Agenda and minutes

10:00

This is a joint item, to be attended by members of both the Adult Services and the Health Overview Scrutiny Committee.

John Dixon will lead a discussion on recent developments in addressing the problem of Delayed Transfers of Care (DTOC) in Oxfordshire. Officers from the ORH, Oxfordshire PCT and Oxford Health will be present and will contribute to the discussion.

The discussion will cover current performance trends and the plans being developed to tackle the problem.

Papers for this item will be attached and distributed prior to the meeting.

The Chairman welcomed the officers and presented the reasons for holding this joint meeting of the committees:

• To inform the committees of the reasons for delayed transfers
• To allow the committees to assess the seriousness of delayed transfers and gain an awareness of the priority being applied to resolving the problem
• To inform the committees of proposed actions to tackle the problem

Dr Steven Richards, Chairman of the Oxfordshire Clinical Commissioning Consortium, addressed the committee on behalf of the four organisations (Oxfordshire County Council, Oxfordshire PCT, the Oxford Radcliffe Hospitals Trust, and Oxford Health). He began by highlighting that more than 97% of patients in acute hospitals experience a smooth and high quality package of care. However the complexities of the system result in poor outcomes for a small minority. DTOC is now being given the highest possible priority.

Addressing system-wide complexities has been identified as the top priority for all four organisations in order to move patients more quickly through the system. Where previously the problem of delayed transfers had been approached independently by the four organisations, the establishment of the Acceptable Care for Everyone (ACE) programme from July has ensured senior commitment to a joined up approach.

A key step in the program is to map the flow of patients and finance through the system to ensure that people are receiving the right care for their level of need. The input of senior clinical staff will be crucial in understanding where changes in the process can and should be made.

John Dixon added that the problem of delays wasn’t primarily about the amount of money in the system but the way that money was used. He mentioned that a key development in improving outcomes and reducing delays will be the establishment of an out of hours emergency home care service. This will ensure that patients without acute needs avoid the need for hospital admissions. All decisions, he stressed, are being made in conjunction with health colleagues.

Sir Jonathan Michael, Chief Executive of the Oxford Radcliffe Hospitals Trust (ORH), assured the committee that the ORH is equally committed to working with others to solve the problem of delays. Addressing the question of clinical outcomes for delayed patients, he stated that long term hospital care can result in increased dependencies for patients and may lead to more severe social care needs in the future. Delayed transfers are also likely to reduce the capacity of the hospital service to respond to elective patients, resulting in outsourcing of operations and other procedures and increased cost to the ORH.

To alleviate short term pressures the ORH are diverting resources to run an enhanced discharge service; setting it up first in Oxford and then in Banbury. It is hoped that this will reduce delays and improve outcomes during the period of transition to the joined-up approach being developed through ACE.

David Bradley, Chief Operating Officer Oxford Health,  outlined the role played by Oxford Health in ensuring that patients receive care at home and in  ...  view the full minutes text for item 149/11

11:00

None

None

To approve the minutes of the meeting held on June 13^th 2011 (AS4) and to note for information any matters arising on them.

The minutes of the meeting held on June 13^th were agreed and signed.

None

11:15

Adrian Chant and Anita Higham will give an update on the Local Involvement Network.

A copy of the LINk newsletter for August 2011 is attached at (AS6).

Adrian Chant delivered an update on the Local Involvement Network. A copy of the report is attached (AS6).

The committee noted the positive developments in improving performance reporting, and stated that the feedback from care home visits was particularly welcome.

11:30

The Director for Social and Community Services will give an update on current local and national issues followed by an opportunity for the Committee to ask questions.

This will include discussion of the actions in place to reduce the number of adult social care clients using care homes, and progress on proposals for the Oxfordshire Care Partnership.

The Cabinet Member for Adult Services will also attend for this item.

The director gave a verbal update on developments at national and local levels. The content is summarised below.

