Oxfordshire CCG
Plans for pooled budgets in Oxfordshire to fight delayed transfers
Health and social care commissioners in Oxfordshire have agreed in principle to a pooled budget for services used by older patients as the central part of a programme to cut the county’s high rate of delayed transfers of care.
HSJ analysis of Department of Health data shows that the Oxfordshire health economy has the highest delay rate in England, with 129.5 delayed days per thousand head of population over the year to June 2012. This compares with a national median of 26.6.
The Oxfordshire system has reported consistent month-on-month falls since March. The most recent weekly snapshot figure showed 130 delays in a day, against 201 five months before. However half of that reduction is thought to be seasonal.
HSJ’s latest Local Briefing details plans drawn up by Oxfordshire clinical commissioning group and the county council to share resources currently spent on health services for older patients and social care services. It is hoped that the integration plan can be implemented by the beginning of 2013-14.
A pooled budget is expected to enable the joint commissioning of care and to remove perverse incentives which currently reward organisations for not taking patients.
However the move is not yet certain, as many details, around lines of accountability and exactly which pots of money should be used, still have to be agreed.
The total pooled budget is expected to be worth around £130m, of which about £100m will come from Oxfordshire county council.
Local health leaders attribute Oxfordshire’s delayed transfers problem to cultural and structural factors.
The county’s 200 community hospital beds are perceived to be causing unnecessary delays by complicating care pathways, putting an extra stage into the transfer of many patients from acute care to home. There are plans being drawn up to use those beds differently, providing “step up” care for patients needing additional primary care, to prevent acute admissions.
Cutting reliance on hospital services should enable Oxford University Hospitals Trust to cut its total inpatient beds by up to 150.
NHS managers are also concerned that local clinicians are “risk averse”, and are reluctant to transfer patients as they are unsure whether they will continue to receive good care in other parts of the system.
Health leaders are running an engagement programme with local doctors to increase understanding and confidence between all parts of the system.
A “major public education and explanation programme” is also being planned, to explain to patients that although they should be allowed choice over their community treatment, this does not mean they can wait in an acute bed until their preference is available.
Patient choice causes around 10 per cent of the county’s delays.
Source:
Information supplied to HSJ
Source Date:
August 2012
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Readers' comments (2)
Anonymous | 21-Aug-2012 2:35 pm
A union view might be that
Community teams are seeing their shifts changed and income cut by Oxford Health FT managers who focus on balance sheets rather than service delivery. And experienced staff are leaving.
The Oxfordshire health economy gets additional Market Forces funding from the government (because of the high cost of living locally) which it steadfastly refuses to pass on to low paid staff through recruitment and retention premia - instead preferring to develop contacts with the SW pay cartel to investigate further cuts in staff pay and conditions.
Oxford Health FT needs to start delivering on the responsibilities it inherited from the PCT.
As for community hospitals the problem is that there is insufficient capacity in Oxford city - not that there is too much elsewhere.
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Anonymous | 22-Aug-2012 2:35 pm
Given a recent experience of my father transferred from an acute to a rehab facility, despite the concern expressed by my mother, and whose staff lacked the training to treat his medical needs and whose environment was totally unsuitable and which culminated in him being left unattended for hours in a closed single room, without his medication and where he fell and badly sprained his arm, bruised his already fractured hip and subsequently developed pneumonia - perhaps local clinicians are right to be risk averse
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