Issue details

Proposed decision:

Approve the expansion of the Kent Enablement at Home Service and support activity transfers to enable the safe decommissioning of the Discharge to Assess Service and delegate authority to the Corporate Director Adult Social Care and Health to take other relevant actions, including but not limited to finalising the terms of and entering into required contracts or other legal agreements, as necessary to implement the decision.

Reason for the Decision:

It is the ambition of Kent County Council (KCC) for the people in Kent to have home-based care and support services, in line with Home First principles and KCC’s Making a Difference Every Day Adult Social Care Strategy.

Discharge to Assess 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 supports people who need ongoing care and support.  It is essential in ensuring people recover at home following discharge from hospital and are supported until further assessment can be undertaken if required. It alleviates blockages in patient flow through the system and prevents unnecessary delayed discharges; as such, it is essential that any new model of service delivery adequately supports both the process and the person.

The Discharge to Assess service contract was commissioned by KCC and forms part of Discharge Services, for people discharged from hospital who need support to recover at home. Across Kent, there are a few services that align with the pathway, commissioned by NHS Kent and Medway and other health partners.

In December 2023, the Discharge to Assess service was overspent against the KCC budget. A decision was made to extend the current contract by nine months, to 30 September 2024, to allow time for an alternative model to be agreed and mobilised.

A new model has now been agreed between KCC and the Integrated Care Board (ICB). Time is needed to implement this. The new model will provide an integrated enablement and rehabilitation offer. The new proposed model will build capacity to create one simpler pathway and will help people in hospital return home faster whilst supporting recovery and retaining independence. The service will deliver reablement, personal care and support nutrition, while also monitoring the person’s condition. They will also contribute to an overall plan of care in their own home. The new team will work in a therapeutic way with oversight from therapists the aim being to assess the long-term care needs at home.

The new model will differ from the current offer of a 7-14 day support period, to an offer of up to six weeks. This will lead to an improvement in outcomes anticipated by moving this service in house, as there will be more continuity of provision for people on their discharge from hospital.

It is proposed that the activity from the Discharge to Assess Service will transfer over to KEAH in a phased way to allow recruitment of additional staff.  Recruitment will commence in February 2024. 

The recruitment schedule for Kent Enablement at Home (KEaH)Service assumes no staff will transfer over from the current Discharge to Assess provider.

The proposed decision supports Priority 4 of Framing Kent’s Future – New Models of Care and Support and objective 2 of Securing Kent’s Future in delivering savings from identified opportunity areas to set a sustainable 2024/25 budget and MTFP.

Other options considered and discarded:

Undertake a Competitive Tender – Co-design a completely new service with experts by experience.

This will take time, circa 12 to 18 months. The current service is over-spent against the budget and is likely to continue to be so for the duration of any service re-design. This will impact on the council’s financial deficit. KEaH already contribute to the Discharge to Assess model.  Across Kent, there are a few services that align with the Discharge to Assess pathway. This option will not address the disparate approach to the Discharge to Assess pathway. Commissioners are looking for a fully integrated enablement and rehabilitation offer and a simpler pathway that is easier for prescribers and people who use it.

Current Provider - Direct Award a new contract to the incumbent provider.

The incumbent service is over-spent against the budget and costs are likely to continue to increase. This service is financially unsustainable for the future.