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Hospital social care staff drive delayed transfers turnaround

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The chief executive of one of England’s top teaching hospitals has set out how it halved its stubbornly high rate of delayed transfers, after introducing a set of reforms including directly employing social care workers. Bruno Holthof, who joined Oxford University Hospitals in October, also set out his vision for the future of the trust.

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Mr Holthof said the improvement, made over six months, had released 75 acute beds.

He also told LGC’s sister title Health Service Journal that the future development of the trust would be based on collaboration with peers, rather than mergers or takeovers.

The chief executive, who previously ran a “multihospital system” in Antwerp, Belgium, said he came to the UK to run Oxford’s “research lab”, to create “breakthrough improvements” in care.

Internal data from the FT, whose health economy has had the worst rate of delays for at least five years, suggests significant improvement over the past six months.

OUH is involved in a programme of joint working between the acute, primary, community and social care in the county, which is likely to include appointing OUH as the lead provider for frail older people. This was originally planned to go live on 1 July, but HSJ understands will now not happen until later in the summer. The lead provider approach has already been adopted for adult mental health in the county, and was tried unsuccessfully for older people in 2013.

HSJ’s analysis of national delayed transfers data revealed that in 2015 Oxfordshire had the highest rate of delayed transfers in the country, with over 9,000 delayed days per 100,000 population during the year.

OUH hired around 60 care support workers in May, who provide social care in people’s homes after discharge from hospital. Dr Holthof attributes some of the improvement to their impact.

He said delayed transfers were like a traffic jam: “The traffic jam gets there because of the last 10 per cent (of cars to arrive) – and the delayed transfers actually happened because we needed 1,600 hours a week of extra home care packages.

“It’s not a lot. It’s 50 full time equivalent staff.”

Dr Holthof said the majority of the new social care recruits came from outside the health and care sector, and had been employed on more attractive terms and with better prospects for career development than are typically offered by social care providers.

OUH’s internal data is based on a “snapshot” of patients who on a given day are medically fit for discharge but are stuck in acute beds. This table shows the reduction it has recorded:

MonthJanuaryFebruaryMarchAprilMayJune

Delayed patients (one-day snapshot)

123

91

93

69

76

57

National reported data only covers to April, but also demonstrates a downward trend. HSJ understands that the rate of delays for the whole county is falling, but less sharply than at OUH.

As well as directly employing social care staff, a set of measures has been adopted which includes commissioning extra intermediate beds in care homes, and OUH staff working much more closely with other clinicians, such as GPs and care home nurses, to increase capacity and capability outside the acute hospital.

Dr Holthof also said:

  • He believed OUH’s future lay in working more with other organisations rather than taking them over. “I don’t believe in big mergers,” he said. “I do believe in collaboration though.” This included better joint working within Oxfordshire, but also increasing collaboration between acute providers, including making joint appointments, and networking services such as radiotherapy across the Thames Valley. He also said a “lead provider” commissioning model could be adopted for highly specialised services, with one tertiary provider coordinating care across several sites nationally.
  • He expected quality improvements to release funding, which in turn would enable the trust to shrink its footprint and invest in new equipment and infrastructure to further improve quality. His priorities include making operating theatres more productive, decommissioning old facilities and upgrading some existing ones, automating administrative processes, and moving diagnostics into the community
  • And, he said that because of the ties between OUH and Oxford University, his health economy was a “great research lab” for developing better care. “We’d like to make sure clinicians, researchers, together with industry and patients, can collaborate, to translate basic science into improved ways of treating disease.” He added: “So I came here to run the research lab - to make sure we are leveraging the strengths of the university… my personal ambition is to work on breakthrough improvements.”
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