Agenda item

11.45

Rachel Coney, Oxfordshire Clinical Commissioning Group and representatives from other partner organisations will attend the meeting to discuss performance and challenges for the Appropriate Care for Everyone programme (JHO8).

John Jackson, Director for Social and Community Services, Oxfordshire County Council, Alan Webb, Interim Director of Partnerships, Oxfordshire Clinical Commissioning Group, Rachel Coney, Lead Commissioning Manager with responsibility for delayed transfers of Care (DTOC) and Dr James Price, Clinical Director of Medicine, Oxford University Hospitals attended to discuss the ACE programme.

Officers noted that current DTOC numbers have come down slightly after a spike in June.

In presenting the report to the committee a number of points were made,

• More people are being referred than there is capacity to accommodate
• More people in Oxfordshire are going into care homes than the rest of the country
• Recruitment is a challenge as many parts of the system are recruiting amongst the same pool of candidates.
• The new crisis service is working and the hospital discharge service at capacity by the end of July.
• A provider action plan has been agreed by the Chief Executives’ group (CE’s from provider and commissioning organisations).

The discussion was opened out to questions from members.

• In response to a question from Cllr L Stratford it was noted that the issue is about how community hospital beds are being used rather than simply increasing the number of beds
• The length of stay in a care home is increasing so the aim to support people to stay in their homes longer.
• The provision of housing for assisted living is key to having an impact. Whilst we were slow in Oxfordshire to develop this over 300 places will be available in the next year.
• The difficulty in encouraging people to move from their homes was acknowledged and the need to provide alternatives for older people.
• Officers assured the committee that there is absolute clinical buy-in to solving this problem and that we need to get to a point where it is natural that people go home from hospital
• There is a need to develop a flexible bed base to deal with the range of conditions and community hospitals need the ability to manage the greater complexity of inpatients. Councillors suggested that there is a need to review the scale and distribution of the community hospital bed base.
• A successful reablement service is key to enabling people to live successfully at home. Numbers currently waiting for this service have been reducing.
• Councillors were concerned that the one-off purchase of placements would not be an effective long term solution to the problem as there will probably be demand again in six months.
• Officers said that social care service delivery needs to adapt and modernise to be able to deal with the current situation.
• There is a need to promote the interest and specialisation of medical professionals in geriatric conditions.
• Councillors emphasised the delays people experience in getting the necessary assessments in order to go back into their homes. It was emphasised that the aim is to move to a position of discharge to assess so assessments happen promptly.
• It was noted that the affordability of housing in Oxfordshire was not known to be a factor in recruitment
• The use of payment by results was noted as an incentive to have successful outcomes and the need for contracts to be flexible.
• The peer review with Buckinghamshire has been useful in particular the learning from the discharge policy which will be developed for Oxfordshire.  
• The committee suggested that single management of these services and budgets would make it easier to have an impact.

The committee thanked the officers for the report and open discussion and asked to be kept updated on progress of the programme.