Agenda item

A presentation will be carried out by Mr Warnes, Chief Commissioning Officer, North Staffordshire Clinical Commissioning Group.

A presentation was carried out by the Chief Operating Officer, North Staffordshire Clinical Commissioning Group (CCG).

NHS Stoke-on-Trent and North Staffordshire CCGs were considering how they commissioned community based services for patients who were currently admitted to a hospital bed.  Their aim was to integrate care services to connect people with the care they need, when they need it.

The proposal was for more community based support for individuals in their own home or closer to home, when they were ready for this, which would result in a reduced need for community bed based services.

The vision was to develop a “step down” model of care, which saw the patient’s journey from the point of admission to discharge supporting less transfers of care between multiple organisations which would result in a reduction of delays.

They would develop a “step up” model, which would see a diagnostic and assessment centre within the community and a continued increase in easily accessible home based services within the community, improving quality of care for all patients.

It was pointed out by a couple of Members that the evidence supplied was quite long standing.  Members were advised that the evidence had been based upon the national users.

The following questions and observations were raised and responses provided by the Chief Operating Officer:-

1.            How could an elderly patient sitting in a chair at home be better looked after to those in a bed, at hospital, with immediate care?

Getting the patient home helps them to maintain their independence.

2.            The community services were not there.

A vast amount of patients were admitted with respiratory problems, within 48 hours that patient required rehabilitation.  If they did not receive it within 48 hours it would be harder to get them home.

3.            What was there in place to avoid patients being admitted into hospital in the first place?  What did you see being in place with GPs locally on an organisational level?

Primary care was struggling nationally.  It was difficult to recruit GPs.  There was a great deal of other primary care professionals to support GPs.  £10½m was to be invested next year into the model of care.

4.            Were there identifying areas where there were greater issues to admission into hospital due to the GP Practices not being efficient and/or deprived areas to be known for high admissions?

Every illness had a social class gradient.

5.            How did the model fit in with carers?

Care homes amount to 6% of A&E admissions.  A pilot scheme was delivered to a pilot population of 171 residents in a single nursing home in 2012. In 2011 the pilot site was not an outlier for either A&E attendance or unscheduled admission rates compared to other local nursing homes.

Following introduction of the service for the pilot population, their A&E attendance rate fell by 25% and unscheduled admission rate by 29%, compared to increases in rates for a local population (386 residents in 4 homes) who did not receive the enhanced service.

The pilot service improved individual pathways of care, increased patient, carer and professional satisfaction, and resulted in net financial savings. Expansion of the service was therefore approved by the Staffordshire PCT Cluster and commissioned as a Locally Enhanced Service (LES) across North Staffordshire from April 2013.

6.            Would the closure of the beds be in a stepped way?

The University Hospital for North Midlands (UHNM) would be responsible from admission to discharge.  The CCG wanted one provider of care not two which was the UHNM, this had been put in place on a trial basis.

7.            People who use the hospital do not understand the system.  There was a need to invest part of the funds on communication on what the CCG were trying to achieve and this was happening far too quickly.  How do you intend to reach the security to people?

The funds had been released.  One of the problems around the arrangement was the patient not being fully recovered and being discharged too early.

8.            Why were the Partnership Trust having difficulties getting staff and the hospital were not?

The Partnership Trust does not recruit from abroad whereas the hospital does.

9.            Have you got the involvement from Staffordshire County Council or from private care?

The CCG had got integrated commissioning arrangements with Staffordshire County Council and had the involvement of the Better Care Fund

The Chair thanked the Chief Operating Officer for the presentation and answering Members questions and concerns.

The Chair informed there was a table top discussion arranged for the 30^th March 2015 at The Ballroom, The Moat House Hotel, Festival Park, Stoke-on-Trent on a proposal for a new way to care for the people of Stoke-on-Trent and North Staffordshire.  Those Members that were interested in attending to inform the Scrutiny Officer.

RECOMMENDED:-

That Committee receive the proposal of a New Model of Care by Stoke-on-Trent and North Staffordshire CCGs.