Agenda item

10:30

Paul Brennan, on behalf of the 4 System Chief Operating Officer’s from OUHFT, OH, OCCG and OCC), will provide the Committee with details regarding the implementation of rebalancing the health and social care system in Oxfordshire. In summary, the proposal is that they contract 150 Intermediate Care beds for 6-8 week period and then continue to contract 75 beds until equilibrium is attained with the aim of reducing Delayed Transfer Of Care. The Committee will seek details on the location of the beds, staff and key performance measures to allow for successful monitoring of the pilot scheme.

The Chairman welcomed the following representatives from the following organisations to the meeting:

-          Paul Brennan, Oxford University Hospitals Foundation Trust (OUHFT)

-          Stuart Bell MBE, Oxford Health Foundation Trust (OH)

-          Diane Hedges and Barbara Batty, Oxfordshire Clinical Commissioning Group (OCCG)

-          John Jackson, Oxfordshire County Council) & Oxfordshire Clinical Commissioning Group

The Committee was seeking more information about the proposal that the JR Hospital and others would contract 150 Intermediate Care beds for a 6 – 8 week period and then continue until equilibrium had been attained, to reduce Delayed Transfers of Care (DToC).  This was against a background of Oxfordshire’s health and social care system having the highest numbers of delayed transfers of care (DToC) in the country. At any one time around 150 patients, whose medical care was complete, had remained in hospital waiting to be discharged. A large number of patients needed some form of ongoing health and social care or rehabilitation in their own homes or nursing home care. Over the past few years a number of plans to reduce the number of DToCs had been developed, but these had not significantly reduced numbers. Whilst there had been improvements to many of the processes which caused the delays, the organisations involved believed that a radical plan was needed to change patient were discharge. The OCCG had offered to provide up to £2m in this financial year to enable patients to be discharged. This funding was a one-off injection of funding. Any ongoing financial implications of this plan would be addressed in the negotiation of contracts for 2016/17. The Committee had requested details on the location of beds, staff and key performance measures to allow for the successful monitoring of this pilot scheme.

Paul Brennan made a presentation giving the detail which had been requested by the Committee at its last meeting. A copy of the presentation was included on the Addenda for the meeting. Information requested included:

·         nursing home beds status

·         Detail on the Patient Transfer Programme

·         The purpose and function of the Liaison Hub

·         The role of the staff in the Liaison Hub

·         The Ward Release Programme

·         General Staffing Information

·         Key Indicators in use to support the programme

·         Potential Outcomes of the Programme

Paul Brennan gave an update from the Liaison Hub established on 7 December, stating that if the programme is successful, the number of patients delayed would fall from the current figure of 167 to approximately 30. By 31 March there was an expectation that there would be no patients delayed. He stressed that some of that number would still be in beds, but in nursing home beds. He reported that, to date, according to the tracking programme which had been put in place for each patient and the Ward Release Programme, 29 had already been transferred by 9 December and a further 18 people had gone home with support. 21 patients were being transferred on the day of the meeting. It was envisaged that 150 would be moved before Christmas. The main transfer was to commence on 14 December and complete by 18 December.

A member asked who was championing workforce issues to ensure that staff involved were valued. She asked if there was any reliance on agency staff and, if so, what was the financial impact. Mr Brennan responded that staff were working on a flexible basis to support the hubs. The OUHFT were working closely with Oxford Health, the Clinical Commissioning Group and the County Council on this and the staff involved had been given appropriate support and training. Staff came from Social Care, Home Care Support and the Hospital Support Teams and there was no agency care staff. All patient transfers were made with family support. He added that an additional positive benefit of the process was that more staff were emerging with a better understanding of the patient transfer process.

Mr Brennan was asked what support was being given to staff in care homes. He responded that the hub operators would make daily contact with care home staff – and, in turn, staff from the homes would come to the hubs to assist the staff who were in the process of tracking patients.

A member of the Committee was reassured that the numbers of people who had passed away and those that no longer needed care were two separate categories. Mr Brennan stressed that the former group constituted those that were very frail with ongoing illnesses. He added that a move to a more homely environment could be a better pathway of care, but it had to be in a setting appropriate for that patient. He pointed out that many of those who remained for a long time in an acute hospital bed and who did not require specialist palliative care, would much rather end their days in a different environment.  In response to a question asking whether patients in DToC situations were necessarily all elderly, Mr Brennan stated that not all were and there were occasions when younger patients no longer needed to be cared for in an acute environment and, following a thorough assessment ,would be transferred to the most appropriate care for their needs.

A member asked about the impact on patients and staff when DToC patients were placed in, say, the orthopaedic ward at the Horton Hospital. Mr Brennan stated that the issues had been discussed with medical/nursing colleagues and they had declared themselves comfortable with these arrangements. He added that some patients might be placed in a side ward, if appropriate, and there would be special training to staff to hand so that they are able to support the transferees.

Mr Brennan was asked how many patients had been able to go to care homes near to their home and how many, needing long-term care, would be able to stay in their placement, rather than having the disruption of being moved again. He responded that all 29 of the people already placed in homes were happy with the location of the move. The Committee, though understanding that all would not wish to stay where placed, asked that continuous attention be given to this issue at all times.

A Committee member commented that there would need to be a big increase in home support if a patient was to be transferred to a home environment and asked if the risks raised by John Jackson were too high. John Jackson explained that in an initiative in 2012/13, only 2% of patients went home. However last year, OCC received winter pressures monies which enabled more input from social workers, therapists etc and the outcome was that 44% went home. This year the target was  66% to go home. He believed the role of the hub to monitor outcomes for patients was of paramount importance in order to hit the target and meet the needs of patients. This would allow appropriate resources to follow. Those that were going home to no acute medical care would receive short, sharp intensive support in order to help them to re-learn how to do things again.

