Agenda item

To provide a brief update on the winter schemes in Brent and to inform the Health and Wellbeing Board of Brent’s preparedness to manage the additional Adult Social Care (ASC) Discharge Funds to support winter pressures on the local health and social care system.

Tom Shakespeare (Managing Director, Brent ICP) introduced the report, which informed the Board of Brent’s plan and preparedness to manage the anticipated winter pressures on the local health and social care system and manage the additional Adult Social Care (ASC) Discharge Funds to support winter pressures. He highlighted that this work was being done in the context of the significant pressures the NHS was currently facing. In updating the Board, he raised the following key points:

• Members had heard at the previous Board meeting the £1m worth of schemes Brent were proposing, and some additional funding of approximately £2.2m was now coming into the Brent system in addition to that £1m to support winter pressures on the acute system. It was hoped those additional schemes would have a significant impact on reducing pressures in the hospital and improving flow.
• All schemes were now live with the exception of three. Two of the three schemes were now in the process of being mobilised. This meant there were a total of 24 schemes developed in Brent from the significant amount of funding that had entered the local system.
• Simon Crawford added that, from an acute trust perspective, they had received good support from the local authority and community services regarding discharges. There were individual cases that were more complex where escalation calls were required occasionally, but generally there was reliable attendance on all discharge calls on a daily basis, including out of hours coverage. He added that this was a significant improvement to several years prior.
• The formal ratification of the Adult Social Care Discharge Funding was required from the Health and Wellbeing Board as this would form part of the Better Care Fund and Section 75 Agreement.

In considering the report, the Board raised the following points:

• The Board highlighted the recent press coverage that elderly people were being discharged into large hotels, and asked if that was happening within Brent. Phil Porter (Corporate Director Adult Social Care and Health, Brent) confirmed this was not the case within Brent.
• The Board commended Antoinette Jones (Head of Delivery (Brent and Harrow), NHS NWL) and her team for co-ordinating the very complex set of funding that had been released from different pots at different times. The timing of funding releases had not always been helpful, and the Council had fed back to the Department of Health and Social Care that it would be helpful to receive money earlier, be clearer about the outcomes they wanted partnerships to achieve, and allow partnerships the flexibility to implement the schemes that were locally needed. The Board recognised the difficulties of the timings of funding announcements. Tom Shakespeare agreed that there was a shared view that it had not been an ideal process, but was confident that Brent had planned some positive schemes despite those difficulties.
• Carolyn Downs (Chief Executive, Brent Council) had been in discussion with all 8 NWL borough Chief Executives and the ICS leadership to raise the issue of the newly announced funding of £250m discharge funding, due to concerns about the requirements of the scheme. From that discussion it was clear that there was a will to look at how systems could improve the flow to both keep people out of hospital and get them out of hospital if they did enter hospital care, which she had been reassured by.
• In relation to funding for care home beds, Phil Porter confirmed that a different set of funding was used for that. A recent cost of care exercise had been done, which would be published in February 2023. The position in Brent was to have a clear focus on the cost of care in order to ensure the rates being paid matched that cost, which was the evidence to date. Having said that, the ICB recognised the pressures on care homes, as well as all services, and there were ongoing conversations between care home managers and the commissioning team to ensure the system was responsive to that.
• The Board asked how patient and resident voice would be factored in to the evaluation of the schemes, which Tom Shakespeare would take away for a discussion. Simon Crawford added that, in relation to patient and resident voice, as part of discharge planning for each patient there were conversations with the patient and family in terms of the most appropriate discharge pathway. With the pressure the acute trust was under, patients did not always get a long list of choice, but they were consulted and an assessment of need done, and then placed in the most appropriate place. Care homes also looked to determine whether they had the right provision in place to be able to care for each patient.

As no further issues were raised, the Board RESOLVED:

i)              To note the report.

ii)             To formally ratify the winter scheme plan and adult social care discharge funding.