which we do that,

and then also some of the other measures we have

on sort of our quality and safety as well that we look at.

Mitchell Fernandez - 0:44:39

Thank you, first of all, I just want to acknowledge

our midwives' colleagues, because yesterday

is our International Day of the Midwives,

and we did celebrate our midwives as well.

And just to point on that as well,

that's one of the reasons as well that we invested

in our midwifery staffing for this year,

and just to make sure that we're aligned

to the national standards as well.

And I'm proud to also report that based on the 10 standards

that were set nationally, which include staffing, we all,

you know, all have been signed off to be compliant with that.

In terms of the never event,

there's always a debate including the national

about the never event, and this is being reviewed nationally

because, as you said, so it should never event.

It should not happen, but still happening across not only

about Buckinghamshire, but across as well

across the country, across the county.

But I do acknowledge that we did have five in 25, 26.

Just to reiterate that some of those never event,

just like in cardiology, that's the first time that we have

for how many years that we have.

So they're not all into one area.

And as Raghu acknowledged that we do a thousand operation,

but sometimes human factors play into that

and we learn from it.

Just to reassure you, that will be part

of our quality account report,

and you will see that the never event.

But at the same time, we've been working across the system.

So we're working with Firmly, with Oxford,

Char and RB8 to be able to work together

on how do we learn from each other.

Because some of those never event is crosscutting.

And some of them is that to review our process

and welcome and make it better across the system.

Cllr Thomas Hogg - 0:46:13

All right, I mean, I won't push this too much further.

But just to say that, you know,

every trust has never events is not quite the answer

that I was hoping you would provide

because they're at one or two per year and you're at five.

So, so -

Councillor Rob.

So, Hogg, sorry.

Raghuv Bhasin - 0:46:31

This slightly accusatory questioning,

I just point, I just challenge back at the moment.

So we're here to try and provide an honest view

of what we do as the organisation.

We've said that never events are not acceptable.

We've said that we've investigated all of them,

we've learned about them, and we're not complacent.

So I don't think your characterization back

of what we said is accurate,

so I'd just like to put that on record

because I don't think the public are watching.

And please don't send in FOI,

just write us a letter and we'll give you the information.

You don't need to use FOI, we're very happy to do that.

Cllr Thomas Hogg - 0:47:03

I was told before that I shouldn't be going

through that route, so I've gone down a different route.

And the reason why I followed up in that way

is because my question was actually why is there a difference between Buckinghamshire

and the other trusts around the country? But there wasn't an answer to the question.

So that's why you call it accusatory. I'm just saying you didn't answer the question that I said.

The second thing that I'd just like to mention here is the number of formal complaints.

And you have an aim to reduce these complaints by 50%.

Now, they've actually gone up.

I don't think that's necessarily a bad thing

if you have a better complaints procedure

and if people feel like they can complain in,

like their complaints might be listened to.

So I'm a bit concerned, actually,

that you have a target of reducing the number of complaints.

And I was hoping that you could explain a little bit more how you go about making sure

that the complaints are listened to and that it's not so much the number that you would want

to reduce as maybe the themes across them that you would want to reduce.

So that's another question.

Raghuv Bhasin - 0:48:35

Yeah, you're entirely right. It's about the themes. So the 50 % reduction is our complaints

due to communication issues. So we know that it's quite difficult to get through to us

on the phone. We know that our administration and some outpatient appointments is challenging

at the moment, which drives the highest volume of complaints. So the 50 % is trying to address

that reduction in that theme of complaints through some

of the work I was explaining to Councillor Clark about.

So a big focus on improving our phone systems.

We had them all upgraded last year.

A big focus on using the patient portal far more

to digitise communications about outpatients.

And we've seen, as Mitchell said, in dermatology,

a huge reduction in complaints and in cardiology

through those processes.

So we actually have the first generative AI tool in the country we built

in Buckinghamshire Healthcare to look at complaints to try and understand those themes.

And then we use those themes to drive improvement work, which is why communication

with patients is one of our breakthrough priorities of this year.

So we took the analysis of what the complaint themes were,

and that's now driving how we're working as an organisation, which I think, as you say,

is the way in which we should be using complaints and the rich information in there.

There is more we should do and can do to focus on some of the other themes that we're picking

up again through challenges around corridor care in the emergency department.

So there's a big focus for us at the moment and also about some of the experience when

people are on our sites in terms of signage, access to wheelchairs, parking.

Again, I don't think as an NHS overall and certainly not in the trust, we paid enough

attention to those patient experience elements which come through in the

complaints and that's why we're focusing on it.

Cllr Shade Adoh - 0:50:31

If I can come back to you Mitchell. So my understanding from what you said about

the never event is it that you're therefore working with Frimley you said

And are you there for looking at other trust on what they are doing?

Because if there are two cases and we are five, you know,

what are the lessons learned and what is the next step?

And I think maybe a bit more explanation on that would be good

because people will be watching, listening, or going to listen later.

Just to reassure you that every never event we have has been done through investigation,

Mitchell Fernandez - 0:51:17

individually, just like I said to you about cardiology was the first one,

but we've done some changes on that. In terms of the other cases we have is that,

one of the never events we have is about the drape, you know, because you cannot see the marking

without either the drapes, and then we try to work with the supplier and how can we change it.

So what we're trying to do with across the system is that we try to learn from individual cases,

you know, rather than, you know, just focusing on us.

So there are things that we work closely with, you know,

with the ICB.

It was the ICB, actually, we tried to initiate it

because there was a benchmark and it was done with the ICB

in terms of the net event across the system

and how do we learn from it.

Some of them is about standardisation

or some of the protocol, the whole checklist,

the stuff, the block.

So in every net event we have,

we share it across our colleagues

and how can we make it better across the system.

Thank you very much.

Councillor Gough.

Cllr Shade Adoh - 0:52:09

That's very kind.

Cllr Phil Gomm - 0:52:11

I'm sorry I had to leave the meeting

and miss some of the dialogue

that come from the old direction.

I just want to pick up,

earlier on you were talking about the voluntary sector

and engagement there.

I'm not going to cross question you in any way,

but what I am going to do is compliment the team,

the steering groups that have been developed

with under Rachel Alley and there,

quite a few of us now sit on those

and it's growing and growing.

So I want to compliment you on the way that delivery

is helping connect with different partnerships

in the voluntary sector.

So that's, sorry I'm not scrutinised,

I'm doing the opposite.

I just wanted to say that.

Cllr Shade Adoh - 0:52:49

I must say that's part of scrutiny.

You have to compliment, you complain,

you talk about the good so that they can learn about it

and then take it away.

So it is part of, it's still part of scrutiny.

Counsellor Rouse, is that a follow on?

because I need to go to Councillor Naylor.

Is he?

No, okay.

Councillor Naylor.

Thank you very much.

Cllr Frances Kneller - 0:53:14

Just to pick up on a couple of issues

regarding maternity care.

In relation to staff, obviously it's a concern

you've got sickness and often as you say

that's to do with pressure.

Are we getting sufficient numbers of people

coming forward who want to train as midwives?

And then when they qualify, are you able to retain them,

or do they actually want to stay in that sector?

I'd be interested to hear a bit more about that.

The other one was a comment that you made regarding the increasing number

of expectant mothers presenting with complex needs.

One of them presumably is about older mums arriving

in that situation.

But I was also wondering, is there

or what should we be considering or could we be considering

about supporting the expectant mums and even pre -pregnancy

within the community?

Is there something more that could be done to reduce

that level of complex needs presenting?

Raghuv Bhasin - 0:54:25

Yeah, thank you. So, yeah, it's a really great question about the trainees. So actually,

for the first time, we were able to, we had trainees we weren't able to offer permanent

roles to. And so people who train with us are choosing to come and work with us, and

more and more people are choosing to come and train with us. So those are both positive

science about the culture in the maternity department and being able to

choose the best from the trainee crop is again a positive thing for us as an

organisation which three four years ago we weren't in a position to do we weren't

able to fill a lot those roles. One of the things we're doing with our newly

trained midwives is splitting some of their time between the acute side of the

expectant mothers and colleagues and patients in the community.

We've got a big focus as an organisation in healthy behaviours,

because that's one of the big drivers of complications,

so obesity, smoking as well.

So we have one of the lowest maternal smoking rates in the southeast of the country,

because we've done a lot with our tobacco dependency advisors in maternity units.

We are working to support healthy eating and exercise in maternal care and pre -maternal care

because those are things that can be done to address some of the challenges that arise

from the increasing complexity of ladies.

We know that more people are choosing to have children later in life

that will bring a rise in complexity.

We also are seeing a lot more women who are choosing to go

with a caesarean section. So we're up at sort of three in every five now and

obviously that places a greater degree of strain on the services as well so

trying to meet that demand and that's not just on midwives that's anaesthetists,

obstetricians, the theatre teams and all the estate as well so we're constantly

reviewing the capacity there but it is a national trend in return to services

more broadly.

Cllr Shade Adoh - 0:56:40

Thank you.

Three questions, if I may.

Cllr Simon Rouse - 0:56:49

First one is, the report is full of some really impressive

performance all the way through.

And I guess what I'm just trying to get

a bit of a sense of from the report that isn't clear

is what are the critical external wider ecosystem

pressures on the performance that it would be useful for us

to understand, drive other areas of performance up?

So in terms of, for example, ambulance performance,

performance from primary care, et cetera,

because it's very difficult to join the dots back

into the wider system.

The second is that the financial performance is

incredibly impressive.

But you talked about needing to deliver that same scale

of efficiency improvement next year, which feels tough,

given that you refer to freezing recruitment

in the second half of the year.

And clearly, freezing recruitment has consequences

related to the programme.

So can you just talk us into a bit more depth

about where do you see some

of that further efficiency coming from?

And if you can't get that scale of efficiency through technology,

through the quality improvement programmes,

where are the tougher areas you're going to have

to take yourselves into for that scale of repeated efficiency.

And then the third is, could you just share with us,

where are you finding the biggest staffing pressures

in terms of being able to identify people

for what you need and what you're doing about that?

Raghuv Bhasin - 0:58:19

If I take one and three, and then John takes two,

and it might come back down the loop.

So overall pressures.

So again, really good question.

So if I take our emergency services, I would say the variation in GP access is driving quite a lot of challenge.

So we know that depending on where you live around the county, you have variable access to GPs.

We therefore see a large number of people turning up at the urgent treatment centres who perhaps could be supported in a different way.

And we're working with GPs to address that.

Some of that is driven by funding.

So the funding formula for GPs in Buckinghamshire suggests that those areas, the funding formula

does not account enough for younger, more complex people.

It's more driven by age solely.

So in some areas of deprivation, those practises aren't funded.

So we're working with them to address that and actually we're looking at putting money

out of the hospital into German practise support that.

So I'd say that is one area of challenge.

I would say there's a broader ecosystem issue

with the challenges people are facing on cost of living,

on the sort of cultural challenges in the climate.

So we're seeing that in terms of people are less resilient,

more broadly socially, and so coming to hospital

when perhaps they might have had greater familial support

or be able to do things in a different way.

and we are seeing a rising tide of abuse and violence

towards our colleagues,

which I think reflects the wider cultural challenges.

