Health and Care Transformation Board - six monthly update
This paper provides a six-month progress report on key activities of the joint Health and Care Transformation programme.
Tom Shakespeare (Director of Integrated Care, Brent CCG & Brent Council) introduced the report updating the board on key activities of the joint Health and Care Transformation programme. The following key points were highlighted:
· The older people’s pathway graph (section 4 of the report) showed significant improvements in Brent’s adult social care delayed transfers of care (DTOC) performance, moving Brent into the top ten performing London Boroughs. Work was ongoing ahead of winter across Health and Social Care to look at NHS delays which had remained variable and high.
· Work on the integrated discharge pathway was underway, detailed in section 4.1.2 of the report. This was a joint piece of work across the trust that focussed on the establishment of a single point of access within hospital to improve the discharge process. Work had now moved into the implementation phase, which included development of a streamlined discharge process and establishment of a single Home First team to manage more complex patients.
· Home First, the existing discharge home to assess protocol, had been expanded in January 2019 to Imperial and Royal Free Trusts and relaunched at Willesden and Central Middlesex Hospitals. The refreshed model included assessment at home, focussing on simple discharges but work was being done to expand to more complex patient needs. The model was seeing positive improvements with the target for accepted referrals now being regularly exceeded.
· A new discharge to assess protocol had been agreed to support the discharge of patients with complex needs for NHS continuing healthcare (CHC) support, with ten beds procured to support the process in addition to the recruitment of a CHC nurse assessor to support and manage the flow through the Winter period. The funding had been provided through existing CCG and local authority contributions to the Better Care Fund with additional funding for the nurse the adult social care winter funding. Adult Social Care would continue to make spot purchased placements where required.
· The winter pressures plan priorities for allocation of the £1.3m Brent allocation had been implemented during 2018/19 with a new plan developed for spend in 2019/20. The enhanced Winter Plan formed part of the 2019/20 BCF Plan, as detailed in section 4.1.4 of the report.
· The Placement Premium pilot scheme had been launched in February 2019 with the ambition to speed up assessment and placement into residential nursing homes through incentivisation for assessments made within 24 hours and again when patients received placement within 48 hours of assessment. The pilot had an impact in speeding up assessment and placement, shown in the graph in section 4 of the report. There had been a proposal to build on this work and it was proposed that the board look to review this on a 6 monthly basis.
· Progress had been made on the challenges reported at the last meeting regarding integrated commissioning. Unfortunately it had not been possible to progress the joint brokerage role however a review of joint working had been undertaken with work now focussed on the alternative areas outlined in section 4.2.2 of the report.
· There remained a good level of engagement with the Care Home Forum, which had enabled significant progress to be made on key priorities. Progress continued to be made on the three key strands within the transformation programme relating to dementia and challenging behaviours. The three areas identified included dementia awareness in homes without specialist dementia capacity, workshops to train and develop care home staff to support people with dementia, and a dementia in reach service to provide specialist support to dementia care homes, funded as part of the 2019/20 BCF and on which further updates would be provided as the new pilot service model was progressed.
· GP Enhanced Care Support was reviewed by CCG and a new service specification had been agreed, focusing on the nursing homes with the highest hospital admissions within Brent, which aimed to reduce duplication with existing GP responsibilities and provide MDT support.
· The range of other schemes also being taken forward, as detailed in section 4.3.4 of the report.
· An improved self-care referral pathway had been developed to align Brent’s Social Isolation in Brent Initiative service to the new Link Worker roles within the Primary Care Networks with work to develop a Brent wide model also being progressed on which a further update would be provided for the Board.
· Progress also continued to be made on the development of a new Integrated Care Partnership (ICP) model with the new service now operational and due to be rolled out across the whole of Brent from December 2019, as detailed in section 4.6.1 of the report.
· The development of a technology and able care strategy supporting people at home for highest risk service users.
· An update was also provided (as requested by the Board) on the existing integrated arrangements which involved a number of existing pooled budgets and integrated service arrangements between Adult Social Care and NHS organisations, as detailed in section 4.6.2 of the report. A further paper would be provided for the Board regarding the the future integrated commission arrangements.
In the ensuing discussion, the Board noted the following matters:
· A correction was issued on page 26 of the report that the £1.1m contribution for integrated rehabilitation and reablement service was not from London North West University Healthcare Trust but had been provided by the CCG, with London North West University Healthcare Trust as the provider.
· Phil Porter (Strategic Director, Community Wellbeing, Brent Council) felt it important to highlight that Brent outscored many other Boroughs on CCG Care Home ratings and was regarded as system leaders in this respect. The overall approach was focussed on providing good quality care aimed at improving quality of life, with the specific example provided of an approach being piloted in relation to tdental health care facilities.
· Tom Shakespeare clarified that there was scope for providers from the Community and Voluntary Sector CVE to be involved in the self-care steering group, and informed the board that the sector was already represented on the Group.
· In response to queries about workforce planning in relation to Care Home provision post Brexit, Tom Shakespeare advised that he had not been made aware of any issues with many care home providers already tracking and monitoring the situation in order to identify and mitigate potential risks. Phil Porter also advise that the Council were actively monitoring risks associated with Brexit.
· As a result of the update provided, Councillor Hirani felt it would be useful to promote the work on assistive technology and integration and practical changes to people in the Borough.
· Carolyn Downs welcomed the positive improvements in delays to discharge but also felt there was a need to consider the impact in relation to costs being passed on to partner organisations which it was felt needed to be carefully reviewed and managed with any impact recognised and the resulting costs equitably shared across the system. The Board recognised the issue raised but were also keen to ensure that the benefits to patients in relation to the integrated discharge strategy remained the focus in order to secure the best outcomes. Simon Crawford (Director of Strategy, London North West Healthcare NHS Trust) also felt it was important to note the work focussed around prevention. He gave the example of the work being undertaken with the London Ambulance Service to ensure patients were being directed to the most appropriate form of care which would not always involve A&E. Through the correct discharge processes this stopped patients getting into crisis.
As no further issues were raised, the Board acknowledged the progress made and subsequently RESOLVED that the progress against the action plan for 2019/ 2020 be noted.