Agenda item

11:00

Representative (s) from the relevant organisations will attend the meeting to give details on the end of pilot review (JHO7).

This item will also give information on the next steps, including:

·         Detail of the timescales for implementation and consultation

·         The impact of the proposals on patients and the public

·         The impact of the proposals on adult social care, community services and on GPs.

The Chairman welcomed the following representatives who were attending the meeting in order to give details on the end of the pilot review and to give information on the next steps:

Paul Brennan – Director of Clinical Services, Oxford University Hospitals Foundation Trust (OUH)

Lily O’Connor – Divisional Head of Nursing and Governance & Liaison, Hub Manager, OUH

Karen Fuller  - Adult Social Care Service Manager, City and Hospitals, Oxfordshire County Council

Dr James Price - Divisional Director for Medicine & Clinical Lead for Gerontology, OUH

Paul Brennan gave a brief overview of the information contained in the report JHO7 about the review of the pilot. He concluded by stating that the Hub was now in operation using 55 beds – a reduction from 150 beds at the start of the pilot. He added that patient feedback had been good overall, particularly as people were being moved out of a busy acute ward to a different environment.

Mr Brennan agreed to provide the Committee with the key performance indicators which had been used to monitor during the evaluation.

A member asked from which areas were the staff recruited. Mr Brennan reported that 70% were targeted from retail with an attractive package, including a good wage, full-time work for those who wanted it, access to a full NHS Pension Scheme, possible access to a nurse’s induction programme or development into the Healthcare system.

In response to a question, Paul Brennan reported that the 55 patients still in hub beds were there for further assessment and work with the family. The beds were used as though they were community beds and were not classed as delayed transfers of care as they were not in the acute sector. Lily O’Connor explained that many patients in community hospitals were there for rehabilitation reasons and were not categorised as delays. She added that it normally took a long time to work out their long-term care, requiring talks with the patients themselves and with their families. Paul Brennan further explained that the pathway had been changed for patients in acute beds, so that before they became a delay, they were moved out and placed in intermediate care beds. A member commented that it was difficult to tell where the 476 patients cited in the report had been placed. Paul Brennan explained that one third had been placed with nursing or care homes, one third had gone home and one third had either died or been readmitted to hospital. Karen Fuller further explained that social workers worked very closely with community colleagues to ensure that patients were moved out and negotiated into homes. Their presence in the Hub put Social Care in a position to ensure that the market was managed well. Paul Brennan added further that when the audit of the first 150 patients had been undertaken there had been no expectations as to where they would be placed.

In response to a question, Paul Brennan reported that the total number of delated transfers of care was currently 78 and 30 were in community beds. He added, in response to a further question, that Oxfordshire was no longer near the bottom of the national table and these figures had reversed the trend (expected 185). He added the view that nationally the measurement tool had changed a number of times. The focus was always on getting patients home quicker.

Dr James Price commented that in the experience of patients, and in that of expert staff, all were very motivated to deliver. Staff working in the Hub Teams were very positive about both because of the good outcomes for patients and because of the learning and innovations gained over the period. He added that care homes had learned the important capability to manage change, the Trust had learned how to apply principles more generally and families and carers how to manage people in their own homes as a result of the changes.

Dr Price was also questioned about the mortality rate from those readmitted to hospital. He reported that mortality figures had fallen during the study, adding  that many patients want to return to their own home, even if it may mean a readmission was necessary a few days later.

A Committee member commented that it was pleasing to see that family carers had been included in the figures. Karen Fuller responded that this was shared and updated in the Hub at present. A member also commented that it was also pleasing to see the inclusion of medicine management so that patients arrived in homes with their prescribed medicine.

In response to a question about the availability of nursing home beds, Paul Brennan explained that there was now a partnership approach to this. Karen Fuller commented that currently at any one time there were over 200 beds available at different prices and staff in the Hub had been successful in providing beds. She assured the Committee that there was an availability of beds in Oxfordshire.

A Committee member asked if Health and Social Care were experiencing problems in getting homes adapted for patients. Karen Fuller commented that it was very unusual to have a delay regarding home adaption. Social workers worked closely with District Councils who were very proactive in dealing with it early. Across the board there were very few delays regarding adaptations and alternatives were considered if there was a problem to ensure that patients were not remaining in acute care.

The Chairman thanked all the representatives for responding to questions about the evaluation of the review. She then introduced the next part of the discussion the purpose of which was for the Committee to understand the next stage of the reconfiguration, which it was understood would not be funded by the OCCG. Prior to this she invited Councillor Mrs Judith Heathcoat, Cabinet Member for Adult Social Care, to make a written statement to the meeting, as follows:

‘As the Cabinet Member for Adult Social Care I am hugely concerned about the paper before you today, Before I talk of my concerns can I say that I do wish there to be a ‘working together ‘ of Health and Social Care so that the system is more joined up and easier to navigate. I attend Transformation meetings representing Adult Social Care.

Adult Social Care in Oxfordshire is nationally high performing, being the sixth best rated authority in the national outcome framework for social care. There is a high level of satisfaction from people who use the service – 90% of our users are reasonably/ very/extremely satisfied. Nationally in the last 12 months social care delays vary by 32% whilst here in Oxfordshire they fell by 36%. The numbers of people we support has not fallen and the amount of home care we buy has almost doubled since 2010.