So we're really focusing the organisation

on bringing ourselves together,

but also being very clear that actions like that

do have consequences and we can refuse to treat people.

Obviously we'll treat people if it's life -threatening,

and so trying to engage with that.

So I'd say those are two of the overall pressures,

but in general we work really closely with our partners very closely.

I suppose a third, if I could just flag, is the, there is a change

with the integrated care board now, and they're taking on a different role

around strategic commissioning.

We in Buckinghamshire have very much been on, we think we're a pretty clear place,

single council, joined up primary care,

single mental health provider, big voluntary sector ourselves.

So we should determine the decisions ourselves.

There is a, we are working with the ICP to say,

well, what was done at 10th value level versus Buckinghamshire

that we need to work through.

So that's a key issue for us.

Jon Evans - 1:01:03

Maybe if I pass this to John on the financial issues,

and I'll come back to the last question.

Yeah, of course. Thanks. Thanks for that.

So there are a few things I think to kind of pick up.

So one kind of what does the overall shape

of the money look like and how does that play

into the decisions that we've made over the last kind of 12 months.

And then a question about the how does that work moving forward

and where do those opportunities look like?

And if that doesn't add up, where do we go?

So on the kind of last 12 months, so yes,

I've described quite a challenging financial position.

I don't think that's unique to BHT.

In fact, it's not unique to BHT.

It is relatively unique to acute hospitals in the NHS, if I'm being honest.

given the approach to funding certainly over the last five

to seven years for mental health services has changed.

There's been kind of ring fence growth money based

on a national agenda to increase funding into mental health

to ensure parity.

That's not been the case for acute services

and that's certainly not been the case

for emergency stroke non -elected acute services.

So part of the conversations we've been having

about how do we simultaneously invest in services

that will reduce burden on emergency care

whilst asking those services to operate more effectively

to be able to create the money in the first place

to be able to do that is the challenge.

I mean, we're in a constrained financial environment

nationally and certainly for the NHS

and that is the ask on us.

I mean, that is the job.

I think we are tactically trying to work our way through that.

So we had some conversations before about what we're doing around hospital at home services.

That is investment upstream or investment downstream to make sure or to support patients

not to come into hospital in the first place or to allow them to move into their place

of home earlier so that they're not in a bed in hospital and therefore aren't consuming

resource and or preventing other patients that would otherwise need that from requiring

that resource.

So that is the work and we are, we work, we're trying to balance as best as we possibly can

the kind of scaling up investment in those services whilst testing that they're doing

what they need to do with the kind of amount of money that we've got.

So this bit needs to operate more efficiently to create money for us to invest there and

And we're always kind of going through that conversation and trying to balance those things.

Hence why we made quite a conscious decision for our new financial year 26 -27 not to ask,

like we basically said, we can't deliver more than 5%.

We were very clear about that.

That was a conscious, informed decision.

And therefore we worked through all the other moving parts to say, what have we got available

to now invest in new services?

And where do we get the most return for that?

Where are those priorities?

So we don't...

And on the kind of where does that efficiency of existing services work?

So the programmes of work that we're focusing on for this forthcoming financial year and

beyond are...

We've talked about digitization.

I've kind of given my view from a resource point of view.

This is about giving access to people that are able to use those services, access to

services so that the more manual, I would argue, more manual and kind of, I'd argue,

kind of legacy systems that we've got can then free up capacity to support

those patients that actually need to use them in that way. That is, we've got a large -scale

programme called Smarter Working within the organisation this year where we are

looking to focus on those digitization programmes, reorganise the

workload of our colleagues within administrative roles so that we are

better able to support those patients that need to call,

and actually pick up the phone to them.

So that's a deliberate programme.

In terms of our workforce over the last year,

our workforce has reduced.

So if I kind of just give you two or three

quite big numbers, so kind of pre -pandemic,

so we're talking 2019, 20,

the organisation kind of employed and paid

for about 5 ,900 hold times.

So let's ground it 6 ,000.

As of last year, that workforce number was about 6 ,600.

So it would increase by the numbers about 13%,

around it for 10.

So the organisation has grown by a little bit more

than 10 % over five to six years.

That's more people employed and paid for on the trust.

Our clinical activity hasn't gone up by that much.

And therefore we are now refocusing on those areas

that have grown, aligning that with the workload

for those teams and going, are we,

have we kind of optimised those

or is there further work we can do?

So that is a quite clear, focused piece of work, as you would expect us to do.

We have been quite fortunate as an organisation to access quite a lot of money to invest in new scanning capacity.

So we've got a community diagnostic centre in Amersham, we've got new scanning capacity at Stoke Mandeville,

and we will be bringing online more scanning capacity in our new building, Wickham.

That's all capacity that needs to be staffed.

We set up with a standardised model, we now need to go through the loop of checking it's working as effectively as it can.

So we've got quite important, I'd say quite large scale,

pockets of our workforce and pockets of services

that have changed quite a lot over the past five years

that we need to optimise.

And we're doing that kind of with those teams.

And then the final bit is going to be

basic housekeeping and cost control.

So where is it that we're not making the best decisions

that we could with limited resource?

Our conversation is about trade -offs.

So we've got to, it's necessity for us to invest

in maternity services.

One, so we meet national compliance standards.

Two, so we've got a supported and engaged workforce.

What is the trade -off on those things

that we aren't then able to do?

How do we have that conversation openly with our colleagues?

How do we have those conversations where,

why is it that we've got a recruitment freeze,

you refer to that,

and yet you're able to buy a five million pound building

in Wickham and invest in maternity?

And we are working really, really hard

to articulate that storey.

there are some areas that we are going to say our priorities,

estate safety, maternity, fragile services,

and we are going to deliberately invest in those areas

because it's the right thing to do.

That means the rest of the organisation,

the other 650 million, needs to work a bit harder to allow us to do that.

And just on your last question, Councillor Ayles, on the shortage areas.

Raghuv Bhasin - 1:07:44

So I think I put them in two buckets.

So one, we are seeing it more challenging

where people have got an alternative employment potentially in the private health care sector.

So think about physiotherapy, pharmacists.

So we do have shortages in those areas and that's one of the last areas where we're having

to pay quite high temporary staffing to deliver the service because people can have effectively

slightly better paid, easier jobs in those sectors and people are choosing that.

The second is some of our specialty services,

which are kind of networked with other places like Oxford,

which is our tertiary centre.

So oncology, so cancer treatment,

there aren't enough oncologists in the country.

It's a training issue.

So we're trying to work in a more networked way

to get resources.

But in general, for our big workforce groups,

there are, there's greater supply out there

than probably the demand at the moment.

Cllr Simon Rouse - 1:08:43

Sorry, can I just briefly follow up?

So just I have to say, you're incredibly

good at describing the financial picture and the management

of the financial picture.

And one of the things that you do

is you paint it in a very graphic, clear way.

One observation I would just make

is in the papers that we get, which are very text -based,

that storey doesn't really come out.

And I think showing that in the way

that you're describing the balance and the choices

that you're making and why you're making them,

I think would be really compelling and a good way

of being able to articulate it to the public.

Just an observation, because I think we've extracted

quite a lot from the financial discussions,

but it doesn't come out from the report,

but graphically you could present, so just an observation.

Cllr Shade Adoh - 1:09:25

I was going to do my follow -on as well.

How would the patients on the ground

who don't have 20, 30 minutes to read through be able to see

and think, okay, Raghu, Michelle, John, oh yeah, that's why they're doing that.

This is why they're making this decision.

But we're not going to suffer.

There's not going to be any impact on us.

It's just sort of rejigging to make it work.

But these are the focus, these are areas of concern that we have said in the next three years,

we're going to hit the ground running with it.

I think graphics would be good.

Raghuv Bhasin - 1:10:04

Yeah, and I think more broadly, and John and I have talked about this,

we sort of slightly underplay some of the hard choices

that have been having to be made against the evidence

of what the demand is from the public.

And I think we're thinking about how we do that

to start with to our own colleagues,

and then to reach out and use potentially

some of the council communications to set out those choices.

Because some of the things we're doing,

which we actually agreed on Tuesday in our executive,

it's really exciting about new services

and meeting demands in a different way,

but it will mean that things will need to change

and some expectations will need to change,

both amongst colleagues, but also patients.

And so we need to be able to communicate that more clearly.

And I think it's very important in confidence building

Cllr Shade Adoh - 1:10:51

and reassurance and trust that the residents feel

that their interest is being taken into account.

And it's not about getting rid of some services

or support system that people are familiar with at the expense of others.

So I think communicating that is vital.

If I can go to Councillor Sherwood, please.

Cllr Alan Sherwell - 1:11:17

Thank you.

Slightly left -field question, but it arises from all the stuff you've been saying, really.

I absolutely understand that you need to have the facilities to do whatever it is you want to do.

and clearly something is happening in Wickham that's great and understand that.

Part of the scheme has been to try to drive services that can be provided by primary care sites to primary care sites.

Again, absolutely in favour of that.

I have a regular diabetic eye cheque.

I now get it at Barrowcroft, which is much more convenient for me

It also means I don't have to find somewhere

to park at Staunton -Anderville.

But that requires the facilities to be there.

Berrycroft is a new health centre

which has plenty of space.

Most of the surgeries in Aylesbury

do not have lots of space.

There is a lot of development going around Aylesbury,

so we've got a lot more people that we

need to provide services for.

In planning applications around the area, we get all the usual stuff about schools and all the rest of it,

which is absolutely right in terms of the facilities that are needed,

but I almost never see a comment on a planning application from the health service.

I think you are missing a trick here.

You really need additional facilities. You may not need them at hospital level, although there is stuff going on at Stoke too and hopefully they understand that.

Primary care level, the pressure on surgeries at the moment is great, partly because most of them haven't got enough GPs, but that's not your problem, that's a separate storey.

But partly because the new states by and large are not having that requirement met.

And you guys putting stuff into planning applications might actually help all of us.

Yeah, so it's a really good point, Councillor Schell.

Raghuv Bhasin - 1:13:33

I might bring in John to talk about what we do in terms of funding of health for development.

But the approach we're trying to take and we're supporting is to have one set of conversations

about health and care estates in Buckinghamshire.

And we have a Bucks estate group, which we run with the council, primary care, again,

voluntary sector, mental health.

So, and that is driving some of our decisions because in sort of blunt terms, we get most

of the money as the acute community trust, but we need to use that for the benefit of

everyone and that is very much our intention and that is not common to most hospitals.

But we know that's our role, hence why I'm coming to Victoria Road.

And for example, I was speaking to a practise in Halesbury last week who got an opportunity

to expand and we're having a conversation about how we can jointly fund that and take

that forward.

So that's how we need to plan and take them forward as one.

And we'll be really clear as part of a local plan that rather than sort of each development

saying, right, we'll put up a GP surgery.

We need to think about how that money's pooled

to meet demand in a different way.

But John, do you want to talk a bit about the engagement

we've had with the council on this?

Yeah, of course.

