Agenda item

11:20

 

Rachel Coney, Chief Executive of Healthwatch Oxfordshire (HWO) will give an update on recent projects (JHO9). Also attached at JHO9 is HWO’s report entitled ‘Improving Discharges from Hospital in Oxfordshire.’

Rachel Coney and Eddie Duller OBE, Chief Executive and Chairman, respectively, of Healthwatch Oxfordshire (HWO) attended to give an update on recent projects (JHO9). This included a report entitled ‘Improving Discharges from Hospital in Oxfordshire.’   

 

The Committee took the ‘Improving Discharges from Hospital in Oxfordshire’ report first, commenting that it was a ‘sound’ piece of work and welcoming the fact that 80% of those interviewed were satisfied with their discharge.  Eddie Duller introduced the report and handed over to Rachel Coney to respond to questions from the Committee.  Rachel Coney explained that there was a sample size of respondents, though they had exceeded their target for the number of people they had spoken to and HWO were delighted with the level of co-operation from the communities and from providers. Agreement to the methodology had been sought from the start.

 

A Committee member commented that he had been involved in a scrutiny review about DTOC (Delayed Transfers of Care) 9 years ago and one of the recommendations was that Social Care should have equal access to patient notes alongside the medical practitioners. Rachel Coney responded that great strides had since been made with the interaction between both parties, and clear plans and policies were now in place. There were only a few glitches in the system remaining and the report recommended some small changes which would assist with patient experience and care as they proceed through the discharge process.

 

Members asked if problems with the transport system had been raised and whether respondents had felt reticent about complaining in case there were consequences in relation to their care. Rachel Coney responded that these issues did not feature much in this particular project and the question of timing and manner of transport home and of complaints, were far more the subject of concern in the dignity report. 

 

With reference to the question of whether GP’s were told of the imminent discharge of their patients, Rachel Coney responded that GPs did like to be informed as they were responsible, alongside nursing staff, for the coordination of their patient’s care. She added that this was an issue to be taken up with the OCCG in due course.

 

Rachel Coney was asked why so many of the respondents wished to discuss their discharge from the JR Hospital, to which she replied that the majority of people who responded online wished to cite the OUHT facilities. She added that volunteers had talked also to patients in other hospitals and in the community hospitals. 

 

The Chairman then invited Paul Brennan, (speaking on behalf of OUHFT, OCCG and OCC) and Yvonne Taylor, Oxford Health, up to the table for their comments in relation to the report. In respect of Committee members’ queries, Paul Brennan made the following observations:

 

-       The electronic patient record could be operated online and was backed up every 30 minutes. Business continuity arrangements were in place should the system go down;

 

-       The hospital and social care were fully integrated, both parties had access to patient notes; and

 

-        Patients were not sent home without all parties knowing about it. Community Hospital Managers come into hospital to assess patients prior to their discharge;

 

In respect of the report itself, Mr Brennan commented that the representative organisations had some concerns about the way in which the report was structured, its use of data and about some of the recommendations relating to DTOC. He added that whilst they could not respond to the report recommendations at this stage they had agreed with Rachel Coney that they would sit down at a later date to go through the report in more detail and link the data analysis with the recommendations. He added that this could have been done earlier if organisations had had the opportunity for discussion prior to the report being published. There would have been no intention of influencing its findings.

 

Yvonne Taylor concurred with Paul Brennan’s comments. She added, in response to a member’s view that it was important to see the findings in the paper in a positive way, that OUHT spent a lot of time seeking information on patient views and their experience via feedback from the ‘Friends and Family’ test in order that necessary changes could be made across the whole system. Paul Brennan added that patient experience information was sought from all on discharge via a national patient questionnaire and this was was published annually.

 

Despite the report not relating to patient discharge delay, Paul Brennan informed the Committee that a piece of work had been completed which followed patient’s day to day causes of delay. Moreover, a detailed report was about to be produced on the findings and the issues involved. The Committee asked that it be brought to the next meeting in November.

 

A member of the Committee was of the view that a third party’s view on patient discharge experience had strength and therefore had value. She urged that the response to HWO’s report be made as speedily as possible. Paul Brennan responded that the organisations had only received the report three weeks ago, but would make the response as speedily as possible.

 

Members of the Committee were very supportive of the idea of the poster which linked up the responsibilities of the hospital, the pharmacy, GPs etc being reproduced in the form of a letter to be given to patients, friends and family at the point of admission. Paul Brennan was asked if equal attention could be given to the clinical end also. He responded that the NHS was in the process of transitioning to electronic patient’s records which could also contain an electronic information link to all parties.

