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.
Minutes:
The Chairman welcomed the officers and presented the reasons for holding this joint meeting of the committees:
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 the community, and highlighted the success of a pilot ‘hospital at home’ programme carried out in Southern Oxfordshire. Funding is in place to extend the pilot across Oxfordshire and effective integration will depend on the holistic assessment of appropriate care pathways being carried out under the ACE programme.
Reference was also made to the development of an emergency reablement service that will provide initial concentrated support to patients when they come out of hospital.
Committee members were then invited to comment and ask questions on the presentations. Further key points arising are addressed below:
· Why are the figures for delayed transfers of care in Oxfordshire so poor relative to other authorities?
A number of factors contribute to Oxfordshire’s comparatively poor ranking. Counties tend to rank lower than urban authorities and Oxfordshire has a high number of community hospitals compared to other counties, meaning there are a higher number of NHS beds in which delays could take place. Furthermore it is believed that the practice of recording delays varies among authorities making comparisons somewhat unreliable.
· Is the pooled budget working as effectively as it should?
The complexities of running a pooled budget were outlined. A key workstream of the programme related to understanding the flow of money and the incentives/disincentives created at key junctures. Work is underway to improve the functioning of the pooled budget.
Lessons will be learned from what has happened in the past and better ways of doing things will be developed. For example, it was recognised that they had not been good at getting people into the right care stream in the past and that is an issue that is being addressed.
Communications had not been good and pathways have been too complex. Work is being done to improve matters and change is taking place now.
· Does the need for joined up working call for an extension of powers for the Health and Wellbeing Board?
Steven Richards stated that improvements were achievable through the ACE programme and that this was the current priority. However, it is likely that the proposed Health and Wellbeing Board will play a prominent role in the future.
The committees NOTED the positive developments underway in tackling the problem and AGREED to revisit the issue at a joint meeting of the committees in six months’ time to assess progress being made against the program’s aims.
The Adult Services Committee will revisit the issue at the next meeting.