Agenda item

10:25

The Committee will examine Oxfordshire’s response to the winter pressures with specific focus on Accident & Emergency departments and delayed transfers of care. Representatives will attend to account for the response from their organisations (JHO6).

The Committee examined Oxfordshire’s management of the impact of winter by the Oxfordshire Healthcare system. A report prepared by Alison Edgington, Deputy Director for Delivery and Localities (Interim), Oxfordshire Clinical Commissioning Group, was before the Committee at JHO6.  Representatives from the following organisations attended and responded to a number of issues raised by members of the Committee:

·         Dr Barbara Batty and Alison Edgington – Oxfordshire Clinical Commissioning Group

·         Yvonne Taylor – Oxford Health

·         John Jackson – Oxfordshire County Council and Oxfordshire Clinical Commissioning Group

·         Paul Brennan – Oxfordshire University Hospitals NHS Trust

Alison Edgington, in her introduction, outlined various initiatives which had culminated from closer agency working between Health organisations within the County highlighting the following:

·         Additional patient transport to be provided by the South Central Ambulance service;

·         Meetings with counterparts in other counties to learn how to move patients from out of county to nearer their own homes;

·         Additional week-end support for patients.

In response to a question relating to the problems of access to GP and the detrimental effect this had on numbers attending Accident & Emergency departments, Alison Edgington commented that there were varying reasons for the increase such as more visits by the elderly who were suffering from more complex, more serious illnesses and who required instant treatment. Paul Brennan added that there was no evidence that the national increase in numbers was due to alcohol related problems or to people not being able to get appointments with their GP.

A member of the Committee asked if consideration had been given to a solution which could meet the heavy amount of resources required to carry out winter pressures work, such as the provision of additional beds in community hospitals, more patient transport etc. Alison Edgington responded that additional community hospital beds had been opened during the winter in response to demand. However, this focus on increased bed numbers was not sustainable due to available staff numbers. The CCG and County Council commissioners were currently looking at all aspects of spending via the Joint Older People’s budget , looking at how the system worked as a whole, finding out what worked best and what did not, and then thinking about how resources could be targeted as a result. A comprehensive plan had been developed and a plan which had pulled together services across the system in Health and Social Care. Plans and policies already in existence would be evaluated in 3 months’ time.

With regard to Delayed Transfers of Care (DTOC), a Committee member asked when the issues relating to capital in the various organisations would be addressed, and what the position was so far. Alison Edgington responded that previously the different organisations had worked separately, adding that DTOC was not an easy problem to solve in light of the many different factors involved. However, a large amount of learning had occurred over this last winter and there would be a transformation of the current system via the Better Care Fund Plan. John Jackson added that one big capacity issue to solve was that of the workforce in light of the low level of unemployment, the rural nature of Oxfordshire and people’s reluctance to travel longer journeys to work. Alison Edgington also cited problems in recruiting support care staff and domiciliary reablement type workforce. Adult Social Care had worked on various strategies to address this matter including that of ensuring a presence at employment fairs, giving career talks in schools etc. Paul Brennan added that the turnover of staff at OUHT was, on average, 13% but a figure of 8.5% - 9% was preferred. He cited the key issues for staff leaving was congestion on the roads, reluctance to travel distances to work, car parking at hospital sites and the higher cost of living in Oxfordshire.

In response to a question regarding the numbers of people not being seen within the 4 hour time frame in Accident & Emergency, particularly at the end of March 2015, Paul Brennan stated that statistics showed a continued increase in attendance figures and continued high levels of admissions. He added that there were certain spikes in attendance during the winter months. Moreover, colleagues working across all organisations were in the process of trying different approaches to ensure patient flow through the system was located in areas appropriate to their care. Dr Batty commented that GP surgeries were experiencing similar issues with managing demand and extra capital had been injected over the Christmas period in Banbury. She added that hopefully, the Prime Minister’s Challenge monies (£5.5m) would help to improve patient assessment and treatment and thus avoid admissions into hospital. John Jackson informed the Committee that Oxfordshire’s joint Health and Social Care proposals put forward for Pioneer funding had been unsuccessful.

The Chairman thanked all attendees for an optimistic and encouraging report.