Agenda and minutes

Apologies were received from Moira Logie and Cllr Susanna Pressel.

There were no declarations of interest.

Clive Hill – Chipping Norton Action Group (CNAG) addressed the meeting in relation to Agenda Item 3 ‘Rebalancing the Health Social Care System in Oxfordshire’)

Mr Hill emphasised that he was not in any way criticising non-NHS nursing care but it was the view of the CNAG that if patients’ needs were to be better diagnosed, then nursing care would be better carried out at Chipping Norton Hospital by NHS nurses, who would be better placed to supervise.  He added that, from statistics put together by a local resident in Chipping Norton, it had become apparent that NHS nursing performance was significantly better than that of non NHS care. It would then follow that the NHS staffing and manager provision would be best qualified to reduce delayed transfers of care. In light of these statistics he requested that Chipping Norton Hospital retain its NHS nursing staff and managers until the countywide review of community hospitals had been completed. Furthermore, it was the view of the CNAG that Oxford Health had the scope to do the job at Chipping Norton Hospital and, if fairly costed, he believed that this would prove a better alternative. He pointed out that the hospital was ideally situated for this given its proximity to the GP Health Centre and the pharmacy which were on the same site.

Councillor James Mills addressed the meeting in relation to Agenda Item 3 – ‘Rebalancing the Health Social Care System in Oxfordshire.’

Cllr James Mills, Councillor for West Oxfordshire District Council and member for West Witney and Bampton, addressed the meeting in his capacity as a County Councillor. He commented that he was broadly in support of the information contained in the paper. He also commended a video on the Oxford University website as very useful in helping to promote understanding. He was keen to understand what made Delayed Transfers of Care (DToC) so urgent particularly as the issues were so long-standing in Oxfordshire. He stressed the importance of communication to the public in order to gain a greater understanding of the issues involved and he asked that information be provided to the public from the service providers at the earliest opportunity. He added that he had expected that the revised ‘HOSC Substantial Change’ Toolkit would be presented to the last scheduled meeting of the Committee for consideration, which had not happened.

The Chairman responded to Cllr Mills by stating that an explanation had been added to the Chairman’s report to the last meeting, which stated that officers were currently looking at best practice from Councils across the country and that the revised toolkit would be presented at the next scheduled meeting on 4 February 2016.

10:30

Paul Brennan, on behalf of the 4 System Chief Operating Officer’s from OUHFT, OH, OCCG and OCC), will provide the Committee with details regarding the implementation of rebalancing the health and social care system in Oxfordshire. In summary, the proposal is that they contract 150 Intermediate Care beds for 6-8 week period and then continue to contract 75 beds until equilibrium is attained with the aim of reducing Delayed Transfer Of Care. The Committee will seek details on the location of the beds, staff and key performance measures to allow for successful monitoring of the pilot scheme.

The Chairman welcomed the following representatives from the following organisations to the meeting:

-          Paul Brennan, Oxford University Hospitals Foundation Trust (OUHFT)

-          Stuart Bell MBE, Oxford Health Foundation Trust (OH)

-          Diane Hedges and Barbara Batty, Oxfordshire Clinical Commissioning Group (OCCG)

-          John Jackson, Oxfordshire County Council) & Oxfordshire Clinical Commissioning Group

The Committee was seeking more information about the proposal that the JR Hospital and others would contract 150 Intermediate Care beds for a 6 – 8 week period and then continue until equilibrium had been attained, to reduce Delayed Transfers of Care (DToC).  This was against a background of Oxfordshire’s health and social care system having the highest numbers of delayed transfers of care (DToC) in the country. At any one time around 150 patients, whose medical care was complete, had remained in hospital waiting to be discharged. A large number of patients needed some form of ongoing health and social care or rehabilitation in their own homes or nursing home care. Over the past few years a number of plans to reduce the number of DToCs had been developed, but these had not significantly reduced numbers. Whilst there had been improvements to many of the processes which caused the delays, the organisations involved believed that a radical plan was needed to change patient were discharge. The OCCG had offered to provide up to £2m in this financial year to enable patients to be discharged. This funding was a one-off injection of funding. Any ongoing financial implications of this plan would be addressed in the negotiation of contracts for 2016/17. The Committee had requested details on the location of beds, staff and key performance measures to allow for the successful monitoring of this pilot scheme.