Jon Evans - 1:14:49

So we had a relatively timely conversation on this

as our executive management committee

only earlier on this week.

So I think we've got quite a constructive relationship

with the council in this space.

We've agreed certainly over recent years,

a consistent approach to how we would bid for this type of thing.

So the terminology for individuals that are listening,

there is a process through something called Section 106,

infrastructure funding.

We bid for about £9 million worth of funding through that route,

so quite a significant amount.

The timeline for that funding coming to fruition

is a longer period than most of us operating.

I live kind of, well, a week to a week, month to month, year to year.

and that's multiple years on.

So I'm comfortable and can give some assurance

that we are engaged with the right people

within the council.

I can give some assurance that the scale of money

that we have bid for is sizeable.

As I said, it's about nine million pounds.

The amount of funding we've actually received

is about a hundred thousand pounds.

So, but that's not a criticism,

that's a, because the timeframe

for kind of accessing this money is multiple years,

is it not?

The conversation that we've had as a team, as part of our response to the Bucks Local Plan,

is how we can now move away from a, we need to access this funding to build capacity for oncology or diagnostics, etc.

to how we can now use it to support our integration at place and locally.

So I think if I was to give us a chance to say,

nationally the drive to operate care closer to home

and the national impetus and structure

to be able to make that happen is still relatively new.

So we are in now, we've just started the first year

of the 10 year old plan.

So year one of 10.

The kind of structure, the governance,

the resource allocation and rules

to be able to make that happen,

and I think it's fair to say is embryonic

and is still being worked through.

We are working away, and I think we are at the vanguard

of those conversations, given our relationship

with the council and given our relationship

with partners locally to push and in fact inform

some of those national conversations and policy.

We are absolutely aware of our need to now do this

at a larger scale and in a different place

to where we've operated before, but we're just starting.

So I think it's an acknowledgement that yes, that's the case.

We have engaged around quite significant millions of pounds of bids.

We're aware that it's a longer term thing. We need to join up those strategies.

It's a conversation we've only had this week.

Cllr Alan Sherwell - 1:17:36

Thank you very much for that. That's encouraging. It's still frustrating.

I've sit on zillions of planning committees over time, so I understand the process.

We've just had one recently for South West of Aylesbury.

about 150 page report or something like that without a single mention of the health service in it.

Cllr Shade Adoh - 1:17:55

So, you can understand my concern.

Thank you, thanks. And I think you've indirectly, directly answered Councillor Clark's question as well.

So that is good.

Councillor Hogg, before I go to two last questions.

Cllr Thomas Hogg - 1:18:09

Yeah, and just a context, some context by the way on my line of questioning.

Even if you guys as a trust were the best performing trust in the world, I see it as my role to find the weaknesses, highlight them, and to push you guys to improve them.

So don't take it personally, but I think it should be a little bit uncomfortable, the back and forth.

So the next two questions that I have. Firstly is something that was in the report.

You mentioned that you have a target of a 75 % staff flu vaccination uptake,

but you only achieve 46 .5%.

So my question is, do the staff not believe in flu vaccines?

Do they not think that this is the right thing to do?

If so, then, you know, that's a concern.

Either we shouldn't be doing the vaccine or there's a concern with the staff.

And the second question is something that wasn't in the report, but I had hoped that

it would be, which is continued professional development.

The only mention of CPD that I found is from a document in 2022 where it says that the

trust received almost four times more funding for CPD than in 2019.

I wonder, Mr Evans, if that is still the case, but most importantly, what sort of CPD is

it?

Because there's CPD that you can just basically pretend to listen to a lecture for half an

hour and you've not actually improved anything.

And then there's active CPD where you might be involved in the latest research or whatever.

It's so different.

And so I was wondering what it looks like at the trust and how you're optimising the

active version of the CPD.

Yeah, so it really helped.

I hope that it's not just listening.

It's really helped questions.

Raghuv Bhasin - 1:20:09

So if I'll come, I'll do CPD,

and then Margaret mentioned to do vaccines.

So CPD, so yes, we are very much in the mode of

engaging continuing professional development,

and we actually get really positive feedback about our CPD

and a lot of other trust come to our CPD

because we run it largely around simulation based

continuing professional development.

So live, we've got a simulation suite at,

so at Mandeville, people come in, you can watch,

you can observe, you can then reflect on that.

We do a lot of teaching on the wards in situ as well.

So we use quite a lot of that CPD money

to pay for what we call practise development nurses.

So those are colleagues who's experienced nurses

whose roles are to go and stand alongside colleagues

and teach in situ, which I think is really,

really important.

The third area is we've recognised that,

and we're making a slight shift to where we're focusing

some of our development on sort of leadership skills

more broadly rather than task -based training.

So we were doing more task -based training,

sort of how to manage a budget, et cetera.

Actually, what you need is how do you make difficult

prioritisation decisions?

How do you take people with you?

how do you have challenging performance conversations?

So we're moving, shifting some of our training

for the management side to those sorts of skills,

largely because AI will do most of the tasks for you.

And so that's a big shift we're making this year.

But we're relatively flexible with how we use the CPD money

to meet the needs of colleagues.

There's a, just so you're aware,

there's a national review underway on mandatory training,

because there's been a lot of mandatory training just added and added and added and obviously to put 6 ,500 people through an hour training

that's quite a lot of cost for each hour of training so we're looking forward to the review is to try and reduce the volume of mandatory training

for example I need to do fire safety training every year is that is that completely necessary?

The reason I say that is to suggest that I don't think it is,

but we'll wait for the national energy training to come through.

But Mitchell's going to come back and back to you.

Mitchell Fernandez - 1:22:26

So in terms of flu vaccination, we do acknowledge that there's a drop nationally in terms

of the uptake across the, you know, across the NHS in terms of the staff vaccination.

And we've been given a target of an increase of 5%.

And I'm so happy, actually, that we reached the target and we are the second

across the system in terms of the uptake.

So, previously, we only got a 47 % uptake and managed to deliver 54 % in this last year.

And I do acknowledge that we still need to do a lot of campaign, but it's a multi -factorial,

you know, reason for why is the new uptake across the country, but we're working closely

with our colleagues.

And we do some, you know, we go like a trolley dash, we go to our frontline staff, our exec

colleague has been participating in it, but actually in terms of the numbers, we did very

well compared to other organisations that we have in terms of flow boxing.

but there's more things to be done going forward.

Raghuv Bhasin - 1:23:16

So I think on your question, Councillor Hogg, so we are doing.

I managed to miss Mitchell Jabbard me.

I think he got John and the chief nurse Jenny got me.

So we are trying to role model as a senior leadership team

and make it turn it into a bit of a competition as well.

But there is a there is there are two things.

So there's increased vaccine scepticism in the country,

largely driven by the Covid vaccine, not the flu vaccine,

but they're being conflated.

And for the first time in a few years,

through just giving flu rather than COVID,

but I don't think people fully understand that.

And the COVID vaccine is where there is scepticism.

And there's also a bit of sort of apathy

that's growing as well,

because people have been jabbed quite a lot

over the past five or six years.

So we are trying to drive that

with quite both clear messages

about the patient, very real patient impact

that may happen,

as well as making it as easy as possible,

or whether you're out in the community

or in one of the sites,

whether you're working at nights or during the days

or weekends, try to make it as easy as possible to access,

which has driven some of the uptake,

but there's more to go on that.

Thank you very much.

Cllr Shade Adoh - 1:24:26

Sorry, just a - Are you working with -

Would you mind if I just had a very quick follow up?

Cllr Thomas Hogg - 1:24:30

Very quick. Very quick.

So this is for Mr. Evans about the CPD levels of funding.

So that was the part that I'm still missing

from this answer. So it said 2020 to 2021 received four times more funding than 2019

to 2020. So compared to 2019 to 2020, inflation adjusted, are the CPT levels still four times

more or where are they now?

Jon Evans - 1:25:01

Off the top of my head, I don't know the answer to that level of detail, given the 700 million

pounds that we spend. I'm happy to come back and respond via email if that's okay.

Cllr Shade Adoh - 1:25:11

That would be welcome. Thank you. Right. I'm just, I know the council does it and you've done it several times.

Always making reference to the national picture. I think we should try as much as we can. What is a

picture. Vaccinations, apathy, but what are we as people of Buckinghamshire? Are we responding?

Why are we doing what we're doing? I think that would be good because that would require

you reaching out through all the patient groups, other things, other groups there to find out

why are we in Buckinghamshire behaving this way? Because I think that would just help

to be locally focused.

So that's my general view on everything

we've been talking about.

Thank you very much.

So last two questions I have for you,

I don't think my colleagues have anymore.

One, because we've just had, like I said,

the emergency care review.

And one of the areas that came up

is the issue around corridor care.

and Dr. Anna Frelty.

Phelps, Dr. Phelps.

Yeah, you know, on Frelty and there's so much that is going on that the Trust is doing

and it was an eye -opener for a lot of us, you know, in that review group

and people I know are aware of it.

So it would be great, comes, comes, comes, another thing that we came up with.

People need to know.

Discharge, going in, you know, hospital to home care,

that needs to come out.

But for my question, as part of that review,

we had a patient experience storey.

And that was, it was a sad storey.

But I would say from colleagues, it kind of did end well,

you know, but it was a sad storey.

and informed a significant part of our conversation.

And it did highlight areas of significant improvement,

including staff training, that aspect of human touch.

We can do the clinical bit,

but that sometimes the human touch is so vital.

So that by the time the person is leaving that room,

that space, they feel great within themselves,

and they feel valued, that it's not just about my diabetes,

it's about me.

So, you know, what assurances can you give that, you know,

you will prioritise and monitor the workforce

in the emergency department

to ensure best practise becomes embedded?

My other question is on pressure ulcers.

The trust has seen an increase in pressure ulcer incidents.

We raised concerns about pressure ulcers and the way it was reported in your quality account last year.

Can we see some more detail around this, broken down by category?

Where have you had the greatest increases occurred? Is that hospital or in the community?

And are there any specific improvements being introduced to reduce pressure ulcers?

Jon Evans - 1:28:43

Raghuv Bhasin - 1:28:46

So if I take the first question, maybe Mitchell comes in on the pressure answer question.

So corridor care is one of our major areas of focus to reduce that.

It's not right for patients.

It's also a huge issue for our colleagues working, sort of walking past or having to

treat people in corridors.

So we have expanded our emergency department in terms of space, so we have more appropriate

It's basically that in January, we haven't been in the corridor for about five or six weeks now,

and we've got a trust -wide programme to continue to keep out of the corridor,

so led by our chief nurse, Jenny Ricketts.

The sort of point you make, I think I completely agree with about almost basic humanity in some of

interactions and taking the time to listen and have a conversation in a

really busy emergency department. And again we recognise that

given some of the pressures on the service, some of that's been, it's not

where it needs to be. So we're doing quite a lot of work with the senior

nursing team in the emergency department to build that back into the daily

practise and using a lot of patient feedback to understand whether that is having an impact.

And I sort of sign off and read every complaint that comes into the organisation and a lot

of those are driven by not so much the care received but the communication and sort of

the time spent in the organisation that we need collectively to address.

