Agenda item

Report CS17134/CS17136

The Sub-Committee considered two reports providing an interim update on the Local Authority’s winter resilience schemes for 2016/17 and outlining Bromley Urgent Care system performance and the progression of commissioned schemes by the Bromley Clinical Commissioning Group (BCCG) during Winter 2016/17.

The Local Authority had received an NHS Winter Resilience Grant of £1,009,000 for 2016/17 to increase capacity to support hospital discharge and prevent patients’ readmission.  This funding had been used to support four schemes which aimed to increase care management staffing capacity within the PRUH and in community teams, introduce a Fast Response Personal Care Service to facilitate discharge of patients within four hours upon receipt of their Discharge Notification and an Intensive Personal Care Service, and the provision of four additional Step-down Units in Extra Care Housing Schemes to allow discharge of patients in need of community-based reablement, rehabilitation and interim care.

Dr Angela Bhan, Chief Officer, BCCG reported that the winter period 2016/17 had been very challenging and that there had been a much higher demand for urgent and emergency care services than in recent years.  A range of schemes had been put in place by the BCCG including the establishment of a Patient Champion, GP and Community Matron in the PRUH and a dressings’ service and this was contributing to the management of pressures.  The BCCG met with all health partners on a regular basis to review the performance of winter resilience schemes and the operation of the Transfer of Care Bureau and there would be a formal review to evaluate the effectiveness of winter interventions during Spring 2017.

In considering the update, the Chairman noted the difficulties in persuading care agencies to provide the Fast Response Personal Care Service commissioned by the Local Authority due to the shortage of care staff over the winter period. The Head of Assessment and Care Management reported that the Local Authority and BCCG were working closely together to develop a completely different approach to commissioning care schemes in advance of next winter.  A recent NHS paper had explored a number of models of care services provision across the country, and the Local Authority and BCCG would be developing a bespoke model for Bromley residents, including a discharge to assessment procedure. 

With regard to the Rapid Response scheme which had been implemented by the BCCG as an alternative care pathway for care homes to avoid unnecessary Emergency Department admissions, the Chief Officer, BCCG confirmed that this was currently being piloted at ten care homes but that it was hoped to roll it out further and Domiciliary Care and Extra Care Housing providers had expressed an interest in participating in the scheme.  A key service area to be reconsidered was end-of-life care where people were likely to have an increased number of hospital admissions in their final year of life and how they could be supported to remain within their own homes.  Consideration was also being given to other services including how people with heart failure could receive more community-based treatment and whether it would be possible to deliver a more integrated therapy service across the Borough, which incorporated hospital, social care and reablement therapy.

The Chairman underlined the need to ensure support was in place for carers to help them maintain their caring responsibilities.  In general discussion, Members emphasised the importance of all key partners working together to support the health and wellbeing needs of Bromley residents, including third sector organisations.  The Chairman highlighted that assistive technology should be installed in a timely manner to support people in their reablement, and that Home Assessments should be undertaken prior to discharge to reduce waiting times where appropriate.

The Chief Officer, BCCG advised Members that Integrated Care Networks were now being used to support a number of patients in Bromley and an early impact report would be provided to the next meeting of Health Scrutiny Sub-Committee on 13^th June 2017. 

RESOLVED that the update be noted and a further update be provided to the Sub-Committee in due course.