Agenda item

12:45

Sula Wiltshire, Director of Quality & Innovation, and Lead Nurse, OCCG, together with Ros Alstead, Director of Nursing & Clinical Standards, Oxford Health, will attend to provide an overview of community nursing provision and the 2015/16 review (JHO9).

Sula Wiltshire, Director of Quality & Innovation and OCCG Chief Nurse and Ros Alstead, Director of Nursing & Clinical Standards, Oxford Health attended for this item. Sula Wiltshire introduced the report (JHO9) which provided an overview of community nursing provision and the 2015/16 review.

The Committee heard that there were 325 district nurses in the county and these were based in GP practices. They worked in teams and were managed by a senior district nurse and a senior matron provided general management support. Some worked closely with primary care services mainly focusing on housebound people. There was a big demand on the services from frail, elderly and housebound people with respiratory and cardio - vascular conditions. There was also a cancer service and they also provided insulin at home, along with bladder care and care for people suffering from leg ulcers. Some patients were being looked after by a relative, and there were standard procedures around how often they were to be seen and how well they managed their own care.

Ros Alstead was asked if she regarded 325 district nurses as sufficient and if there were any plans to cut numbers further? She responded that there had been an increase in demand given the demographics in the county. More staff would be needed in the future, including community nurses. She emphasised that this was a service which was not being reduced, but the needs of the service had risen considerably, hence the review. She added that the Care Quality Commission (CQC) had rated the service as good overall and had in general found staff to be very compassionate and caring.

A member asked how strong the link with GP Locality Teams was. Ros Alstead responded that work was currently underway within the integrated locality team to determine what needs to be provided at a GP level, or cluster level or at a more specialised level.

Ros Alstead continued that there were two elements to the review. It focused on finding different ways to provide integrated work with GPs and how to release time by changing practitioners and working more efficiently. Options considered and measures taken were detailed in the report.

A member asked if district nurse work was allocated by a team. Sula Wiltshire responded that this was via a conversation between the GP and the district nurses at primary care team meetings. She added that social workers, the practice manager and health visitors may also be involved in those meetings.

Ros Alstead was asked how the service worked with Carer’s Forums. She replied that community services could not run without the support of family carers. Individual support was given to carers regarding treatments, for example – and community nurses worked with carers to educate and support them. She added that it was important to ensure people with caring responsibility had the capacity of assessment and the ability to make judgements.

A member asked if there was an issue with morale within the profession and, if so, how could it be improved? Ros Alstead responded that morale was variable, stating that there were times when community nurses found their workload more difficult to tolerate. It was important to try and understand where the issues lay and to address them at a local level. She was also aware that district nurses often spent time delivering care outside their contracted hours and this was an issue.

A member asked if timetabling was sufficient to look after patients appropriately.  Ros Alstead responded that the time slots worked well - a large amount of thought went into it and the CQC had complimented the Trust on this. However, she stated that it was not a perfect science and sometimes there was a need to complete a holistic assessment on a person. :

She added that the new integrated locality teams will bring a multi-disciplinary element in which may benefit the service.

A member commented that district nursing should therefore feature quite highly in the forthcoming Transformation Plan asking were there sufficient numbers to support it? Ros Alstead responded that there was a need to do more work with the nursing workforce to help them understand the benefits of working in the community. The profession also needed to ensure that there were sufficient opportunities for undergraduates to have a lengthy experience of working in the community, which was a good and satisfying career.  She referred to a specialist practitioner course at master’s level which provides training for very bespoke support for acute nurses to work independently in the community. She highlighted that opportunities for handovers would require structural support.

Ros Alstead was asked what her experiences were of recruitment and retention of district nurses and how involved had she been in the development of the Transformation Plans. She was also asked if the service would receive more money to allow patients to have their care at home? Ros Alstead replied that recruitment and retention within the county was not an easy problem to solve - many issues were as a result of the high cost of living in the county. The profession faced a variety of vacancies across the board.

Ros Alstead was asked if the service made use of agency staff. She replied that it did, but only targeted staff who were prepared to work with the service over a period of time held a caseload. Sula Wiltshire added that recruitment and retention issues were their biggest challenge, whilst trying to create the reality of a ‘workplace without walls’. They had looked at examples in Holland where the community care model was rooted. Hospital was not the best place for patients, the aim being to make their stay as short as possible.

A Committee member commented that the Kings Fund had claimed that there were 50% fewer district nurses than there was 12 years ago. Given the drive for greater partnership working, she asked whether the service could be extended to encompass work with social landlords and Age UK etc? She also asked if there were sufficient hospice places in Oxfordshire. Ros Alstead responded that the number of district nurses in Oxfordshire differed to the national figure. She added that some areas did not fund the district nurse programme, but it was felt in Oxfordshire that it was important to support it. With regard to partnership working, there was already vital partnership working in place with the voluntary sector and GPs via the integrated locality teams. The expectation was that there would be an increase in partnership working with a variety of organisations. Regarding hospice places, Sula Wiltshire stated that people do prefer to die at home, and community nurses worked closely with MacMillan nurses to facilitate this. 

The Chairman thanked Sula Wiltshire and Ros Alstead for their attendance.