Agenda item

This report introduces the joint Intermediate Care and Reablement Strategy between the Council and NHS Medway Clinical Commissioning Group (Medway CCG) and provides information on future implications.

Discussion:

The Director of Children and Adult Services introduced a report on the Intermediate Care and Reablement Strategy in conjunction with the Chief Operating Officer, NHS Medway CCG.

The Director of Children and Adult Services explained that the Council and CCG had worked closely together to ensure a joined up approach and would be working with families, service users and carers to bring about a better use of collective resources for a better outcome and experience for those needing intermediate care and reablement.  She stated that it was in the best interests of most people to be supported and assessed in a home environment rather than having an unnecessary delay in hospital once they are medically fit or even admission in the first place.  This would encourage mobility and recovery as it was proven that reduced mobility when in a hospital bed caused deterioration.  This work was one strand of Medway’s Better Care Fund programme and builds on those agreed key principles.  The aim was to have less institutional care, more care within the community and a greater joint approach across health and social care.

The Chief Operating Officer informed the Committee that an audit had been undertaken involving Medway NHS Foundation Trust (admissions and beds) and within the intermediate care bed facilities in the community.  She advised that the audit had demonstrated that there was an efficient use of beds and for intermediate care over half of the people who were over 75 years of age did not need to be there.  She explained that the intermediate care strategy was about the best use of services – both step up and step down from hospital and was aimed at giving the right care at the right time and would vary from person to person.  Reference was made to a small pilot that would be starting at the end of the month as a home to assess scheme, supporting people out of hospital.  Work was already underway to integrate the equipment services currently commissioned separately by the council and CCG into one contract which was essential to ensure that this service could be more effective.  There has already been engagement with patients, their families and carers and the voluntary sector.  More work would also be done to engage with the voluntary sector to support service users at home or in the community.

The Deputy Director, Children and Adults Services referred to the enhancement of the reablement service which was focussed on recovery and stated that the intention was to commission a specialty service for reablement to more effectively support the Discharge Home to Assess Project.

The Director of Children and Adults Services informed the Committee that the Strategy itself did not constitute a substantial variation or development in terms of consulting the Committee but that the detailed work flowing from the Strategy may be a substantial variation or development.  This more detailed work would be brought back to the Committee for their input and scrutiny.  Having discussed the matter with the Chairman, Vice-Chairman and opposition spokespersons she stated that it may be necessary to hold a special meeting of the Committee in the Autumn as the October meeting would be too early to bring back a report and the December meeting too late.

The Committee were generally supportive of the aims of the Strategy but a number of Members expressed the view that until they had the practical details it was difficult to comment further.   A view was also put forward that a possible over-dependence on the voluntary sector to support the aims of the Strategy needed to be thought through on the basis that a large proportion of the voluntary sector was already at capacity. 

The representative from the Pensioners Forum referred to some specific cases where care had not been at a satisfactory level in relation to pensioners.  The Chief Clinical Officer, NHS Medway CCG stated that these scenarios were ones that highlighted the need to do better collectively and remove barriers to people receiving the care and support they need.

In response to a question the Chief Operating Officer, NHS Medway CCG reassured the Committee that the focus was on providing care around individuals, no-one would be sent home unsafely and that each case would be assessed individually to ensure the right package of care.

The Director of Children and Adults Services, responding to a further question, stated that the Strategy was a high level document and set out a direction of travel and an agreement to work together.  The next report would contain the detail explaining how this could happen and the proposed changes to the service offer.

Decision:

The Committee recommended to Cabinet the Intermediate Care and Reablement Strategy and supported the associated work needed to produce successful outcomes in respect of the following way forward:

Develop more community based services to support people at home including the following actions:

a)    Make more use of and develop better reablement services

b)    Develop a responsive Integrated Community Equipment Service

c)    Develop Telecare services

d)    Work with the voluntary sector to maximise the contribution the voluntary sector can make to supporting more people at home and to self help and community resilience

e)    Develop a Home to Assess scheme to keep people away from hospital and get them back home sooner

f)     Place the care around the individual in the setting they choose which will usually be their home

g)    People tell us they want to be supported a home so we will shift the balance of care away from institutional settings towards supporting more people at home.