Reason for the decision:
It is the ambition of KCC for the people in Kent to have home-based care and support services, in line with Home First principles. Discharge Pathway 1 Services enable the Council to deliver towards this ambition. The pathway relates to people being discharged from hospital with home-based support; all people needing such support should be offered reablement and rehabilitation and, where necessary, time for assessment and future care planning. This includes people whose package of care is being restarted after lapsing during their hospital stay.
The Discharge to Assess Service Contract was commissioned by Kent County Council (KCC) and forms part of Discharge Pathway 1 Service, for people discharged from hospital who need support to recover at home. Across Kent, there are a few other services that also align with the pathway, commissioned by the Integrated Care Board (ICB) and other health partners.
Discussions between KCC and the ICB resulted in in principle agreement to a new model, but more time is needed to undertake appropriate governance and subsequent implementation.
Options (other options considered but discarded)
Do nothing – if the contract terminates this would impact on people who require support at home in the early days post discharge, the Discharge to Assess activity would transfer to higher costs services and the gap in service provision would impact on delayed hospital discharges.
Financial Implications
This is a demand-led service and activity can fluctuate. The annual budget for the Discharge to Assess is £2,953,400 with additional budget of £732,600 for bridging. The service’s forecast spend this year is £3,928,400; an overspend of £242,400.
If the contract is extended by nine months, it is anticipated that costs of the extension will be circa £2,970,000 (based on current activity) and within the budget for the service.
Historically, the ICB has financed additional Discharge to Assess capacities (for example from NHSE winter funding); the ability to incorporate additional funding, including from the ICB, over and above the KCC budget allocation will still be available within the extension period.
Decision type: Key
Decision status: Implemented
Notice of proposed decision first published: 18/12/2023
Reason for urgency:
If the contract terminates on 31 December 2023, this would impact on people who require support at home in the early days post discharge from hospital. The activity from the Hilton service would transfer to higher cost services e.g. care home support and the gap in service provision would impact on delayed hospital discharges
The proposal to Direct Award the Discharge to Assess Service to the current incumbent was not planned but has become necessary as it has taken longer to develop the new model than anticipated, ensuring a collaborative and joined up approach with NHS Kent and Medway, and more time for mobilisation is required, ensuring safe transfer of individuals from the current to the new service.
There is also insufficient capacity to provide enablement support for everyone in hospital who can be safely discharged home with a short-term package of care. For this reason, the Discharge to Assess service is still required to ensure sufficient capacity over the winter period
Anticipated restriction: Part exempt - View reasons
Decision due: 18 Jan 2024 by Leader of the Council
Reason: This decision will be taken under the urgency procedure
Lead member: Leader of the Council
Lead director: Richard Smith
Department: Social Care, Health & Wellbeing
Contact: Steve Richards, Finance Policy Officer Email: Richard.ellis@kent.gov.uk or 03000 410077 Email: stephen.richards@kent.gov.uk.
Consultees
Due to the urgency of this decision no formal Cabinet Committee consultation has been undertaken – views from Members will be sought and included in the decision paperwork. The decision will be reported in retrospect to the Adult Social Care Cabinet Committee on 18 January 2024.
Financial implications: Please see detail above
Legal implications: Legal advice in relation to the proposed award has been taken from Legal Services. The relevant legal considerations are appended in an exempt section to the Decision report.
Equalities implications: Equalities Implications: An Equalities Impact Assessment has been completed (full details at appendix 1) and this indicates no substantive negative impact on protected characteristic groups. Data Protection Implications: A Data Protection Impact Assessment has been completed for this service.