Agenda item

Report attached.

The Committee received a report from the Project Manager, NHS Support for Social Care on Integrated Case Management.  The aims of the  Integrated Case Management programme (ICM) were to avoid unnecessary hospitalisations, to reduce demand on health and social care, to maintain independence in the community, to promote self care and self control over individuals’ own lives and to reduce disabilities and disadvantages arising from chronic illnesses.  This was carried out by providing suitable individuals with intensive support for a 3 month period.  At the end of this period the individual would have an increase confidence in managing their own conditions, better awareness of the support available and decreased social isolation.

The Committee noted that there were existing links between Health and Social Care and these were being strengthened through ICM and other Health and Social Care developments.  The annual cost of ICM was £822,000.  There was other funding available for reablement.

Research into ICM had been carried out by the University of East London and Kings College, London.  In the last year there had been a pilot however very few GP practices participated with only 10 from the Havering area.  Officers explained that this was Health-led and brought together multi-agency, multi-disciplinary person centred support.  The service consisted of a team of Community Matrons and Social Workers who provided support to individuals in their own home, coordinated other interventions and helped individuals develop the capability to support themselves.

From the research and the pilot it had been estimated that ICM had led to a reduction of emergency admission of approximately 30%.  The Committee were informed that for ICM to be effective, it was essential to identify the right patients.  This was done through a tool called Health Analytics which matches data from GP records and hospital records and predicted risk of unplanned admissions using an algorithm developed by the Kings Fund.  This stratifies the patient list, identifying both very high and high risk individuals who are then clinically prioritised for referral to ICM.  The key was for GP’s to take ownership, and all practices would have links to ICM.

The Committee were informed that Community Matrons have fortnightly meetings to validate new patients and ensure that interventions were in place for patients already on the caseload. 

The service will be reviewed alongside similar services in place across outer north east London in December to ensure that the service is optimised and that there is the correct mix of multi-agency, multi-disciplinary support.

The Chairman asked what the view of the service users had been. Officers stated that there had been both six and twelve monthly reviews of how the service had helped with daily life, and there had been an 80% improvement rate in A&E admissions.

A member asked what the length of the additional budget would be.  Officers confirmed that the service was currently in its first year, and the second year was due to end in March 2013.  However this could continue into a third year with the changes in GP Commissioning.  This had already been agreed by the Health and Wellbeing Board.

Officers explained that there would be added benefits for GP’s in that they would be able to prevent their own patients from being admitted to hospital and they would also benefit from the skill mix of district nurses, social workers and the availability of general advice on benefits.

The Committee were advised of the budgetary figures and it was explained that this was NHS money and not LBH funding.

Members asked about how the service was being publicised.  Officers explained that there was no real publicity, as this was more a target of getting GP’s, Social Worker and Clinicians to refer patients, and was not a self-referring scheme.  Officers explained that the Community Matrons do have some case studies of what effect the scheme has had on individuals and agreed to circulate this to the committee.

The Committee noted the report.