To receive a presentation from Cheryl Coppell.
Minutes:
The Board received a presentation from the Chief Executive Officer of Havering who also chairs the Independent Care Coalition (ICC).
The Independent Care Coalition was originally formed because of issues around the local hospitals. The ICC brought together key partners within Outer North East London to develop improvement programmes across health and social care. Since the establishment of the ICC, NHS (London) had asked that a number of partnership tasks be undertaken and these had been added to the original role of the ICC so as to prevent a range of difference partnership groups operating in a unco-ordinated manner. The Urgent Care Board (UCB) acted as a sub group of the ICC. The ICC was not a decision making body and all decisions on contracts or spending were enacted through the relevant governance structures such as Health and Wellbeing Boards, Clinical Commissioning Group (CCG) Boards and Provider Trust Boards.
The original programme, agreed by the ICC was to improve community capacity in order to prevent avoidable presentations at Accident and Emergency and hospital admissions. Due to the high incidence of frailty, including older people presenting at A&E, the community responses were targeted at this group. In order to reduce unnecessary hospital admissions, a range of services were piloted and these have now been mainstreamed as part of the CCG contractual arrangements and the Better Care Fund. These are as follows:
a) Integrated Case Management (ICM)
The Havering Integrated Care (IC) Team comprise of a GP, Community Matron, District Nurse, Social Care Lead and Care Liaison Officer and deliver appropriate care to patients in the community so as to reduce avoidable hospital admissions. In addition, they also deliver a high quality service for high risk patients. There are six clusters across Havering with a Community Matron and Integrated Care Liaison Officer allocated to each.
Quarter 4 data identified that Havering was on target for caseloads with 2053 service users receiving support in 2013/14. Key Performance Indicators for 2014/15 would aim to facilitate improved performance in areas identified in the in-year diagnostic e.g. a greater focus on effective management of caseloads and throughput of the service.
b) Community Treatment Teams (CTT)
The CTT consists of doctors, nurses, occupational therapists, physiotherapists, social workers, and support workers. The CTT provide the following:
· Short term intensive care and support to people experiencing health and/or social care crisis to help them be cared for in their own home rather than be referred to hospital.
· Support for people to return home as soon as possible following an acute/community inpatient stay where this is required or appropriate.
· A single point of access to intensive rehabilitation at home or in a bed in a community rehabilitation unit if necessary.
· CTT runs in all three boroughs from 8am – 10pm, seven days a week which align with peak attendances in A&E and therefore should help to relieve the pressure on A&E.
Performance data for 2013/14 indicated a good performance in the Queens hub with 1576 referrals received of which 78% did not go on to be admitted to hospital. The community spoke was also rated green on performance against target, with 2707 referrals received; 94% of which were treated and maintained at home without the need for an acute admission.
c) Intensive Rehabilitation Service (IRS)
The team consists of nurses, occupational therapy staff, physiotherapy staff and rehabilitation assistants with access to a geriatrician as required via the Community Treatment Team. It aims to provide an alternative to admitting patients to an inpatient unit for rehabilitation by supporting people in their own homes where it is appropriate to do so. The in-home support provided is intensive and involves between one and four home visits each day, depending on the patient’s needs. The service operates from 8am – 8pm, seven days a week.
Trial of the new intensive rehabilitation service went live from November 2013 allowing people to be rehabilitated at home rather than in a non-acute bed. Performance data for 2013/14 showed that Havering received 159 referrals against a target of 69. Patient satisfaction was good and continues to be monitored monthly.
Nursing Home Scheme
Baseline conveyances by London Ambulance Services (LAS) from nursing homes was 320 in the first quarter. In the second quarter, this reduced to 294 and 317 in for the third quarter.
In order to prevent unnecessary conveyances to hospital from nursing homes, 31 homes in Havering have signed up to the scheme.
Intermediate Care (CTT/IRS)
A paper detailing progress and performance of the trials of these programmes and recommendation as to next steps following the trial period was submitted to CCG Governing Bodies in January 2014. All 3 CCGs agreed the continuation of the trial of CTT/IRS 2014/15 with a view to:
· A review of the model in one year following further evidence
· finalising the proposed model of intermediate care in partnership with the local authority, and;
· consulting on any significant service changes for 2015/16.
A nomination for the HSJ value in healthcare awards regarding the new model of intermediate care has been submitted by NELFT and the CCGs.
