Agenda item

This report provides an update to the report presented to the Health and Wellbeing Board on 3 November 2016. The Kent and Medway Transforming Care Partnership (TCP) Plan 2016-2019 was submitted to NHS England (NHSE) in May 2016 and refreshed and re-submitted in November 2016. The Plan, which included a Kent and Medway Executive Summary, Risk Register and Finance and Activity Template, as well as separate Kent and Medway local Transforming Care (TC) plans, were accepted.

Medway’s inpatient figures are increasing. We do not yet fully understand the reasons for the upward trend, although it appears that the lack of forensic outreach and adult ASC provision and Tier 4 CAMHS pathways may be contributing to admissions. Transformation grants received this year and a bid for next year address these concerns.

A TCP Finance Plan was required to be submitted to the NHSE Regional Team by 18 January 2017. A Business Case was also required by 18 January to detail how and when cost and responsibility will move through the system over the remainder of the three year TC programme.

Discussion

The Interim Senior Commissioning Officerintroduced the report to update the Board on the Transforming Care Plan, following the previous update provided to the Board in November 2016. Transforming Care Plans set out how people with learning disabilities or autism could be moved from of inpatient beds, which were often located outside Medway, into community based provision. At the start of January 2016 there had been 16 Medway inpatients, including two young people.

The resources made available through this change could be used to improve provision and therefore avoid further admissions to out-of-area hospital beds.

Careful financial planning was crucial with the Kent and Medway Transforming Care Partnership being required to submit a joint Finance Plan as well as a Business Case. The Finance Plan had been submitted on 18 January 2017, with the Business Case currently being under development. A sub-group had been established to oversee development of the Business Case and Finance Plan and to provide financial governance. This was led by the Chief Finance Officer (CFO) of West Kent CCG and would include the CFOs of all partner organisations. The first meeting of the sub-group was due to take place in February.

It was noted that the Transforming Care programme was overseen by NHS England, with Kent and Medway the only Transforming Care Partnership in the South East to have submitted a detailed Finance Plan so far. Feedback had just been received from NHS England, which as anticipated, was mixed. A second draft was due to be submitted by the end of March.

Close working was being undertaken with Sussex and Surrey, who were South East Transforming Care Partners, in order to identify needs as a region as this was likely to be more cost effective than individual procurement of provision.

The Committee raised a number of points and questions as follows:

Role of the Discharge Planning Group - The Discharge Planning Group was responsible for overseeing Care and Treatment Reviews (CTR), which were provided to patients who were ready for discharge. The CTR would make specific recommendations in relation to each discharge, with the review being  undertaken up to six months ahead of a planned discharge, in order to ensure that appropriate provision was in place. There had sometimes been delays in this process. A multi-disciplinary group had been established in order to ensure co-ordination between partners and reduce delays. In response to Member concerns that there needed to better co-ordination of the delivery of Disabled Facilities Grants and that the time between grant application and award was too long, officers advised that better co-ordination was one of the reasons for the establishment of the Discharge Planning Group. In addition to Disabled Facilities Grants, a Repatriation Fund was also available for patients who had been in hospital for a long period. The fund enabled bids to be made for grants of up to £15,000 that could help adaptations.

Medway Challenging Behaviour Service grant bid – The possibility of making a bid for funding for a Medway Challenging Behaviour Service had been investigated but it had been decided not to submit a bid. This was due to NHS England having advised that the proposals did not match the criteria for the funding available. A successful bid would still present challenges as funding would only be allocated for one year and ongoing match funding would be required. It was noted that the Lenehan Review into the Care of Children with Learning Disabilities had just been published. This had made a number of recommendations in relation to the ownership of the health of children and engagement between partners. Medway would be establishing a young person’s Transforming Care working group in February in recognition that ownership of outcomes for children was required in addition to engagement with this group.

Extra Care Housing – A Member raised concerns that not enough housing was being provided, particularly Extra Care housing, in view of the shift towards people remaining in their own homes longer and then moving into Exta Care provision at the end of their life. In response, the Interim Senior Commissioning Officer said that there was a need to ensure that discharges were sustained and that they did not result in unnecessary readmissions. There were some grants available that could be bid for to support this work. The Discharge Planning Group would seek the views of the Council’s Housing Service as part of its work. The Interim Director of Children and Adults advised that there was a group of children and adults with specific needs. Improvement work was being undertaken as part of the Adult Social Care Getting Better Together Strategy and joint working was taking place with Housing on the development of an accommodation strategy. It was suggested that it would be beneficial for officers to meet with the Portfolio Holders for Adult Services, Housing and Community Services and Children’s Services in relation to the needs of young people.

Use of Technology – A Member of the Board highlighted the increasing importance of technology in relation to the facilitation of hospital discharge and the need to ensure the education of clinicians in this area. Good work had taken place in Medway and a challenge under the Sustainability and Transformation Plan process would to encourage some areas in Kent to advance work in this area. It was noted that there was no reference to use of technology in the Transforming Care Plan update provided. The Interim Senior Commissioning Officer acknowledged that technology had not been a consideration in the Transforming Care Plan to date. The Interim Director of Children and Adults provided reassurance that work was taking place with colleagues at Medway Commercial Group and that a range of technology was used that was specifically designed for adults with a learning disability. However, the use of technology would need to be considered as part of the development of Transforming Care Plans. It was agreed that a meeting would be arranged between relevant Members and officers in order to further discuss the issue.

Involvement of the Health and Wellbeing Board – In response to a Member question that asked what support was being sought from the Board, the Interim Senior Commissioning Officer advised that the Board had a role to play in overseeing joint working and it was suggested and agreed that a further update would be presented to the Board in three months time once the Finance Plans and Business Case had been agreed.

Decision

The Board:

i)       Considered how the Health and Wellbeing Board could promote and engage with the Transforming Care Plan agenda going forward and offered support, feedback and leadership to ensure the successful implementation of the Medway Transforming Care Plan.

ii)      Agreed for a progress report to be presented to the Board in three months, including an update on the Finance Report and Business Case.