Agenda item

10:20

Our main Health partners will provide an update on performance and planned actions to address delayed transfers of care (JHO6).

The following representatives will attend:

-       John Jackson, Director of Adult Social Services (OCC) and Director of Strategy &Transformation (OCCG);

-       Paul Brennan, Director of Clinical Services, Oxford University Hospitals NHS Trust.

The following representatives of the main Health partners attended the meeting in order to provide an update on performance and planned actions to address transfers of care (JHO6).

-       John Jackson, Director of Adult Social Services (OCC) & Director of Strategy & Transformation (OCCG);

-       Diane Hedges, Director of Commissioning (OCCG);

-       Paul Brennan, Director of Clinical Services (OUHT);

-       Yvonne Taylor, Chief Operating Officer, (OH)

In response to a question about delays in accessing available resources, John Jackson explained that Oxfordshire’s Better Care Fund Plan had not yet been signed off by Oxfordshire’s Health & Wellbeing Board due to specific financial challenges in the county, to the timetable for introducing Outcome Based Commissioning and in light of recent increases in the rate of emergency admissions. It was noted that a special meeting of the Health & Wellbeing Board would be held on 8 January at 1.30pm to consider the full Plan prior to its submission to NHS England on 9 January 2015.

The Panel were asked if the community hospitals were being used correctly for reablement and assessment purposes . Diane Hedges commented that a major cause of pressure was that expertise from individual organisations was not being pulled together sufficiently in order to drive action. Yvonne Taylor commented that delays were down, pointing out that three years ago 306 patients were waiting for a hospital bed, now the figure was 31. John Jackson also pointed out that the highest level of delay tended to be for those patients living in the rural areas of Oxfordshire, also adding that the longer people stayed in hospital, the more likely they were to require complex care packages. He also pointed out that new contracts had been introduced on 1 November this year and delays for home care were now at 30 per week. This was not the major problem. Anne Brierley pointed out that there had been a significant amount of investment in reablement services across the county recently, resources had been pooled, patient handover had become much slicker and any problems responded to in a quicker way. She added that the biggest challenge was how quickly patients were identified in the acute hospitals, particularly those requiring bed-based care outside of the acute hospital. There were no delays for those entering community hospitals.

John Jackson was asked if the major problems were caused around the need for nursing care. He responded that if they were self - funding then a choice delay for a particular community hospital or nursing could ensue, if full to capacity. He added that the trend for numbers of patients waiting for a nursing home had taken a downward turn, with currently under 10 delays across the system as a whole.

When asked how many readmissions there had been on a monthly basis, Paul Brennan responded that winter pressures monies had been allocated jointly amongst organisations leading to increased patient bed capacity and 7 day working. In addition, colleagues in the South Central Ambulance Service (SCAS) had extended their period of community working by operating a bus to assist students working weekends and evenings to get to and from work. Readmissions statistics were well within the national average, a 20 day standard. He congratulated Social Care for their work in reducing delays.

When asked whether the delays were due to the length of time it took to install adaptations required in a patient’s house, John Jackson responded that this was very rare and was also the subject of target monitoring. Moreover, the problems tended to occur around those at risk of entering hospital and insufficient use by GPs of the ‘alert’ service whereby a call centre could arrange for a person to be attended at home, thereby avoiding hospital admission. Mr Jackson added that in reality, there were now more patients with a complex needs condition(s) resulting from a 50% rise in those aged 85+ in the past 5 years. This had led to a substantial increase in pressure on Health and Social Care, adding that there was an argument for doing even more to reduce delays. Moreover, the number of people supported at home had increased by 60% since April 2011. The issues surrounding the scale of rises in the ageing population was being addressed across all of the Health services including the Out of Hours Service, Accident & Emergency, Primary Care etc. He concluded by commenting that, in his view, the major issues associated with discharge arrangements in acute hospitals required more work, explaining that the people who entered hospital, and who were delayed, were generally frail older people with uncertainty around their condition from day to day, with no family carers living nearby.

The Committee asked if patient experience had been reported and detailed family information had been done for these patients. Paul Brennan responded that the OUHT’s Quality Committee had requested an audit of patients who had not been delayed, and of those that had. The Committee had also looked at patient conditions whilst in hospital, patient mobility etc. The audit outcomes had shown that there was no difference for those classified as delayed, than those who had not. However, it could potentially be a problem if a person’s condition deteriorated following their discharge. Diane Hedges reported that two reports were to come back to the CCG Governing Body, the first on what needs to be done for intensive support, and the second looking at named individuals who had been the subject of a delay, highlighting the key reasons for that delay and considering the various actions that were taken at different levels. The aim was to work out what actions made the most difference.

In response to a question from the Committee about whether Outcome Based Commissioning (OBC) would make a difference to the situation and whether capacity or acuity and demand were the real issues, Paul Brennan commented that in his view there was no need to be incentivised to resolve this issue. The real issue was to ensure that patients were in the correct place on the care pathway with all agencies working together. The OBC opportunity would create an environment where different ways of working could be looked at and it would be the driver of new service configuration. Moreover, OBC would release the capacity to improve performance within the resources available. Patients in all the various parts of the system, who are not able to benefit at present due to capacity issues, would then benefit from being on the next step of the pathway.

The Committee asked about the cost of patient delay for those in acute care. Paul Brennan responded that there was an average of 120 patients classified as delayed in the Trust hospitals – not all of which were Oxfordshire residents. This would equate to approximately 5 wards, at a cost of £1.3m per annum for staffing and £6.5m per annum to run. John Jackson commented that the question was how to use the resources to the best effect as bed-based care was very expensive, it being much better for them to recover at home supported by care services.

Dermot Roaf, Vice Chairman of HWO, reported that a part of the current review into the quality of care in discharge was to look at the patient perception of it, rather than looking at it from an administrative view. He commented that HWO also awaited with interest to see what fruits OBC would bear. He reported that HWO were pleased at the degree that the Trusts were willing to participate in the review and their openness was appreciated.

The Chairman thanked all those who attended.