Agenda item

To consider progress made by the health and social care system towards Outcome 3 of the Health and Wellbeing Strategy

(1)       Mr Gough said Malti Varshney (Consultant in Public Health) would set out performance against key indicators relating to Outcome 3 (Quality of life for people with long term conditions) of the Kent Health and Wellbeing Strategy (KHWBS) and this would be followed by consideration of out of hospital care across the county which was also integral to the work on the Sustainability and Transformation Plan (STP) being done across Kent and Medway.

(2)       Ms Varshney introduced the report which provided information on indicators related to Outcome 3 of the KHWBS.  She drew particular attention to performance in relation to the number of adult social care clients receiving a telecare service and the target of increasing the proportion of older people at risk of long term care and hospital admission, who were still at home 91 days after discharge from hospital, where performance was good and to performance in relation to reducing hip fractures for over 65’s and for injuries due to falls in people over 65 where performance was below the targets set.  She also said that although performance in relation to delayed transfers of care varied over the months, it had increased in July 2016 for reasons related toboth NHS and Social Care.

(3)       In response to questions she confirmed that the data she referred to was available to clinical commissioning groups and her team would assist with access on request. She also said that if local health and wellbeing boards would find it useful, consideration could be given to quantifying the annual direct health care costs of fractures and falls as well as the on-going costs to social care.

(4)       Ian Ayres(West Kent CCG), Dr T Martin (Thanet CCG), Dr J Chaudhuri (South Kent Coast CCG) , Dr F Armstrong (Dartford Gravesham and Swanley CCG), Dr S Phillips (Canterbury and Coastal CCG), Dr N Kumta (Ashford CCG), Dr B Bowes (West Kent CCG)  and Ms C Selkirk (Medway CCG) gave a presentation on progress on implementing out of hospital care in each CCG.  A copy of the presentation is available on-line as Appendix A to these minutes.

(5)       Following the presentation comments were made as follows:

·         Given the shortage of GPs consideration be given to having frailty specialist nurses;

·         Given the contrast between Kent having seven clinical commissioning groups and Medway having one it was unsurprising that integration of health and social care appeared to be more advanced in Medway;

·         Kent had implemented a range of integrated services such as learning disabilities, children’s services and mental health but progress was less in services to older people that would be central to the development of the STP;

·         The need to involve social care providers (both domiciliary and residential) in discussions at an early stage;

·         The need to develop core strategies and principles for service delivery which could be interpreted locally for different environments;

·         Assumptions being made about reducing the cost of care, by moving care from the acute sector to integrated service delivery around hubs or clusters might have an impact an internal NHS markets;

·         The need for good “cross-border” arrangements between hubs or clusters to ensure economies of scale;

·         The potential for the Integration Pioneer to test models of care to ensure they were safe for both citizens and professionals and that there was a consistent approach across the county which was sufficiently flexible to recognise local differences;

·         The development of the STP and the integration of health and social care are predicated on assumptions, supported by evidence, that care of people in their own homes improves clinical outcomes, improves re-ablement and enables a better quality of life: however, the vision of how this might operate in practice from the patient’s perspective needs to be more clearly articulated and not considered only in terms of organisation design;

·         Since July 2016 much work has been done to draw learning from pilots and the next step was to quantify and describe in detail what the various elements of the service might look like and plan its implementation;

·         All GPs were urged to submit data to a central repository to enable the robust needs assessment backed up by evidence from the whole STP area to be produced;

(6)       Resolved that:

(a)       Local health and wellbeing boards undertake a review of injuries due to falls in people aged 65 and over, and report back on progress in delivery and outcomes at the Board meeting in March 2017;

(b)       Subject to clarification of the data relating to hip fracture, and agreement by email, to ask local health and wellbeing boards to include hip fractures in their reviews;

(c)        To align outcomes of the current health and wellbeing strategy with the delivery outcomes of the STP;

(d)       Issues relating to social care be included in the work being undertaken for the STP by Carnall Farrar;

(e)       A progress report be considered by the Board in six months.