The Committee considered an update on the Bromley Discharge to Assess (D2A) scheme that had been operating in pilot form. 

In Bromley, the D2A pilot was established in order to transform out of hospital assessment and support processes for people with on-going care and support needs.  D2A enabled a person to leave hospital with immediate wrap around care and support in the community, reducing their length of hospital stay. The assessment of their long term care and support needs was undertaken at home or in a community setting rather than in hospital. Evidence suggested that assessing people in hospital resulted in an over prescribing of on-going care and support needs. Assessing at home, could result in significant reductions in levels of on-going care and support and improved independence.  The pilot also sought to reduce delayed transfers of care (DToC) and the impact prolonged hospital stay had on frail and elderly individuals including reduction in muscle mass and physical ability as well as mental and emotional decline.  The D2A service had a number of positive impacts on individuals and was shown to make a marked improvement on the Delayed Transfer of Care (DToC) figures for Bromley.  In terms of total delays across health and social care, Bromley now had the lowest number of DToC – and therefore the highest performance – amongst comparator local authorities, significantly outstripping the average performance across London and England as a whole.  The pilot was helpful in identifying areas to improve efficiency further and these were already being implemented by management.  If  approved, the revised service would be evaluated with longer term recommendations being made to Members in March 2020. The alternative was to terminate the service which would not only impact negatively upon Bromley’s DTOC performance but would potentially have a considerable impact upon residents leaving hospital.  In addition to this following Executive approval the service would be exposed to competition via a tender, resulting in an interim contract that would run from August 2020 to August 2021.  A parallel domiciliary care tender would ensure that any longer term arrangements were facilitated via the new domiciliary care model.

The Committee noted and supported the following amended recommendations which were tabled:

2.2a   That Executive agree a one-year continuation of the D2A service, revised in light of learning from the pilot, pending an evaluation of the revised service and longer term recommendations being made to Executive in July 2020.

2.2b    Subject to the approval of recommendation 2.2a above, that Executive agree to meet the cost of the overspend on the D2A service with a contribution from the Better Care Fund, currently estimated at £850k.

RESOLVED: That the Executive be recommended to:

1. Note the progress on the D2A pilot and the positive outcomes achieved for individuals;

2. Agree to a one-year continuation of the D2A service, revised in light of learning from the pilot and funded jointly by the Council and Bromley Clinical Commissioning Group from the Better Care Fund, pending an evaluation of the revised service and longer term recommendations being made to Executive in July 2020;

3. That a one-year continuation of the D2A service be agreed, revised in light of learning from the pilot, pending an evaluation of the revised service and longer term recommendations being made to Executive in July 2020;

4. Subject to the approval of recommendation 3 above, that the cost of the overspend on the D2A service be met with a contribution from the Better Care Fund, currently estimated at £850k

5. Agree a tender for the D2A service which will result in the Council commissioning a one year contract to run from August 2020 to August 2021.  However a tender award will be subject to further approval from the Executive (March 2020).  Additionally the recommendation for award will only be presented if it is also recommended (following the service review in January 2020) that the model should be endorsed.