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Agenda item
Models of Health and Social Care
Minutes:
Mike Hennessey, Service Director, Care & Support Adults, accompanied by Tim Wye, Principal Commissioning Manager, Sonia Moore, Care Act Implementation Lead, and Margaret Kemp, Acting Head of Better Care, provided a briefing on Better Care Bristol and the Three Tier conversation.
Better Care is a national requirement directed by government to deliver the integration of health and social care. The Vision:
Better Care Bristol will:
• drive the transformation of care and reduction of inequalities by establishing integrated local services where health and social care resources are brought together in a coherent, locality model, targeting resources where the need is greatest
• driveprevention and self-care. Working on key priority areas, we will help people to manage their lives well, stay healthy and avoid deterioration. We will promote independence and help people and their carers to manage conditions once they are established
• design and put in place integrated pathways that support people in managing conditions from the earliest indications through to severe and complex needs. Through these we will deploy resources, at whatever point they are most relevant
Better Care Bristol Governance arrangements, done through 3 Boards
· Health & Wellbeing Board
· Better Care Commissioning Board (Adults)
· Better Care Transformation Programme Board
The resources available are pooled from that of Bristol City with a contribution of £13million and the Clinical Commissioning Group providing £29million total pool £42million. The money is not new money but pooled from existing resource.
Better Care Bristol Ideas, that acknowledges that different communities have different needs.
• Community webs and social prescribing
• Integrated nursing pilot
• Multi Disciplinary Team approach
• Single Point of Access (Integrated Professional Line) and front door streaming at UHB
• Investments in Social Care to support system flow including front door and discharge
• Discharge to Assess - significant whole system approach working to reduce DToC
• Integrated approach to reablement
• Information Advice and Guidance – whole system approach
The formal agreement for funding, known as Section 75 Agreement 2016/17 had been signed off in June with the Health & Wellbeing Board, the full reports can be accessed via (https://bristolintranet.moderngov.co.uk/ieListDocuments.aspx?CId=213&MId=270&Ver=4).
The following was noted when questions were invited.
a. Members welcomed the presentation and explanation provided noting that it would aid understanding when performing their role. Acknowledging that integrated working brought with it better outcomes for service users.
b. Members were concerned about the additional pressure that GP’s would face particularly in areas such as the South of the City that are under pressure because of the lack of GP’s. Officers explained that GP’s practices could benefit from BCB as it would divert a percentage of service users to alternative areas for care that would support better health.
The Sustainability and Transformation Plan (STP) – across the Bristol, North Somerset and South Gloucestershire (BNSSG) region.
The Scrutiny Commission would receive a briefing on STP on the 1st December 2016, at City Hall, jointly with Members from regional authorities.
The STP must be signed off by the Department of Health. The key principles of the STP are there to support the delivery of the NHS 5 year plan, that had been agreed 2 years ago. The principles understood that commissioning alone would not solve the health care problems and that systems must be planned across all partners that met the varied and differing needs across the regions three health care providers.
STP 3 work areas:
· Prevention, Early Intervention & Self Care
· Integrated Primary, Community & Social Care
· Acute Care Collaboration
Questions were invited from Members.
a. STP would work to address issues arising from residents of regional authorities remaining in hospital because social workers from that authority are not available to assess for a discharge. There could be an opportunity for Bristol social workers in situ at the hospital to support regional authorities residents by providing the service needed, to allow for an early discharge.
b. STP allows for the better use of available funds, for example one day stay in hospital is approximately £800. The same sum spent on social care to stop that day needed in hospital could go further and if a patient is discharged to social care the money available would be used more efficiently.
c. Workforce & Capacity remains an issue. It was acknowledged that the service had an aging workforce and that a number of factors had impacted the availability of health care professionals. With a population getting older and remaining older, the demand for support continues to escalate and a service can only be provided with health care professionals.
The Three Tier Model - Diagram added as separate document
There are a number of challenges facing the ongoing provision of service.
· More people are living longer
· Dramatic increase in over 85’s (21% over 10 years)
· Care Act 2014
· Transfer of the Independent Living Fund
· Deprivation of Liberty Safeguards Supreme Court ruling in 2012
· Requirement for Integration
When the model was shared with social workers and then implemented the initial view of many were that they had been working in the way outlined but following implementation the feedback from staff was positive. The general consensus was that the model now put people at the heart of what they did, with quicker outcomes.
The following was noted from the discussion that followed:
a. Members were concerned about the over reliance of online assessment. How would those with limited ability, due to illness and disability, access and understand online information. Assurance was given that support would be available for personal conversation when required.
b. Social work had been redesigned resulting in more emphasis on the availability of social workers and minimal managerial roles.
CQC (Care Quality Commission) and the State of Social Care (http://www.cqc.org.uk/content/state-of-care)
The CQC inspected the state of personal care, for example shopping and help provided to undertake personal care. The service provides only a small percentage of this form of care. The link provided above is the pathway to the full report.
The Commission is to receive a presentation on Commissioning and Quality Assurance, the strategy on dealing with inadequate service provision by service providers
Resolved:
i. To note the report
Supporting documents: