Agenda item

The Board received an update on performance against the outcomes agreed for 2017-2018, quarter 2, in the Joint Health & Wellbeing Strategy, in the following categories:

 

(a)  progress against the Outcome Measures agreed for 2017-18;

(b)  accident and Emergency Delivery Board Targets; and

(c)  Adult Social Care Outcomes Framework Published Results for 2016-17.

 

(a)  Progress against the Outcome Measures agreed for 2017 – 18

 

Target indicator 1(1:1) – Priority 1 – ‘Ensuring children have a healthy start in life and stay healthy into adulthood’ – ‘Waiting Times for first appointment with Child & Adolescent Health Services (CAMHS)’

 

In response to a challenge about  performance in this area, Stuart Bell, Oxford Health Foundation Trust (OH), reported that a new model of working with a consortium had just commenced based on work with Buckinghamshire. Barnado’s had also given significant assistance with the planning of this. He added that demand for this service had risen significantly for a variety of reasons and users should see a difference over the next few months in terms of access.

 

Target indicator 2(2:3) – Priority 2 – ‘Ensure that the attainment of pupils with SEN & Disability (SEND) but no Statement of Education Health & Care Plan is in line with the national average’

 

In relation to the challenge posed by a Board member relating to the extent that school exclusion and home school schooling could be a factor in non-attainment, Lucy Butler commented that this area was a major focus and the Children’s Services Directorate had key plans and initiatives for this area which she outlined.

 

Target indicator 3(3:5) – Priority 3: ‘Keeping children and young people safe’ – ‘Reduce the number of hospital admissions caused by unintentional and deliberate injuries in young people aged 0-14 to the national level’  -

 

In response to a challenge that the Board understand the reasons behind the sharp rise in children self-harming, non-accidental or deliberate injuries, the Board requested that a more detailed analysis be submitted to a future meeting.

 

Target indicator 3(3:6) – Priority 3: ‘Keeping children & young people safe – maintain the current number of looked after children’

 

In response to a challenge by the Board about the rise in the number of Looked After Children (LAC) which was above the national average, Lucy Butler stated that the past four years had seen a rise in child protection statistics. However this year was the first in which the trend was moving downwards. She voiced her uncertainty as to when this trend would affect the LAC statistics, but more work was taking place in this trajectory to ensure all that was possible was being carried out to keep them out of care.

 

Target Indicator 5(5:3) – Priority 5 – ‘Working together to improve quality and value for money in the Health and Social Care system’- ‘Reduce the average length of ‘days delay’ for people discharged from hospital to care homes’

 

A Board member challenged whether the recent reduction shown was sustainable. Kate Terroni responded that it was a challenge, but the collaborative working in Oxfordshire was helping it to move in the right direction, adding that there was a need to keep up all efforts. It was pointed out that the average length of stay per treatment was also better than most areas.

 

Target Indicator 6(6:9) – Priority 6 – ‘Living and working well: Adults with long term conditions , physical or learning disability or mental health problems living independently and achieving their full potential' - ‘Reduce the number of people with Learning Disability and/or autism placed/living out of county’

 

The Board AGREED that it needed to keep track on those people choosing to stay out of county and to request Kate Terroni to report back to the Board.

 

(b)  Accident and Emergency Delivery Board (AEDB)Targets

 

The Board considered the Accident & Emergency Board Targets performance report (October 2017) and reviewed the areas where performance was below target.

 

David Smith informed the Board of the following:

 

·       AEDB was chaired by the Chief Executive of the Oxford University Hospitals NHS Foundation Trust (OUH) , Dr Bruno Holthof;

·       All agencies were represented on it

·       It was tasked with ensuring the whole of emergency and the urgent care systems, which were under significant pressure, were working well;

·       Actions to date from the team had included the introduction of GP streaming into A & E; an investigation into demand for A&E services and tracking patient users of the service;

·       Emergency admissions were benchmarked very well to accord with their peer group;

·       A paramount issue for the team was how not to admit people into hospital who did not need to be admitted. Finance and staffing factors were critical to this;

·       The Team was trying to do as well as it could in relation to these targets. Currently it was not achieving the 4 hour wait target but expected it to reach 95% by March 2018.

 

Dr Tony Berendt (OUH) stated his support for the inclusion of these targets within this report in order alongside the other partners in order to show the overall shape of the system. He believed the process was not yet configured properly, for example, in relation to the difficulties experienced with patient discharge. He reassured the Board that the OUH Trust Board took it very seriously and was in discussion with their Regulator on the matter. Dr Berendt further stated that the ‘breaking the cycle’ meetings had proved to be very useful and illuminating, adding that work was still in progress to beat the DTOC problem.

 

He highlighted the following problems current in the system:

 

-        DTOC;

-        The closure of a number of beds due to staffing issues, significantly the inability to recruit as highlighted may times. However, a constant for the Trust was a paramount commitment by the Trust to patient safety;

-        Staffing pressures encountered by Social Care;

-        Problems admitting patients as quickly as the Trust would like.

 

He stated the strong commitment of the Trust to a hospital protocol with all systems working as one.

