Agenda item

To receive a report from the Leader and Cabinet Member for Health Reform, giving an outline of the implementation of Local Care within the Kent and Medway Sustainability and Transformation Partnership and the key areas in development and those enablers required to deliver Local Care at pace.

Ms J Frazer, Sustainability and Transformation Programme Lead, Adult Social Care and Health, was in attendance for this item.

1.            The Leader, Mr P B Carter, introduced the report and highlighted the latest developments in local care in the Kent and Medway STP footprint. He chaired the Local Care Implementation Board (LCIB), for which the Government’s arrangements had recently been streamlined. The newly-constituted LCIB would meet shortly.   It was well known that, in the vision for health and social care integration and transformation, the health economy had become divided into ‘local care’ and ‘hospital care’. His focus was on local care, on which he had been tasked to work with health colleagues.  In the integration of primary care, community services and social care, the voluntary sector would have an important role to play. He had previously told the committee about efforts to secure commitment to an extra £32m of revenue resource for the local care model, hopefully rising to an extra £100m in the medium term. 

2.            It had been very encouraging that, on the same day on which the NHS launched its 10-year plan, the Secretary of State for Health, Matt Hancock, had alluded to his wish to see a greater proportion of the £20+bn going into the NHS being spent on local and primary care.  Mr Carter said his priority was to explore how the £32m in the current financial year would be spent, in the hope that Kent could recruit more district nurses and therapists to work with GPs.  Ms Frazer and her team had met with Kent and Medway health economy and primary care practitioners and those who delivered local care.  Mr Carter said he had been much encouraged that GPs had coalesced around more than 40 primary care networks across Kent and Medway and had bought into the concept of being supported in those networks by multi-disciplinary teams (MDTs). Within MDTs, £32m would increase trained staff to increase support for GPs in primary care networks.  Money was starting to be invested in various ways, including in care navigators to help connect patients to third sector services. He said he would like to see a workforce plan to focus on more district nurses, physiotherapists, occupational therapists and mental health practitioners in outreach work in patients’ own homes and residential and nursing homes. This coverage had been inconsistent in the past. 

3.            The biggest issue remained the recruitment, retention and training of staff to address the skills shortage across the health service. Having now secured extra funding, the challenge was to use it to recruit staff needed in the MDTs, including those delivering social care services.  He was keen for the Cabinet Committee to have a further report setting out how the social care aspects would sit within MDTs to facilitate triage and assessment to help patients access the services they needed as soon as possible.  The LCIB hoped to be able to identify how many patients had been able to avoid hospital admission by accessing services provided by the MDTs, in their own homes or residential and care homes, and how they could be helped to leave hospital faster, with district nurses and enablement services, to return to their own homes or access step-down beds in residential homes. The County Council would seek to ensure that social care services were being delivered beside health services in a timely way, to make sure no patient was at risk.

4.            The LCIB had had conversations around smaller GP practices being fragmented and the need to have new GP hubs, similar to those established in London and elsewhere in the UK. A capital program needed to be put in place to deliver the same model in Kent, using primary care hubs supported by MDTs.  Examples of social prescribing had shown positive outcomes, for example, at the Estuary View surgery in Whitstable, including a reduction in hospital admissions. 

5.            In conclusion, the largest challenge now was to find qualified practitioners to join the MDTs, and Kent would need to trawl across the globe to find people with the right qualifications to complement the current workforce. Kent would need to recruit and train them quickly to meet the urgent need. The Secretary of State for Health, Matt Hancock, understood this and supported the use of applied technology to help and improve primary care, but it was most important that GPs were behind it and supported the MDT model, that the Government backed it with sufficient funding and it proved possible to recruit practitioners to deliver better local community health services alongside GPs.

6.                    Members made the following comments:- 

a)    the report and the introduction of different ways of working were both welcomed as being very timely.  The establishment of MDTs around the patient was welcomed but the scale of the challenge ahead was enormous, and it was accepted that, to attract the number of suitably-qualified staff required, it would be necessary to look further afield. Kent’s aim to secure additional funding above the £32m was supported, and it was hoped that the Government would provide full financial support to train these new staff.  Mr Carter said Kent would need to present the right environment to be able to attract health practitioners to move here, for example, by using social housing to offer them good-quality homes. The Estuary View practice had no problems attracting staff as it was an innovative, exciting practice;

b)    it was difficult to get appointments and prescriptions as very few of the 12 GPs at a local Ashford surgery worked full time. Calls were triaged and the wait for a call back or appointment could often be 4 – 7 days; 

c)    concern was expressed that a hub in Thanet would potentially serve 30,000 patients while the bus service which would serve that area was apparently earmarked to be discontinued. The speaker was advised by the Chairman that the local bus service was not to be reduced but taken over by a different local provider. If a service were to serve a potential population of 30,000, surely there should be sufficient custom to make a commercial bus service viable;

d)    concern was expressed that social worker numbers were insufficient and some families could miss out on receiving the services they needed. The Cabinet Member for Adult Social Care and Public Health, Mr Gibbens, asked that Members raise any concerns about specific social care service provision with him;

e)    the developing ways of working were welcomed as good news for Kent and it was suggested that the Cabinet Committee have regular updates on the roll-out and monitoring of the new ways of working set out in the report;

f)     the report was welcomed and Mr Carter thanked for his commitment to drive this forward. Asked if the GP ‘buy-in’ included social prescribing, and if health inequalities would be addressed by the new ways of working, Mr Carter said the Estuary View model had been at the forefront of directing the patient to the right service at the right time and had been a key factor in reducing Accident and Emergency attendance.  Ms Frazer added that social prescribing had been delivered successfully in East Kent by Red Zebra for some time and was being rolled out across the county, so should soon start to show a positive difference; and

g)     asked if a patient would need to be registered at a practice to access the innovative services available there, following a local case in which someone had been turned away, Ms Frazer explained that, if someone wanted to use a GP surgery, they would need to be registered as a patient there in the usual way. However, the new model would improve clarity for the public about where to go to access services locally, and the ideal for the future was that there would be ‘no wrong door’. She undertook to look into the individual case mentioned.

7.         Mr Carter advised the committee that he, Ms Frazer and Mr Gibbens were shortly to visit the Greater Manchester combined authority to see how health and social care services were being delivered within the new devolved powers. He also thanked Ms Frazer for the great amount of work she had put into developing the new work streams and for writing the report.

8.         It was RESOLVED that the progress and direction within Local Care be welcomed and endorsed.