And that's again why improving patient experience is one of our top five top four priorities

for this year

but is

It's not acceptable

Some of the care that has been provided for individuals and we are determined to sort of

Address it then if Mitchell comes in and pressure ulcers

Mitchell Fernandez - 1:30:46

So in terms of pressure ulcers

So I do acknowledge your comments on the previous quality account and we will going to break down the data for the quality

account for this year in terms of the community and, you know, hospital

interest to differentiate that. At the same time, just to be aware as well, the

patient safety priorities we have for quality account for 26 -27, pressure also

is one of them that will be taken into, you know, that will be a priority. So

looking at our data for a pressure also, we did a thematic review. In the

previous year, we saw the increase of the pressure also in the community. Some of

could be attributed to patient nonconcordance,

some of the patients who have a private carer,

and we're trying to influence that

by giving them so much information

on how can look after their pressure.

But they acknowledge that we're not there 24 -7,

so we give them information and some of those patients

are able to do their own decision,

but we try to give them information as much as we can.

But lately, we've seen as well the increase,

not only in the community, but in the acute hospital,

if that's attributed, that's why there's an increase.

We've seen some introduction of our mattress when we changed it.

And there's, you know, with that increased pressure also.

Incidents, some of them could be probably we could learn from in terms

of launching the new medical devices.

There are some gaps that we acknowledge.

And we're working on that already.

And we have some SOP on how to use the, you know, the machines

and the mattress that we embedded.

But at the same time, we have some, you know, we need to go back to the basic.

That's why we've been working with our matrons

and the ward sisters as well to make sure

that the pressure also is always on the top of our agenda.

And that's part of our performance report

in every month.

And we have a quality report and a thematic report on that.

So there's a big focus with the pressure also reduction

going forward.

Thank you very much.

Cllr Shade Adoh - 1:32:38

If there are no more questions from colleagues,

thank you very much for your time.

We appreciate it.

and we look forward to our continued partnership with you.

And please do come back to us with any questions,

any queries, and I hope we can do the advice for her.

Thank you very much.

Thanks, Raghu.

Thanks, John.

Thank you, Michelle.

And if I may, if I can ask us to have five minutes break.

7 Oxford Health NHS Foundation Trust - refreshed strategy

Cllr Shade Adoh - 1:33:09

All right.

Good morning.

Welcome back, colleagues.

And thanks for, I hope you enjoyed the last few sessions that you were part of.

So thank you very much for joining us this morning.

Just to let you know this agenda item seven,

we've got colleagues from Oxford Health NHS Foundation Trust

and we're looking at your refreshed strategy.

How we as members, you know,

can consider any initial reflections

on the emerging direction of your strategy.

So you want to contribute,

or you want us to contribute to that and give our views.

And that's why we're here, to support you,

to get the services right for our residents of Buckinghamshire.

Just to say that we have a question from a public question

that will be put into you.

and that question was submitted by Mike Etkind.

E -T -K -I -N -D.

It's his surname and his name is Mike.

And I'm going to, he's unable to be here today

and I'll be asking you to verbally respond

to that question and also to submit everything

response for inclusion in our minutes.

Yeah?

And once the question has been done

and you've done your response, I'll ask you to kindly introduce yourselves and your role.

And then it's all yours. Over to you.

Elizabeth Wheaton - Principal Scrutiny Officer - 1:35:13

Thank you, Chairman. So the question that has been submitted is,

the Care Quality Commission has just published the results of its survey of patients aged 16 and over

between August and November 2025.

Responses were received from 254 people about Oxford Health NHS Foundation Trust.

The results for the trust are in all but one case about the same as for other trusts.

However, the scores range from 8 .3 out of 10 for psychological therapists to 5 .2 for crisis care support,

3 .8 for support with other areas of life, and 2 .1 feedback.

How will the strategy result in improved patient experience

between 2026 and 2031 for the categories

where the scores are currently low?

Amelie Bages - 1:36:13

Does this work?

Yes. So obviously I want to look at the data in more detail,

But one of the key element of our strategy and we've come to it is to focus on patient

experience.

One of the area of work that we're really pushing throughout all of our services is

recording and understanding patient reported outcomes.

That means what is meaningful from a patient perspective and how effective our service

in delivering this, but also looking at the experience

of patients who come into our services through co -production.

So we're really looking to embed this much more systematically

in how we deliver care.

And that will impact, obviously, on our patient experience

feedback, which I think would address

the result of this survey.

We also, in terms of our prioritisation of investment,

children and young people are one of our key priorities.

We've been discussing these for mental health across the ICB

and specifically for Berks,

making sure that we improve waiting times

and our crisis offering.

So that's also a key element of the plans

that will end up in the strategy.

So I think that's why I would say for now,

I would look in more detail at the data

and provide more detail and so.

Cllr Shade Adoh - 1:37:43

Thank you very much.

Is there anything from you, Sam?

I think there are, thank you.

Thank you.

I would just like to take this opportunity to say...

I'm not sure if I heard or not, but there's no initial support other than this.

Your mic.

That's it.

Yeah.

I'm just wondering, just the definition of support in other areas of life, working with Buckinghamshire Council in social circumstances and other financial difficulties, what is that category?

Cllr Julia Wassell - 1:38:38

Amelie Bages - 1:38:42

Yes, so if I understand your question correctly, working with partners, so the council, our

acute colleagues, our voluntary sector partners is a key element of our strategy going forward.

It's already the case, but we know that to address the challenges that the NHS is facing

in the coming years, we can't work within our boundaries.

So this partnership working through neighbourhood health care models or other models is a key

component of our work going forward.

Great, it seems there's a lot to do there.

Yes, indeed. Thank you.

Cllr Shade Adoh - 1:39:15

Right, before I hand it over to you, finally,

I just want to say thank you to Mike Etkin

for taking the time to read the report

and actually, you know, send his question in,

which is quite appreciated,

and we will be sending the response once we get it.

But thank you and we want to encourage other residents as well.

Read the reports, ask your questions and we'll be able to share it with our partners.

So thank you very much.

Mr. Mike Etkin, over to you.

Please introduce yourself, your roles and then tell us.

Amelie Bages - 1:39:54

First I wanted to say what you said, that we always welcome feedback from people in

our communities and that's what we've been trying to enhance, developing this strategy

and Jen will come to it.

If we can get the exact wording of the question,

I want to make sure we respond in detail.

So first introducing ourselves.

I'm Amélie Bage.

I'm the Executive Director of Strategy at Oxford Health.

And this is my colleague Sam.

Hi there, I'm Sam Sheppard,

Deputy Director of Strategy and Planning

with Oxford Health.

So thank you for giving us the opportunity

to come and present on our developing new strategy.

We already received a feedback from the council

and from this committee a few months ago, we've been embarking on the strategy development

process for over a year now, and we've really prioritised engagement in this process, so

we really welcome the opportunity to be talking to you about it.

In terms of context, I think you'll be well cited.

The government has published a new 10 -year health plan and has asked all NHS providers

to refresh their strategy in light of this.

In our case, our current strategy was coming to an end, so we are really looking at our

strategy in the round and we're drafting it fully.

So what we want from you today is feedback on our draught strategy.

We haven't started drafting it, so we are really at the development stage still, so

there is a real opportunity to influence the content.

You've had the report, so we won't present for very long, but I still wanted to tell

us, tell you a bit about ourselves, and we'll tell you a bit about how we've developed the

And then I will highlight the key points of the strategy,

and then we'll open for discussion and questions.

So in terms of ourselves, we are a large NHS providers,

and we operate all across the south -east of England.

We deliver services, mental health, learning disability,

social care, and physical health care.

But we also commission services across a very large geography.

So we commission very specialised mental health

services.

In Buckinghamshire, we provide mental health services, and we work very closely with partners

through the Buckinghamshire Executive Partnership to make sure

that we coordinate care around the patients.

In developing this strategy, we've really taken the time as a board to stop and reflect,

hear about what our partners, people accessing our services, our communities,

and our colleagues in the trust thought about our current work

and priorities for the future.

And we really aimed at creating a strategy

that is action focused and will shape all of our colleagues

in the organisation work in the coming five years.

And I hope this comes through the document and I'll describe it

in a bit more detail going forward.

But Sam, first if you want to say a bit about engagement work

and then I'll come to the detail of the strategy.

Sam Shepherd - 1:42:50

Thank you.

So you'll notice from the information in the report

we provided, but also through the communication

that we have with this committee back in the autumn last year,

that we started a real listening exercise

before we drafted anything.

So in September, we launched our first phase of engagement,

where we used a range of methods to engage people.

And those people included patients, carers, and families.

But they were also our own colleagues,

as well as the partners that we work with,

both in the public sector,

but the voluntary and community sector as well.

So we had a survey, we had strategy conversations,

we had webinars, we had focus groups,

and really importantly, we had a group of experts

by experience that we were talking to throughout our first phase of engagement.

We touched on the voices of 50 experts by experience, and we also had 40 responses

to our online survey from patients and the public.

So that exercise to really listen to people on what it is that Oxford Health does well

and what it is that we can improve,

and where we can build on opportunities,

was that listening exercise to understand

what do people think before we put pen to paper.

We did also, in that exercise,

we heard from over 600 of our own staff,

so we really have heard quite a number of voices,

but we do also recognise within that

that no engagement can be completely exhaustive.

So we recognise that there are always limitations

with exercises like this,

but we feel as though we have heard a representative view

and the views that we've heard have triangulated

with one another and resonated with one another.

So thank you to this committee for submitting a letter

in that first round to tell us your thoughts on what it is

that we do well and where we can improve.

We'd also like to thank Buckinghamshire Council

and Public Health Department in particular for their response,

which was really helpful and informative.

What we heard in that first round is a strong appreciation

for the professionalism, the compassion, and the commitment

of our colleagues of Oxford Health staff.

We did hear significant concerns around access times, speed of referrals, and the consistency of appointments and service availability.

We also heard about barriers that were linked to the location of services, travel, and navigating complex pathways.

So quite a bit of feedback around access in its various different forms and what that

means to different people.

There was a recurrent theme around communication and people wanting clearer information, better

updates, smoother transitions to manage those moves between teams and between services.

and a clear call from people for a greater level of involvement

of those with lived experience in the decisions

and the accountability for our services and our organisation.

We also heard that there was quite an interest

in prevention and early intervention.

That's an area that we do contribute to,

and we heard that there was a desire for more joined -up working

across mental health and physical health to aid that.

So this feedback that we heard really informed the emerging

framework that you have in front of you today.

And so particularly by strengthening the focus

on coproduction, on the voice of patients, improving access

and experience, about addressing inequalities, and how we can

work to embed prevention and early intervention.

We have also included an emphasis in our strategy around shaping neighbourhood health -based models of care.

We then have taken the draught strategy that you have today and we've had a second phase of engagement that has been running throughout March and April.

Again, with a range of methods, again with a range of stakeholders, really importantly,

We've had an experts by experience reference group who have worked very closely with us on what it is that they

Think and given us feedback on how we can take this forward

So we have had also public survey. We've had

a joint webinar that was held between

Buckingham

in Buckinghamshire to discuss.

