Minutes:
It was suggested that this update may be better titled as ‘Integrated Care Network Update’.
Dr Bhan made the point that the emphasis over the last two months for the CCG had been concentrating on work relating to children. However, it was still the case that the CCG and LBB had been working collaboratively on health and social care integration which was still being funded by the Better Care Fund (BCF). Lorna Blackwood had been leading this for LBB, and had been working closely with the CCG. Part of this work involved looking at social care implications.
It was noted that Dementia Hubs had been set up and financed by the BCF and that there had been a national drive to increase diagnosis rates for dementia. Access to the hubs was not only via GP’s, but also via Oxleas and the third sector. It was felt that it would be a good idea if data concerning the dementia hubs could be brought back to the HWB, part of the data should relate to the discharge of patients. Various winter initiatives were being developed as well as the Transfer of Care Bureau.
Dr Bhan felt that good progress had been made concerning the development of the ICN’s (Integrated Care Networks), and expressed her thanks for the support that had been received from the HWB and partners. It was now the case that standard ICN operational procedures and protocols were being written up.
Dr Bhan explained that in the future, GP’s would have the option to refer complex cases to a Multi-Disciplinary Team (MDT). A pilot for this would be in place by the end of November 2016. The plan was for 3 MDT’s to pick up 10 patients each at any given time, and that over the course of a year they would manage 1600 patients. At the time of writing, no significant extra burden was expected to be placed on LBB in terms of social care provision. Further development was required in terms of dealing with the housing needs of people in care homes. This was likely to take the form of an upgraded version of the Visiting Medical Officers Scheme, but was currently in an early stage of development.
Good progress had been made with developing the Frailty Unit in Orpington, including the provision of new geriatric services. Dr Bhan informed the Board that 1/3 new geriatricians had been recruited, but more were required. Care Navigators had been recruited to help the public ‘navigate’ the new system. The Frailty Unit (FU) would have 36 beds (and chairs) and would open in January 2017. It was anticipated that the size of the Unit would gradually expand, and would provide a step up service for people in the community. All parties involved were working very hard to make the new FU successful.
The Leader was pleased to hear of the progress made in developing the ICN’s. He asked Dr Bhan what the impact would be on social care due to the increased volume of referrals, as this would have an impact on capital and resources. He also asked if the funding for any social care referrals would come from the BCF. Dr Bhan responded that she anticipated that currently there would be no new demands on social care resources. However, she did mention that it remained to be seen if there were new needs that may need to be met. Dr Bhan stated that the objective of the FU was to reduce the number of hospital admissions, and also to reduce the need for packages of care from social care. It was anticipated that use would be made of the third sector to assist with reablement, and to counter the negative effect of isolation. Dr Bhan was confident that LBB had the relevant systems in place, and it was the case that BCF monies were available for another 3 years to assist.
Cllr Diane Smith expressed concern at what she perceived to be a limited number of beds in the FU, and asked what measures would be in place to ensure that enough step up beds would be available. Dr Panajape answered that the FU at Orpington would work differently, and that the FU was integral to a proactive frailty pathway. The plan was that under the new system,s the focus would be on identifying patients that were escalating in need, and would therefore benefit from being cared for by the MDT. It had been proven that patients benefited from multi-disciplinary case management, and that referrals to the FU would need to come from a gerontologist.
Colin Maclean referenced the Bromley Third Sector Enterprise (BTSE).
This was a new venture that had been established by some of Bromley’s key charities.
The aims of BTSE were to:
It was also the case that Community Links were working on developing a social prescribing scheme.
Matthew Trainer was glad that the FU was not going to be treated just as an extension to hospital treatment, and stated that care pathways had to change to reduce pressure that was building up in the system. He felt that too much care in previous models had been required to be given to those who were in a position of crisis; this was very detailed, costly and technical. It was also the case that patients that spent too much time in hospital were in danger of developing muscle wastage and infections. He expressed the view that the current NHS model was unaffordable. The Chairman felt that it would be a good idea to have an FU update at the next meeting.
RESOLVED that the ICN update be noted, and that a further update be brought to the next meeting of the Board, which would include an update on the development of the Frailty Unit.