Paul Brennan made a presentation giving the detail which had been requested by the Committee at its last meeting. A copy of the presentation was included on the Addenda for the meeting. Information requested included:

·         nursing home beds status

·         Detail on the Patient Transfer Programme

·         The purpose and function of the Liaison Hub

·         The role of the staff in the Liaison Hub

·         The Ward Release Programme

·         General Staffing Information

·         Key Indicators in use to support the programme

·         Potential Outcomes of the Programme

Paul Brennan gave an update from the Liaison Hub established on 7 December, stating that if the programme is successful, the number of patients delayed would fall from the current figure of 167 to approximately 30. By 31 March there was an expectation that there would be no patients delayed. He stressed that some of that number would still be in beds, but in nursing home beds. He reported that, to date, according to the tracking programme which had been put in place for each patient and the Ward Release Programme, 29 had already been transferred by 9 December and a further 18 people had gone home with support. 21 patients were being transferred on the day of the meeting. It was envisaged that 150 would be  ...  view the full minutes text for item 118/15

11:15

Oxfordshire, is currently in discussion with Government over a County devolution proposal and this has been discussed in Council and other public meetings over the last few weeks. One strand of the Oxfordshire proposal is specifically about health and wellbeing and proposes the benefits for the public of working more closely across all Oxfordshire’s health, social care and public health services, and linking these closely with community planning. This builds on the close strategic work between CCG and County Council, NHS England , District Councils and Healthwatch through the Health and Wellbeing Board over a number of years. It also builds on increasingly close working relationships between our major NHS Foundation Trusts.

This direction of travel has recently been supported and given impetus by the Chancellor in his Autumn statement which proposes the integration of NHS and Adult Social Care services across England by 2020. Because of the nature of the discussion with Government, this topic is progressing rapidly.  The views of the Health Overview and Scrutiny Committee will help shape the proposal and taking this work forward.

Oxfordshire was currently in discussion with the Government over a county-wide devolution proposal. This had been discussed in Oxfordshire County Council and other public meetings over the last few weeks. One strand of the proposal was specifically about health and wellbeing, and proposed the public benefits of working more closely across all Oxfordshire’s health, social care and public health services, and linking these closely with community planning. This built on the close strategic work between the Clinical Commissioning Group (OCCG), the County Council (OCC), NHS England, the District Councils and Healthwatch Oxfordshire through the Health & Wellbeing Board over a number of years. It also built on increasingly close working relationships between Oxfordshire’s major NHS Foundation Trusts.

This direction of travel had recently been supported and given impetus by the Chancellor in his Autumn Statement which proposed the integration of NHS and Adult Social Care services across England by 2020. Because of the nature of the discussion with Government, this topic was progressing rapidly. The views of this Committee were sought to help shape the proposals and take the work forward.

Dr Jonathan McWilliam gave a presentation which briefed the Committee on the current thinking behind the proposals made to Government. He emphasised that there had been no formal proposal made to Government, or local decision made on this subject. Dr McWilliam was accompanied by David Smith, Chief Executive, OCCG and Stuart Bell, Oxford Health NHS Foundation Trust (OH).

Dr McWilliam began by highlighting the problems with the current system which were:

·         System was very complex, making it hard for the user to use and causing confusion for all. It also made it difficult to scrutinise;

·         There were three decision – making systems, causing bureaucracy and duplication;

·         Financial Plans were mis-aligned (NHS being over a single year, OCC being over 3 - 5 years);

·         Value for money could be improved if there was a single plan;

·         There were long-standing issues arising from its complexity, such as DToC.

Dr McWilliam made the following points on how integration and devolution could help:

·         Although organisations had started to fix problems (integration of Health and OCC to the sum of £30m), devolution would help to finish the job by bringing together CCG, OCC, Health Trusts and NHS England services, eg Pharmacy, dentistry and specialised services;

·         3 - 5 year financial plans could be aligned;

·         local political and clinical leaders would be able to make decisions in one place – thus bringing local democratic aspects to the fore and making one accountable body;

·         Services would be easier to use and more easily accessed at a single point, and they would be commissioned in a unified way, via integrated commissioning. Delays would be reduced and duplication would be erased;

·         Devolution would improve the health and wellbeing and prosperity for the 670,000 residents of Oxfordshire. By 2020 there would be a decrease in mortality from, for example, heart disease and a reduction in health inequalities.

Dr McWilliam stated that talks had been held, or were to  ...  view the full minutes text for item 119/15