Agenda item

12:15

Representatives from the Oxfordshire Clinical Commissioning Group, the County Council, Oxford Health Foundation Trust and the Oxford University Hospitals NHS Foundation Trust will report on the following issues (JHO10):

·         How ‘innovation’ is being interpreted and used in the Oxfordshire system to address the CQC findings;

·         How learning from best practice is being incorporated into the work in Oxfordshire;

·         The work being undertaken to address the housing and workforce issues within the system; and

·         A proposed evaluation framework for actions arising from the system review to assess the impact on service users and patients, to aid scrutiny by the Committee.

13:00 LUNCH

The Chairman welcomed the following representatives from the CCG, OH, OUH and OCC:

-       OUH – Dr Bruno Holthof and Sam Foster – Chief Executive & Chief Nurse

-       OH – Stuart Bell, CBE – Chief Executive

-       CCG – Lou Patten – Chief Executive

-       OCC – Kate Terroni, Director of Adult Services & Helen Sanderson

A briefing paper was attached at JHO10 and a presentation was given. The Committee thanked all for the useful paper, particularly because it contained specific examples.

Questions from the Committee and responses received were as follows:

-       Kate Terroni was asked if there was a clear business case to roll out Amazon Echoes to assist older people living at home. She responded that there was and this was an endeavour to avoid the need for carers for particular tasks;

-       Dr Holthof was asked if the AGE UK provision for patients in hospital would be via new monies or would it be via existing contracted services with Age UK. He responded that the Trust would pay and no extra funding would be received for this additional service;

-       A member commented that 48% was a useful statistic in relation to keeping people out of hospital and asked what the mortality rate was. Dr Holthof undertook to send a paper for information;

-       In response to questions asking who was commissioning the Wellbeing Teams? who was funding the delivery of the service? and who was accountable for the recruitment of outside organisations and development of the service? Kate Terroni responded that OCC was funding the Wellbeing pilot and was accountable for the delivery outcome for the one - year pilot. She added that it demonstrated a new way of working locally and it was her view that it was accompanied by the right values and attitudes.  Moreover, Adult Social Care was to set up some flexible home care services looking at a whole range of options for delivery. She added that the private sector would be encouraged to participate. Performance screening would look at workforce issues and an Officer would be attending a future meeting to present the outcomes and respond to questions;

-       Kate Terroni was asked if OCC would be supporting the ongoing work to gain recognition for the inclusion of care workers into the definition of key workers. She responded that there was a need to work up a definition of key workers and would come back to Committee on this issue if required;

-       Kate Terroni was asked if the potential partnership agreement with Cherwell DC might address the need for housing and recruitment of staff workers. She responded that Lou Patten and herself had met the previous day and had agreed that there was a potential to look at housing at local level, which could be quite exciting if the opportunity arose;

-       In response to a question about how home care scheduling worked for self-funders, she reported that there was a very active and vibrant domiciliary provider market with whom they were working. She added there was also a willingness to help them to look at current service users and also at people who would potentially need care packages in the future in order to assist in the targeting of particular agencies to suit needs;

-       In response to a number of questions relating to the quality checks that were in place for the carers of patients coming out of acute care, Sam Foster responded that nurses would be SEN trained with 2 years of training from the National Medical Council. Kate Terroni added that Social Care paid staff also had to be regulated regulated. Service providers would be expected to submit all appropriate data and would be expected to be working to assured models to ensure safeguarding issues were addressed. There was also some expectations put in place for volunteers. The Chairman added that this Committee would be picking up this up with the CGC at the September meeting. Helen Sanderson added that skills appropriate to the advised level would need to be up and running in Oxfordshire where system leaders were gathering an army of volunteers who would require training. OCC’s Performance Scrutiny Committee was investigating this further;

-       Stuart Bell and Dr Holthof were asked about the refreshed vision for the integrated Health and Social Care service, as monitored by the Health & Wellbeing Board (HWBB) whose constitution and methods of working was under review. Stuart Bell reported that both himself as Chief Executive of OH and Dr Holthof, as Chief Executive of OUH had now joined the Board as system leaders. The vision had been agreed at the special meeting of the HWBB on 10 May 2018. He added that a new Strategy for Older People would take time to construct and was expected in the Autumn. When asked about resilience and system level measurement, he reported that there were many measures in existence but so far there was no system method of measuring the patient flow through the system. Lou Patten added that the AQC Panel was to look at the evaluation of the programme. She pointed out that the revision of the HWBB would bring with it an opportunity to bring about a better informed, better experience of how it would deliver services in an integrated way. It would become all the more important to share ideas about how to configure itself, in particular the promotion of integrated care in Oxfordshire in a much more focused manner. The HWBB would be the statutory vehicle with which to provide that and give it oversight. It was also an opportunity for a much more active discussion with the district councils on health matters and more focus on health at county level. Dr Holthof added that the four system leaders would be working diligently to re-design the governance, hold fewer meetings and focus on the right topics leading to the Board implementing some of the actions which would make a difference for patients;

-       A member put forward their view that understaffing and under resourcing in the reablement service had been major factors in the problems experienced previously with DToC. Kate Terroni stated that it was important that reablement was part of the system. There had been a significant amount of good work to improve the situation and to ensure that it was not seen in isolation in relation to the delivery of the contract. This was an important issue for system leader discussion. Sam Foster responded also that an example of some improvement work undertaken internally was a peer review with some of the patients to ascertain that a community hospital bed was not always required and patients were able to go home earlier when discharged to reablement teams;

-       In response to a question from members asking if housing for key workers was being investigated, Stuart Bell cited a piece of work entitled ‘Homes First’ had been undertaken with Adult Social care and Age UK to get patients home first. Its aim was to reduce the burden of domiciliary care. He added that sub-contracting with OH had enabled delivery of 96% of the contract, but it should be kept in mind that demand had significantly outweighed capacity.

At the close of the discussion, the Committee AGREED to request to view:

(a)  the framework for the measures that would be put in place; and

(b)  any examples of best practice from elsewhere which had been used to cut delays.