Agenda item

10:20

To provide an update (JHO6) on progress on the proposals for future services for the new hospital.

David Smith, Chief Executive, Oxfordshire Clinical Commissioning Group, will attend for this item.

Councillor Nimmo-Smith addressed the meeting emphasising that despite a number of meetings since the July 2015 meeting of this Committee, the Townlands Steering Group (TSG) was still not fully convinced that the intermediate care proposed was in the best long-term interests of the communities served by Townlands Hospital. He commented that he had joined the Committee visit to the Isis Care Home in Oxford and had seen the manner in which intermediate care, or recuperation, was delivered. However, whilst he was pleased by what he saw and with the discussions with staff, he was aware that the Henley model differed slightly.

Moreover, he wished to emphasise that the TSG wished to continue to work with OCCG in order to achieve the best possible medical pathway and provision for the Oxfordshire residents in the Townlands catchment area. He added that to this end members of the Committee had been sent a dossier containing the TSG proposals for combining an Emergency Multidisciplinary  Unit (EMU)with a bedded service. He added also that the key question was the manner in which the new model would be deployed and whether it would be successful for not; and that the TSG would like to assist in any way it could with this process in order to reassure the community that the new arrangements were at least as good as the existing ones. He stated also the TSG’s hope that the OCCG would continue to involve them in the process.

Cllr Nimmo-Smith also commented that TSG were pleased that the Royal Berkshire NHS Foundation Trust, Reading were working with the service commissioners to assess the impact of the bed model. However, the TSG had been informed that until that was concluded they remained concerned about the impact of the proposals on them.

He concluded by stating that the issues were about whether the change in the location of the beds would improve health outcomes for patients. Furthermore it was about whether it was possible to implement the change safely in the very short time which was left available.

The Committee had before them a paper by the OCCG (JHO6), the purpose of which was to provide the Committee with an update on progress on the proposals for the future services at Townlands Hospital, following the OCCG’s Governing Body meeting on 30 July 2015.

David Smith and Andrew Burnett of the OCCG were invited to introduce the report.

A member of the Committee asked if there had been attention given to acquiring the correct performance indicators that would inform on factors such as actual length of stay and readmissions, for example. Andrew Burnett responded that statistics would be evidence based and would be based on reablement beds and short-stay beds for patients assessed in the Rapid Access Care Unit (RACU).

Andrew Burnett was asked why it was proposed that care at Townlands Hospital be based on the RACU model rather than a combination of the RACU and EMU models. He explained that the RACU was based on a catchment area of 40 – 45k patients, in contrast to an EMU which would be based on 100k patients. However, many of the good elements of EMU care had been tuned into the provision at the RACU. Moreover, the RACU would not be just for older people’s care but would assist and provide medical advice for younger people also in terms of step up and step down care. He added that what was established would not be set in stone and would continue to be ‘tweaked’ in line with the commitment to improve the service.

Mr Burnett was asked about the costings and whether there would be savings made from the proposed changes. He responded that the proposal was to provide better value care for more patients together with more appropriate care.

With regard to issues raised about the quality of Orders of St. John (OSJ) versus NHS nursing care, Mr Burnett explained that this was a matter for OSJ but that the CCG would commission a certain level of care, adding that there were no grounds to say that there would be a lower standard of nurses working at Townlands.

A member of the Committee asked about the wider issue of delays for patients relying on community health care packages and how this would work in this context. David Smith informed the Committee that a resilience group comprising all organisations were meeting together to try to fix it.  He added that he had agreed with the Chairman of this Committee that he would bring a report to the next meeting which would cover the issues around community care that are seen in Oxfordshire, together with a process to go forward with.

A member asked if there would be sufficient home care commissioned to support patients. Andrew Burnett commented that it would be a challenge, and John Jackson had given his assurance that OCC would provide more packages. He added that one of the strengths of the RACU was that Social Care would be working much more closely with Health providers which would lead to a much more efficient system. John Jackson, Director of Adult Social Services was invited up to the table to respond. He explained that Oxfordshire was very much a victim of its own economic success which meant that there was a constant funding issue linked to recruitment as there was very little unemployment in Oxfordshire. OCC’s workforce strategy allowed employers to pay above minimum time and travel time.

A member asked if the move to OSJ would require a change to the current commissioning arrangements for intermediate care beds. David Smith replied that a pooled budget between OCC and the OCCG was in operation, adding that OCC had a contract with OSJ. Contractual discussions were ongoing, with efforts being made to get the right arrangements with OSJ. In response to a query about whether there were incentive payments to move patients out quickly, David Smith explained that there was a block contract in place and payment was not made on the basis of episodes of care, but on outcomes. He added that, in general, successful outcomes depended upon how the provider worked with the GPs and clinicians at the point of making the decisions around the patient. Therefore, it was clinical performance that provided the motivation for the movement of patients out of hospital – the driver being dictated by the conscious need for beds for other patients coming in. John Jackson added that there was a key emphasis on quality of care provided and the monitoring of this was being undertaken by expert therapists and by local GPs.

John Jackson and Jonathan McWilliam explained that Oxfordshire’s situation was challenging, complex and sometimes very confusing in terms of how to navigate the commissioners, providers and contract cycles. Members agreed that as a scrutiny committee there was a need to understand more fully expected outcomes of the monitoring and to have a clearer outlook on how relations between organisations was working, and future directions of travel, in order that the Committee could challenge the many issues which were prevalent in the communities in a more productive manner. David Smith offered to hold a workshop/seminar to take Committee members through all of the above.

In light of the above, it was AGREED to:

(a)  thank David Smith and Andrew Burnett for the report on proposals for future services at Townlands Hospital and to wish Townlands success; and

(b)  accept David Smith’s offer of a workshop/seminar encompassing the issues discussed above.