Issue - items at meetings - Short Term Services

Report of Chief Operating Officer, Brighton and Hove Clinical Commissioning Group (copy attached).

(1)       That the general update on the Community Short Term Service be noted. 

8.1       The Committee considered a report of the Chief Operating Officer which provided a general update on Community Short Term Services and on the areas highlighted for the next steps in the report submitted to the Joint Commissioning Board on 28 January 2013.  The current report drew attention to ongoing issues that needed resolution where decisions would need to be made over coming months.   The Head of Commissioning, CCG presented the report.

8.2       Councillor Meadows referred to A) the sixth bullet point of paragraph 1.3 – “integrating of the community rapid response elements of the service with a view to creating a single service by April 2013.”  She asked if this was having an impact.  B) Paragraph 3.3.1 relating to the Sussex Community Trust review of nursing needs of the patients in the Community Short Term Services beds.  Councillor Meadows asked for details of the outcome of the review.  C) Paragraph 3.8.1 which explained that over recent months, providers were reporting that people were being discharged with increasingly high levels of need.  Councillor Meadows asked if these people were fit to be discharged.  D) Paragraph 4.2 which related to feedback from user engagement with people in receipt of Community Short Term Services.  This stated that some issues fell outside the remit of the Provider Management Board and would need to be addressed with other organisations.  Councillor Meadows asked how officers could ensure that these matters were addressed.         

8.3       The Head of Commissioning, CCG explained that A) the community rapid response elements of the service had been divided two parts.  There was now a single point of contact and this appeared to be having a beneficial effect.  B) Sussex Community Trust did have a nursing review.  Officers were in the process of discussing the outcome of the review and whether the right nursing model was in place.  C) High levels of need were partly a consequence of the long drawn out winter.  It was also recognised that if people were not managed assertively, they could stay in hospital longer.   There was a need to work with the hospital to ensure the right model was in place and that fewer people were discharged requiring a bed based service.   D) Issues would be monitored by officers as the work progressed.

8.4       Councillor Meadows asked how long it would take for the Sussex Community Trust nursing review to have an impact.  She informed the Committee that the Health and Wellbeing Board had received a presentation on the 3T’s Development.  It had been stated that the Trauma Centre did have an effect on late discharges.  Councillor Meadows stated that the CCG were responsible for the Patient Management Board.  She asked how people would know that the PMB was working effectively in decreasing delayed discharges? 

8.5       Geraldine Hoban explained that there was a longer term model for the Short Term Service.  This was being continuously reviewed.  Additional capacity was being provided in the short term.  There would be a meeting with the Sussex Community Trust on 18 June to discuss a long term model of short term care that was required.  Officers wanted a clear model of care in place by September or October 2013.  There would be high level scrutiny analysis which would look at options to make the Patient Management Board work more effectively.  The Trauma Centre had not had a major impact on hospital delays or discharges. 

8.6       Councillor Wakefield referred to the Age UK report.  Page 46 of the agenda referred to discharge booklets.  Councillor Wakefield thought it would be interesting for the committee to see the booklets.  She stressed that some people had poor literacy levels and that it would be helpful if there was pictorial information.  She asked what was being done for people who did not speak English.   

8.7       The Head of Commissioning replied that she could pass Councillor Wakefield’s comments to the Patient Management Board. She assumed the Discharge Booklets were published in a range of languages. 

8.8       Councillor Norman referred to paragraphs 3.2 & 3.3.2 and asked about completion dates for Knoll House and Craven Vale.  The Executive Director of Adult Social Services explained that she was waiting for confirmation of nursing support for Knoll House but hoped to be in a position to confirm a completion date shortly.  The view from the service was that some people had complex needs and were refused by nursing homes.   Craven Vale was open and there was need to look at the model in terms of extra capacity. This was ongoing work and the specification needed to be correct.  

