Agenda item

The purpose of this report is to provide an update on the Haringey’s Design Framework for Integrating Health and Social Care, with a particular focus on the work across health and social care to improve discharge from hospital pathways and market developments to support this.

John Everson, Assistant Director of Adult Social Services, provided an update on Haringey’s Design Framework for Integrating Health and Social Care. Mr Everson commented that his report provided a particular focus on the work that had taken place across health and social care to improve discharge from hospital pathways and market developments to support this.

The Panel was informed that the Haringey Design Framework provided a clear, shared and strategic view across health and care partners, to ensure the  independence of all residents. The Panel was asked to note that the Design Framework was underpinned by a number of important principles, including:

-       Preventing avoidable health conditions

-       Connecting people to their communities

-       Maximising independence and wellbeing

-       Integrating and joining up health and care to deliver seamless services

-       Delivering fair and equal care across the borough

-       Co-designing support with citizens to promote choice and control    

The Panel was informed there were four patient pathways and that these were based upon the level of support required on leaving hospital. The following points were noted:

The Panel was informed that discharge to access was a change to NHS and Social Care procedures, moving all non-essential processes, including assessments of long term care needs, out of the acute setting. Mr Everson went on to provide clarity on the discharge to access statement of principles:

-       Home First: The Panel was informed every effort would be made to enable people to go home and that creative solutions would be used to keep the person at home following discharge. It was noted that readmission would be the last resort.

-       Simplification: The Panel was advised of the importance of providing one number for wards to ring (Single Point of Access) and for not insisting on lengthy or duplicating assessments before a patient left hospital. The importance of making discharge pathways as simple as possible and taking as many discharge-related tasks out of the hands of ward staff was also noted.

-       Responsiveness: The Panel was informed care needs would be assessed in a residents home within two hours of discharge. It was noted any necessary equipment would be provided on the same day or the day following assessment. The importance of providing necessary care packages and putting in place wrap-around support to keep the patient at home longer, reducing reliance on long term care services in the future, was also highlighted.

In response to questions, Mr Everson explained there were benefits to patients (reduced risk of deconditioning and hospital-acquired infection), staff (more time to focus on patient care) and hospital and social care (more bed capacity and reduction in longer term social care packages).

Mr Everson concluded his presentation by outlining a number of case studies which highlighted improved outcomes across each of the pathways.

In terms of market development, Charlotte Pomery, Assistant Director for Commissioning, answered a number of questions in relation to section 3.5 of the report.

The Panel was informed Haringey’s reablement service was a key component of the Design Framework. This ensured people were supported home in a timely manner and received the care they needed to recover their independence. However, it was noted that additional capacity and market development was also required in order to manage new ways of working. In response to questions, Ms Pomery explained that by changing the commissioning approach for home care – now supplied through a Dynamic Purchasing System – the Council had ensured sufficient local capacity to meet need, had stabilised the home care market across the borough, had decreased local provider reliance on zero hour contacts and were now in a position to redesign the model of home support more fundamentally.

Ms Pomery advised that work was ongoing with partner authorities across North Central London in order to safeguard capacity for the local health and care economy, particularly in respect of nursing care. Due to the considerable demand for this type of provision, and with limited supply, the Panel was informed the Council was working on ways to stimulate and develop the market so it was better tuned to meet demand.

During this discussion, a number of issues were considered in relation to the consultation which had taken place in relation to a proposal to close Osborne Grove Nursing Home, following concerns about the quality of care and safety of residents. The Chair advised that these issues would be addressed fully under the Cabinet Member Q&A (item 11 on the agenda). This was agreed and the Panel went on to consider a range of issues in relation to:   

-       Work that was taking place through the Providers’ Forum.

-       Ways to develop additional home based reablement capacity.

-       The Home from Hospital Service, provided by the Bridge Renewal Trust.

-       The commissioning of additional intermediate care beds to support different levels of need.    

In conclusion, Mr Everson commented that the approach, reflected in Haringey’s Design Framework, had resulted in significant improvements to the experience of residents and in their outcomes. The Panel was informed that decisions about residents’ short and long term care needs were now no longer made for them from a hospital bed, but alongside them in an environment more like, or that was, home. The following points were considered in relation to the reablement service: 

-       It was noted that the service could now respond within 24 hours of a resident’s discharge, providing opportunities for 849 residents to benefit from reablement intervention in 2016/17, compared to 459 in 2015/16.

-       The fact that refocusing and re-specifying the service had helped to reduce unit costs from £45 to £23 per person. 

-       The facilitation, on average, of 10 discharges per week through reablement from March 2017 to October 2017. It was noted that this had reduced the time that residents spent in hospital by saving 2-3 bed days per discharge.          

-       That, on average, since April 2017, 76% of people with complex needs who had been supported by reablement had recovered sufficiently from their crisis situation in hospital and did not require a long-term social care service. It was noted that this potential cost avoidance to Adult Social Care, attributed to transforming reablement, was reported at £1.1 million.  

AGREED:

(a)  That the update on Haringey’s Design Framework for Integrating Health and Social Care be noted. 

(b)  That an item on Haringey’s Design Framework for Integrating Health and Social Care, with further information provided on targets, outcomes and the financial implications for each discharge from hospital pathway, be included in the Panel’s future work programme for 2018/19 (date TBC).