Agenda item

10:45

The Chief Executives of Oxford Health Foundation Trust (OH), the Oxford University Hospitals Foundation Trust (OUH), and the Oxfordshire Clinical Commissioning Group (OCCG), together with Oxfordshire County Council’s Director for Adult Services (OCC) will present for scrutiny Health & Social Care’s response to the outcomes of the recent CQC Local System Review and subsequent Action Plan (JHO7).

The Committee is RECOMMENDED to note the progress made and to provide any comments or observations that it believes may assist in assuring delivery of the agreed Action Plan.

The Committee considered a summary report (JHO7) by the Oxfordshire system leaders in relation to the CQC Local System Review. It summarised the outcome of the Review, its recommendations and the high – level Action Plan developed by system leaders in response to those recommendations, as well as setting out the proposed governance for ensuring the delivery of required actions. This Committee was asked to note the progress made and to provide any comments or observations that it may assist in assuring delivery of the agreed Action Plan.

The Committee welcomed the following representatives to the meeting:

-       Stuart Bell CBE, Chief Executive, Oxford Health Foundation Trust (OH);

-       Dr Tony Berendt, Medical Director, Oxford University Hospitals Foundation Trust (OUH);

-       Lou Patten, Chief Executive, Oxfordshire Clinical Commissioning Group (OCCG)

-       Kate Terroni – Director of Adult Services, Oxfordshire County Council (OCC).

Kate Terroni, in giving a presentation to Committee, began by giving a recap on the CQC’s approach to the review, which was to look at the Health and Social Care systems as a whole and how people and patients moved through the pathways. She stated that one of the main messages of the report was the absence of a single vision in Oxfordshire and the need to set clear strategies where it was required to avoid fragmentation and duplication.

She then gave an update on the actions included in the Action Plan, which, she stressed, were a very real opportunity to bring all the organisations together under one umbrella. To this end, the Oxfordshire Health & Wellbeing Board (HWBB) had agreed to call a special meeting on 10 May 2018 to consider a governance review of the Board which would formally pull together the efforts and powers of all organisations to give a much more unified view of the health and social care systems, which would be easier to scrutinise and hold to account. She stressed that the governance review would indicate that it would be a different way of moving forward.

The Chairman stated that the Committee would like to see actual results before it could be deemed successful and asked that this be borne in mind during the discussions.

Lou Patten stated that the aim of the Action Plan was to bring people together and to be as productive as possible in its delivery via the Integrated Care Delivery Board, which would be accountable for the areas of transformation. She added that an example of the new leadership was that of two assurance meetings which had taken place this year when NHS England and NHS Improvement had brought the entire system together in order to have a regulations conversation regarding performance. Going forward this very positive type of meeting would now be employed as a system. The aim was to empower the patients situated at the front end of the service line, rather than that of the organisation itself. An example of this was the focus on those patients who were in a hospital bed who did not need to be there. By focusing on gathering a group of ‘doers’ in a room to problem solve, they had started to create a ‘freeing up’ of the system which would assist with the patient flow. She further reported that a Winter Plan review had taken place which gave opportunities to learn externally. This would be brought to the next meeting of this Committee.

Kate Terroni also gave the following examples of ’mini’ teams comprising representatives from all organisations looking at capacity over the whole system and how to respond:

-       A single approach to target reporting;

-       A workforce group looking at commissioning; and

-       More joint posts, for example, a joint care homes commissioner

Lou Patten added that, as part of this new approach, future consultations would concentrate on developing spaces that brought together the social and health care needs for patients in each area of Oxfordshire.

Stuart Bell commented that there was also a need to ensure that Oxfordshire learned broadly from the experiences of other systems outside of Oxfordshire. He referred to the impetus given to giving a stronger central role to provider services within the HWBB. He also made reference to the challenges Oxfordshire was facing in recruitment and retaining staff and with the availability of housing. An important part of the local system review was to address how to make the best use of people already living in Oxfordshire. He pointed out some good work undertaken on ‘stranded’ patients, which would make a real difference to frail older people.

Questions, comments and issues from members of the Committee included the following:

-       With regards to transformation, the role of the community hospital needed to be brought to the fore to help address staff morale. Lou Patten stated that there was no sense in consulting on the buildings themselves, but on what was needed in each locality;

-       A member stressed the importance of using plain English;

-       In response to a request for more of a focus on where the innovation was in the system review, Kate Terroni responded that at this stage it was deemed helpful to focus on how to model health and social care differently and to the best advantage, such as the creation of Wellbeing Teams in each locality; or looking at care-worker routes to make them more effective; or looking at support from voluntary sector partners. She undertook to present what was innovative to a future meeting. Conversations were taking place with other authorities, for example with Shropshire and Frome. Lou Patten added that part of the process at the scoping stage was to look at what was happening elsewhere. This practice was being embedded as a thread throughout. The Chairman suggested that this Committee could focus on how innovation was being interpreted and used in the Oxfordshire system;

-       A member asked why the possibility of having an in-house, domiciliary care service was not mentioned in the Action Plan.  Lou Patten agreed that this would prove to be very effective. Kate Terroni reported that an options appraisal was currently being developed for a small, flexible health-care service. These were due for completion in June/July;