We also have had a conversation with a group of children and young people, their carers

and their link workers, which was absolutely fascinating in terms of what really matters

to them about the care that they receive and that they need to navigate as young people.

So we've again captured as many voices as we can through this exercise.

We did also hear from our partners.

We have a number of voluntary and community sector partners.

We have a number of local authorities that we work closely with, and we have written

to those partners in both rounds of engagement, and their feedback has been really important

to us. We have also engaged with our university and academic partners, our ICB and other NHS

trusts throughout this exercise. So I hope that gives you a flavour of what it is that

we've been doing in terms of really reaching out, being open and transparent about the

way in which we're developing this strategy and how the voice of those that we work for

and that we work with matter to us as we move forward for the next five years.

Thank you, Sam.

Amelie Bages - 1:49:40

In the back on slide 16, you have the draught strategy that we've engaged

on in the phase two of our engagement.

It is high level but it constitutes the key elements and the skeleton

of what our future strategy would be and that's what we're asking

for feedback from you today.

So I'll take you through it, and then I'll open for questions.

On the left -hand side column, we effectively set the scene for the strategy

by describing a long -term vision for the organisation.

And in a long -term vision, the words of compassionate care

and helping people achieve their best quality of life for me are critical.

It really builds on the feedback that we receive about one of our strengths

as an organisation being around providing compassionate care.

But it also recognised the need to look at outcomes

that are more holistic than just the result of a treatment,

but to look at quality of life and in a way that

is meaningful for the people that access our services

in the round.

And that really points to the fact that as an organisation,

we need to work outside of our boundaries,

and we cannot achieve the challenges of the future

and address them on our own.

So I think that's really important to emphasise

about the vision.

At the bottom of that column, we mentioned strategy foundations, and these are the core

elements that are the parameters within which any strategy that we would set need to operate

and that are essential for us as an organisation.

Our quality governance, our digital and data infrastructure, but also our green plan and

financial sustainability are key parameters that we're taking into account whilst developing

any ambitions for the future.

On the right -hand side, we effectively

lay the key elements that will inform our future strategy.

At the centre of the circle, you'll see our three aims.

And they really outline the direction of travel.

They are the compass for the next five years.

What do we want to achieve in five years?

How will we know if we're going where we want to go?

Around these, you have six priorities, and these are really action focused.

It is to see the change that we want to see happen, what are the areas

that we're going to focus our attention.

And as I said at the beginning, as a board, we've really worked really hard to make sure

that our strategy would be actionable.

So it's a commitment to our partners, to our community, and to the people

that will access our services about what we're going to do.

But it's also a guide for our staff, for our colleagues, for our teams, for the organisation.

This is the framework that will inform how we plan, how we deliver for the next five

years.

We wanted to make sure that the strategy would be something that we can implement.

So I first wanted to say something about our three aims, our compass for the next five

years.

The first one is around patients, carers, and families.

you would expect to see this in an NHS provider strategy.

I'd want to emphasise that we've specifically focused on quality

of life, as I said, a broader focus, a more holistic focus,

and experience of care.

We know there's much more to be done to improve

and understand the experience of people that are coming

through our services, and we wanted

to recognise that up front.

The second thing that I would

like to emphasise is we have explicitly mentioned patients,

carers, and families to recognise

the importance of including carers and families

systematically in our thinking when we plan and deliver care.

This aim will encompass improving outcomes

that we are starting to understand much better

through patient -reported outcomes,

improving waiting times, and improving feedback

from carers and families.

Our second aim is around the people who work

at Oxford Health.

And that's something that felt really critical for us

to include as one of our three aims for the next five years.

All of the evidence shows that you cannot deliver

high quality care without prioritising the well -being

and the inclusion of your colleagues.

It's not a means to an end, it's an end in itself.

So that's why we've put our people

or at the centre of our strategy.

This will encompass our learning and education offer.

As a provider, we are not liars

in how much we invest in our education offering,

how much we do in terms of supporting apprenticeship,

how much we do in terms of offering

developmental opportunities for our staff,

and we want to continue doing this.

It will also encompass our anti -racism

and inclusion and diversity work.

We've made good progress on this, but we can do better.

And it will also encompass our culture work

and flexible work over the next five years.

And finally, our third aim is around communities

and populations.

And this is a key shift from our current strategy.

Any NHS strategy would always hint at the need to look

at communities and broader populations.

But we wanted to make it clear that over the next five years,

we recognise one of our aim is not only to look at people

while accessing or waiting to access our services,

but to adopt a much broader length

and think about our role in impacting the wider

communities.

And that's been an area that has been much debated

in our engagement, not because people disagree with that.

I don't think anybody disagrees.

But because people recognise, well,

if you take into account the parameters,

it's quite difficult to do from a financial and also from an operational perspective for

our colleagues in the trust.

So we're not saying it's going to be easy, but we recognise that when you look at the

data, when you look at the trajectories for health need across the NHS, there is no other

way to improve care than thinking about ourselves as having a role to play in improving the

health of communities and population beyond our boundaries.

One of the elements I wanted to emphasise on this point is we mentioned people locally,

nationally, and beyond.

It may feel a bit grandiose, but the reason why we're mentioning nationally

and internationally is because a key element of what we do as an organisation is research.

We asked the Department of Psychiatry of the University of Oxford, and a lot of the work

of our staff actually has a potential to impact internationally in terms

of improving mental health care.

So that's why we've mentioned this scope.

In terms of what success would look like in this area,

definitely impacting health inequalities

and seeing differences reduced.

But also when thinking about neighbourhood care,

impacting some of the metrics that

would be agreed collectively with partners

for what good neighbourhood care look like.

So the three aims really will guide our work

for the next five years.

And how will we get there?

So we've identified six priority for action

that will inform all of our work and our annual planning

going forward.

The first one is around co -production

with patients, their carers, and their family,

but also with our communities.

We have very good areas of best practise in the trust,

but I don't think we do this systematically.

We know it.

There's a lot of work to be done.

And we thought it was essential to say to our colleagues

within the trust, this is one of the things we expect from all

of you when you design, think about services, et cetera,

these needs to be co -produced.

And we want to move much closer to that ladder

of co -production and do this more systematically.

The second one, making things simple,

is linking with what we've heard.

We know that people find it difficult to access services,

navigate them, understand them.

So we have a duty when we design our services

is to think about how do people access this easily,

and that links to the neighbourhood health agenda.

And once people are receiving care,

how do they interact easily with their services?

And that's really a guiding principle

that we want to inform all of our work going forward.

The third one is on collaborating with partners.

As I said, we know we can't work on our own

to address the challenges of the future.

And the neighbourhood healthcare model

is gonna be a key element of how we need to work

in the future and think about our services.

So for any staff in our organisation, this needs to be part of their job.

You have to work with partners and you have to think about delivering services across boundaries.

The fourth one is around tackling health inequalities.

Again, we have pockets of best practise, but we are not systematically tracking health inequalities within our services, within our population,

and putting in place systematic approach to address this.

So we want to do that in a data -driven way,

much more systematically.

And we'll be working closely with the ICB

and the population segmentation work to be able to do that.

Fifthly, fostering a positive and inclusive working culture.

That's an area as a trust where we've done a lot of progress.

We've had very good staff results.

But this is an area that we need to keep prioritising,

so we'll continue to do that.

And lastly, the use of knowledge.

We are an organisation that produces a lot

of knowledge through research.

We have a great quality improvement infrastructure.

And we have a lot of innovation

that often our clinicians generate on their own.

We can do much better at streamlining

that across the organisation and making sure that the use

of knowledge and how you apply it

to improve care becomes part of the day -to -day life.

So that's why it's one of our priorities.

So to conclude, this is our high -level framework

for what the strategy we're proposing would look like.

Following publication of this, we will develop a strategy delivery plan.

One of the feedback we received through the engagement is obviously this is high -level,

and the strategy will remain high -level.

We are a very complex organisation. The strategy has to apply to everything we do.

But we will have a strategy delivery plan that will break it down for each of our area

of care and we lay out what are the key programmes of work that will sit under each of these

priorities and what would be the metrics that will inform our performance against these.

Every year through our annual planning process, we'll publish our plan against these and we

already do so against our current strategy and say what we will be delivering in year.

So I guess in terms of what we're asking for the committee, in terms of feedback,

does the emerging direction seem clear to you?

Is that in line with what you would be expecting?

Are there any areas that you think would require further emphasis?

And is there anything that you would like to consider,

like us to consider that you haven't seen in our emerging strategy?

Thank you very much.

Cllr Shade Adoh - 2:00:58

Thank you very much Amelia and Sam. That's very long. People have read the report and you've sort of put more flesh on it, which is good.

And I'm sure there will be more questions coming from colleagues.

As a committee, we understand the ambitions and what you're requiring of us, particularly

looking at the NHS 10 -year plan.

And there's got to be that integration of service provision between the acute setting

and the community.

How do you see that integration happening more and more

from the service you're providing?

And also looking at patient care,

young people particularly using the service.

Amelie Bages - 2:02:02

So we're looking in the sense that we have experience from both sides.

In Oxfordshire we provide community services, physical health services,

and mental health services.

In Buckinghamshire, we provide mental health services only.

So when thinking about the integration of care,

we have the experience of doing both,

and we have the experience of providing only

mental health services.

I think one of the key elements for making

this work in the future will be how we develop the neighbourhood

model of care.

And I think Buckinghamshire is very well

advanced in the thinking.

And the work with our colleagues that were here just before us

in this area is and will be critical to enable that coordination of care.

We started to map our services to the emerging neighbourhood thinking,

we are attending the key work streams, and we are very much gearing

to be able to deliver much more patient -centred care through this new healthcare delivery model.

Thank you very much.

Councillor Picnic.

Cllr Shade Adoh - 2:03:07

Thank you.

Cllr Dominic Pinkney - 2:03:09

Thank you, Chair.

And thank you to you both for coming here today and presenting this information and

also the work I'm doing.

I appreciate how hard it is to do a collaboratively produced strategy.

It is hard work, but hopefully that means you'll have more success when you get to the

difficult bit, which is obviously to implement that strategy.

I have some feedback regarding and a question.

So feedback in the document mentions the voluntary community sector, I think kind of once, but

that both of you today have already talked about

the importance of working with the voluntary committee

sector, which could produce really very powerful

partnership, however they are, the sector is under

massive pressure, so I think a really key aspect

at a high level is to look at how you could work

strategically with the voluntary committee sector,

but also on a practical level in terms of how are they

going to be resourced, part of decision making,

and funding to operate, I think that's really key.

My question was regarding co -production.

So you sort of talk about co -production

and I know that term can be misused sometimes.

So offline I've heard that from what you said,

so co -production does have a sort of specific meaning

but from what you said it sounds a bit more like it.

Do you really mean co -design

or do you really mean co -production?

What if you could explain a little bit more

about how that works?

Thank you.

Amelie Bages - 2:04:35

And first on your feedback, this is a feedback we've heard many times, so definitely take

it on board for the final strategy.

