Agenda item

2:55

50 mins

Person(s) Responsible:       The Oxfordshire Health & Wellbeing Board

Reports presented by:          The Director of Social and Community Services, Chief Clinical Officer, OCCG, Locality Clinical Director, OCCG

At the last meeting there was a themed discussion on the subject of Frail Old People. This joint paper, submitted by the John Jackson, Director for Social & Community Services, Dr Stephen Richards, Chief Clinical Officer, OCCG and Dr. Joe McManners, Locality Clinical Director, OCCG, identifies proposed actions to be taken in response to the discussion and continuing performance issues.

A background paper submitted by the Director for Social & Community Services is attached at HWB9.

Action Required: The Board is asked to endorse the draft action plan and agree to wider discussion with NHS providers, GP localities and representatives of older people and carers.

The Board were asked to endorse a covering report and draft Action Plan (HWB9) which related closely to several of the adults’ indicators in the joint Health & Wellbeing Strategy, in particular around delayed transfers of care, reablement services and admission to care homes (indicators 6.1, 6.2 and 6.4). The Action Plan was prepared in response to the Themed Discussion on Frail Older People item of business at the last meeting, and also in response to continuing performance issues. The Plan focused on immediate priorities (by March 2013) as well as longer term actions that would link closely to action plans for the joint Health & Social Care older people’s commissioning strategy, due for completion by April 2013.

Dr Richards commented that much work was in progress to deliver a discharge pathway, covering a broad spectrum of activity. Some of this work had been escalated in order to deliver a reduction in delayed transfers of care. John Jackson endorsed this pointing out that an agreement with the Oxfordshire Clinical Commissioning Group had been reached on a Discharge Policy. Feedback on the Plan had been given by Age UK and the Older People’s Panel and all that was required was a discussion with Oxfordshire Health and Oxford University Radcliffe NHS Trust.

The Board gave the following responses:

·        It was a good Plan with a multiplicity of initiatives, giving greater accountability and more of a sense of what the priorities were. It was hoped that it would initiate proactive activity which would, in turn, lead to greater efficiency;

·        It was imperative that all organisations work together in a coordinated and integrated manner ie. a single multi-disciplinary team to be in place to make the discharge and following this, a single point of access team to plan and co-ordinate services. Assessments to be undertaken at home following discharge. A monitoring group to be formed to ensure that the outcomes are good, together with a number of indicators to be recognised by commissioners within the public domain;

·        It is necessary for information to be in the system as a whole for GP’s to access;

·        The reality was that the numbers of older people would increase, but the public purse would be tighter. However, locally progress had already been made to implement the recommendations in the Director of Public Health’s Annual Report for more Plans to be joint and commissioners more united;

·        The three areas to be focussed on were firstly, the integration of clinical and social care teams; secondly, the prevention agenda; and thirdly, the need to give constructive help to villages and communities in order for them to help themselves. There is a requirement for more supporting volunteers and, in turn, for volunteers and carers to be supported in a more co-ordinated way;

·        There was still a need to keep the agreed shared finances in an uncomplicated, formalised pooled budget as part of the approach to outcomes based commissioning;

·        More liaison between the GP Locality Leads and the District Councils was required, in light of  the latter’s involvement with the Public Health portfolio and their contact with the voluntary sector; and

·        There was a need for a county wide specialist money management advice service to be provided for individuals managing their own care.

Following a lengthy debate, it was RESOLVED to endorse the draft Action Plan and to agree to wider discussion with NHS providers, GP localities and representatives of older people and carers.