Agenda item

Nathan Atkinson, Assistant Director Strategic Commissioning, RMBC and Keely Firth, Chief Finance Officer, RCCG to present (report attached)

Keely Firth, Rotherham CCG, and Nathan Atkinson, Assistant Director Strategic Commissioning, presented a progress report of the Adult Care Development Programme and the Better Care Fund (BCF) as of Quarter 3 December, 2016:-

 

Nathan Atkinson reported on the Adult Care Development Programme - the overarching strategy to transform Adult Care highlighting the following:-

 

-          Community Catalysts, a not-for-profit organisation, had recently won a tender to provide expertise as to the development of community groups to deliver preventative services and supplement the wider Adult Care offer

 

-          The Village integrated health and care locality pilot had been running since July, 2016.  A Key Performance Indicator suite was being developed to enable practical comparisons to be made with other localities in terms of performance and impact.

 

-          Training commissioned to support operational workers with understanding and delivery of a strengths based approach to assessment.

 

-          Formal consultation on the future offer in Rotherham for people with a Learning Disability.

 

-          All eighty-four customers attending Charnwood Day Centre had been reviewed and moved to more appropriate support.

 

-          Current offer by the Shared Lives Team had been reviewed with a view to the development of an effective expansion plan based on national best practice.

 

-          Community Opportunity Pathway Programme continued to work with ten customers and their families.  Support for the programme ended in December, 2016.

 

Keely reported that the Better Care Fund was made up funding from the CCG (approximately £20M) and the Local Authority (approximately £4M).  There were thirty-six schemes which had now been categorised into six key objectives of the Fund.

 

During 2016/17 a review had been carried out of all the services for strategic relevance, whether there were strong robust contracts in place and ways of measuring success and the outcomes.

 

Seven of the eight national conditions were being fully met.  The remaining condition was partly met;  better data sharing between Health and Social Care based on the NHS number (fully met) and better data sharing including whether Adult Care could ensure that patients/service users had clarity about how data about them used, who may have access and how they could exercise their legal rights (partly met).

 

What had the Fund done for the people of Rotherham:-

 

-                   Defined, improved and increased the joint working with Social Care.

-                   Mental Health Liaison Services introduced where Mental Health Workers from the local Mental Health Trust now worked in the front end of the Hospital allowing people accessing A&E Services to have intervention before admission and if admitted, through the Mental Health Liaison Services, they could be targeted much faster.

-                   Social Prescribing – excellent feedback and had given real benefits to those in receipt.  It had now been extended for Mental Health Services.

-                   Increase in the number of community beds which enabled patients to be discharged safely from Hospital where appropriate and had meant delayed transfers of care was less of an issue.

-                   Increase in the number of people that accessed Personal Health budgets.

-                   Community Occupational Therapy Service had been subject to a rigorous review resulting in some innovative practice that had reduced waiting times and enabled people to return quicker to their own homes.

 

The BCF had enabled changes but had also resulted in partners working well together, especially through the difficult period of winter pressures.

 

Discussion ensued with the following issues raised/clarified:-

 

·           The Community Catalysts would be working in Rotherham for two years (February 2019) and would work with the Service to create different options and look at shifting the way of thinking and current practice models, especially for people with Learning Disabilities.  It would run alongside the current consultation.  A diagnostic exercise of looking at what was available in the community had commenced.  It was hoped to create fifteen alternatives within Rotherham communities in the first year starting with some taster sessions to give people an opportunity to go and test different activities, options and things that were available in the community.  It would also include looking at community assets and buildings and working with the Community Link Workers.

 

·           The emergency re-admissions target was a contractual Indicator and included in the Foundation Trust’s contract with the Trust being incentivised not to discharge patients before it was safe to do so.  However, the problem with the BCF metrics, and was a national issue for both emergency re-admissions and non-elective metrics, was that it was counted differently using different activity and patient groups.    It almost became a spurious figure.  Consideration was currently being given to replace it locally with an equally strong measurement with the same aims of the BCF metric. 

 

·           Continuing Health Care (CHC) was where packages of care were put into place; that was not in the BCF at the moment.  The Fund had been generated through local investment as BCF was not a national pot of money but derived from partners assessing which national conditions had to be met and agreeing on the funding to pool.  There had been some additional investment in Social Care but the bulk of it came from the partners.  When the Fund was set initially the focus had been on the areas that felt intuitive to deliver the objectives but there was nothing to prevent the inclusion of CHC. 

 

Both the Council and CCG were investing more in the CHC type packages.  There was no cross-subsidisation but there was an increase in investment in CHC from a different set of funds.

 

·           Consideration should be given to CHC becoming part of the BCF.  There were CHC reassessments of adults whose health were not going to improve and then that funding was lost together with residential and nursing homes then competing for funding to care for the older people.

 

·           There had been some marked improvements in the Integrated Health Village recently.  An event was to be held on 24^th January to refocus activity. 

