Agenda item

Present for this item: Mark Atkinson (Director NHS Kent and Medway, Operational Planning and Commissioning)

1.      The Chair notified the Committee that he had received a letter from Deal Town Council around their concerns with delayed discharge from hospital due to issues with wheelchair assessment and provision and physiotherapy availability for stroke patients . The Chair said he would respond to Deal following the meeting.

2.      Mr. Atkinson ran through some key points from the report which included:

(a)       The Kent and Medway allocation of national funding to support delivery of timely discharges was £15 million, with NHS receiving 60% and the local authority 40%.The money arrived in two waves and was monitored through the Better Care Fund.

(b)       Funding from wave 1 was allocated as follows:

i.            25% in pathway 1 (Domicile care and homecare market),

ii.          25% pathway 3 (care home provision),

iii.         25% pathway 2 (intermediate community based services),

iv.         25% on equipment and enablers.

(c)        Funding from wave 2 was described as the “discharge fund”, and NHS England was invoiced for eligible spend. The ICB invoiced for £6.3 million out of an available £7 million. NHS England monitored the impact of the spend weekly, and whether long length of stays had reduced. Funding was spent as follows:

i.            25% on pathway 1 (Domicile care and homecare market),

ii.          61% on pathway 3 (care home provision),

iii.         13% on enablers.

(d)       The funding not only assisted reducing acute discharge delays, but other areas such as helping people stay in their own home and additional support to care homes.

(e)       Kent and Medway performed comparatively well over the winter period though there was always room for improvement.

(f)         The risk created by the additional funding was that it raised some providers expectations (in relation to how much they would be paid per bed) which was not a sustainable model. A sustainable model in future would involve promoting more care for people in their own homes and not in care homes.

(g)       Other projects, such as Frontlands, were underway to improve the discharge system. Reviews and workshops were being held to assess the impact of all schemes.

3.      A Member asked where Key Performance Indicators could be found for the discharge policy that would provide reassurance that the funding achieved it’s aims. Mr. Atkinson referred to two metrics:

(a)    the number of patients readmitted into hospital.

(b)    data captured within adult social care specifically the number of hand-backs – the ICS was looking to develop a dashboard.

4.      The Committee considered how it interacted with the Adult Social Care Cabinet Committee. Recognising the committee’s remit to scrutinise only the NHS, the Chair offered to speak to the Chair of the Cabinet Committee about options for a joint session.

5.      Answering what more could be done to ensure patients were always treated with dignity, and that they were supported to stay at home for as long as possible, Mr. Atkinson agreed patients should always be treated with dignity. Recognising that the care system were under enormous strain, capacity constraints had led to shortcomings in service provision. Mr. Atkinson explained that additional support to care homes had been provided, along with seeking non-clinical support from the voluntary sector.

6.      The sustainability of the homecare market was discussed, recognising workforce constraints as well as the high costs of using quality providers. Social care teams used to be embedded in acute discharge teams but that was no longer the case and this led to gaps.

7.      Mr. Atkinson commented that he had seen improvements in the discharge pathway over the years but agreed more integration across the system was needed, including greater emphasis on the preventative agenda.

8.      RESOLVED that the committee note the report.