A Committee member asked what would be the wider impact on the market for beds ‘becoming available’? Also, how permanent was the £2m funding from the OCCG? Cllr Mrs Judith Heathcoat, as the  cabinet Member for Adult Social Care,  came to the table expressing her concern that the market was becoming flooded with only a limited number of beds. John Jackson referred to the background OCCG paper that had been circulated which expressed concern that they were struggling to purchase traditional community hospital beds at value for money. He agreed that it was a big issue to support a cap on a system which was already heavily strained, but there were also benefits. For example, an expanded Emergency Assessment Unit would benefit those patients who were in a ward long term and who were at risk of a deterioration of their health. This would enable more resources to be given to that patient, in the form of, for example, reablement treatment, which could avoid any deterioration and assist them in promoting a quality of life. He added that the nature of this work was fundamentally different to that which had gone before. The Chairman commented that the Committee would expect to be told of any ongoing concerns about the risk element to the plan.

A member of the Committee asked if there were arrangements for rebooking the beds after the 8 week period and also was proximity to people’s homes taken into account when booking beds? Mr Brennan responded that beds were booked for an 8 week period and 75 beds were to be kept ‘in reserve’ until the end of March 2016. Proximity to homes was taken into account.

Cllr Mrs Heathcoat commented that one of the risks was that beds would have to be purchased at the right price, otherwise there would be further pressures on the Adult Social Care budget. Diane Hedges, in response to this, referred the Committee to the background paper which had been circulated (in the Addenda) which explained that if there were excess bed days, there would be an excess daily charge. She added that a further area in which patients could be helped and supported was that, providing there was the right rebalancing of reablement, any money saved could be re-invested into the community. The Chairman stated how important this project was, and crucial that the public get the message that hospital might not be the most appropriate place to be at the end of their lives.

A member echoed the concern about the unknown impact of implementing the national living wage, particularly on the community hospitals. John Jackson strongly agreed stating that he had sent an email to all three Health Chief Executives reflecting discussions which had taken place in the OCC Cabinet on this issue. He stressed that OCC was not in a position to provide additional funding as a consequence of this plan. Any costs had to be met so that resources were available for Health and Social Care in 2016. The Committee AGREED that it was important to carefully track the impact of the plan on other community packages, together with any risk to the OCCG budget.

Diane Hedges commented that there could be too much focus on the risks, wheras the real prize was reaching equilibrium and doing the right thing for the patients in their move from hospital and ensuring the right kind of support for them out of hospital. She added  there had been positive developments  from this work, such as asking the voluntary sector to work more closely together to provide a consistent response. She emphasised organisations were now working creatively to provide solutions in working together more effectively. Organisations were trying to understand the specific needs of the individual in terms of therapeutic support, domiciliary care requirements etc and directing them to the right care.

A member asked how certain were organisations that the new plan addressed all the previous causes of delay. Diane Hedges referred members to page 34 of the background report for the major causes of delay.

A member expressed concern that patients requiring residential nursing care would not be going to the most appropriate setting. John Jackson responded that the numbers of people going into nursing care was limited, and if they needed that care they would receive it. He added that most of the DToC plan involved patients who wanted to go into residential community hospitals.

John Jackson was asked what systems were in place for complaints. He explained that there was a team of people monitoring the quality of care in community hospitals. They would be talking to residents, staff and families and would be liaising closely with the OCCG Quality Team, GPs and the Care Quality Commission (CQC). A traffic light system was also in operation and if necessary, detailed checks would be conducted. A member asked if spot checks were made. John Jackson stated that Social Care had no right of entry, unlike the CQC who were able to look at records, medicines, staff etc. He stressed therefore, that if relatives had any concerns, they must let Social Care know, who would then notify the CQC. He was also asked how much of a discussion they have with Healthwatch Oxfordshire (HWO) about complaints. He responded that engagement happened with many parties and HWO was an important part of it.

In response to a request that the OCCG would fund a project looking into the mortality rates of the over 85’s in various settings, Diane Hedges undertook to circulate the outcomes of the research on completion

A Committee member asked what input the community hospitals were putting into the plan and also what staff Oxford Health was putting in.  Stuart Bell explained that, of the 150 beds, 30 were community hospital beds. With regard to staff he said that a very significant part of the whole Oxford Health service was working to progress the Plan. This would comprise part of the Health Visitors team, the whole of the Hospital at Home Team and the whole of the Oxfordshire Reablement Services Team. The Nursing Home Support Team would be working with the Hub. He emphasised that Oxford Health were keen to operate as a ‘whole system’ alongside the other organisations.

A member asked if the Liaison Hub, and the financing of it, was intended to be a permanent fixture. David Smith referred members to the next item on the Agenda, saying that the OCCG had committed finances for the remainder of this financial year, but subsequently more work would be required from the component agencies working as a whole system to think about how to effect a shift of resources from the acute sector to other forms of care. David Smith continued that the current system, where each organisation was a separate statutory body, carried risk, making it very important to work out what was best for patients and to ensure that no single organisation would be carrying the bulk of it. If this was to be a long-term process then money would have to be pooled.

A member asked if 18 more patients recently able to go home on the DToC project, was it the result of better assessment. Diane Hedges commented that an improved, less fragmented, multi-agency process helped to focus on the patient’s needs more appropriately and thus lessened the need for any delay.

All the representatives were thanked for their attendance.