Agenda and minutes

Apologies were received on behalf of Councillor Anthony Gearing.

None

To approve the minutes of the meeting held on 8 March 2011 (AS3) and to note for information any matters arising on them.

The minutes for the meeting held on 8 March 2011 were agreed and signed.

116/11 Councillor Larry Sanders referred to the briefing on ‘continuing health care’ circulated to the committee by the Director for Social & Community Services.  It was AGREED that the briefing would be added to agenda for next meeting.  Nick Graham (check) to be invited for this item.

Sean Gibson reported that the record of attendance at meeting had been updated.

10.15

The Director for Social & Community Services will give a verbal update on key issues. The Cabinet Member for Adult Services will also attend for this item.

The Director for Social & Community Services gave an update on:

Interim Deputy Director, Adult Social Care

The Head of Adult Social Care, Paul Purnell, left his role in March 2011.  Given the current uncertainly surrounding the future of health and social care, it was considered sensible not to recruit a permanent replacement until direction of travel had firmed up.

With this in mind, John Dixon has been appointed as Interim Head of Adult Social Care.  John Jackson said that John Dixon is a person of great experience and knowledge in this area having been Director of Adult and Children’s Services at West Sussex for several years , and past President of the Association of Directors of Social Services.  He is expected to be in post for several months.

The Chairman noted that there is a high proportion of older people in West Sussex.  John Dixon agreed, and hoped that his experience in West Sussex would inform policy development in Oxfordshire.

Day Opportunities for Older People

On 16 November 2010 the Cabinet approved the implementation of the strategic commissioning framework to move to day opportunities for older people and carers within Oxfordshire.  The model is based on three tiers reflecting the range of universal services, specific support, and specialist social and health care provided to individuals and their carers:

1. Community Engagement
2. Community and low level support
3. Specialist Health & Wellbeing Resource Centres

Community Engagement:

The fund which allocated small scale grants for community-based options has been transferred to the Big Society Fund.

Community and low level support

Tier 2 is supported by voluntary sector, and includes important initiatives such as, for example, lunch clubs.  Existing contracts have been extended to September 2011.  As Tier 2 services will be decided at a local level, there will be a clear accountable process on allocating resources.  The way forward is to locality boards, an approved provider list, and a simplified procurement system.

Best practice is to work with providers in order that they are in the best position to complete.  As part of this support, a commissioning conference will be held in May 2011.  It was noted that Age Concern were a major provider in this area.

Regular monitoring of the performance of providers will be ensured with monthly reports being put in place.

Councillor Arash Fatemian (Cabinet Member for Adult Services) stressed the importance of simplifying the procurement process to reduce the burden placed on providers.  He added that the locality boards will include local Members, and that the committee will see detail proposals when ready.

Specialist Health & Wellbeing Resource Centres

Initially seven centres were proposed, but  eight have now been included.  This is due to the Wallingford centre successfully arguing to provide an overflow service which will only work if people are willing to use what is on offer.

Specialist Health & Wellbeing centres are likely to be run by larger organisations who have an understanding of complex procurement procedures.  Interest in running the centres has been shown by internal providers, Leonard Cheshire  ...  view the full minutes text for item 128/11

11.00

A verbal statement on the current position in respect of delayed transfers of care in Oxfordshire.  This is an update on the position reported in the paper that was discussed at the March meeting.  The item will be presented by John Dixon (Deputy Director, Adult Social Care).  Alan Sinclair (Assistant Head of Adult Social Care for Older People and Physical Disability Services) and the Cabinet Member for Adult Services will also be present to answer any questions raised. 

The Chairman began this item by referring to the recent news reports which argue that the issue of ‘bed blocking’ was getting worse due to the social care element.

John Dixon responded by stating that Oxfordshire’s approach to this issue is similar to that of other areas, and that improvement can only be achieved by NHS, voluntary sector, families and the council working together.  He stressed that Oxfordshire has all the ingredients in place to make a positive impact, and that the media reports are wrong.

Commenting on the medium term strategy to address Delayed Transfers of Care (Adult Services Scrutiny Committee meeting, 8 March 2011, item 7, para 13), John Dixon emphasised the importance of keeping the process simple so everyone knows how it works, and the need to further develop pooled budgets (especially for older people services).

He added that it is vital to have reliable and timely data, and acknowledged that there are some delays in reporting data, but that the recent trend is downwards though remains well above a satisfactory level.  Analysis shows that the there are a number of pinch points in the process, and understanding the whole pathway is crucial in dealing with these pinch points, that is; the lead up to a hospital referral, the hospital experience and leaving hospital.

