Agenda item

To provide a progress report on key activities of the joint Health and Care Transformation programme.

Tom Shakespeare (Director of Health and Social Care Integration, Brent Council) presented the report which provided an update on the progress of key activities of the joint Health and Care Transformation Programme over the past 12 months. The programme was overseen by the Health and Care Transformation Board, which reported directly to the Health and Wellbeing Board. He raised the following key points in relation to the report:

Care Homes:

• Over the COVID-19 period the work and priorities of the Board and Programme had necessarily changed to respond to issues that had presented during COVID-19. The work in care homes and the support provided to care homes during COVID-19 was highlighted, with the weekly care home forum noted as having provided a good grounding for the work done with care homes over the COVID-19 period. Direct contact was established with Provider Relationship Officers to address outbreaks of COVID-19 and provide support, training and peer-to-peer support, which resulted in positive outcomes in the context of COVID-19.
• Employment of a key role working with managers on a peer support basis had begun, looking to drive up the quality of care homes and get more homes in Brent ‘good’ or ‘outstanding’ from a CQC perspective.
• There had been a push to get NHS mail rolled out and tablets rolled out to enable video consultation across care homes which was now live.
• Training had continued, including Public Health infection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      control training and support.
• Work was being done with the Council, CCG and other colleagues across health services to support the roll out of Direct Enhanced Service (DES), an enhanced healthcare service across all care homes providing a direct GP link and dedicated support.

As the care home representative on the Board, Basu Lamichhane agreed that care homes felt very supported by the integrated programme and the forum had been a very useful resource during COVID-19 and the uncertainty regarding PPE and testing. Managers felt comfortable talking about what was going well and also where things were going wrong through the peer support scheme. He advised that moving forward they would like to see more repeat testing available in care homes and allow designated visitors to come to the care home through that type of testing system.

Hospital Discharges:

• A single hospital discharge hub had been established for Brent and Harrow based in Northwick Park which accepted referrals from other trusts and took a Multi-Disciplinary approach. It was noted that there had been significant improvements in the flow and discharge out of the hospital and pathways and models of care had been agreed to support the delivery of the hub.
• Simon Crawford (Director of Strategy, London North West Healthcare NHS Trust) advised that the discharge hub had worked very well supporting the response to COVID-19 and made a huge difference to managing the crisis. He felt it demonstrated the good work in co-designing the hub and in joint working.

Rehabilitation and Re-ablement:

• The provision of rehabilitation beds at Central Middlesex Hospital was due to be recommissioned within a nursing home setting. Twenty beds would be re-provided with the additional equivalent of beds being supported by a new dedicated community rehabilitation service, working with the integrated rehabilitation and re-ablement service within the community to support people at home. The service was due to go live on 1 November 2020. Tom Shakespeare expressed confidence that the model was backed up by data and evidence of moving people out of hospital and into the community.
• Regarding the rehabilitation and re-ablement service, the Board heard that the model had been co-developed across the CCG, Council and Trust and it was confirmed the service had a multi-disciplinary team delivering care. The care home provision and nursing staff would be provided by the care home and the Trust would provide medical input and leadership both through GPs and clinical supervision meaning it would be a high quality clinical model and have appropriate therapy provision. They were working hard to ensure handover between services would be as smooth as possible and would report back to the Board on progress to ensure the service was being implemented as intended. Simon Crawford expressed that the service would be critical to resilience to winter pressures and a potential spike in COVID-19.
• Work was being done for the re-provision of the in-house re-ablement service and given the financial pressures the Council were now facing they were looking to bring a more detailed model to the Board following further discussions as to how they would be supporting an improved model of re-ablement working with the independent sector going forward.

In response to a query from the Board Tom Shakespeare advised that the procurement process for rehabilitation beds had begun and the criteria set only enabled them to go with one home which had a discreet ward to support COVID infection control processes and ensure it was operating at higher standards of rehabilitation.

Better Care Fund:

• The Better Care Fund guidance and deadlines for submission had not yet been released for the financial year but Tom Shakespeare reassured the Board that work was being done to be clear where funding would go and what support would be available for winter pressures over the coming weeks. The proposal would be discussed at the Joint Health and Care Transformation Board and return to the Health and Wellbeing Board for formal ratification.

RESOLVED: To note the progress against the plan agreed in 2019/20.