Agenda item

This report provides an overview of Delayed Transfers of Care (DToC) in Oxfordshire. It includes recent performance compared nationally and locally as well as a summary of the challenges facing the Health & Social Care System that have on impact on DToC performance.

Oxfordshire is one of the worst performing systems in the country in terms of DToC consistently ranking in the bottom quartile nationally, and for the current financial year is ranked 147th out of 149 authorities . It is recognised that being delayed in hospital has a detrimental impact on a person’s health and wellbeing. It is therefore critical that Oxfordshire’s health & social care system partners work together to improve on recent poor performance in this area.

There are a number of challenges which impact on this performance, some of these challenges are being experienced by systems across the country, whilst others are specific to Oxfordshire. These are described in this paper as well as work that is underway to mitigate these challenges. As requested by the Performance Scrutiny Committee there is a specific focus on Reablement.

The Committee is RECOMMENDED to note the report.

Stephen Chandler introduced the report and gave a short presentation on some of the related statistics.  There are over 100 contracts for home care.  Progress has been made – the number of delays per month was double the current figure – but Oxfordshire still has the third poorest record in the country.  The number of “joint” delays is the worst England – that is, those attributable jointly to the NHS and Adult Social Care.

Officers responded to Members’ questions as follows:

·         There can be differences in recording delays and disputes about this between the Council and hospital in some cases, but better relationships will ensure more accurate recording.

·         The Home Assessment Reablement Team (HART) has become a bottleneck in the system.  There is a range of support for which people need to be assessed.  The Council is proposing changes to the contract to tackle this.

·         The £23 per hour that the Council pays for home care goes to the care provider.  There is nothing in the contract to require disclosure of the amounts paid to workers.  The Council would prefer this to be transparent.

·         The Council is exploring options to re-tender for home care with a standardised more transparent agreement.  Providers have asked that the required activity be defined and the Council has agreed to this.

·         The HART contract ends September 2020. What happens following this is currently being reviewed.  The Council is recommending more hospital-based reablement with contracts linked to home care.

·         In the meantime, the Urgent Care Working Group is looking at the whole system.  There was significant improvement in the December and January figures despite it being winter.

·         HART was reportedly only 80% staffed but more have been recruited recently.  Staff there are doing their best, the challenge is with the contract.

·         While there is a lot of focus on the hourly rate, the quality of care is monitored too.

·         There is a window of opportunity now to improve reablement.  Daily contact gives the best outcomes.

·         At one point the Council and NHS were competing for care home beds.  Now all go through the Council so it is simplified with agreement on who gets beds.

·         It is important not to be too prescriptive.  Some people do not want carers in.  The Council also considers community networks and technological solutions.

·         Age UK do a lot of good work – in particular in supporting people in the difficult first few days back at home.

The Committee supported the principle that there should be transparency in contracts to ensure that the Council is aware of the rates that workers are paid by providers.

Councillor Richard Webber asked if a scatter graph could be provided showing home care costs against cost of living in the various areas.

The Chairman paid tribute to care workers who are often low-paid but still go out of their way to help.  She asked that workers from other EU countries be assured that they are still welcome.  Stephen Chandler agreed that the work being done should be acknowledged publicly whenever possible.