I am genuinely concerned about this paper – ‘plans for acute bed and service reconfiguration’, the word ‘reconfiguration’ has an air of permanency. The proposal is to shed a further 118 beds – the word ‘release’ keeps being used but there is no mention of a trial period, so to go through all this upheaval must mean permanent. The paper discusses ‘details of Ward Relocations’ which sees an immense amount of work for a pilot. With the 74 beds already released, plus the proposal for 118, this brings the figure to all but 200 beds to be released. What period of time is being envisaged to be given to this pilot? The 74 beds that were released initially were for a ‘pilot’ but we have no end date for this I believe?

I understand that there is no funding from the CCG for this further closure of beds. Adult Social Care had not been able to quantify the costs and the impact on the Care Home provider market or the Home Care market. The OCCG did support financially the 76 beds ‘released’ in November 2015 and Adult Social Care absorbed the costs. It was believed that the releasing of the 76 beds was a pilot.

The question for me now is whether the Committee sees this as a substantial change. If the ‘Toolkit ‘assessment made by the Trust states that this is not a substantial change, I would disagree and I would suggest therefore that these proposals should go forward and be put into the forthcoming consultation. The release/closure of beds will have an impact on beds’.

Paul Brennan, in responding to Cllr Mrs Heathcoat’s statement, commented that he had been involved in a number of conversations with adult social care colleagues regarding this to ensure that any changes were supportable. And no-one had been able to identify an impact on social care costs. He asserted  that, apart from the 55 already in situ, there was no intention to purchase any more beds. He added that the Trust was investing £4.1m on services to support patients in their own home which included social worker support. The OCCG had funded part of the Hub work to the amount of £900k and the OUH had funded the balance. The OUH was also pump-priming that funding. By moving out of the bed base, all monies would be invested up front and there would be no impact on nursing homes.

In response to a question asking how the closure of 118 beds was being managed, Mr Brennan explained that the OUH had appointed 50 staff and OCC has awarded the reablement contract to OUH at a fixed cost, to which OUH would add to if it was found to be necessary.  The Trust was investing £1.6m in the development of an Acute Hospital at Home service and was also investing in a discharge service (45 nurses, medics and therapy staff). Patients would be managed on a Treatment Pathway. Dr James Price further explained that arrangements would be made for those patients suffering with transient episodes who would usually require prompt assessment. He added that hospital care for frail elderly patients with social and psychological problems could be risky and it did not benefit them overall. Moreover, an in-flow system-wide access to hospital when necessary, together with a capable team situated in the community (including families) was very important, and would make for very good decision making. He added that the current arrangements across the system were not as good as they needed to be. Capable people were required to make a diagnosis and deliver a treatment plan as quickly as possible. The paper laid out a whole range of options and support arrangements with patient care, SHEDS (Supported Hospital Discharge Service), multi-disciplinary teams and community based teams to aid better outcomes and a better patient experience. Dr Price commented further that much thought was being put into rebalancing physical space. Historically there had been too many overnight beds for patients, even when it wasn’t in their interest. A rearrangement of clinical support was required to give better care. In working with patients, carers and families, patients could be supported better and at the same time better support could be given to those who did benefit from being in hospital. Furthermore, it could be particularly difficult for many patients in hub beds and in intensive support settings, or who were in the last year of their life. For the above reasons, this was a very strong model, supported by local clinical opinion and by the National College of Physicians and the future Hospital Commission. A member of the Committee asked if there was a precedent.  Dr Price responded that there was national evidence that such services were successful, and also local examples had supported the principles, for example, Abingdon EMI (Emergency Multi - Disciplinary Unit) and the assessment unit at the JR Hospital.

Paul Brennan stated that it was his view that this was not a substantial service change because patients would still access health care in the same way – there would just be a change in the care pathway. He stated also that the direction the Trust was going in was consistent with the national view and with the Liaison HUB strategy. He added that the changes would take 12 months.

A member commented  that in the face of the closure of 118 beds, demand for services was growing, waiting lists were longer, and ambulances queuing up at Accident & Emergency. She asked why a report had not been written from a GP’s perspective – which would serve to give a feel for the Committee of the patient pathway. Paul Brennan responded that the report sought to explain this with the description of the creation of the Unit at the JR Hospital. He added that GPs had already stated they wanted access to acute professionals when needed, to help support them when dealing with patients at home. It was confirmed that GPs would have this access from November.

The Chairman referred to a further aspect of the proposals which was the purchase of care home beds at a high price than that offered by Social Services, thus causing possible blockages when patients were moved  out of acute care, supported by adult social care. She stated that this had not been understood by the public and by the patients affected. The question of timing of the proposal needed to be considered in relation to the timescale for the Transformation Plan. The role of this Committee was to ensure that patients and the public alike understood the situation. She added that the Committee had asked that a substantial change assessment be completed by the OUH, although a completed version had not been received in time to enable the Committee to meet with the Trust prior to this meeting. Furthermore, the proposals needed to be considered in light of the Transformation Plan on which consultation had been delayed until early in the New Year. It was therefore

AGREED (nem con) that it was this Committee’s view that this stage of the Rebalancing the System work was a substantial change of service and therefore required full  public consultation. According to the terms of the legislation, the Committee should attempt to come to an agreement before referring it to the Secretary of State. Therefore, further discussion with the Trust would take place at a special meeting of the committee on 30 September 2016 in relation to the following issues:

·         The impact of the Plan on other providers, including Social Care; and

·         The Plan in relation to the forthcoming Transformation Plan consultation.