 

David Smith cited the problems encountered with high numbers of people attending Accident & Emergency at the Horton Hospital and John Radcliffe Hospital, which was currently being addressed by the OCCG via the ‘Admission Avoidance Workshop’. Positive and concrete actions being considered to help all across the system were:

 

-        How to improve access to GPs

-        More flexible use of community nurses

-        How to support care homes better.

 

Dr Berendt added to this by stating that the acute ambulatory Unit which assisted with scans had increased its activity over the last 2 years and it was proving to be very successful. The Trust was also working closely with community nursing. In brief the Trust was looking at both internal and external processes to make improvements in acute patient care. All were looking at changing systems and looking to different ways of prioritising. He added that combined working looking at the dynamics of patient flow in different situations in order to understand better ways of understanding it, leading to better means of intervening, would assist enormously.

 

Professor Smith stated that HWO, who had a seat on the A & E Delivery Board, had looked at peaks of demand for A & E services and had concluded that, in order to mitigate this, the following was required:

 

-        Meal breaks for ambulance staff needed to be staggered to take account of peaks and surges;

-        Many patients could be dealt with in the primary sector – thus later opening hours in GP surgeries would assist;

-        Hour by hour data changes in arrivals need to be tracked to ascertain what proportion could be dealt with in the primary sector, particularly in the early evening from 7pm onwards.

 

The A & E Delivery Board was endeavouring to understand a combination of factors, such as those below, which could serve to improve the current system.

-        Many GP surgeries did work on past 7pm as part of the GP Out of Hours services, to which attendance statistics was rising;

-        The CCG considered it of the utmost importance for people to access the 111 services and for more clinicians to be present to deal with these calls. People could then be signed to other more appropriate services rather than to A & E;

-        Part of the work to be done in the community was to look again at good examples in the use of EMU’S in Abingdon and Witney, for example for them to provide the necessary clinical advice. In addition to this,  clinical advice could be made available to care homes to avoid A & E visits;

-        Currently there was no continual access to MIU’s in the county. There was a need to hold discussions on how to do this with a view to gaining agreement across all parties and an overall picture of what was to be done;

 

Views and challenges expressed by the Board were as follows:

 

-        Comparable data was required and it was important for components to be separated within it rather than looking at global figures;

-        Traffic flows to the new, larger Health centres would need to be looked at, together with the numbers of people with no access to transport;

-        Tracking the additional numbers of people who would be attending the JR Hospital for treatment was vital;

-        Tracking the numbers of people attending A & E who were making use of facilities such as Out of Hours and MIU’s was vital. Also it was important to track how many GPs were liaising with the hospital to measure activity ;

-        To ensure that there were targets measuring numbers of older people attending A & E and their pathway, including their waiting times.

 

 Dr Berendt pointed out that OUH was in the process of developing Frailty Units at the JR. He warned, however, that every new service needed to be sustainable, safe and resilient and this brought with it a cost. Dr Batty also added that the CCG was doing more work around how to better manage frailty. Part of this was to quickly identify patients from care homes.

 

The Board AGREED  to include the above performance data on all Agendas. Work on changes in the system could then be kept abreast of and critiqued in the same manner as the other performance data.

 

(c)  Adult Social Care Outcomes Framework Published Results for 2016/17

 

The framework was presented and Kate Terroni, Karen Fuller and Benedict Leigh, Adult Social Care made themselves available for questions.

 

In response to a challenge about what action was being taken to ensure social interaction and support for older people in light of the decrease in the number of day centre places, Karen Fuller responded that Age UK were continuing to track all who had been offered an assessment. In addition, Age UK was working with 40 individuals who had not settled in their placements. Further assessment was also undertaken in 3 months to ensure that they were settled. A review was then to be completed after 6 months to assess the impact of this action. In addition, two social workers had been allocated to each of the remaining day centres.

 

Very positive stories, indicating good engagement had emerged, including the successful mixing of people with Learning and Physical Disability.

 

Benedict Leigh also highlighted the usefulness of the forthcoming round of Daytime Support Grants for older people. Kate Terroni added also that feedback regarding the new service at Abingdon Hospital had been very positive and encouraging.

 

In response to a comment on the success at Torbay of the integration of care works and qualified nurses into a Team which had led to a higher level of home support and a challenge for Oxfordshire to produce similar results, Kate Terroni stated that a Homecare Board, using Health, Domiciliary and Voluntary services had been set up in recognition of the importance of integrating the Health profession into Home Care. However, recruitment was a challenge, particularly in Oxfordshire, and the importance of encouraging people to value this work was of the utmost importance. She reminded the Board also that Social Care and Healthcare were already integrated in various localities.

 

Dr McManners stressed the need to be very clear about what was meant by integration in a context of fragmented and duplicated services. He added that all aspired to tight integration and for those Teams to work in smaller, more local areas.

 

Following a request, Kate Terroni undertook to come back to the Board with information regarding an Adult Social care Outcome Framework (ASCOF) measure for mental health.

 

The Board was reminded that many of the issues discussed in relation to more general health and wellbeing performance had been considered at meetings of the Health Improvement Board.