Agenda item

Dominic Blaydon, TRFT to present

Dominic Blaydon, The Rotherham Foundation Trust (TRFT), presented a briefing paper to update the Health Select Commission on progress in relation to further development of the Care Co-ordination Centre (CCC) and Integrated Rapid Response (IRR) services currently provided by TRFT. The ambition within the Rotherham Place Plan was to extend both services to include mental health and social care, providing a multi-disciplinary approach to address the whole needs of the service user, resulting in an improved experience and more effective use of resource.

The role of the Care Co-ordination Centre, which was developed about five years ago, was to provide a telephone based nurse-led approach providing advice to health professionals on the correct care pathway for patients in urgent need. This could be through a district nurse, community physician or a referral to intermediate care. It was intended to address the high number of GP initiated hospital admissions and to act as a portal to community health to see whether they were able to support a patient rather than them going to hospital. It has been very successful, for example reducing GP referrals to the Medical Assessment Unit by around 20%.

A phased approach was being taken to implementation to realise benefits within the available resource and to manage risk.  The first phase was to include urgent mental health referrals; work on this had commenced and from a local authority perspective was quite straight forward.  Then they would be looking at linking up with RMBC and the work that they were doing on social care referrals, for people in crisis or with a high level of need.

The Integrated Rapid Response Service, formerly known as both the Fast Response Service and as the Community Assessment Rehabilitation and Treatment Scheme (CARATS), was commissioned to provide short term care packages at home for people at risk of hospital admission.  It could also be used to expedite hospital discharges of vulnerable patients who no longer had a medical need and to prevent hospital re-admissions, and was working well.  Instead of a patient being admitted to hospital because they were not safe at home, the IRR service went in and provided wrap around care, followed by a handover to Community Health after 72 hours.

The Service works alongside the CCC and the intention was also to extend IRR to include Mental Health and Social Care needs by working with the local authority, to provide time limited re-ablement for people experiencing a short term crisis. This would lead to a more holistic approach to care to support people with a greater level of need or more complex needs and would address any safety issues arising from providing a more one dimensional service.

Partners were also considering how IRR would link in with the integrated locality.  The thinking was that urgent on the day care could be transferred to IRR, thus freeing up integrated locality workers to carry out the planned work with people with long term conditions and to be more proactive.  Phase 1 of the Rapid Response Service would be co-location prior to full integration in phase 2. 

The following issues were highlighted/discussed:-

·         Patients calling the CCC directly and how long they might wait to speak with someone – At present the CCC was only accessed by health professionals not patients, mainly when there were working with someone and wanted information about care pathways. There had been discussion regarding expansion to specific groups of patients being able to make direct contact with the CCC.  More broadly, how and where people access the NHS was almost a separate workstream.

Under RDaSH’s old structure, patients would contact each business division, which were set up and resourced differently, including different service hours.  Then overnight calls went to clinical staff at one central contact point and if clinical staff were busy then they did have to wait.  Under the new CCC arrangements the initial point of contact would be staffed by administrative staff 24:7 who then passed on the record to the right people; this was a significant improvement.

·         Amber risk regarding GPs, what were the issues and were there contingency plans to prevent this becoming red? – There was an issue around how the CCC fitted in with the sepsis care pathway they were trying to resolve. More generally GPs feared that a reconfiguration of the CCC would mean its existing functions were compromised by the changes as it was such a good service for GPs in providing advice about current care. A fuller response would follow.

It was highlighted that from the RDaSH perspective it was a very phased implementation to help manage risk, so initially the administrators would just be working on mental health and then  other RDaSH services would be gradually introduced, to help manage that, both for patients and for the existing service.

Resolved:-

That the Health Select Commission note the update.