8.9       Councillor Mears asked where people went when they had complex needs.  The Executive Director explained that not all people with complex needs went to nursing homes.  Some went to Knoll House where they were supported by community nurses.  There was a need to increase the skills of staff in all nursing homes so they could deal with complex needs and dementia. 

8.10    Councillor Mears asked for an explanation of paragraphs 3.83 and 3.2 in relation to Knoll House.  The Executive Director explained that the CQC improvement plan was already in place in October 2012 when the council took over the service.  The council were working through these actions.  Most actions had been completed. 

8.11    Councillor Barnett asked if assessments for patients who needed care were competed over the phone.  She stated that she would like to visit Knoll House and considered that staff training in nursing and rest homes should be continuous.  The Head of Commissioning explained that assessments were made face to face.  There was one phone number for referrals. 

8.12         The Executive Director explained that there were various reasons why some homes could not take clients.  There were clinical issues and sometimes homes were not suitable for people with dementia.  Knoll House for example, may be more suitable.  The Executive Director agreed that training for care staff should be ongoing.  She suggested that members who wished to visit Knoll House should speak to Karen Divall, Head of Adult Provider Services.    

8.13    Councillor Barnett asked how many homes were suitable for dementia and special needs.  The Executive Director replied that a new BUPA home had recently been opened.  Details of the numbers of homes could be brought back to the committee in a performance report.

8.14    Colin Vincent referred to paragraph 3.8 and asked for details of the Provider Management Board’s membership and how often it met.  Mr Vincent referred to paragraph 3.4 and asked if the out of hours service was from the same provider as the roving GP service or someone with the specific task of dealing with short term services.   

8.15    The Head of Commissioning explained that the members on the Provider Management Board were from Adult Social Care, the Sussex Community Trust, South East Health (out of hours provider), Age UK and an independent sector nursing home provider.  The aim was for them to work in an integrated way to a single service specification.  The Provider Management Board was accountable to the CCG and the Local Authority.    The Board met monthly.  The roving GP service was a local care service operated by GPs.   It provided a rapid response service and also provided medical cover in short term beds. 

8.16    Councillor Bowden referred to paragraph 3.4 and stressed that older people were often reluctant to disturb their GPs out of hours, and the GP Service was notorious for not wanting to provide a service out of hours.  He asked who provided and monitored this work. 

8.17    The Head of Commissioning explained that the out of hours service used to be controlled by GPs.  In reality GPs worked together to provide care.  There was now a contract with South East Health.  A number of local GPs worked within the service which had robust standards.  There was a good quality local service.  However, there was an issue about people understanding how to access the service.   The CCG had the responsibility of monitoring the management of the service.  There was also a requirement for the service to be monitored by the CQC.

8.18    Janice Robinson remarked that she was reassured by the report which she considered to be very open and honest about problems being experienced.  Ms Robinson made the point that short term services received people who were very ill and not able to quickly take up rehabilitation options.  She asked how the Committee could be reassured that the right people were selected and rehabilitated. 

8.19    Ms Robinson referred to the assessment process and noted that members of the user group stated that they had to be assessed time and time again.  Ms Robinson asked if the Committee could have a report back with information about the quality assurance process. 

8.20    The Head of Commissioning explained that the right people would be selected for rehabilitation through the needs assessment process.  This was being monitored and reviewed.  There was now one referral and one assessment process. A single point of access would help improve the process.  The Age UK report reflected a period before this process was introduced.  

8.21    Councillor Meadows stressed that there were only 65 short term places in the whole system.  She asked what affect BUPA would make. 

8.22    The Head of Commissioning replied that Short Term Services needed to be flexible in terms of numbers over the winter period.  Numbers would not be fixed at 65.  In the private sector, 15 places had been purchased to compensate fro the loss of Knoll House.  

8.23    The Executive Director reported that BUPA was a registered provider.  

8.24    The Chair stated that BUPA would provide a useful addition in long term dementia care.

8.25    RESOLVED - (1) That the general update on the Community Short Term Service be noted.