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System-wide problems

A Care Quality Commission review of health and social care in Oxfordshire has revealed the entrenched problems the area is facing with delayed discharges and integrated care.

The report into system integration found some patients “did not always receive safe discharges home”. It said it was “unacceptable” some patients had been sent home at 2am or 3am and found “widespread concerns” that others were passed on to social care providers without discharge letters. It also found issues with the accuracy of letters, with some failing to say when a patient’s medication had been stopped.

The regulator also reported “some discharges may have happened too soon”. Compared to the national average, lengths of stay in hospital in the region were shorter but readmissions were higher throughout 2016-17.

The county appears to take a reactive approach to discharges and winter pressures. According to data supplied by South Central Ambulance Service, over 71 per cent of inpatient acute discharges were unplanned. Similarly, when the trusts in the region were facing major capacity problems, the regulator found escalation processes became “normalised among frontline staff.” For 80 per cent of November and December 2017, the region operated at OPEL 3 or 4.

The problems do not seem easily resolvable as closer relationships across the patch were still being developed.

The report found that historically “difficult” relationships have improved but there were still “deep rooted issues in respect of organisational culture [and] trust” between organisations in the region.

It also said although Oxfordshire intended to move to an integrated care system the regulator found “no evidence of commitment from partners to drive this, or a plan to achieve it”.

Going off plan

Ahead of the publication of the latest financial performance update for the NHS providers, HSJ finance correspondent Lawrence Dunhill writes:

“NHS Improvement’s quarterly performance report for the trust sector, showing the latest financial position and year end forecast, was supposed to be published earlier this week but did not appear.

“At a meeting of finance directors hosted by NHSI last week, I’m also told the regulator dodged questions on the latest position.

“This suggests something may be up (or down) with the forecasts, and some to and fro could be happening between the regulator and trusts over the numbers they’ve submitted (as we’ve seen before). Or perhaps they just need more time to work on the communications strategy.”