So thinking about the ladder of co -production, I think depending on our services, there's

quite a lot of variability.

In some areas of care, there is genuine co -production.

In some other, we are at the stage of early engagement.

So in terms of our priority, it's around moving, as it was, much closer to co -production that does not apply to all of our services.

So for example, in Oxfordshire we provide physical healthcare services and probably what we will aim there will be quite different from what we would do in our mental health services,

just because the way the services are designed and delivered are different.

And in terms of our ambition, it's

making sure that, for example, if we look at our trust

governance, we can see a much more prominent role

for experience throughout our governance.

We're not there yet.

And in the design of our services,

that we support all of our services

to move closer to true co -production.

I don't think in five years we will co -produce

across all of our services, but we really want

to push people up that ladder.

That's encouraging.

Cllr Shade Adoh - 2:05:53

That is good.

Councillor Owles, please.

Thank you.

Cllr Simon Rouse - 2:05:57

Thank you for the document and explanation.

And you asked for our initial reflections.

Please take this feedback in that spirit, which is, it's a, you described it.

I think that was a good way of describing it.

It's an incredibly high level document.

And there's a bit of a risk with it

that it is containing quite a lot of generic strategy

concepts and phraseology that you could take Oxford Health

out of it, and it could be any organisation.

And I think what isn't clear to me from the document is,

firstly, there's obviously a fantastic amount of engagement.

But I think when you look at the outputs of that engagement,

It doesn't strike me that there's much in there that should have been a surprise

About where the organisation is at but what I don't see in the document is that fact -based

What's the start point of where the document is?

What's our where the organisation is today the outcomes the organisation is delivering and how do those?

outcomes connect back to what the public is telling you and where are the

Discrepancies between what you're delivering what the public feels is getting and that that sort of richness of insight

I think is missing from this phase of the document.

You're moving quite quickly to a formalised final strategy

without that phase, which in strategy terms,

I would call the fact -based stage of the strategy.

So I definitely feel that's missing.

And I think the reason that matters

is that you talk in some statement document

about illustrative examples of delivery.

I think where strategies in all organisations go wrong

is they are so high level, so generic,

that when they get to the execution phase,

the gap is so big that it just becomes a worthless document

that's created very little impact.

And I think what I struggle with in the document

is I cannot see the route from where you are today to execution

of the strategy.

And I think bringing out a connexion from the fact base

what your stakeholders have told you to,

a much more detailed sense of the delivery themes

that that will create, I think will create public confidence about you

understand where you're at, you understand how that connects the

feedback of your stakeholder environment and here is what we are going to be

executing against that and that is where again the fact base of where you are

today to where you want to be by 2031, what are the outcomes that those

initiatives this strategy will therefore deliver, is the connexion that's missing

for me and that's my sort of honest observation

of the document having seen lots of these documents.

There's a real risk it just becomes a document

and not an execution plan which is what I think it needs.

Thank you very much.

Amelie Bages - 2:08:48

I think it's a very fair comment.

What we've shared is high level.

We had a board workshop last week

where we were discussing some

of the initial feedback received on these.

And we were specifically discussing the fact

that in the strategy and the strategy delivery plan

that sits beneath it, the need to say, that's where we are,

that's the gap, and that's how the priorities will

impact on that.

So very fair comment, and we will

seek to address this once a document is drafted

and published.

Sam Shepherd - 2:09:15

Can I just also add, I do appreciate

that what we're sharing is high level

and has the things that have bubbled to the surface based

upon everything that we know.

And feedback has been really important to help inform that.

But it's not been the only thing that we've looked at.

We do look at the policy contacts

for the national picture.

We look at our ICB commissioning intentions.

We've looked at our population health needs across all

of the geographies that we serve.

So we've been looking at JSNA's.

We've been looking at ward profiles where they exist.

We are looking through a whole host of data and information

so that what we've really got that sits behind this is

that is really a library, I suppose, of evidence.

So like I said, feedback's a really important piece

of that jigsaw.

But we have grounded this in all of those pieces

that I've spoken about, but also in our own performance data

and information that we understand about our services

that we're monitoring on a constant basis.

So I did just want to highlight that,

because I do appreciate that that doesn't come across

in what it is that you've had, particularly for you

as a committee, we really wanted to highlight

and demonstrate just how feedback of patients

and the public has impacted on what we do,

because we know the voice

of your residents matters most to you too.

Thank you very much.

Cllr Shade Adoh - 2:10:50

And I think it's on the back of that, the residents

and how it comes across that Councillor Rous is making that suggestion and hearing from

you when you know doing your introduction sort of explains it but you want you know

the average person to be able to get what you're saying.

Councillor Gough please.

Cllr Phil Gomm - 2:11:14

Thank you chairman. Now this is why I love the select committees because each council

has their views and opinion.

Councillor Rouse is extremely good when it comes down to that sort of stuff.

And that's why I look at him when taking advice.

But when I'm looking at this myself, my way, I like it because, you know,

you've gone away, there's a lot of energy and compassion being put into this strategy.

And I like the way that you designed it in a will, because it looks like it's going

to be a working strategy all the time.

It's going to keep chopping and changing, upgrading, and stuff like that.

If I read it wrong, tell me, because you haven't put it there.

That box is going to be done.

And then that box, it looks like it's going to keep rotating and grow all the time,

which I quite like.

So, you know, with our opinions, it's just going to improve.

What I would like to see, possibly, I don't know if this is going to happen,

but maybe in a year's time, once you get this strategy up and running,

that we just see a result, see how it's progressing as we come through.

But with all of our creative sort of views and what you've put in,

that would be quite good.

That's it.

Thank you.

Amelie Bages - 2:12:19

Thank you, and we'd be very happy to do that.

Over the past few years, our board has put a lot of effort

to try to build the infrastructure in our trust.

So all of our teams across the organisation

work to plan to clear expected results,

and that we report this publicly.

So we're really hoping that having this strategy now

we can build on this infrastructure

to really drive specific outcomes, et cetera.

Cllr Shade Adoh - 2:12:45

I would be very happy to come back and talk about it.

Thank you very much.

Councillor O 'Lough.

Cllr Thomas Hogg - 2:12:52

I would absolutely underline what Councillor Rous said.

It needs that starting point.

I'll mention something related in a moment.

I like the strategy in its general direction.

I think it's a good strategy.

I'm worried that it's not focused enough though. So you've got this priority

called make things simple and it feels to me that you are underestimating just

how unbelievably difficult that is to do because you've got all of these other

priorities as well. I think there's a Steve Jobs quote about how it's that

making something simple is the hardest thing in the world. If I were that is

that would be such a huge improvement.

To make things simple would mean a huge improvement

for carers, for example, who are really struggling.

And it sounds sort of boring

because it's not a bell or a whistle,

you know, that's off the side,

but that's where I would move most of your efforts

if I were you.

I think the other thing that I'm worried about

is connected to this focus problem is prevention, right?

So when it comes to mental health,

it's connected to just everything.

It's connected to everything in life.

And so how do you make sure that when you do the prevention,

you don't end up spraying your resources

in a thousand different directions?

And what is the low -cost, high -impact places that you could get involved in?

For example, we know that if people take more exercise, that they're going to be in a better

place.

We know if they go to beautiful places, that they are happier people.

Have you been speaking to the design code team at Buckinghamshire Council, for example,

for the local plan?

You know, there are various things which would cost you nothing, but could help you reach

your goals.

I think that low cost, high impact thing is a way to go.

And the final point I would just make is on measuring this.

So a lot of the prevention side of things will be trying to convince or persuade people,

carers, parents, schools, children, and it's very easy to put together a kind of

an awareness campaign. It's much harder to know whether it's had the the effects

that you you want and it's also in terms of the metrics on how mental, how

especially the children's mental health is doing across the county and working

with schools to get early indicators where things might be going wrong.

So before they end up in a really bad place,

but being able to see what's happening across.

Well, I mean, we're most interested here in Buckinghamshire, right?

You'll be interested in a larger area.

So I think those are the things which I think are missing,

making it more concrete and focused.

Amelie Bages - 2:16:15

Thank you. Our current chief exec would be pleased that you recognise and support the making things simple priority.

That's his direct input into our strategy. I was really keen on this one and I agree with you. I think it's the most difficult.

So I agree it's high level. It's more the design principle stage within the framework of the strategy.

I think it's really important because, as you say,

making things simple is incredibly difficult,

and it's not something that people automatically do.

So I'm really clear that I want it

to become a design principle for all

of our colleagues in the organisation

when they do any piece of work.

Making it simple is a kiosk.

And that is actually quite counterintuitive.

So hence the high -level wording in the strategy.

But as I said, we want to use it as a high -level framework

to direct action throughout the trust.

And I think this one will make a big difference.

We will have specific workstream sitting underneath.

I think, for example, we're looking at our CAMS pathways

and thinking about how can we streamline how we do things

and have the same kind of processes across all of our areas

to measure and understand the pathways

and obviously have variation wherever it's warranted,

but try to be very clear that's how we do things

and therefore we understand any variation

between our services and we can track things

much more systematically.

And that's difficult.

when we think about digital systems,

we customise them sometimes too much

to address the need of specific team

and therefore when you aggregate these at trust level,

that means that you can't really use data

that you're intending to do.

So that level of simplicity

and pushing that through the organisation

is incredibly difficult to do,

but we have very practical applications.

So the two things I can think of on top of our mind

is pathway designs,

but also our electronic patient records,

how we systematise the way in which we do things

in a simple way to then be able to take action.

On the prevention, as you say, that's an area

that we've had a lot of debate with our colleagues,

our medical colleagues, notably about how can we do something

in this space whilst completely depleting our resources

because we can't do everything in mental health.

Everything impacts on mental health,

and that's one of the very difficult areas of work.

I think the neighbourhood health approach will really help

because we can think about how do we have a core provision

at community level that is geographically equitable.

We've done a lot of work in mental health over the past

to integrate health workers with primary care, et cetera.

That has worked to some extent, but there's been a lot

of variation.

I think the neighbourhood model will give us a systematic, nationally supported approach

to work with partners to create something that makes sense at neighbourhood level and

that would include working with people considering physical exercise, gardening, green space,

etc. in a much more systematic way.

I think that structure has been missing and hopefully the new approach that we're taking

in Buckinghamshire will help with that and having a way to work with partners really

to account for the needs of the locality.

Cllr Shade Adoh - 2:19:34

Thank you very much.

Ansela Wessel.

Cllr Julia Wassell - 2:19:36

Thank you, Chairman.

It's a very interesting read,

and to hear about your approach to the involvement.

I was wondering how much social policy and legislation

impacted on your strategy,

and I was particularly thinking of the Mental Health Act reforms and the government's inclination

that anxiety and depression can be normalised because obviously in Buckinghamshire we're

looking at your mental health services primarily. Another issue that's a hot topic for High

particularly where myself and others represent, is the new hub that's going to be created

in the former council offices and whether that forms part of your strategy.