Community Health and Social Care Service (CHSCS).
Community Health and Social Care Teams development to progress in 2 stages:
1. NELFT are to reconfigure identified services (community nursing, ICM, Therapies, MH link worker) into locality based teams. In Havering, the first stage of CHSCS went live on 28 April 2014.
2. Plans to consider integration of partners outside of NELFT e.g. Social care and others. In Havering, proposals are currently being discussed re: piloting better integration between community (CHSCS) and secondary care via an MDT approach for those particularly complex patients that ICM are finding difficult to manage within the average 8 weeks. The pilot is due to go live in one cluster in May.
Non Acute beds
2013/14 data identified that referral to transfer rates continued to meet 72 hour targets (22 hours on average). Some additional ‘winter pressure beds’ opened during the first week of January 2014 and closed in early April 2014. The number of beds required to manage demand in this period was significantly less than in previous years and was also less in number than predicted which may have been due to winter capacity modelling.
A&E Attendances and LAS conveyances to BHRUT
Latest information shows that there were reductions in A&E attendances within BHRUT and that Local Ambulance Service conveyances to local hospitals in BHRUT were also showing a reduction. The Chief Executive tabled the following figures which depicted the impact of the ICC on the reduction of emergency, hospital admissions and care transfers.
BHR – Quarter 3 in13/14 compared to Quarter 3 in 12/13
A&E attendances – reduced by 6.59%
Non Elective Admissions - reduced by 14.35%
Delayed Transfers of Care – reduced by 25.5%
Havering – Quarter 3 in 13/14 compared to Quarter 3 in 12/13
A&E attendances – reduction in overall attendances by 12%
Non- Elective Admissions – reduced by 9%
End of Life Care
The Integrated Care Coalition have agreed that end of life care will be a priority. The Barking & Dagenham, Havering and Redbridge end of life subgroup of the Integrated Care Coalition (ICC) have agreed five priority areas which are:
· GP end of life training
· Strengthen co-ordination of end of life services
· Case for investment in community nursing
· Consider the BHR approach to CMC
· Provide guidance on local applications following he recommendations from the national independent review of the Liverpool care pathway (LCP)
Havering end of life group has the following key actions:
· BHRUT Improvement plan - Contains actions to improve consistency of end of life care across sites and BHRUT wards and improve end of life training.
· Dying matters week - 12th to 18th May 2014. Havering CCG is working with St Francis Hospice, London Borough of Havering and other local organisations on this project aimed at raising public awareness of end of life issues.
· Standardised DNR forms - the group is working up a plan for introducing and implementing a fit for purpose ‘do not attempt cardiopulmonary ressusitation’ (DNARCPR ) form. NELFT have a policy already for this.
The Frailty Academy has been set up to ensure that lessons from all of these initiatives are learned and developed with effective mainstream services. The Frailty Academy is a virtual academy comprising clinicians and other staff such as the Local Authorities, Social Care, nursing professionals and academics from University College London. There are currently 34 participants enrolled in the Academy from multi-professional and multi-agency backgrounds including LAS, NELFT, BHRUT, Age UK Redbridge, and Havering Care Association. The curriculum is well developed and a range of improvement and innovation materials have been designed across four phases of delivery: Understand, Co-create, Plan & Test, Adopt & Diffuse.
There are further projects planned including the setting up of a website to provide a starting point for discussions around frailty.
Resources
Confirming resources for the programme work remains a priority. Immediate needs for the project teams include administrative and analytical support, and communications support. It is proposed that the Programme Director is asked to scope requirements.
In linking to the rest of the system, it was noted that a manager has been appointed to the Joint Discharge team and staff consultation processes were continuing. The Re-commissioning of urgent care centres at the acute hospitals was underway. The BHRUT Improvement Plan was submitted following special measures introduced at BHRUT hospitals. The new plan ties more directly into ICC work streams that demand management into and out of the acute trust and efficiency and improved clinical leadership inside the acute trusts.
The Chairman commented on the need to maintain discussions about the provision of future health services within the three boroughs particularly due to the increase in populations.
The Chief Executive advised that there was a lot more work to do over the coming two to three years, however, the five year plan for the local health and social economy would be available in June 2014.
The Chairman on behalf of the Board thanked the Chief Executive Officer for a most detailed and informative report.