10.30
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Background Information: |
The Transforming Community
Services (TCS) Policy was launched by the Department of Health in January
2009 to strengthen PCT capabilities in delivering community services. It aims
to enable transformational change and support the provision of high quality
care which is responsive to local patients and communities. |
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Along with all other PCTs,
NHS Oxfordshire has been charged with transforming the commissioning of
services in line with World Class Commissioning (WCC) criteria and assuring
that organisational arrangements are fit for purpose. This comprises a wholesale review of community
services and high level market analysis, together with PCT Board decision on
the most appropriate options for future organisational form for its Provider.
The attached paper will be presented by Catherine Mountford,
Director of Standards and Quality at the PCT. It summarises work completed to
date and outlines the PCTs vision for the
transformational change of Community services. |
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Why has it been
included? |
The
Committee is requested to consider the attached paper (JHO8) and provide comment that can be reported back to the PCT
Board at their next meeting on 30th October 2009. |
Minutes:
The Transforming Community Services Policy had been launched by the Department of Health in January 2009 in order to strengthen PCT capabilities in delivering community services. It aimed to enable transformational change and support the provision of high quality care which was responsive to local patients and communities. Along with all other PCTs, NHS Oxfordshire had been charged with transforming the commissioning of services in line with World Class Commissioning criteria and assuring that organisational arrangements were fit for purpose. This comprised a wholesale review of community services and high level market analysis, together with a PCT Board decision on the most appropriate options for future organisational form for its provider.
A paper was before the Committee (JHO8), which was presented by Catherine Mountford, Director of Strategy & Quality, Oxfordshire PCT and Geoff Rowbotham, Managing Director of Community Hospitals, Oxfordshire.
Mr Rowbotham commented that the internal processes were about separating out the Community Hospitals Oxfordshire (CHO) strand from within the PCT. This process of change had been part of their focus over the past six months. It was designed to ensure that, as an organisation they could respond in an innovative way to allow challenge to be made more openly. He added that this would work as long as they worked in partnership with other providers. CHO coordinated a plethora of services within the community, which was a key part of its success. In reality, CHO was a separate entity, although legally it belonged within the PCT. It had its own Board, its own financial accounts and its own sense of direction. He added that there was a recognised need to get back to basics with the provision of community based health care. Over the next 6/9 months CHO would be looking at key core services such as district nursing to see how they might be driven forward, in partnership with key partners.
Members of the Committee asked a number of questions, some of which are included below:
Q Much of Oxfordshire is rural - will there be sufficient funding to allow district nurses to travel between patients? Where will you recruit from and has the Council got sufficient funding in place to enable it to happen?
R (GR) CHO has the funding and can decide which areas it wishes to spend on. Mr Rowbotham stated that he had had a number of meetings with district nurses to hear their views. He added that Oxfordshire had an ageing profile with regard to district nursing staff and this needed a response and a strategy. At the moment the district nurses saw themselves ‘in limbo’, but there were exciting opportunities for the service.
Q Will the services be in place at the right time? Are there sufficient resources in place? How will we find out whether patients are satisfied?
R (CM) From a community point of view we have worked with the patients, public, CHO, ORH etc. We have got to get a lot better at checking patient experience ourselves or via our providers to ensure that we act on what is not working. We have done a technical ‘unbundling’ of the tariff to ensure that part of the money goes to CHO to run the services.
GR added that it had been demonstrated by the beneficial changes made to Stroke services within the county that communication can be handled well. It is also a very good example of what can be done, quickly and effectively. The patients and public will quickly see significant benefits – there are good examples already emerging. With regard to feedback on our services, the commissioners are doing it and we also do our own surveys. We also meet with the public regularly in order to monitor what they are saying – as well as taking analytical data .
Q Are you
asking people what they want? Are you, for example, linking with colleagues in
the Oxfordshire LINk?
R (GR) We do ask and we do listen. As a result we are opening an interim community hospital in Oxford. In the meantime we are asking for representatives to input, discuss, and get actively involved in the decision making.
Q If the
public say that 20 beds at Oxcomm are not sufficient,
will you give them 28?
R (GR) If a case is made for 28 beds then we will respond. We need to manage the whole bed base across the whole of Oxfordshire. Wherever we can put local patients in a hospital local to them, we will, but we cannot always guarantee it. At the moment our work indicates that 20 beds at Oxcomm is a sufficient number. If this proves to be wrong we will have to respond to it.
(CM) We are asking what is important to the public in accordance with national guidance about where the PCT should be focussed. We continue to have open conversations with the public, asking what is important to them, how it should be done and how they ought to be delivered.
Q Will you be able to satisfy public expectation? It could be that you will bot be able to afford everything?
R (GR) There is no spare money. Like Social Care we have a very challenging efficiency programme this year. We have the ability, now that we are a separate organisation, to respond to the community agenda and make our allocations appropriately. This is a very challenging period in that we have to help the public to understand that we have choices to make and get their backing for those choices. If we, for example, decide that we are going to drive more effective district nursing services, something else will have to give.
(CM) We recognise that, In order to make the best use of the £800m, it will be necessary to work together with the main providers and the public. For example, there is to be a seminar next week with partners, including the Chairman and officer of this Committee, to focus on this very issue.
Q How are
these arrangements an improvement?
R (CM) There is now a contractual relationship in place. CHO have their own funding, and this cannot be taken away for other projects.
(GR) This would certainly show significant benefit to any organisational change. The question as to whether it would give a better basis for the provision of better services – this has not yet been proven.
Q How do you
propose to link in with the providers of the Mental Health services, given that
it is often not obvious that people have mental health problems?
R (CM) We have, as commissioners, strategic goals in this area for the next 5 years, significant parts of which will be jointly led by the PCT, the County Council and a Mental Health Strategy. The providers already work closely with the mental health services.. The PCT are doing a significant amount of work in developing community Mental Health services.
(GR) There are three areas where we will be working with the Mental Health Care Trust; Huntercombe Prison, the homeless centre and the PCAMS service.
(CM) There is significant input from the Community Psychiatric Nurses into the Intermediate Care Team in terms of the provision of support to people with mental health problems and to people with dementia.
Q (To GR) How
do you see your style in the future in view of the CHO separation?
R One of the current debates has been about its future form. A paper is going next week to the PCT Board to discuss what form it can take and the next steps. It is crucial we involve the public in the debate.
Q How many
district nurses will you need?
R (GR) 200 at the moment. We need to look at what the retirement rate is and what role we want them to perform in a new healthcare market which is community based.
Q What
monitoring arrangements have you made to ensure that all the services will be
joined up?
R (CM) There are no separate conversations - the providers are coming together to say that they will be able to deliver a particular service. The Partners know how best they will be able to deliver a service – they want to engage with one service called ‘NHS’.
Q Now that
you are set up as a separate organisation, are you anticipating any extra
costs? Will you, for example, be setting up administration which might
otherwise have been used for service provision?
R (GR) There are additional costs and we are aware of it. We have to demonstrate that we can provide a more efficient community health service and that the benefits outweigh the cost. CHO is very outcomes focussed , we do not see it as a cost, but as an investment.
Following a full discussion and question and answer session, the Committee thanked Catherine Mountford and Geoff Rowbotham for their attendance and for making themselves available for the question and answer session.
The Committee were pleased to learn that the NHS would respond to a case made for additional beds to be provided in Oxford, should it be deemed necessary in the future; and also that there was sufficient funding ring-fenced for CHO to carry the plans forward for Oxfordshire as a whole.
Members also stressed the importance of ongoing formal and informal consultation with this Committee, and other parties, at each phase of the project.