National

Commission on the Funding of Care and Support

On 4th July, the Commission published its proposals for the funding of adult social care.  They would involve a very radical change in the funding of adult social care.  The key recommendations are as follows:

·         Individuals’ lifetime contributions towards their social care costs – which are currently potentially unlimited – should be capped.  After the cap is reached, individuals would be eligible for full state support.  This cap should be between £25,000 and £50,000. The Commission considered that £35,000 is the most appropriate and fair figure;

·         The means-tested threshold, above which people are liable for their full care costs, should be increased from £23,250 to £100,000;

·         National eligibility criteria and portable assessments should be introduced to ensure greater consistency; and

·         All those who enter adulthood with a care and support need should be eligible for free state support immediately rather than being subjected to a means test.

The Commission estimate that the cost of its proposals - based on a cap of £35,000 - would cost about £1.7 billion.

There was widespread support for the proposals. It is understood that the Department of Health is planning to carry out widespread consultation on the proposals during the autumn.  The response will be reflected in a White Paper on Adult Social Care which will be published next spring.

Andrew Dilnot will be invited to address the committee on the proposals and their potential impact on Oxfordshire. A presentation on the proposals is attached (AS7)

NHS Changes

·        The NHS has announced that SHAs would be clustered with one SHA covering the whole of southern England (from Cornwall to Kent).  Sir Ian Carruthers (current Chief Executive of the South West SHA) has been appointed as Chief Executive.  Geoff Harris, currently Chairman of South Central, has been appointed as Chairman.

·        Locally, Sonia Mills has announced that she is to step down from her role as Chief Executive of the Oxfordshire and Buckinghamshire Cluster PCT.  This will take place on 7^th November.  The PCT are in the process of finding a successor.

Local Developments

Southern Cross

·        The announcement was made on July 11^th 2011 that landlords were withdrawing from the Southern Cross group. Therefore the operation of Southern Cross homes will transfer to other care providers.

·        The County Council has been monitoring the situation through ADASS information, contact with other local authorities and regular meetings and telephone contact with Southern Cross managers.

·        The County Council is currently purchasing 105 beds out of the 225 beds in the 6 Southern Cross homes in Oxfordshire.  We understand that the landlord for two of the homes is NHP, that 3 are owned by PHF(Four Seasons) and the sixth by London & Oxford Estates. 

·        The latest information from Southern Cross is that transfer of its 752 care homes is underway and is expected to be complete by the end  ...  view the full minutes text for item 155/11

12:30

6 months on from the formal end of the programme in March, John Dixon, Deputy Director of Adult Social Care, will update the committee on progress made towards embedding the changes.

John Dixon gave a progress update on the transition to personalisation. The presentation is attached (AS8). The presentation covered the progress made on the number of people receiving personal budgets and the necessary next steps to embedding culture change as an organisation. Risk aversion in the assessment process was highlighted as a key barrier to improving outcomes for clients. Evidence was given showing a significant increase in customer satisfaction for clients in receipt of direct payments.

Members expressed concern regarding the quality of assessments if adherence to the quality assessment framework is reduced.

The Deputy Director assured the committee that the aim was to make the depth of the assessment process proportional to the level of need, as opposed to a reduction in quality across the board. There is currently an overemphasis on the assessment system due to its central importance to the rationing of resources. This will not be the case under the new model of care, leading to less bureaucracy and increased client satisfaction.

The committee noted the changes and proposed that the member-led TASC workgroup resume its function in assessing the transition to personalisation.

13:00

This item will include discussion of the Service and Resource planning meeting of the committee on December 15^th 2011.

The following items were put forward for the meeting of October 25^th:

·        Briefing on the experience of Sheltered Housing clients

·        Briefing on Continuing Healthcare

·        Presentation from Andrew Dilnot on the proposals outlined in the Commission on the Funding of Care and Support

·        Update on Delayed Transfers of Care

13:15

The meeting closed at 13:15