Agenda item

Stephen Beet, Rosanna Jones and David Jarrett introduced this report and made the following presentation:

·       This programme involved the assessment of a programme of work related to the discharge of better care support fund diagnostic and priorities.

·       The Board was provided with an element of how we can assess the Better care Support Fund

·       The findings of diagnostic had been set out across BNSSG and endorsed key priorities

·       Home First set out the totality of transformation programmes when they require an extra level of support and involved whole swathe of prevention activities

·       This required a more enhanced level of care. The Home First pathway provided the appropriate level of care to meet the population needs with rapid care services and a greater level of acute care in the home environment. Once patients passed through the hospital care setting, they were discharged to the most appropriate point of care

·       Future clinical care needs at home would consist of four pathways for people who need more limited support including those who require some care support, those who require technology in their home or in another care facility and people with more complex needs albeit with some rehabilitation which required an in depth assessment

·       A peer review in 2022 had assessed that too many people were spending too long in hospital and that over this period of time their health can deteriorate

·       It was noted that there was a lack of flow in hospitals and the community resulting in ambulance delays. As a result of continuing recovery from the pandemic, there was a workforce issue resulting in recruitment changes and a failure to meet targets for average length of stay in hospital

·       In November 2021, the business case had been prepared and in May/June 2022 this had been followed by a performance assessment. The findings of the LGA Peer Review had been made available in June 2022. This had spent time speaking to front line staff and a long term plan taken to system executives which refreshed in January 2023 with a longer term plan

·       It was important to assess the current challenge and adapt decision-making accordingly. The risk of wrong outcomes needed to be addressed. Whilst recruitment was not a quick fix, the assessment enabled an analysis of how staff were being used

·       It was difficult for staff to see the end process. The combination of numbers and performance was a key part of the diagnostic which enabled a focus on rehabilitation to enable people to reach the maximum level of independence

·       There was a need to change the decisions made and the hospital length of stay to provide a greater focus on outcomes, processes and relationships. The current plan assumes we can make approximately 40% improvement and reduce the time in hospital by 25%. There was a need to ensure hospital beds were used by people when they are needed.

·       The priorities of the BNSSG were to improve decision-making through Transport of Care Hubs to integrate all partners to do this sooner and ensure capacity at home (include voluntary sector etc) and also ensure people who need beds have the right level of support therapy and staff

·       There was a need to build relationship within the community and join up support there, as well as changing the capacity in place to make this happen.

·       There needed to be support in the right environment. The  findings of the BCF Support Fund diagnostic were required on key issues of challenges delivering effective hospital discharge pathways in the BNSSG and considering and endorsing key priorities. These had been identified for continued improvement and transformation work via the Discharge to Assess Transformation Programme wider Home First portfolio

·       There would shortly be a programme to launch pathways in an accessible way

Board members made the following comments:

·       This programme should be endorsed. It was important to focus on improved outputs and drive better performance outcomes without getting an unexpected outcome

·       The lessons of COVID were important in ensuring funding was maintained longer term to avoid year on year difficulties and having to rely on the Voluntary Sector for support. Greater partnership and participation was also important, especially in areas such as the race ecosystem

·       There was definitely a need to avoid short term funding

·       It was nice to see some of the ideas which had previously been suggested by organisations such as Health Watch coming to fruition. It was noted that sometimes families were not involved in the process

·       Whilst the recommendations were excellent, retention of staff and the need for family involvement were all key issues. The voluntary sector were a key element of the process

·       There was already good co-ordination between different parts of the voluntary sector. The Youth Alliance could also help with developing this approach

·       It was important to engage with locality partnerships and develop a framework with a strong alliance of organisations

RESOLVED  – that the Health and Well Being Board:

(1) receives the report

(2) notes the need for support in the right environment

(3) notes the support and findings of the Bette Care Funf Support Fund diagnostic on key issues of challenges delivering effective hospital discharge pathways in BNSSG

(4) considers and endorses the key priorities identified for continued improvement and transformation work via Discharge to Assess Transformation Programme wider Home First

ACTION: Stephen Beet