Agenda item

Report CS18068

The Committee considered a report seeking the approval of the Council’s Executive to establish a pilot scheme implementing the Discharge to Assess model within Bromley Adult Social Care, utilising £818k from the Better Care Fund.

Successfully tested by a number of recent national pilot schemes, the Discharge to Assess model supported people to leave hospital as soon as they were medically ready to be assessed for their long term care and support needs.  The assessment process took place outside of hospitals in a more familiar, community-based setting, and was focused on enabling people to return home wherever possible and reducing the amount of time people remained in a hospital bed unnecessarily which could lead to a decline in their levels of functioning, independence and wellbeing as well as having a significant cost implication.  It was proposed that a Discharge to Assess pilot scheme be implemented in Bromley to provide a temporary, community-based joint team of health and social care officers to support prompt hospital discharge and deliver a multidisciplinary enablement and assessment function alongside the existing hospital-based Care Management Team, with a view to establishing a permanent local Discharge to Assess model should the pilot scheme be successful.  The proposed pilot scheme would test three pathways comprising returning home, an interim placement at a ‘step-down’ facility and a long-term nursing home placement depending on people’s care and support needs.

In considering how the scheme would operate, the Head of Discharge Commissioning reported that it was planned to establish the community-based joint team whilst working to transform existing hospital-based discharge and assessment processes.  Hospital staff would continue to be closely involved in the discharge of patients, and this would be supported by a ‘patient passport’ providing details of service user’s hospital treatment from the point of pre-admission that could be carried through their hospital stay and into the discharge and assessment process.  Service users would be supported to understand the potential costs of their longer term support needs at the point of discharge from hospital.  Existing staff had expressed a high level of interest in the innovative Discharge to Assess pilot scheme and it was not envisioned that there would be any difficulty with recruitment.  A Member underlined the need to ensure sufficient capacity for the ‘step-down’ pathway and the Head of Discharge Commissioning confirmed that sufficient resources had been built into the pilot scheme to enable spot-purchasing of step-down beds. 

A Member queried the impact of not implementing the Discharge to Assess model.  The Head of Discharge Commissioning advised that sign-off of the Improved Better Care Fund was dependent on clear plans to implement the ‘High Impact Change’ model, and that failure to achieve the Discharge to Assess target set by NHS England could result in a financial penalty applied against the Improved Better Care Fund allocation.  The Director: Adult Social Care noted that there was also a risk to the Local Authority in relation to fines for delayed transfer of care attributable to social care and that if this fine had been levied by the Princess Royal University Hospital for 2016/17, the Local Authority would have been liable for a £653k penalty charge. 

A Member was pleased to note that best practice from other local authorities had been utilised in developing the pilot scheme.

RESOLVED that the Council’s Executive be recommended to:

1)  Agree the drawdown of £818k from the Better Care Fund to support the implementation of a Discharge to Assess pilot in adult social care; and,

2)  Note that an evaluation of the Discharge to Access pilot will be reported back to Members in May 2018.