Plans for pooled budgets in Oxfordshire to fight delayed transfers

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.