Agenda item

To consider an update on progress with the Non-Elective Admissions target and the results of the Care Homes Deep Dive and the Falls Deep Dive.

Marco Inzani, Commissioning Lead: Better Care Fund (BCF), provided an update on the information that had been presented to the Panel in October 2015.

 

Mr Inzani explained that continued progress had been made in delivering a reduction in Non-Elective Admissions (unplanned and emergency hospital admissions). The Panel noted that reduction in non-elective admissions was the main target for the BCF. 

 

During the discussion, reference was made to the following:

 

-       The fact that a large proportion of non-elective admissions in the over 65 population were due to falls and/or came from care homes.

 

-       The fact that higher numbers of non-elective admissions placed pressure on care home admissions.    

 

-       The increase in permanent residential and nursing home admissions.

 

-       The  effects of delayed transfer of care and work the council and partners were doing to improve this.

 

-       The fact that Haringey had the highest number of care home admissions and spend in relation to their comparator group.

 

-       The increase in the length of stay in step down facilities.

 

-       Ambulance callouts requested by healthcare professionals. It was noted that the main reason for callouts was the healthcare professional protocol. This accounted for 37% of callouts while falls was noted as the second main reason, accounting for 11% of call outs.

 

-       It was noted that non-elective rates by GP Practice were variable. It was also explained that data was missing for half of residential and nursing homes and that as a result there could be up to twice as many admissions from care homes.

 

-       Respiratory, Urinary Tract Infections and Musculoskeletal issues were noted as the top three reasons for non-elective admission from care home.

 

-       The work that was taking place in relation to reviewing Haringey’s strategy for intermediate care.  

 

In response to a Care Homes Deep Dive the panel was assured that the following actions/themes had been discussed with key stakeholders:

 

-       Develop a Primary Care Led Care Homes Service Pilot with one GP Practice linked to one are home (three in total). It was noted that this would focus on Priscilla Wakefield, Spring Lane and Osborne Grove and would prioritise falls, Urinary Tract Infections and respiratory.

 

-       Review the impact of winter schemes including ‘Living Care at Home’. It was noted that this was a 2 week package of support to stabilise people at home following discharge from hospital.

 

-       Continue to develop the role of social brokerage in developing alternative and cost effective solutions to in-borough care home placements.

 

-       Develop the market for alternatives to residential and nursing care. For example, extra care sheltered accommodation.

 

-       Determine the reasons for higher care costs in Haringey.

 

-       Develop a business case for an integrated discharge team.

 

-       Develop a business case for Step Down support to reduce the need for care home admission.

 

-       Develop a business case to expand the provision of reablement including provision to step-down facilities.

 

-       Undertake community engagement to determine issue that prevent carers from wanting a patient to be discharged home.

 

The Panel was informed that the actions above would be incorporated into the work programme of the Intermediate Care Group who would monitor implementation.   

 

Mr Inzani went on to provide a summary in relation to the Falls Deep Dive (outlined in the report). The Panel was asked to note:

 

-       There had been a 9% increase in the rate of falls related injuries in the over 65s in Haringey (2013/14 to 14/15).

 

-       There had been a 17% increase in the rate of non-elective admissions falls in the over 65s in Haringey (2013/14 to 14/15).

 

-       Falls were mainly happening to women over 85 in the west of he borough.

 

-       There had been a 7% increase in referrals to the Integrated Community Therapy Team falls service at Whittington Health between 2013/14 and 2014/15.

 

-       32% of social care clients had been assessed as being at risk of falls, with 54% of these clients receiving housing adaptations or equipment.

 

In response to the Falls Deep Dive the panel was assured that the following actions would be incorporated into the work programme of the Integration Implementation Group who would monitor their implantation:

 

-       Continue to monitor the balance and strength exercise group

 

-       Continuer to ensure that people at risk of a non-elective admission due to falls are supported by the Locality Team, particularly in the West.

 

-       Review the evidence base regarding the use of falls prevention information resources in primary care.

 

-       Explore the linkage of the falls pathway to hospital discharge.

 

-       Explore the development of a fracture liaison service for Haringey.

 

(Clerk’s note: The Chair requested a written response in relation to a number of detailed questions that had been set to Charlotte Pomery, Assistant Director Commissioning, via email)  

 

AGREED:

 

(a)  That the progress in delivering a reduction in Non-Elective Admissions be noted.

 

(b)  That the themes and actions from the Care Homes Deep Dive be noted.

 

(c)  That the themes and actions from the Falls Deep Dive be noted.

 

(d)  That an update on the Better Care Fund, including progress in relation to the  themes/actions from the Care Homes Deep Dive and the Falls Deep Dive, be prioritised as part of the panel’s future work programme for June/July 2016. It was agreed that this should include information on the costs / cost savings associated with the actions.