 

Mr Brennan was also asked if there was a procedure in place so that patients were asked on admission what arrangement would be in place on discharge. He reported that there was work underway across social services and the communities looking at an ambulatory pathway. He added that it was not practical for all patients admitted to have an estimated date of discharge at the outset, as this would use a lot of hospital resource. Mr Brennan agreed however that there was a need to learn from HWO’s report and to focus on the areas in the report and recommendations that could make the biggest impact.

 

The Chairman thanked all for their attendance and, on behalf of the Committee looked forward to seeing the response to the report from all organisations at the next meeting.

 

The Committee then considered the HWO report JHO9 which, aside from their project on Hospital Discharges, included information on community hospitals, the Big Plan and feedback from the OCCG locality forum Chairs.

 

In respect of the Big Plan, which had been approved by OCC Cabinet on 17 March 2015 and by the OCCG on 27 March 2015, the Committee heard that since it had been approved, commissioners had been working through a number of suggestions and comments from people with learning disabilities, (both directly, and via Healthwatch Oxfordshire), their families, GPs and providers. The HWO report included a brief resume of the concerns raised with them.

 

Kate Terroni, Deputy Director of Joint Commissioning, then read out an agreed statement between OCC, OCCG, Southern Health and Oxford Health (a copy of which will be included with the signed papers) informing the Committee that the questions that had been raised were concerned with the pace of change and how the changes, as set out in the Big Plan, could be made in a safe and effective way. She added that this would need to work both for service users and the organisations and staff who provided them.

 

Kate Terroni announced that in light of the feedback received, it had been decided to review both the timetable and approach to the implementation of the Big Plan. She reported that:

 

1.    Oxfordshire Clinical Commissioning Group was in discussion with Oxford Health NHSFT with a view to becoming the preferred provider of future mainstreamed health services for people with learning disability.

 

2.    Oxfordshire Clinical Commissioning Group proposed to take over the contract with Southern Health NHSFT for the provision of health services for people with learning disability.  Subject to further current negotiations this would be achieved by 1 February 2016 and earlier if possible. The benefit of this change was that it would allow one commissioner to manage both the outgoing and future provider of health services for people with learning disability. In the short-term the people supported by the Southern Health service will be supported by the same teams who support them now and in the longer term this arrangement will help all parties manage the transition. The contract would be extended with Southern Health FT through until December 2017.

 

3.    Oxfordshire County Council has extended the Southern Health NHSFT contract to ensure that there was time for the clinical commissioning group and Southern Health to carry out their negotiations.

 

4.    Both Southern Health and Oxford Health had supported these discussions and had indicated their wish to support the safe, effective transition of health services for people with learning disability.

 

5.    Oxfordshire Clinical Commissioning Group and the County Council were setting up a Transition Board to oversee this process. This Board would have an independent chair from outside of Oxfordshire, dedicated programme support and an independent clinical adviser. The Board would have representatives from commissioners in the clinical commissioning group, the County Council and NHS England, together with Southern Health and Oxford Health and representatives would be invited from the Oxfordshire Learning Disability Partnership Board.

 

6.       The Board would report into Oxfordshire Clinical Commissioning Group’s Governing Body. The first meeting of the Board would approve its term of reference and the transition plan. This first meeting would take place in September 2015.

 

Rachel Coney welcomed the fact that the system had listened carefully to concerns and that focus had been between safety of transition and timeliness. She asked if there would be representation from ‘My Life, My Choice’ on the Board, to which Kate Terroni replied that there would be representation from voluntary organisations on the Board.

 

Members commented that this was a good example of a well-run, well - attended consultation that had effectively listened to public opinion, and which had led to a good set of recommendations.

 

The Committee were asked by Rachel Coney to address the motion submitted by Cllr Laura Price and agreed at the County Council, which had asked that:

 

‘in their role as commissioner, the OCCG lead on a full public consultation on the future shape of Oxfordshire’s Community Hospitals and that OCC fully engage with the process before further incremental changes damage the public’s relationship with these vital services.’

 

The Committee considered the view of HWO that it did not see how a consultation on sub-acute care could be carried out effectively without including intermediate care into the picture.

 

John Jackson commented that everybody agreed with the principle that the overall position should be considered, but it was important to look at the breadth of provision which is currently provided within the context of community hospital care and also acute hospital care. He added that the intention was that there should be an overall piece of work to try to map it all out. He warned against a fixation on bed - based care rather than the outcome, pointing out that bed - based care was often not the best care for people.

 

Following a discussion the Committee AGREED to:

 

(a)  note the report and recommendations by HWO;

 

(b)  consider the HWO Dignity Report (including transportation issues) at the next meeting of this Committee; and

 

(c)  with regard to the motion approved by Council on 8 September to request OCCG to conduct a full consultation on the future of community hospitals, to RECOMMEND that the consultation includes the future provision of community care services more broadly.