Discussion by members highlighted the importance of reablement working effectively, and the recognition that DTOC is more a managerial issue than financial.  The financial aspect of delays on a person’s quality of care should not be underestimated, but for the process to work smoothly requires good management.

Cllr Peter Skolar said that HOSC should be asked to consider the aspect of how consultants decide on when  a patient is to leave hospital.

A vote was taken on the Chairman’s proposal to inform Cabinet that: ‘The financial basis for delayed transfers of care is adequate, any improvement will depend on the efficiency and effectiveness of the different organisations working together’.

8 voted in favour, 1 against.

11.30

Contact Officers: Jon Ray, Senior Project Manager and Rachel Lawrence, Service Manager, Promoting Independence and Prevention.

A report on the Turnaround Project is attached at AS6. The item will be presented by John Dixon (Deputy Director, Adult Social Care).

The Committee is invited to conduct a question and answer session on the Turnaround Project.

John Dixon (Acting Head of Adult Social Care) reported on the progress of the Turnaround Project.  He stressed that it is key to the improvement of Delayed Transfers of Care (DTOC), but highlighted the difficulty in identifying those who are at risk of being overly dependent on Adult Social Care services.

The aim would be to provide support to people at the beginning rather when they have fallen into difficulties.  Like DTOC this would require an understanding of the whole system in order to target intervention effectively.

The Chairman was concerned that the project may be considered a ‘nice to have’ rather than an essential service which could be vulnerable if budget is under threat.

12.00

Contact Officer: Varsha Raja (Assistant Head of Adult Services)

Attached at AS7a is copy of the minute on this item from the meeting on 7 December 2010 and at AS7b a report giving an update and details of the current position in relation to the local implementation of this strategy. Ms Varsha Raja and Ms Suzanne Jones will be present to answer any questions.

Varsha Raja (Assistant Head of Adult Services) and Suzanne Jones (Senior Commissioning Manager Older people, Directorates of Service Redesign – Oxfordshire PCT) reported on progress in

• Quality care in the community
• Improved dementia care in general hospital
• Early diagnosis for dementia and intervention in the community
• Community support

The Chairman asked about GPs handling of dementia patients, and noted the reluctance of individuals and families to admit to issues of dementia.  During discussion of these points, Cllr Larry Sanders asked about the quality of memory assessment.

Varsha Raja explained that the introduction of Dementia Advisers in surgeries is helping with these matters, as well as raising awareness of dementia in general.  Suzanne Jones added that early diagnosis and intervention was key to improving the care package for patients.

Councillor Anda Fitzgerald-O’Conner referred to reduction in the use of anti-psychotic medication noted in the report and asked how this is being managed.  The Chairman suggested that training for carers to help with this, and Varsha Raja thought that this could be achieved via GP surgeries.

12.30

The Committee is invited to receive the update from the Oxfordshire LINk as at (AS8a). Adrian Chant (Locality Manager) and Dermot Roaf (Chair of LINk Stewardship Group) will be present to answer any questions on the report.

A document is attached as at (AS8b)which promotes the work being carried out by the recipients of the Community Chest/‘Have a Say’ Fund 2010 grants.

Adrian Chant (Locality Manager, Oxfordshire  LINk) and Anita Higham (member of Stewardship Group, Oxfordshire LINk) reported.

Dermot Roaf (Chair, Stewardship Group) would not be attending as noted in agenda.

Adrian Chant reported that Oxfordshire LINK will be located under the aegis of the Oxfordshire Rural Communities Council (ORCC) at its offices in Cassington with all current staff transferring to ORCC.  There is an on-going review of finances and there may be some redundancies due to the transfer, but service continuity will not be affected.

Anita Higham (Board member ) spoke about recent projects Oxfordshire  LINk has been running:

‘Have a Say’ which she said is quite constructive in assessing the quality and access to food and drink in hospitals.  It is intended to undertake some work on the patients experiences of the quality of leaving hospital.

A report is expected in June of the work into reaching out to Black and Ethnic Minority groups in order to collect views of using health services.

Anita reported that Oxfordshire LINk intends to apply to be a HealthWatch England pathfinder in order to be in at the start of the new initiative.  This would put the local LINk in a strong position.  It was noted that Aniata Higham is the South East LINks representative on the department Of health’s Advisory Board in regard to the establishment of HealthWatch England.

Councillor Larry Sanders referred to the point on the quality of food, and reminded the committee that a major project was undertaken in 1999/99 in community hospitals.

12.45

The Committee is asked to suggest items from the current Forward Plan on which it may wish to have an opportunity to offer advice to the Cabinet before any decision is taken, together with details of what it thinks could be achieved by looking at any items.

13.00