Agenda item

The purpose of this report is to provide the Health and Wellbeing Board

(HWB) with an update on progress on the Older People’s Acute Liaison

Service (OPALS) business case for Northwick Park Hospital.

This is one component of the Unified Frailty Pathway and part of Delivery

Area (DA) 3 - the Older People’s services workstream of the Northwest

London Sustainability and Transformation Plan (NWL STP). It also forms a

key workstream of the Brent Health and Care Plan (the Brent Plan).

Helen Woodland introduced the report which provided Members with an update on the United Frailty Pathway and progress on the Older People’s Acute Liaison Service (OPALS) business case for Northwick Park Hospital, which had been discussed at the last meeting of the Board. She noted that this formed part of the extensive ‘Older People’s Services’ work stream within Brent’s Health and Care Plan.

James Walters (Divisional General Manager, London North West Healthcare NHS Trust) explained that the first part of the report detailed the systems approach to preventing unnecessary admissions and maintaining care outside of the hospital setting. He noted that admissions numbers had been rising for older age groups and that frailty often exacerbated existing health conditions, which in turn had the unwanted consequence of seeing people stay in hospital for longer periods. The Board heard that the aim of OPALS was to provide a model of care which sought to address frail patients once they had entered the emergency department in order to substantially reduce any potential length of stay in hospital. Mr Walters mentioned how OPALS linked with the Short-Term Assessment Rehabilitation and Reablement Service (STARRS) programme once the patient had been moved to a community setting. He concluded by detailing the proposals within the business case and the potential for significant savings if the patient had a reduced length of stay in an acute setting.  

Members asked for clarification on the proposed timeline for putting OPALS into operation. Helen Woodland outlined that the aim was to ultimately have the full frailty pathway in place in Brent by 2020/2021, however there were aspects of the pathway within this that were already operational. Members commented that there was a need to be clear on the incremental steps which needed to be taken and which of these had been making progress.

A Member of the Board questioned whether OPALS would provide a community ophthalmology service to deal with any eye-related emergencies. James Walters agreed to arrange a briefing to Members on what specific services were provided in this area and how they linked to the OPALS model.

Questions also arose on the working arrangements with other neighbouring boroughs and whether there had been any collaborative working on the proposals. James Walters responded that there was a willingness to have this service operate effectively across boroughs. He noted that there had been positive in-depth conversations with the London Borough of Harrow on moving ahead with this model and on what each borough could specifically do to support the concept. It was also mentioned that OPALS built on the hospital discharge project work being undertaken by the West London Alliance and that there were also plans for a similar model to be undertaken on an appropriate site in Ealing.

Discussions moved to the proposed finance arrangements for the model and which budget the plans were being derived from. Members heard that that there was a need to work out what was proportionate for each Clinical Commissioning Group which would be involved via the Northwick Park base and that the OPALS evaluation from 2015/2016 had been funded by money made available for winter pressures. It was mentioned that the resource implications were still being monitored but that the evaluation had suggested that the model could ensure a reduced length of stay and better outcomes for patients. It was also discussed that the A&E performance trajectory was agreed system wide by both NHS England and NHS Improvement, and therefore each of the boroughs involved would ultimately benefit from finding resources for this service model as each would be working to meet the same targets. James Walters added that an additional incentive for the different boroughs was that OPALS and STARRS were deemed to be models of best practice in this area and were being supported accordingly by the NHS’ Emergency Care Improvement Programme.

It was RESOLVED that the report be noted.