Agenda item

To receive an update in respect of intermediate care provision, including urgent community response, national milestones, and the reablement service.

Consideration was given to a presentation in respect of Intermediate Care and Reablement services presented by the Director of Operations of TRFT, Strategic Director Adult Care, Housing and Public Health, Rotherham MBC and the Joint Head of Adult Commissioning for Rotherham Place. The presentation outlined service delivery in respect of urgent community response, including the new national standard almost one year after implementation in April 2022. National milestones that have been achieved were also described as part of the presentation. It was highlighted that the service meets and exceeds the 70% response standard within two hours. The service responds to several clinical conditions which were explained in the presentation. Data around response standards was provided. The Urgent Community Hub offer was described. Ways in which the Service invested in the workforce in a variety of ways were outlined. This offer supports recruitment, development, and retention. Further, the presentation emphasised how the right care at the right time and in the right setting was facilitated by the service and its pathways to manage flow and avoid unnecessary conveyances and admissions, supporting discharge. The reablement service was also described, including the two approaches to frailty assessment that are currently used in parts of the community. Ongoing challenges were described as well as next steps.

In discussion, members requested additional data evidence of the impact of the service. The response from the Director of Operations noted the existing data around hospital avoidance, as well as data collected with Yorkshire Ambulance around the push model. Regarding how the service improves quality of life, patient feedback had noted that people want to return home and the home first model benefits faster recovery and less deconditioning. The Strategic Director of Adult Care Housing and Public Health noted the data illustrates longer mean times between admissions. The strength-based approach is taken to take account first of what the individual wants to do.

A positive experience was noted regarding the GP out of hours service, which works closely with the Community Hub arm of the Intermediate Care and Reablement Services.

The co-opted member representing Rotherham Speak Up for Autism requested additional information regarding how the Services are trained to work with people who have additional needs or Autism, as preparing to go into hospital can be very stressful. The response from the Director of Operations noted the mandatory training across the Acute and Community Trust around providing care to people with Autism and LD. It was acknowledged that everyone had different needs and this training helped clinical and non-clinical staff understand what those needs are. The response from the Strategic Director noted that there was training and a learning disability service, but that more work to be done in terms of understanding and being able to offer a quality Reablement offer for people with Autism. The Service would continue to work with Speak Up to develop in this area. The response from the Joint Head of Adult Commissioning described a working group for discharge for people with LD and Autism was working to improve the experience after they leave hospital, and liaison was welcomed to help improve the experience prior to going into hospital.

Prior to the pandemic, the thrust seemed to be avoiding the need for people to go into hospital, but there did seem to be a growing suggestion that more acute beds were needed. The response from the Director of Operations noted that it had been recognition nationally that bed occupancy had not matched the need, especially through winter. Over the next twelve months, the Trust was asked to increase bed occupancy in the Acute Trust, with plans underway to work out how to achieve that. Running at full occupancy all of the time is not great for patient care, so one of the challenges over the next year would be to increase bed occupancy.

Regarding the next steps, Members requested more information around growing the Urgent Response, and how confident that targets could be met. The response from the Director of Operations noted the importance of recruitment and growing the team. Currently, the response standards were being achieved by moving resource from another area of the community services, which is fine for now, but to grow the service, the team must be in place. The Service were retaining staff well in these areas. As the Service grows it will attract more interest as outcomes become available.

Resolved:-

1.    That the presentation be noted.

2.    That the welcome liaison of the Service with Speak up for Autism be noted.

3.    That the data around impact of the Service be provided.