10:50
Paul Brennan (Oxford University Hospitals Foundation Trust) will attend to provide an oral update on the rebalancing of health and social care after the discussion at the special meeting of this Committee on 11 December 2015.
Minutes:
Following discussion at the special meeting of this Committee on 11 December 2015, Paul Brennan, Oxford University Hospitals NHS Foundation Trust (OUH) gave a powerpoint presentation updating the Committee on the pilot project to rebalance Health and Social Care. He stressed that the project was not at end until 31 March 2016, and to date, there were no plans to make it permanent. John Jackson, Director of Adult Social Services was also at the table speaking on behalf of the whole system.
Paul Brennan reported the key issues of concern to date. These were:
· Movements in the workforce as a consequence of the changes were overall in line with projections at this point. However, the numbers of patients needing to be discharged to the reablement service were behind target, due to a reluctance of staff wishing to be transferred;
· Delayed Transfers of Care (DTOC) performance figures were good during the first few weeks of the project, when the numbers delayed dropped from 150 to 90 – but over the Christmas period the numbers had risen as expected;
· Section 5 discharge orders were issued over 7 days per week. However, during friday – monday bank holidays there had been no teams able to discharge patients. This problem was continuing;
· A key challenge was that the number of patients with no home placements was currently at 37. 27 were waiting to go home with domiciliary care and 8 with reablement through the supported hospital discharge service. The total numbers of DTOC was 121 to date;
· Performance from when this initiative was started was at 85%, and at one point had risen to 90%. As a consequence of delays, this had decreased to 75%.
The Committee asked what actions were to be taken to alleviate this setback. Mr Brennan responded that the Team had agreed a series of additional measures to bring it back in line. The biggest single issue was the number of patients needing reablement services provided by Oxford Health (OH). The Team had agreed a programme for all staff to work in the OUH, including part-time and bank staff. A staff incentive had been offered in a bid to achieve an additional 1,600 hours per week in February and March. This measure had had a virtual 100% response rate. Current caps on NHS agency staff had been released in order to remove blocks in the flow of the system.
A member asked how OCCG focused on individual patient experience, having heard anecdotal stories of patients being moved a number of times; of families upset; and patients being taken to nursing homes with little attention being given to reablement. Mr Brennan responded that any feedback was being monitored, and an evaluation would be undertaken in order that patient stories could be compiled. No formal complaints had been received from any patients or relatives, to date. A formal evaluation was also to be undertaken.
In response to a Committee member’s comment that District Councils were failing to adapt sufficient homes for people to be discharged to, John Jackson stated that these delays few and far between.
Mr Brennan was asked how many out of county delayed transfers there were. He responded that the figures reported were for Oxfordshire patients only, but at any time there were approximately 20.
When asked if patients were being transferred to locations closest to their homes, Mr Brennan answered that there were 70 homes in different geographical localities and staff did try to match homes to where patients lived.
In response to a question about whether there were sufficient home care staff to ensure people were looked after in the proper way when sent home, John Jackson explained that this was being monitored closely. He added that home care hours purchasing had risen in December/January by 10%. However, demand had continued to grow, particularly for home care and there was concern around getting more resources from the Health sector to support it.
In answer to a question about how many patients had been readmitted to hospital, Mr Brennan responded that the figure was at 14. Some of these were still in hospital and some had been discharged to their own home. A report would be made at the end of the project.
A member asked what was the impact of more GPs leaving the profession. John Jackson responded that the whole question of recruitment was a real priority, to be identified by the Transformation Board. He added, in response to concern expressed that the doctors’ trade union had voted to withdraw their services to care homes, that this was untrue and doctors were not withdrawing their services.
In response to a question about how many acute beds were now closed, John Jackson stated that, from November 2015 to date, the number had reduced by 96 and 20 had been reopened as an extension to the emergency admission unit. He added that this figure was very close to the original proposal to close 70 beds.
Mr Brennan was asked about the current financial position of the programme. He stated that at the outset it had been made clear that although £2m had been made available from the OCCG for this project to the end of March 2016. The current position as at the end of January was £250k below budget. He added that this may well pick up in the second phase of the programme and expressed his confidence that it would come in within budget at the end of March.
Mr Brennan and Mr Jackson were thanked for their attendance.