Agenda item

Advancing Integration - Health and Social Care

To receive an update from Carnell Farrar on the ongoing intermediate care review.  Also to report on future planning/workshop outcome and the Quarter 3 report.

Minutes:

Lancashire Intermediate Care Review

 

Dr Jo Andrews and Becky Taylor from Carnall Farrar attended the meeting to give an overview on the Lancashire intermediate care review.

 

The Board were given an overview on how intermediate care played an important role in the care of people and was an essential part of avoiding hospital admissions and allowing people to leave hospital as quickly as was appropriate.  Care in the community was around understanding the health and care needs of a population along with proactive care and support to avoid admissions to hospital.

 

With regards to adults 65+ years across Lancashire, there was a lot of variation and complexity where intermediate care services were diverse, with many different services available in different areas, with different names and different inclusion or exclusion criteria.  The volume of activity being delivered was variable, and there was a different distribution of types of service user by geography.

 

The aim of the review was to determine the optimum provision of the service to do everything possible to keep a person at home and design services to meet the needs of the population/carers, to maximise their independence and improve their outcomes and experience.  It was also to reassure the taxpayer that the funding of intermediate care was responsible and appropriate.

 

A new care model for intermediate care across Lancashire would be developed and agreed through two clinical and professional group workshops and would inform the current understanding of current models.  The workstream would develop a common definition and principles of intermediate care, define the scope and services included, the criteria, the outcomes, the pathways and interaction with other services and governance.

 

A demand, capacity and financial model would also be developed to underpin the new intermediate care clinical model.  The model would understand current demand, capacity and costs of intermediate care by neighbourhood area and project demand based on demographic and non-demographic growth.  It would use the area model developed to project demand, capacity and costs of intermediate care and assess potential future funding and provision options.

 

Based on the outputs of the care model design and the demand, capacity and financial modelling, the review would facilitate alignment on the future intermediate care model and governance between system leaders through a system leadership workshop.

 

The final report and recommendations were to be developed by 31 March 2019.

 

Based on the views from the Clinical and Professional Group a set of design principles for intermediate care had been developed.

 

Findings were starting to emerge with regards the level of contribution from intermediate services and opportunities to shift from hospital based to community based, however, there still appeared to be a gap in home based and bed based services.

 

Dr Jo Andrews and Becky Taylor were thanked for their report.

 

Better Care Fund – Quarter 3 Report

 

Paul Robinson, NHS Midlands and Lancashire Commissioning Support updated the Board on the Quarter 3 Better Care Fund report and gave an update on progress.

 

Better Care Fund Metrics

 

1.  Reablement – performance was better than target at 86.3% of people being at home 91 days after discharge from hospital.  Use of the service saw a slight decrease for the first time.

2.  Permanent admissions to residential and Nursery Care – there had been a further improvement in Quarter 3 over Quarter 2 with the number of admissions in the year to date reducing to 709.3 per 100,000 population 65+.  However, this remained considerably worse than the national average rate of 585.6.

3.  Non-elective admissions – there was a sharp increase in Quarter 3, 11% above plan with 2018/19 levels staying higher than 2017/18.

4.  Delayed Transfers of Care – while Quarter 3 performance was worse than target and worse than Quarter 2 there was some improvement seen in December 2018 although still above target.

 

The Future of the Better Care Fund/Integration

 

The outputs and conclusions reached from a Better Care Fund hosted workshop being held on 22 March 2019 would be brought back to the Board for further discussion, guidance and to agree actions.  These would be set in context of the national review of the Better Care Fund and the Better Care Fund Policy Framework and Guidance for 2019/20 once published.

 

The Board noted that there was some variation around data for Fylde and Wyre and Paul Robinson was clarifying this and would report back to the Board at a future meeting.

 

The Board agreed that the language used needed to be different as the public did not understand it and this was crucial going forward.

 

The focus was to get people out of hospital, however the focus should also be on helping people to stay out of hospital.

 

Resolved:  That the Health and Wellbeing Board was recommended to:

 

i)  Note the performance against the Better Care Fund metrics.

ii)  Note the ongoing work to review and confirm the role of the Better Care Fund locally and nationally in the context of driving integration forward.

iii)  That Fylde and Wyre data would be clarified and reported back at a future meeting.

 

Supporting documents: