Agenda item

10:20

80 Minutes

Following the local CQC system review of Oxfordshire, which took place in November 2017, the CQC re-visited the system one year later in November 2018 to look at progress against the submitted action plan that was developed in response to the findings.

Attached at HWB6 is the full report of the progress review from the CQC for presentation to the Board.

At the conclusion of their presentation the Inspectors briefly summarised their findings as a significant amount of work had been done, but there was more to do. This, they could say with confidence, would be conducted with the same strong commitment already shown. The Board was advised not to place too much emphasis on chasing the performance indicators, but to embed good practice which would in turn deliver good performance.

The Chairman thanked the CQC inspectors for their presentation stating that the review had given the Board some welcome impetus and challenge. He pointed out that he had visited the John Radcliffe Hospital to observe how the teams were working and was impressed by the lack of demarcation between Health and Social Services.

Stuart Bell added his agreement with the helpful advice given by the CQC which was not to become too led by performance indicators. Using the example of DToC, he commented that there was a need to think more about the need to focus on hospital avoidance, adding that progress had been made on this. The CQC’s first report had been very helpful in advocating this. Ann Ford commented that a solution to problems such as DToC was to tackle the broader symptoms, rather than the performance indicators. However, it had to be said that performance indicators were important and served to inform the conversation. A longer, more strategic outcome - focused approach was more beneficial.

Kate Terroni thanked the CQC for a very balanced report which had given recognition to the progress made. However, she expressed her surprise that the CQC had challenged the pace of the review, stating that there had been a keenness on the part of the Board to do things correctly and in the right order, which, in all, had taken some time. Deanna Westwood stated that the Board’s whole ‘joint vision’ approach had been very helpful and showed shared endeavour. Indeed, the CQC would like to see this approach to be rolled out across the country.

A member of the Board asked how to embed the changes across the whole of the workforce, asking also for examples of systems which had successfully changed. Deanna Westwood, in her reply,  recognised that this was also the biggest challenge for Stoke – on – Trent, which was one of the other authorities reviewed. During the review, the CQC had seen relationships much repaired, and collaborative working in place across the system. Top leaders at Stoke had empowered staff to get engaged and run with the changes, so that they could personally identify the wins and thus believe in the vision and make it their own. At management level there was clear, visible leadership and good strategic direction. Louise Patten added that this gave her a cross-cutting challenge and was key learning for her – as it was for all staff. The key issue was how the Board could keep hold of the methods used. In response to this, Ann Ford undertook to share any methodology which the CQC had utilised, for example, relational audit, key lines of enquiry and reduced data set. She suggested that this could be used with peers in order to give a good indication of the direction of travel.

The Stakeholder Reference Group had been formed as a key mechanism for other groups to have their say in the work of the Health and Wellbeing Board.

The Chairman added his recognition of the importance of working with district council colleagues on housing for the workforce, which was a primary issue facing the system. There was considerable discussion by the Board in relation to housing issues and a number of issues raised. There were as follows:

-       There were very ambitious targets associated with the number of housing to be delivered by 2031 and it was important to ensure that some developments contained homes which were designed as homes for life. Extra care housing appeared to be seen often as an ‘extra’ to the economy. There was a call amongst members of the Board for the process to be integrated to ensure residents had the best quality facilities. Affordable housing set the scene for a caring Oxfordshire. A member called for a joint approach from decision -makers around the Board table to follow Cherwell District Council’s bid to endeavour to influence developers. It was recognised that the biggest challenge was money and how to spend it in relation to the engagement in and delivery of front-line services;

-       It was pointed out that there was a need to make affordable housing available to workers already living in Oxfordshire to ensure opportunities were available for Health and Social Care employees. There were many jobs unfortunately being lost in retail which could afford opportunities for a change of career in Health and Social Care;

-       A member pointed out that there was a need to take a step back and reassess the district councils’ approach to the green belt and make a step change in policy approach. There were signs of a less stringent approach to this, which would open up opportunities for housing; and

-       A member of the Board wondered if the Board ought to be lobbying for Oxford weighting on salaries.

Yvonne Rees commented that being a recent appointment, she had arrived into a system which was both collaborative and which put patients and residents at the heart of the issue. She added that, together with partners,  there was the ability now for the Board to take it to the next level. She added that the Board recognised the need to push forward. Stoke was exactly where Oxfordshire needed to be in terms of aspirational leadership and visibility.

The Chairman concluded the meeting by thanking Deanna Westwood, Ann Ford and Nick Warren for attending and for their very valuable presentation and looked forward to a further review of where Oxfordshire had got to next summer.