10.50
Paul Brennan, Oxford University Hospitals Foundation Trust (OUH) and colleagues will give a presentation on the pilot review.
Minutes:
The Chairman welcomed the following representatives from Oxford University Hospitals Foundation Trust (OUH) and Oxfordshire County Council to the meeting:
· Pau Brennan and Lily O’Connor – OUHFT
· John Jackson and Karen Fuller - OCC
Paul Brennan gave a presentation on the pilot to tackle Delayed Transfers of Care (DTOC). He reported, to date, there had been a 30% reduction in delays against an expectation of 25%.
Challenges highlighted in the presentation were:
· Workforce recruitment and retention – some staff tended to find a combination of high cost housing, the cost of living, transport movement around the City a disincentive and move away;
· The 4 hour standard in Accident & Emergency – reaching the desired level of 70% was moving in the right direction, but not as quickly as was hoped;
· Re-ablement care was still posing a challenge, demand being greater than capacity;
· Readmissions had been higher than expected.
Lily O’Connor gave a flavour of how the Hub staff (comprising Occupational Health, Physiotherapy, Social Workers, Contracting, Financial Assessment, Nursing staff, Administration, Medical staff) were working interactively – and were meeting on a formal basis once a week. The Hub was staffed at weekends by nursing staff and Oxford Health Medical Assessment staff. She reported also that there had been a number of readmissions at the start of the project. However, as the Hub had gained in confidence, communication with the Care Homes had improved, and many patients had either been placed in Homes close to their own homes, or been given rehabilitation enabling them to go back home with reduced packages of care.
Karen Fuller spoke of issues which were being dealt with by staff at the Hub, including assistance with obtaining legal power of attorney consent. From an Adult Social Care point of view, there had been a number of key benefits to working at the Hub, such as staff being able to conduct daily tele-conferences to discuss clients, to which key organisations would contribute. This enabled the flow of patients to be managed better. There were good, positive outcomes owing to a robust multi-disciplinary team assessment. Intensive rehabilitation, in conjunction with social workers, enabled patient pathways to change. There was also good communication between organisations which enabled staff to focus resources to the most appropriate point.
In response to a question, it was confirmed that there had been a sufficient number therapists recruited.
In response to a question about funding of the project, John Jackson reported that funding had been via the OCCG, who were currently looking at continuing the project beyond April 2016 at a reduced level.
A member asked how nursing staff in care homes coped with patients with very complex conditions. Lily O’Connor explained that Hub staff went out to homes to support this category of patient when required, and worked alongside staff. There was also a care home support service who worked with other staff in the Home to aid the management of such conditions on a long term basis. Any problems with patients’ medication were dealt with on an individual basis via liaison with this service if more support is needed. In all, Lily O’Connor stated that staff in care homes were gaining in confidence, given that they had never been exposed to this situation before. A sense of trust between the Hub and the care homes was more apparent and there were signs that they were working with a problem rather than contacting the emergency services to send the patient into hospital.
In response to discussion around patient deaths, the Committee was informed that patient deaths were automatically reviewed. They were also informed that this patient group were usually more frail and older. It was the view of the speakers that death in a home environment was invariably more dignified.
In response to a question concerning the number of acute beds that had been released to date, Paul Brennan reported that 76 beds that were not in use, had been released, but not closed, as it had been agreed that this would be a consultation issue, as referred to earlier by Stuart Bell. The intention was to maintain the released beds, though it would be highly likely that there would be a recommendation that they be permanently closed at the consultation stage.
A member asked if the released, acute beds had been made available for winter pressure use. Paul Brennan responded that beds often did not require acute care and that a focus was needed on patients who were on an ambulatory pathway, who only needed them for a few short hours before going back home. John Jackson added that if more capacity was taken for the purpose of winter pressures then this would have an impact on funding. With regard to the funding of beds, Karen Fuller added that working together with the social care placement officer had been beneficial, giving an opportunity to negotiate a price when necessary and not pay higher prices. Paul Brennan added also that overall, the cost of support was less than the cost of running an acute bed, thus the cost of running 76 beds had been less.
Paul Brennan, in response to a question, reported that 17 nursing homes had been used across the county and the number of beds used had been just over 70. Every effort had been made to cite a nursing home close to the patients’ own town/village and there had been no issues reported over choice.
In response to a question concerning notification to the regulator of clinical incidents, Lily O’Connor explained that the rules and procedures had remained the same and had not been undermined in any way to suit the circumstances.
Lily O’Connor gave her assurance that lessons would be learned as part of the final evaluation.
John Jackson clarified the position with regard to the impact on Health & Social Care of people working in retail, for example, being paid above the living wage. He stated that there was a need to look further at the impact of this if a negative situation was to occur, adding that 2% had been set aside in the County Council’s budget to meet the costs of the national living wage.
The Chairman thanked Paul Brennan, Lily O’Connor, John Jackson and Karen Fuller for their attendance and Paul Brennan for the presentation.