This report provides an update on: Local Care governance, in line with progress and alignment to Strategic Commissioning development; Local Care deep dives; progress on an Implementation and Local Care Delivery Framework; actions for winter pressures and details of how Local Care is supporting carers and care navigation.
The STP Local Care Lead summarised amendments made to the governance arrangements for Local Care. This included the establishment of a new, smaller strategic Local Care Board which would be comprised of senior leaders from key organisations involved in the commissioning and delivery of Local Care services across the Kent and Medway health and social care system. She explained that the existing Local Care Implementation Board (LCIB) would not be disbanded, as this Board had been invaluable in bringing together a wide range of organisations. However, it was noted that the focus of LCIB would be amended. It was considered that this Board would be a “learn and share” Board, in which practical information to support the delivery of Local Care could be discussed. Owing to the emergence of Primary Care Networks (PCNs), the STP Local Care Lead also explained that the Local Care Workstream was working to align to the newly formed Primary Care Board with the delivery of Local Care.
The Joint Board was advised that the Local Care deep dives for East Kent and Medway, North and West Kent, set out at section 4 of the report, were held on 23 November 2018 and 11 December 2018 respectively. The STP Local Care Lead undertook to circulate a more detailed update from the deep dives to the Joint Board, but summarised the key themes which had emerged, this included:
· Workforce challenges - It was explained that attendees concluded that a holistic workforce plan across the Kent and Medway STP was required. They asked whether there were suitable and sufficient resources working in an integrated manner on pathways for discharge/transfers of care and they established that there was a need to align resources to, and improve Multidisciplinary Team/s (MDTs) working. A need was also established to utilise the existing workforce better and to consider whether it could be made easier for staff to rotate across organisations, i.e. a staff “passport”. It was considered that the latter could help with the recruitment and retention of staff.
· Primary Care – It was explained that attendees expressed support for the development of PCNs and the Local Care workstream working in collaboration with PCNs. It was added that the optimum conditions for PCN development needed to be defined and the importance of GP continuity was stressed.
· Investment and Implementation – It was explained that whilst £32M was actively being invested in Local Care, attendees considered that there was a need to secure a sustainable investment for Local Care going forward. A need was also expressed to increase the scale and pace of implementation. Enquiries were also made into how organisations could work towards a shared finance and risk framework.
· Estates – It was explained that attendees considered the possibility of a one public sector estate and working with local authorities to solve some of the estates funding challenges for the NHS. Further considerations included how best use could be made of non-acute beds, including extra care housing and what was the Kent and Medway step up and step down bed strategy.
· System Governance - It was explained that attendees expressed a need to: harmonise plans as each sub-system had their own; use consistent language; have shared metrics and comparators and an agreed framework for measurement across Kent and Medway; and a single point of entry/access across Health and Social Care. Further considerations included how partnerships could be leveraged for the benefit of Kent and Medway e.g. joint commissioning.
· Outcomes – It was explained that an outcomes framework would be developed from the information obtained from the deep dives. This would be presented to Local Care Board in February 2019.
Lastly, the STP Local Care Lead drew the Joint Board’s attention to an update on actions for winter pressures, set out at section 6 of the report, and information on how Local Care was supporting carers and care navigation, as set out at section 7 of the report.
A Member expressed support for having a strong focus on Local Care. A Member also considered that it was important to embed prevention into Local Care and asked that consideration be given on how this could be achieved. It was also considered that it was important for the work of the Design and Learning Centre to fit with Local Care.
The Kent and Medway Joint Health and Wellbeing Board:
a) noted the content of this joint report, including the verbal update on the Local Care deep dives;
b) agreed that at its next meeting, on 19 March 2018, the Joint Board be presented with a report which sets out greater detail on the Local Care deep Dives and progress on the outcomes framework; and
c) considered the scope of the deep dives in relation to support for carers and support for growing the voluntary sector as set out in paragraph 7.5 and 7.6 of the report respectively and agreed that these be scheduled on the work programme for September 2019.