-       In response to a question asking why carers were not recognised in the report and asking if the Action Plan adequately tackled the shortfall in carers required, Kate Terroni stated that it was believed that 60k people provided informal care in Oxfordshire, and of those, 7k were known to OCC. In the recent past a decision had been taken for GPs to allocate carer’s grants as a single approach. Since then, carers had been offered the ability to self-assess their eligibility. She added that the value of carers was both enormous and essential and the question which needed to be asked was whether to support carers more;

-       A member commented that that a ‘stranded ‘patient was not a good term. Lou Patten responded that she had a sympathy with this comment but stated that it was a national term which was used to categorise patients in order to give a better understanding, a baseline for performance and information on any constraints within the system;

-       In response to a question about how far the organisations had gone in their work towards a vision to have a fully integrated health and social care system for the benefit of Oxfordshire residents, Kate Terroni stated that it was almost there. The vision was due to be considered at the 10 May 2018 special meeting of the HWBB for sign off. The next strategy was to look at where the systems were and where they needed to be.  Again, in response to a question as to whether all the organisations were acting differently in relation to this, Lou Patten stated that it was all about open and honest challenge. Conversations had taken place with all providers and commissioners;

-       It was the view of a Committee member that any innovation monies would be needed first in the communities, as community services needed to be improved before any beds are closed; and asking how this would be financed as to date there had been no mention of a pooled budgets? Lou Patten responded that funding for community health services for local patients were set by a funding formula. Oxfordshire was one of the lowest funded counties because it was seen as both healthy and wealthy in comparison to other areas. Discussion had indicated that £30m would be top sliced which meant that there would be a struggle to work with that sum reasonably. There would be a need to be as efficient as possible within the available resources. It was hoped that there would be more productivity and efficiencies within the overlap in service locations. Kate Terroni stated that one of the first pooled budgets for £350m was pooled across the OCCG and OCC (as referenced throughout the report). There was a challenge each year to make it more meaningful and each year there was important decision making made by people in joint posts;

-       In response to a question regarding what, in their view, was missing from the report, Kate Terroni stated that it was key worker housing. However, Cherwell DC and Oxford City were looking collectively at how this could be tackled. Stewart Bell added that OH and OUH were looking at sites in order to assist. He echoed the need to work with the district councils on affordable housing;

-       A member pointed out that more liaison was required with the district councils to ensure that they were bidding for sufficient housing. It had been shown as part of the Growth Deal that Oxford City Council had put in a claim for 98 affordable houses, Cherwell District Council for 82, South Oxfordshire District Council for 6 and Vale of White Horse for 6. Lou Patten undertook to take this up with the key providers across the system;

-       With reference to a question regarding IT capability, Kate Terroni stated that an IT person would be placed in an inter-operability function. There was also a need to look outside of Oxfordshire for ideas, for example, at how North East Lancashire had achieved the bulk of provision on the same IT system. Stuart Bell commented that progress was being made on the interactivity of GPs, Mental Health practitioners and with the communities;

-       In response to a question about how the system review would sit alongside DTOC statistics, Kate Terroni stated that this time a year ago the statistics sat at 180-200 as compared to 88 compared to that week which stood at 98. If one was to take the longer view, it was heading in the right direction;

-       With reference to a question about what principles system leaders would work together by, Lou Patten stated that would be governed by regulations and a set of working principles which would provide both a check and challenge to each other. There would be a tangibility about it. She reminded the Committee that this would not be the first time that leaders had gone through contracts together as previously they were NHS England assured. Stewart Bell stated that Lou Patten and himself were already doing it at Buckinghamshire – which proved it could be done;

-       In response to a view expressed by a Committee member that currently there were fewer health and social care providers, Kate Terroni stated that the fragility of the Health Care market could not be underplayed. She assured the Committee that officers would be acutely aware of the situation in the rest of the market when doing the appraisal. She added that the hourly rate was £19.40 per hour and, with the addition of more precept by the Better Care Fund, it was now set at £20.40. Since this had been set there had been no health care providers exiting the market. The option appraisal was currently being prepared – adding that there was a value in having a form of in-house provision;

-       A member expressed a view that there needed to be a significant culture change to make this venture work. Lou Patten responded that it was about knowing and understanding the motivation of clinicians, nurses, carers etc and then making it tangible and in the best interests of the patients. For example, clinicians had expressed a wish to take patient care out to place based locations and to work out the best solutions for their clients, such as frail people.

-       At the close of the discussion all were thanked for their attendance and for responding to questions.

Dr McWilliam reminded the Committee that this was a review that was specifically looking at social and health care systems working and it was the Committee’s decision as to whether it wanted to scrutinise the Health & Wellbeing Board’s efforts to look at it in its totality.

It was AGREED that:

(a)  a framework be provided to the Committee indicating how it was envisaged a framework would be provided and how each outcome would have a positive impact on users and carers; how it would be picked up by the Health & Wellbeing Board; and what the broad timing was for each expectation; and

(b)  this piece of work to include the following three distinctive areas which would be useful for this Committee to pick up:

-       what was the innovative aspect of each outcome;

-       how plans for housing and workforce were to be incorporated; and

-       how was Oxfordshire incorporating best practice from other areas in the plans.