Agenda item

10:20

The Committee will consider proposals for the evaluation of action taken following the CQC system review (JHO6).

In April 2018, following a presentation on the progress of work being carried out in response to the CQC Local Area Review, this Committee had asked Oxfordshire System Leaders to develop an evaluation framework to measure how actions taken in response to that review would improve outcomes for people who accessed services.

At the June meeting of HOSC Oxfordshire System Leaders had reported that there was no national framework for measuring the performance of actions plans developed as part of the CQC’s programme of local system reviews. Similarly, the Department of Health & Social Care had not yet developed a performance framework for measuring a health and social care system in its entirety. It was also noted that a number of performance indicators were already being measured and reported on and it was from these that a performance framework would be drawn together.

Also at the June meeting the Committee had received a presentation highlighting some innovative approaches to delivering services, together with an example of how Oxfordshire was learning from best practice elsewhere. The Committee had requested that System Leaders returned to this meeting with some additional examples of how best practice was being incorporated into the work.

The Committee welcomed Louise Patten, Chief Executive, Oxfordshire Clinical Commissioning Group (OCCG); Kate Terroni, Director for Adult Social Services, Oxfordshire County Council (OCC); and James Underhay, Director of Strategy & Communications & Deputy Chief Executive Officer (South Central Ambulance NHS Foundation Trust) to the meeting.

Kate, introducing the item, stated that since the CQC inspection, discussions had been underway on how to draw together the Action Plan and how to evaluate it in order to allow its scrutiny; and what proposals to take forward to the newly created Oxfordshire Health & Wellbeing Board on 15 November 2018 to allow the delivery of a new HWB vision. She added that there were many actions which are to be done differently with regard to the pathways, the culture and the narrative of the system. Kate stated that all leaders had worked together and through more joint roles in order to make the experience better for patients and residents of Oxfordshire. Kate stated that although the targets set in the paper presented appeared conservative, these were et centrally and locally. Moreover, the system was working towards a more ambitious progress.

Examples given by the presenters of changes made included:

·         Following a two - day event, a proposal was made to create the first system post, that of a single Winter Director with a single team;

·         For the workforce, best practice had been followed and funding had been awarded to develop a system of care certificates which would be portable across agencies, particularly targeting the under 24’s;

·         The Ambulance Service was working nationally with NHS England, putting together a home delivery plan, which would comprise of therapists who were better equipped to pull together and deliver the best service for patients. This work had been piloted in Reading;

Louise Patten reported that the CQC were returning to Oxfordshire on 5 November 2018 to undertake a follow up review. In all 20 reviews had been undertaken, looking at how patients moved through the system and the CQC were keen to return to visit 3 systems to hear about what had been achieved and where it was heading: Oxfordshire had been chosen as one of these. She added that ministers were pleased with Oxfordshire’s progress. It had been suggested that the visiting team might wish to meet with the Chair of Performance Scrutiny Committee or HOSC, but this was to be confirmed.

In response to a comment from a Committee member about the need for the newly formed Health & Wellbeing Board to recognise the need for openness and public transparency, Dr McWilliam responded that the members of the Board had taken the thrust of the CQC recommendations very seriously which was to work as one system to oversee its Strategy and to hold it to account. To this end the Board had taken on a programme of organisational development, the process for which had involved independent facilitators to assist them to define its role. The next meeting of the HWB would take place in public as usual. He added that one of the proposals for its new organisational development was to hold a Reference Group which would comprise of workshops for the public to engage with and discuss key issues in the HWB programme. The public will be able to see the emergence of this at the November 2018 meeting. Louise Patten added that the Health & Wellbeing Board would be measuring progress, not merely signing it off.

Responses to a series of questions from members of the Committee included the following:

-       The latest DTOC statistics for Oxfordshire were at 79 against nationally set targets. Assurance was given to the Committee that there would be no complacency. Reference was made to the HART (Home Assessment Reablement Team) team administered by the Oxford University Hospitals Foundation Trust (OUH) which had been created specifically to assist people with a high level of needs to receive assistance within their home environment;

-       With regard to the issue of ‘Oxford Weighting’, Louise Patten stated that lobbying was in progress for equal weighting with London. She pointed out that Oxford Health and OUH were already offering incentives for clinical and nursing staff. Kate Terroni added also that the hourly rate paid to care staff in Oxfordshire was already the highest rate in the country. This was also reflected in the banding rates for residential homes;

-       Kate Terroni was asked about those current staff who had not undergone the new certificate training course. She responded that there was always an expectation that staff would have undergone some kind of training when they come into employment, and, in reality a new employer would often want a person to redo any training already undertaken. She added that this was an opportunity to work with Health Education England on a new plan, which it was hoped would be in existence in 6 – 9 months. It was hoped also that existing care workers would be able to apply for the certificate;

-       When challenged by a member of the Committee that it appeared that a large amount of work was being undertaken which would have no direct influence on patient outcomes, Kate Terroni stated that the CQC Action Plan was premised on single path commissioning which would require one single conversation and ultimately lead to more coherent planning for a person, rather than the person themselves having to navigate a pathway.

-       When asked if there was a process of measurement in existence which would highlight whether this method was having a beneficial impact on patients, Kate Terroni gave an example of a very different way of working which was to the benefit of the patient first and foremost.  ‘Stranded’ hospital patients were being worked with by an integrated team of practitioners prior to discharge in order to support their leaving in a timely way with the maximum support. Lou Patten added that this also meant that outcomes for patients could be measured in more of a timely way;

-       A member sought reassurance that the Joint HWB Strategy had not been fully finalised and refreshed to align with patient experience, asking if there would be services which the Committee could focus on when scrutinising, which would align with those that the CQC were also looking at. He also pointed out that all the system leaders, or their representatives, were not currently around the table for this item. Kate Terroni responded that all the system leaders were now members of the HWB and would be present at meetings, adding also her assurance that close working was in existence. She pointed out that this item was more about the theory, but the next item, the Winter Plan, would illustrate how system leaders were working in practice. Dr McWilliam gave his assurance that the new, overarching, high - level Strategy would be discussed at the next meeting of the HWB. Moreover, the HWB would address the work of the Integrated Service Delivery Board whose remit covered the work under the pooled budget umbrella. He added that there would be no shortage of dashboards to measure in this system of working. Work was already moving at great speed, for example, the Health Improvement Board and the Children’s Trust were looking at its current and future priorities and how it could align with the HWB. At the end of this process there would be a need to stitch everything together in order to obtain end to end priorities in a format which made sense for all, including the public and that also took account of that the CQC wanted to see. The public would have a hand in shaping this process via the Reference Group. He commented finally that this would not be a straightforward task as there were issues to address requiring further work such as how to improve the DTOC stats, housing etc; and

-       A member pointed out her view that bullet point 4 under 3.1 of the report presented which stated that ‘many of the actions in the CQC Action Plan are strategic in nature and it would be very difficult to link them to specific impacts on people’ needed to be refreshed to take account of the premise that any strategy anywhere should have direct measurable impact on patients at the end of the day.  She asked also if people would be assessed at home without a knowledge of what was needed? Kate Terroni responded that home first was best practice, together with possible short stays in hospitals, therapy or interventions.

It was AGREED to:

(a)   thank all for attending; and

(b)   request the representatives to return in the new year to present the CQC feedback;

(c)   also to request the representatives, when they return, to give some indication of how outcomes have improved given all the hard work undertaken; ensuring that targets identified are nationally set where appropriate, and, alongside this, to identify what the trajectory is for the local Oxfordshire system.