Victoria's mission to free up Oxfordshire's hospital beds

Reducing the number of people unnecessarily delayed in a hospital bed is Victoria Baran’s priority.

Victoria joined the County Council’s Adult Social Care team in March last year, with a determination to continue improving Oxfordshire’s performance in relation to Delayed Transfers of Care (DToC).

Appointed as Area Service Manager for Hospitals, Victoria has worked closely with senior managers across the county’s health and social care system, contributing to a fall in DToC – more commonly known in the media as ‘bed blocking’.

On January 9 that work was recognised by the Care Quality Commission (CQC) as part of a follow-up review. It noted significantly-improved joined-up working across both health and social care services to improve patient flow through the system.

In January 2018 there were an average of 117 acute reported DToCs. Last week this had dropped to 68.

Efforts to maintain the continued downward trajectory of DToC is all part of the council’s commitment to thriving communities – helping people live safe, healthy lives and play an active part in their community.

Stranded patient reviews

Stranded patient reviews were introduced at the John Radcliffe Hospital in March following an initial review by the CQC in November 2017. Then it found there was little collaboration and ‘no shared vision’ between the organisations responsible for providing care in the county.

In response, Oxford University Hospitals Trust invited a leading expert into the hospital to complete a review of stranded patients’ length of stay.

Victoria explained: “A stranded patient is anyone who has been in hospital for seven days or longer. Being stranded doesn’t mean you are delayed. But it means that every day in hospital should be meaningful.

“The reviews have helped us improve our ability to track where a patient is in the system and how long they have been there.

“I do think it has been a brilliant system piece of collaborative work. It has involved a number of staff from organisations including Oxford University Hospitals NHS Trust, Oxford Health, Oxfordshire Clinical Commissioning Group, Age UK and Oxfordshire County Council.

“Having come in from March I’ve been so impressed by the senior leadership sign-up to this. It has enabled us to challenge where a patient is in the system and bring about change in a sustainable way.”

Proud of her team

Victoria has about 100 staff under her leadership, including teams at the JR and Horton hospitals, plus a team responsible for social work input into nursing homes and community hospitals, and a reablement outreach team.

She said: “I’m really, really proud of the team. I really feel that we can crack this nut. We’re doing fantastically well but we’ve got more to do and we are committed to doing it. It has become a bit of an obsession.

“It has been an eye-opener to come to Oxfordshire and look at some of the challenges unique to the county. Particularly the diversity in terms of some of it being really rural and some of it being very urban. That’s a challenge for the staff who are working agilely. They need a degree of resilience and I have been very impressed by their ability to manage their own time.”

Reasons to be positive

Reflecting on a busy ten months, Victoria sees positives ahead as the county deals with winter.

The CQC acknowledged in its follow-up review that the appointment of a Winter Director to lead a system-wide Winter Team had already led to improvements.

Victoria said: “Whilst winter has been a busy time, we have maintained the lower level of delays. Working as part of the Winter Team with a Winter Director has enabled us to maintain oversight of all the pressures across the system and address these together.

“Every day we meet as a system at ‘mission control’ in the John Radcliffe and work out the day’s priorities together. It has been so positive for senior managers to be able to sit down in a room and challenge what each other is doing and be open to feedback. It has demanded a level of honesty from all of us. I think our figures demonstrate our commitment to this model of practice.”