 

·           The review of Breathing Spaces had been undertaken to gain an understanding the flow of patients and there was excellent feedback from outpatients.  The issue for Rotherham was that patients were frequently accessing the hospital initially as an A&E attendee, admitted for short stay assessment and then generally referred/discharged to Breathing Spaces.  An audit of cases had revealed that there were those that were in clinical need and appropriate to have gone to A&E in the first instance but there were also those incidents where 999 ambulance crews had not known of Breathing Spaces’ existence as an alternative.  Nationally Rotherham stood out on how much it spent on people with respiratory disease but also how many people then had a good outcome from the condition.  Rotherham was an outlier i.e. appeared to spend more than others but the outcomes were not showing that immediate benefit.  The review was trying to ascertain what was done there, what was working well and whether things could be done differently.

 

The Foundation Trust was working with the CCG to review Breathing Spaces.  There was an opportunity for more “step up” arrangements and a need to review the clinical evidence base on outcomes.

 

·           The BCF performance metric relating to permanent admissions of older people to residential and nursing care homes was a two part measure reflecting the number of younger adults and older people.  Part one was younger adults and part two was older people where their long term care needs were met by residential care.  It was relative to the population group and measured by how many per 100K were going into provision. 

 

·           The emergency re-admissions Indicator was performing very close to the target.  It was a symptom of how seriously ill people were when they were went into hospital, the care undertaken and the discharges carried out; there would be occasions when people needed to be readmitted.   From a contractually perspective with the Hospital it was not a metric that was underperforming but rather due to the way the metric was calculated.

 

There was with some complexity around the metric.  It would refer to those patients re-admitted with the same condition and there was some detail about other types of re-admission.  The aim was right which was to ensure when patients were treated in the acute setting and that they were supported and discharged at an appropriate point; if things were done prematurely people would be re-admitted.  Scrutiny of the metric was welcomed as it was something that the Trust focussed on to ensure that as the length of stay for patients was reduced, particularly for the non-elective patients, it could be tracked as to whether it created more problems and resulted in re-admissions.  The Trust was finding that as it reduced the length of stay it was still performing and above average in terms of re-admissions level - approximately in the top 1/3. 

 

·           Concern that once local Indicators were selected that the emergency re-admission indicator remain until there was a better understanding of the situation. 

 

·           All of the eighty-four customers attending Charnwood Day Care resource had moved onto alternative provision except three that were still accessing day services but from a different day service. A review would take place with those customers six months post their new service.  No issues or complaints had been received. 

 

·           Information would follow regarding consultation with Light Bite users.

 

Resolved:-  (1)  That the report be noted.

 

(2)  That the possibility of Continuing Health Care funding being included as part of the Better Care Fund be raised at the Health and Wellbeing Board Executive Group.

 

(3)  That feedback be submitted to this Select Commission on the 24^th January Integrated Health Village event and the review of Breathing Spaces.

 

(4)  That a briefing be provided on Community Catalysts.

 

(5)  That the Better Care Fund be submitted to the Select Commission for comment and pre-decision scrutiny prior to sign off by the Health and Wellbeing Board.

 

Lite Bites

A dedicated piece of work has been undertaken to look at the operation of the café Lite Bites which is based within the complex of the Trinity Hall in Wath Town Centre.

 

Lite Bites is under the operation of the Oaks Day Centre and is run by staff with the support of customers from Oaks Day Centre. The work undertaken has looked at the outcomes, cost and any opportunities/threats. The work has been carried out with Oaks Day Centre in conjunction with the operation of the café within the centre itself.

 

A briefing note is being finalised to consider what the options are that should be considered for the cafes. This will be discussed at Senior Management Team in the coming weeks.

 

Health Village

 

The Health village event on the 24^th Jan 2017 was well received and led by the team. Learning and feedback from the event have been incorporated into the action plan which is monitored on a regular basis by the project team.

 

There has been improvement in the staffing levels across the integrated locality pilot, specifically community nursing and the appointment of an administrator to support the team with a particular focus on co-ordination of integrated working processes.  A leadership team is now in place  consisting of lead officer across the services. They have undertaken a review and refresh of the action plan with the priority to support work to reduce winter pressures in secondary care and have begun to develop key procedures to support integrated working practices. Work is also underway to identify an appropriate external agency to support in the evaluation of the pilot over the summer 2017.

 

Breathing Spaces

 

The contract intentions for 2017-18 with TRFT include a review of Respiratory pathways including Breathing Space. This review will focus on quality and performance of the pathways, strategic relevance of services and value for money.

 

Community Catalysts

 

Community Catalysts are now working within Rotherham and have successfully appointed a Catalyst worker who commenced in post on the 6^th February 2017. There has been an initial project group meeting which brought together key partners of the project.

 

The Catalyst will support and compliment the work that has already begun around collation of information and advice and building on the work that Community Link Workers and other individuals have undertaken to build community capacity. The project is focussed around the work for Learning Disabilities and will support the modernisation of the Learning Disability Offer for Rotherham.

 

The Community Catalysts Project forms part of the Adult Social Care Development Programme as a workstream. Therefore this has a requirement for regular updates into the internal and external board meetings to ensure progression.