Agenda item

10:40

Representatives from the Transformation Board including David Smith, Chief Executive, Oxfordshire Clinical Commissioning Group, and colleagues from Oxford University Hospitals NHS Foundation Trust, Oxford Health and Oxfordshire County Council will give a presentation on progress in respect of the emerging system-wide plans for transformation of the way in which Oxfordshire’s health and social care will be delivered to address population growth, demographic demands and pressures on available resources now and in future years (JHO6).

The Committee are invited to comment on the proposed approach and emerging vision.

Stuart Bell MBE, Chief Executive, Oxford Health NHS Foundation Trust, gave a powerpoint presentation on progress in relation to the emerging system-wide plans for transformation of future delivery of Oxfordshire’s health and social care. The plans would address population growth, demographic demands and pressures on available resources for now and in future years (JHO6). Mr Bell was accompanied for this item by Dr Bruno Holthof, Chief Executive, Oxford University Hospitals Foundation Trust (OUHFT), Dr Joe McManners, Chair, Oxfordshire Clinical Commissioning Group (OCCG) and John Jackson, Director for Adult Social Services (Oxfordshire County Council) (OCC)) and Director of Strategy & Transformation, Oxfordshire Clinical Commissioning Group (OCCG)).

The Chairman thanked Stuart Bell for the presentation and invited questions from the Committee.

A member asked for assurance that the correct number of properly trained care workers would be available at the right time in order to meet the requirements of the Plan. Dr McManners responded that there were various initiatives coming from Government that might prove helpful relating to recruitment and retention in primary care. He commented also that the high cost of living and the house prices in the region were an obstacle. Dr McManners explained that the new models of care were crucial to the ways in which GP practices were being, and would be organised, adding that more resource for prevention would hopefully lead to more care in the community. He commented also that the high cost of living and the house prices in the region was an obstacle.

John Jackson stated that new providers of social care would have to be registered with the Care Quality Commission, adding that there was also a need to ensure organisations were well managed and staff well trained. Work on a workforce strategy had been undertaken, some of it resourced by Health Education England. Values based recruitment was also a factor, for example, looking for potential candidates who would gain the most satisfaction from the nature of the work. He added also that there had been changes to the national living wage which would increase pay in the care sector, but this could be a problem if workers chose to go to work in other sectors.

A member expressed concern about the possible increased risks for the field of domiciliary home care, suggesting that people liked to be reassured that there would not be a large scale shift in public sector providers. Stuart Bell responded that this was not emerging as a problem, but a feature that was being communicated strongly was the value of partnerships operating the system together as one team, such as the acute sector and the voluntary sector working together with GPs in the localities. There had been no assumption made that a large proportion of the care would shift to the independent sector.

A member commented that the proposals were being set against the challenge of the possible removal of gateways as part of the budget cuts, such as cuts to children’s centres. Stuart Bell agreed, saying that health funding had historically enjoyed more protection than that of social care.He also suggested that it would be a collective responsibility to understand the pressures on the system and to make the best possible use of resources. John Jackson added that the procurement of care in the community had increasingly been dominated by non – state provision in recent times. However, it was crucial for people to understand that the amount spent on ‘Not for Profit’ care was the same as was paid for private companies to do the same work.

A committee member stressed that residents were anxious about a possible loss of control of their very much valued NHS services. Dr McManners explained that the proposals were about the integration of existing NHS services and operating all as a single system in its entirety alongside equal partners, rather than bringing in other providers. He added that ultimately the OCCG would be responding to the OCC budget savings options and their impact. Stuart Bell commented that the ultimate aim of the programme was not to get the cheapest services, but it was about operating the most capable and sustainable services.

Members were concerned that the Plans were not routed in reality, given, for example, the existing length of the waiting list for non - urgent mental health cases which were classed as preventative.  Stuart Bell pointed out that the plans were not a detailed description and organisations were only at the early stage of engaging with people on how they may respond to current problems.  They had endeavoured to look at the good evidence in the places where proposals were currently working. For example, they were in discussion with Buckinghamshire County Council CAMHS commissioners who, in partnership with Dr Barnado’s, were running an early prevention programme. Dr McManners added that the key here was to receive upfront investment in order that the preventative process could take place. The Prime Minister’s Challenge Fund had allowed this to take place but it had been piecemeal.

A member commented on the growing pressure on hospitals and GPs to cope with the expanding population and housing growth in Oxfordshire. Stuart Bell explained that he had met with the District Council Chief Executives to explore better ways of addressing these issues and the issue of key workers had come up during discussions. He added that there had been a number of issues which had been considered by the Transformation Board on different areas which had involved GPs as care providers. The Chairman reminded members that this Committee had raised the question of the provision of primary care in new housing developments and had asked that the NHS be included in infrastructure strategy.

A member of the Committee asked how an ongoing commitment to public engagement with local communities would fit into the Commissioning Intentions for 2016/17 so that both could be achieved in the short and long term vision. John Jackson stated that it would take time for work with the providers to take place, reiterating that it would be beneficial to receive the funding early on. He added that the OCCG was waiting to hear how much the transition funding would be for Oxfordshire.

A member commented that he was pleased to read of the ambition to move patient centred care to communities using remote equipment but wondered how long it would be before this was implemented. Stuart Bell responded that initiatives would be developed and implemented up to 2020 (and thereafter) and recognised that some changes would be implemented more quickly than others.

John Jackson stated that they would consult when they were clear of the proposals. He pointed out that a part of the schedule of programme, as set out in page 42 of the paper, was already in place or in the process of implementation. He pointed out that there may be new services to be introduced, which had not emerged from analysis as yet.

The Chairman concluded this item by thanking Stuart Bell, Dr Holthof and John Jackson for their attendance.

The Committee AGREED to request that an update (briefing note) outlining what was already being delivered and more specifics on the programmes (including timelines, staffing and funding).