On health inequality, I'm professionally curious as to how far you've engaged with people with,

say dual diagnosis, mental health and learning disability,

the forensic patient, the detained patient,

and some of the people who might really have high barriers

to getting involved with your being consulted

on your strategy.

I'd like to see more about health inequalities myself

because of the really stark mortality rate of people with long -term mental health problems

like schizophrenia, bipolar disorder and so on. That is getting worse because of the cardiovascular

impact. On areas of deprivation, what is your strategy for poverty alleviation then? So

I'm keen on mental health. Thank you.

If I start, can you add something?

Amelie Bages - 2:21:57

So in terms of the policy and the Mental Health Act work,

as well as the expected new frameworks,

this is something we factor in deeply in our work.

It's not directly reflected in the strategy,

but one of our key partnership work

is leading the mental health approach at ICB Leveaux

with Berkshire Healthcare.

So we have created a provider collaborative

And part of this work is to make sure that when we think

about delivering mental health services across the ICB,

we take into account all of the new policy development

and we do this in the most systematic way possible

across the ICB.

So I just wanted to reference that.

So we're really positioning ourselves

with our Berkshire Healthcare partners as, you know,

leading in that space and leading the reflection

on how we can best improve the mental health services based

on the new legislations and change coming in.

In terms of the new hub, one of the key strategies that we follow from our strategy would be

our estates and facilities strategy.

And we are closely working with the emerging neighbourhood approach in each area to make

sure that we think about our estates and our services and link that to the emerging neighbourhood.

So this is something we will work through the detail of when we publish our estate strategy.

Sam, I thought you could cover our work on health inequality because we're doing quite

a lot in advance of this strategy being published to improve how we do things in the organisation.

Sam Shepherd - 2:23:33

Yeah, sure. Firstly, to how it is that we have involved people from a range of backgrounds,

particularly, I think you mentioned, Councillor Russell, those from a learning disability

background and our forensic patients as well and throughout our phases of

engagement we have undertaken specific pieces of work to go to those with a

learning disability who are experts by experience that we have a relationship

with to talk to them about first in that first phase what works well and where

can we improve but also to test through this this trial strategy that you have

in front of you.

And we did also undertake focus groups with forensic patients.

So we have really reached out and gone to where patients are

to be able to have those conversations.

We have also engaged with volunteering community sector

groups and community groups who represent the voices of those

who are less well heard because we recognise

that this is a technical piece of work.

So we really do need to have those representative voices

as well as voices directly.

With regards to our work on health inequalities,

we're doing an awful lot to standardise and raise the bar

on how it is that we understand health inequalities

across our own services.

For the purposes of this strategy, as I said,

we've really looked in detail at JSNA data

And the indices of multiple deprivation is a really

important factor in those JSNA's and how health outcomes are

so different across those geographies.

So our strategy is written in reflection

of those areas of deprivation.

And they've got the BUCS 15 wards that have been identified

as the most deprived.

There's a similar type of approach in Oxfordshire.

So we do know where those areas are.

Our neighbourhood approach in collaboration

with partners has, is very much putting health inequalities

at the heart of its thinking.

So this strategy is really designed to make sure

that that continues to be a focus

for us over the next five years.

Amelie Bages - 2:26:00

And I would say in preparation for this work,

throughout the trust we are starting to look at our data

and looking at index of multiple deprivation,

but also ethnicity and applying this across all of our services to start making sure that our thinking

is geared towards tackling any difference in access

experience where we can have the data and outcomes.

Cllr Julia Wassell - 2:26:27

With the

overrepresentation of certain

groups in the mental health services and the stigma experienced by other groups around seeking mental health treatment.

Do you feel you're addressing those kind of issues sufficiently in your strategy?

Amelie Bages - 2:26:58

Yes, so one of the key elements of the work sitting underneath the health inequality piece

is our patient care and race equality framework

that specifically looks at these differences that you point to.

So we know that we have over representation of black males

in some of our mental health services,

but also in how restrictive practise are applied to them.

So as part of building a core understanding of our data

and health inequalities, we're building that in

so we can start getting a very accurate picture at first level

but also make sure that our services have plans

that address these differences.

Cllr Shade Adoh - 2:27:37

Thank you very much.

Thank you.

Councillor.

Cllr Lesley Clarke OBE - 2:27:40

Thank you, Chairman.

Looking at the two maps that you put in on your slide four,

you've got a huge area that once you're covering a new,

the expansion is perhaps even worse.

What are the differences in the population numbers that you'll be looking at in both

those, particularly in your expansion area, and how many ICBs are you now going to be

covering, seeing that the ICBs are, in some of our views, have split councils and counties,

perhaps not the way we would have done them, being polite.

So with the massive changes being implemented within the NHS,

do you see your strategy eventually covering an increased area

that appears to be on your horizon?

And do you think with the inclusion of neighbourhood hubs

this will actually deliver a lot of your work?

Can we also go towards reducing the health inequalities

that we see?

Amelie Bages - 2:29:00

So in terms of our geography, the first map on the right

shows where we deliver services directly.

The second map with the larger areas

is where we commission all the trust to deliver

very specialised services.

So our role in this geography is slightly different.

We're looking only at highly specialised mental health

pathways.

and we are not delivering in these areas.

So the focus is less on population health because we're,

when we're talking about forensic services, et cetera,

it's a very small percentage of the population.

So our focus is slightly different

and it's more our expertise as commissioners

that is important in these areas.

In terms of the geographies of the first map

where we deliver services,

Our two main ICBs are the now new Thames Valley ICB and our work in the Bas and

Thwindon areas where we deliver mostly children, young people, mental health services.

I'm not expecting that the change of structures of the ICB will impact on the

delivery of our services there. I think specifically in Thames Valley it will be

interesting to see how the operating model of the ICB develops. I think we're

or looking to have more information from the ICB

about how they see their role as strategy commissioners.

What will that mean for places like Buckinghamshire

and Oxfordshire in terms of what happens where, who decides

what, so that we're not clear about yet

as the ICB is going through the process of defining these.

For mental health specifically, as I was saying before,

we have a provider collaborative with Berkshire Healthcare

and the ICB, where we seek to progressively implement

a much more comprehensive way of looking at mental health

at scale.

So that's where we're thinking, for the pounds spent

on mental health in the Thames Valley ICB,

do we see differences between place?

Do we see variation?

Is it variation in services that makes sense?

Or is it something that we need to address?

We're still at the early years of doing this.

But I think that has a huge potential

in terms of making sure that we make the best use of the money collectively across the ICB

and address any variation. That's at scale.

At local level, I do really think that the neighbourhood framework,

because it is a programme that is highly supported and pushed by government, can make a big difference.

There is a clear mandate from the government for people to work together

and deliver outcomes that are meaningful for their population.

So although there's been talk about integration for many,

many years in the NHS, that's the first time

that we have a framework that is a clear ask

for all partners to deliver again.

So I think that will have a real impact.

Cllr Lesley Clarke OBE - 2:31:54

How will you evaluate that you're actually producing

exactly what you hoped to with your strategy?

Amelie Bages - 2:32:03

So this is the most difficult part.

and we started thinking about how will we know.

I think in terms of our aims for people accessing our services,

we will have better outcomes data.

We're starting to get this data, and in five years,

I think we will be able to use it systematically to look

at people who have access to our services based on the outcomes

that are meaningful to them and that they have defined.

Do we see an improvement across the board once they've,

you know, been with us for a while.

We have some of that at the moment for some of our services

like talking therapies,

but we don't have that data across our services.

So that will be a key thing.

For our colleagues working in the trust,

we also have good data in terms of satisfaction, retention,

but we also have equalities measure

in terms of representation of certain ethnicity

at certain grades within our workforce,

but also the user disciplinary procedures, et cetera.

So I feel we have robust data that we can use there.

The most difficult area is going to be around health inequalities.

What we will be able to do is to look at outcomes for people

who access our services based on deprivation or ethnicity

and say, do we see difference?

And have we reduced the difference?

That I'm confident we'll be able to do.

When we think about community or population health level,

that's much more difficult first.

because in terms of what you really want to impact,

which is improving healthy life expectancy,

you don't really see a change in five years,

so it's not really a useful measure for that.

And other measures are difficult to quantify.

So for example, children and young people,

even the data about prevalence of mental health diseases

around children and young people across the country

is very weak, let alone any other data.

So I think for me, that's really the area

where we're gonna have to do a lot of work.

Are we going to be able to say that we've made an impact

for our wider communities and people

that are not necessarily accessing our services

in the next five years?

I haven't got the solution today.

I've been thinking about it.

I think the only way to do that is to work

through the neighbourhood health model,

and if metrics are identified with partners

for the neighbourhood health approach, saying, well,

as a partner, we have to contribute

to improving these metrics

that have been collectively improved, agreed,

and that's how we will know if we've been successful.

but that's really the most difficult area.

People who are not necessarily accessing our services.

Thank you.

Cllr Shade Adoh - 2:34:36

Councillor Neelu.

Thank you for this really interesting and quite

fascinating report.

And I must congratulate you on the way

that you've gone about the engagement with the community

and the wider world.

On the back of that, obviously, you're

now very much at the end of phase two,

wrapping up the last loose ends, no doubt, and we see that the final strategy will appear

over the summer. In terms of the key deliverables that you want to include in this five -year

plan, I was just interested to know how much or how far your priorities are actually aligning

with the responses that you've had back from the wider community, what you think needs

to be done as opposed to what the wider world is telling you they would like to be seen.

Cllr Frances Kneller - 2:35:32

And then in relation to that in terms of the hierarchy or I suppose the sort of the balance

of those deliverables in terms of whether they're going to be much more about quick

wins, that some of the things that you're hearing and finding out about are like, oh

yeah well if we change that approach we should be able to deliver that more quickly.

or do you see much more of the activities that you're going to be looking at in terms of your key deliverables,

much more around structural change, because that model, that wheel that Councillor GOM referred to,

is very much in balance and as time goes by that balance obviously is likely to change and then impact on the deliverables.

So I'm just wondering from your strategy how you're contemplating the delivery.

Okay. Thank you.

Do you want to take the first part?

Sam Shepherd - 2:36:26

Yeah, if I take the first part.

Thank you for the question.

The feedback that we have heard, well, first of all, actually, to mirror your point,

Councillor Nella, that people have appreciated the opportunity to have a voice.

So we feel really pleased about that because that's exactly what we wanted.

We have heard broad support for our strategy.

We have heard support for our aims and for our priorities.

A lot of the feedback that we've heard has been about where a couple of things might be better emphasised.

How we could strengthen the focus on prevention in the wording that we've had.

For example, how it is that we might be able to,

particularly in reflection of the 10 -year plan,

how do we really shine that light on data and digital

and analytics and what storey can we tell around that.

So we have heard those.

We have heard a caution, I think,

around how realistic is our strategy, particularly

around population health, health inequalities

with those resources that we have.

So we've been urged to cheque and balance and make sure that what we're setting here is,

and to Councillor Hogg's point, achievable. Let's bite off what we can chew.

The other really key piece of feedback that we've heard is around the vision that we're proposing,

that people would like wording to be shorter, to be sharper, to be more impactful.

