Agenda item

Under the provisions set out in Section 100B(4) of the Local Government Act 1972 (as amended) the Chairman of the meeting is of the opinion that the above report can be taken after Agenda Item 5 as urgent business for the reason that the Guidance for improved Better Care Funds has only just become available.

The attached report aims to update Health and Wellbeing Board on recent developments with Reducing Transfers of Care, the improved Better Care Fund Planning Guidance and a recent statement by the Secretary of State and for the Board.

The Board is asked to discuss the implications of these changes for Oxfordshire.

David Smith gave a brief introduction stating that the OCCG had worked together with Adult Social Care on the previous allocation of £350m, which was already in place. He pointed out that the theme of the additional provision was to assist with the reduction of the county’s Delayed Transfers of Care (DTOC) statistics which remained high, with the problems sitting with the Oxford University Hospitals NHS Foundation Trust (OUP) and OCC’s Adult Social Care. He stressed the importance of reducing the DTOC figures as a joint venture.

Kate Terroni proposed the recommendations contained in the report citing the Secretary of State for Health’s statement on 3 July 2017 that urged both Health and Local Authorities to be well prepared for the coming winter, asking that they renew efforts in respect of DTOC and to refocus on priorities. She also made reference to his intention to undertake twelve Care Quality Commission (CQC) reviews, of which Oxfordshire would be one. She welcomed the external challenge that this would bring, along with a focus on learning from good practice elsewhere.

Professor Smith, Chair of Healthwatch Oxfordshire, conveyed a message to the Board from Dr Bruno Holthof, Chief Executive of the OUH who had been invited along for this item alongside Stewart Bell, Chief Executive of Oxford Health (OH), both of whom were unable to attend due to a previous engagement. Dr Holthof had agreed with HWO that joint teams comprising OUH care workers and ASC teams for home care delivery was a good idea and he looked forward to an invitation from the County Council to discuss this. Professor Smith suggested that a joint objective could be the upskilling of care workers via ‘on the job’ training with the support of mentors. It was his view that a high level approach was required within a climate of increasingly complex health problems. He also raised the need for more support to be given to carers in order that they may be supported in giving acute care to patients in their own home. He also stressed the requirement for good respite care.

Kate Terroni highlighted the proposals contained in the report relating to how the additional Better Care Fund monies would be spent. She cited the following provision:

·         Raising the hourly rate again for care workers;

·         Exit interviews to be given to people leaving their post, thus ensuring that workforce issues were cited on a constant, ongoing basis;

·         The use of shared care practitioners employed by Oxford Health to upskill domiciliary care workers; and

·         The use of locality-based providers – to which Dr Holthof’s views would be welcomed.

Members of the Board commended the positive attitude conveyed in the report and endorsed the validity of Professor Smith’s comments recognising the need for more support for carers and the importance of respite care for carers, in particular for those caring for dementia patients.

Dr McManners stated that this was a good opportunity for the integration of Health and Social Care workers on a locality basis, and furthermore, to embed social workers and carers into the locality groups. The OCCG were actively encouraging proposals to integrate GPs and community teams, working in parallel with social workers. These ‘locality teams’ could be integrated into locality plans. Furthermore, the OCCG would encourage any reduction in costs or extra investment to be passed on to the care workers at the hourly rate; and for all this to be tied into the appropriate training for the job and recruitment in order to reduce staff turnover, as suggested.

Other comments made and views expressed from the Board included the following:

-       That a sustainable plan must be made in terms of recruitment and retention of staff;

-       It was hoped that the Government would be producing national advice on particular issues such as for areas in low employment, high growth and productivity, to support the plans;

-       The plans for this could be used as an opportunity to re-visit the Mental Health Concordat and to scrutinise the extent to which it had been implemented;

-       Adults of Working Age and child carers should not be overlooked in plans for respite; and

-       Age UK and Oxfordshire Carers Forum could give valuable input.

Dr McManners and Kate Terroni reminded the Board that it had detailed oversight of services for older people, people with mental health problems or a physical disability and adults of working age via the Health Improvement Partnership Board.

David Smith suggested that a time-limited focus group comprising OCC and the OCCG representatives could be created to take a look at what needed to be done. He also undertook to spend time talking to colleagues in other locations and looking at other systems. Kate Terroni agreed with his suggestion stating also that she was working on a clear, shared narrative and diagnostics across the system. 

The Board AGREED to:

(a)  approve the plans for spending the Improved Better Care Fund funding as described in the report;

(b)  approve the governance arrangements as described in the report, including delegating responsibility for implementing these plans to the Better Care Fund Joint Management Group; and

(c)  create an informal, time-limited focus group comprising OCC and OCCG representatives to look at the work that was required to be undertaken.