So we're really taking on board that and without losing those things that are celebrated that we've heard around compassion and quality of life, that patient focus that our vision has.

So we're really taking that on board as well.

So all of that feedback, some of which is quite specific, we're able to now digest that and think through how do we really hone down those words so that every word counts at this high level and creates the right emphasis.

for how we move forward from here.

Amelie Bages - 2:38:41

In terms of delivery of the strategy,

so that has been something that I've been very careful about

when doing the work on the strategy.

We want it to be an operational tool.

It is not gonna be a strategy sitting on the shelf

and it is incredibly difficult to do.

So I'd say our plan is to operate at multiple level.

What you're seeing is that the design principle,

so I want the version of this framework

to be what every team member in the organisation has on the top of their head

when they do their team meetings, when they do their annual planning,

when they set their personal objectives down.

At the high level design, in my job, I'm asked to do all of these things.

This is critical to my job, this is not somebody else's problem, this is my job.

This is mine and this is the job of anybody in the organisation.

That's a design level.

The next level is the organisational level.

And here we have to balance.

We have to balance the need to be granular and be clear about that's what looks like in the future

and that's how we think we will get there with the reality which is things will change

over the next five years, right?

And that's an element of truth.

So in our strategy delivery plan that we have started to think about,

what would look like would be against each of these priorities a definition of in five years,

That's what we could look like from a colleague's perspective,

from a patient's and carer's and family's perspective,

and from a community perspective.

And that's some of the indicators that

could tell us if we've impacted.

And these are the key programmes of work that sit underneath.

Part of that would be quick wins.

Part of that would be longer term.

So if I take the health inequalities approach,

I think a quick win that we've already started

is getting the data presented in a way that is usable and used

across the organisation.

That is a quick win.

We can now do it, so let's just get it done.

So a quick win milestone for the first year.

The long -term thing is we want to reduce all inequalities

that we can see in our data in outcomes and access.

So that's infusing the culture of our teams

to do this systematically, and we're

designing pathways in a way that will achieve these outcomes.

And that's a kind of longer term year three, year four, year

five kind of piece.

So we're balancing that.

So design principle, kind of organisational level strategy.

But the key is then the next layer.

How do we take very different teams of forensic services,

or highly specialised mental health services,

and our district nurses to have a version of these

that makes them for their services.

So we started discussing this draught strategy

with our heads of services that run some of these teams

and saying, we're gonna give you the framework,

we're gonna give you the very high level ambition,

but what we want you to do is tell us in five years what does that mean for you?

And how do you translate it?

And we will have that ready across the organisation, and then we will revisit it year on year.

Some things will change, but the overall direction of travel shouldn't.

And if there's any variation to what we were expecting, we'll be able to see it,

and we'll be able to assess is that a variation that we think is acceptable?

Is there a valid reason for it?

Is it time to change direction?

Or is it actually because we're not doing the right things,

and let's put things back on track.

So I'm confident we have the approach to make this real,

from a kind of high level design at organisational level,

7 ,000 staff, more than multiple geographies,

hundreds of sites, and kind of team level.

Cllr Shade Adoh - 2:42:15

That's quite extensive.

And it is reassuring, I must say.

So thank you very much.

And outcome that you've come here for,

you've asked the committee to consider any initial reflections on the emerging direction

and the strategy. So my question to you is do you feel like the committee's responses,

the questions, the suggestions that have been offered, have you found them valuable? Also,

based on requests, we'll be looking forward to having you back in a year to see where

you've been, how he's been, and what's next.

Right.

I'll give my thoughts.

Amelie Bages - 2:43:03

I think it's been very valuable.

I think some of the comments on what's lacking

from the current document we had already received,

and it's clear we need to address these.

The emphasis on inequalities, neighbourhood level working,

and looking at outcomes for local population

are in line with the broader feedback we've received.

So it's really useful to see which areas of our strategy

needs to be strengthened and how they

tally with what matters to people.

Sam Shepherd - 2:43:35

So extremely helpful.

Thank you.

Really helpful to be able to talk to you

as representatives of your communities about this strategy

and to hear your feedback resonate with that

that we've heard from residents, from patients, carers,

and families really welcome the opportunity to be able

to share how we targeted those groups that have,

their voices less well heard.

And we really want to continue that way

of working throughout the duration of this strategy

so that the voices of your residents are really forefront

and centre as we move forward through the next five years.

I wish to see you next year.

Thank you for having us.

Cllr Shade Adoh - 2:44:24

Thank you very much for your time. Thanks a lot.

Right, whilst you're leaving us, we'll just continue but just ignore us.

So, members, thank you for your time again.

This is our last ASK meeting in this council year, not the last one.

I'm sure you're all thinking, oh gosh.

But that's just for the council year.

And the next meeting is due to take place in early July.

There will be a work programming session

for members once the AGM has taken place.

This will be a team's call to discuss potential items

and possible member visits for the year ahead.

And in order to give officers time to prepare reports,

I would like to propose the following items

that should be on your pack for the July meeting,

8 Work programme

Better Care Fund, Integrated Community Equipment Services,

and Access to Emergency Care Review Draught Report.

How does that sit with everyone?

Is that okay?

Could we perhaps one of the agenda items

Cllr Lesley Clarke OBE - 2:45:34

put neighbourhood hubs, particularly with the work

that the integrated boards are actually doing,

because it would be really good to understand exactly what they're producing and what they intend to give.

Dee Urban is the person I've been working with so it would be really good if we could get an understanding please.

Cllr Shade Adoh - 2:45:58

I think that's a good one. We're looking at the women's health hub as well. So it's all part of that bit there.

So any other one?

Thank you, Chair.

Just one, perhaps a little bit later to put on our list is I'm picking up from the first

item we had today with the Bucks Health Trust, talking about digital inclusion and digital

engagement.

I'd be interested to look at that from the public's perspective.

I think there's a lot of issues there that if it's not just about familiarising ourselves with it,

finding a bit more about how the rollout of digital services across the piece impacts on choices and opportunities for the public.

Thank you.

That will be across the board, isn't it?

Yeah, my, well, that's what comes with one of the things,

but it's also the sort of kind of working

with the voluntary community sector.

It's something that's come up meeting after meeting

and they're talking a good game,

but it'd be great to have something a bit focused on that

so that they have to report more about it.

So, and maybe having some representatives

from the sector as well,

so that we're hearing their side of it too.

I think that's it.

That's, yeah, get people to actually come and tell us what it is and how it is that

they're engaging with them.

Yeah, so that's Help's Watch and the others.

Any other points? No?

9 Date of Next Meeting

So, that brings us to the date of next meeting.

Future meetings will be confirmed following full council on the 20th of May

as they form part of the calendar for the whole council meeting.

and I know we had an earlier discussion before the meeting started and I'm sure you know

Liz will take that away considering all the complexities around this. So Liz, me saying

thank you very much, we've had a good time and I know everybody's busy, busy day as well

so thanks a lot and see you soon, see you on the 20th, I think that's our council meeting.

yeah AGM we are online for the review yeah thank you very much all thank you

Webcast Finished - 2:48:25

thank you very much Sally thank you very much please appreciate

Cllr Shade Adoh

Conservative

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Cllr Lesley Clarke OBE

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Cllr Phil Gomm

Conservative

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Cllr Thomas Hogg

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Cllr Frances Kneller

Liberal Democrats

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Cllr Dominic Pinkney

Liberal Democrats

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Cllr Simon Rouse

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Cllr Alan Sherwell

Liberal Democrats

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Cllr Julia Wassell

Wycombe Independent

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Health & Adult Social Care Select Committee - Thursday 7 May 2026, 10:00am - Buckinghamshire Council Webcasting

Health & Adult Social Care Select CommitteeThursday, 7th May 2026 at 10:00am

Agenda

Slides

Transcript

Map

Resources

Twitter

Forums

Speakers

Feedback

Votes

Cllr Shade Adoh - 0:00:03

1 Apologies for Absence

Elizabeth Wheaton - Principal Scrutiny Officer - 0:00:25

2 Declarations of Interest

Cllr Shade Adoh - 0:00:34

Cllr Julia Wassell - 0:00:48

Cllr Phil Gomm - 0:01:01

Cllr Shade Adoh - 0:01:13

3 Minutes of the Previous Meeting

Cllr Julia Wassell - 0:01:28

Elizabeth Wheaton - Principal Scrutiny Officer - 0:02:50

Cllr Shade Adoh - 0:03:12

Cllr Lesley Clarke OBE - 0:03:28

Cllr Shade Adoh - 0:04:13

4 Public Questions

5 Chairman's update

6 Buckinghamshire Healthcare NHS Trust - key performance and service quality

Raghuv Bhasin - 0:12:04

Cllr Shade Adoh - 0:14:05

Raghuv Bhasin - 0:15:10

Mitchelll Fernandez - 0:16:50

Cllr Shade Adoh - 0:17:21

Cllr Dominic Pinkney - 0:17:44

Raghuv Bhasin - 0:18:10

Cllr Dominic Pinkney - 0:20:53

Raghuv Bhasin - 0:21:19

Cllr Shade Adoh - 0:21:52

Mitchelll Fernandez - 0:21:56

Cllr Lesley Clarke OBE - 0:22:25

Raghuv Bhasin - 0:25:32

Cllr Lesley Clarke OBE - 0:30:36

Raghuv Bhasin - 0:32:00

Cllr Shade Adoh - 0:33:44

Mitchelll Fernandez - 0:34:29

Jon Evans - 0:35:38

Cllr Shade Adoh - 0:40:00

Cllr Thomas Hogg - 0:40:34

Raghuv Bhasin - 0:42:19

Mitchell Fernandez - 0:44:39

Cllr Thomas Hogg - 0:46:13

Raghuv Bhasin - 0:46:31

Cllr Thomas Hogg - 0:47:03

Raghuv Bhasin - 0:48:35

Cllr Shade Adoh - 0:50:31

Mitchell Fernandez - 0:51:17

Cllr Shade Adoh - 0:52:09

Cllr Phil Gomm - 0:52:11

Cllr Shade Adoh - 0:52:49

Cllr Frances Kneller - 0:53:14

Raghuv Bhasin - 0:54:25

Cllr Shade Adoh - 0:56:40

Cllr Simon Rouse - 0:56:49

Raghuv Bhasin - 0:58:19

Jon Evans - 1:01:03

Raghuv Bhasin - 1:07:44

Cllr Simon Rouse - 1:08:43

Cllr Shade Adoh - 1:09:25

Raghuv Bhasin - 1:10:04

Cllr Shade Adoh - 1:10:51

Cllr Alan Sherwell - 1:11:17

Raghuv Bhasin - 1:13:33

Jon Evans - 1:14:49

Cllr Alan Sherwell - 1:17:36

Cllr Shade Adoh - 1:17:55

Cllr Thomas Hogg - 1:18:09

Raghuv Bhasin - 1:20:09

Mitchell Fernandez - 1:22:26

Raghuv Bhasin - 1:23:16

Health & Adult Social Care Select Committee
Thursday, 7th May 2026 at 10:00am