Agenda item

To receive an update on the latest position on the proposed integration of Hampshire County Council and Southern Health NHS Foundation Trust Intermediate Care services. 

The Director of Adults’ Health and Care alongside representatives from the NHS and Southern Health Foundation Trust provided a progress update on Integrated Intermediate Care, last presented in May 2019.

Cllr Thornton joined the meeting at 10:09.

The Chairman reviewed the concept of Integrated Intermediate Care (IIC) and Members then heard:

• Joint provision of services is intended to avoid unnecessary admission to acute hospitals and to allow independent living at home as soon as possible. 
• Support is offered free of charge for a time limited period (6 weeks), though generally shorter with step down into a community or care home setting. 
• Rehabilitation, reablement, and recovery are the key elements.
• Hampshire County Council (HCC) and Southern Health Foundation Trust (SHFT) are progressing towards proposals for a single integrated service.
• Commissioning along NHS lines is critical but complex due to lack of consistency in shared information and technology across providers. 
• This is a positive direction and consultations will follow in due course.
• Arrangements covering all aspects and system functions will be choreographed between HCC and NHS with a possible Section 75 and Local Care Partnerships.

Cllr Hayre joined the meeting at 10:14.

• Modelling in terms of whole population and creating an appropriate footprint with acute hospitals requires detailed work and a business plan for ideal outcomes.
• Commissioning and provider perspectives are both critical to success. 
• With the challenges of Tt2021, ensuring services are joined transparently in terms of finances, expectations, and service delivery details is key. 
• Winter planning is now the focus to match additional service demand across the county and ensuring appropriate services and capacity are available for upcoming needs with greater efficiency and productivity. 
• Service structure planning will reduce areas of duplication with a thoughtful and sensitive approach that dovetails together. 
• HCC and SHFT operational and clinical regimes are different but the integrated service needs to be complimentary, robust, and capable.
• Consultation with staff will commence at the turn of the calendar year. 
• New ways of working together are tested in forerunner projects countywide with local access points and an aim for patients to leave acute settings an at earlier stage as the longer they are there, the more they decompensate. 
• To better their chances for recovery and independent living, acute hospital avoidance is key for those who would receive better care at home. 
• Recent collaboration with South Central Ambulance Service (SCAS) has resulted in over 580 people avoiding acute hospitals and easing the pressures on acute, community, and social care providers, with ideal outcomes and benefits. 
• Communication and engagement with all stakeholders are critical to find new ways of working ground up to meet population needs. 
• The detailed business case is the current focus.  There will be consultations in January with legal services, staff, providers, etc., to be brought back to the HASC in March, and the Executive Member for Social Care and Health, before the service going live in April 2020.

Cllr Fairhurst joined the meeting at 10:21am.

In response to questions, Members heard:

• Collaboration, agreements, and aligned plans with CCGs, STPs, and all partners are critical to develop service and function proposals based on CQC Local System Review (next item on the agenda) and insights from Newton Europe.
• Conditions need to be created to work seamlessly to overcome issues and effects of external forces, and make compromises (hosting, configuration, etc.)
• This is an opportunity to bring together Hampshire care system and Southern Health with a singular goal across both provider organizations.
• 700 staff members will be engaged, for a sense of the scale, size, and reach.
• Lack of and access to GPs are a community issue that lead to more hospital visits, but there are layers of complexity for both service users and providers.
• Primary Care Networks (PCNs), IIC, and GPs will be strongly linked and supported alongside a range of health care workers to provide the right care in the right setting and monitor complex patients to provide the best care.
• The system is increasingly more difficult and complex for people to navigate and this is an opportunity to address challenges and make collective improvements to simplify and delayer services for easy, effective, and timely access.
• With this shift, more NHS funding and resources will need to flow from acute to community organizations.
• People will need to better understand options available to them and vulnerable service users with technology challenges or language barriers must be helped.
• The goal is to provide (previously separate and difficult to access) joined up services with a single access point with savings from scale and less duplication.
• Collaboration with 111, PCNs, voluntary sector, and SCAS will allow all enquiries to use Connect to Support Hampshire’s directory of available services.
• Face to face opportunities for advice will remain for those who may need them.
• The business case will be a joint one with a pooled budget and clear service specifications in fine details from a commissioners’ perspective and detailed operational service and delivery structure proposals from a providers’ view.
• This is an invest to save opportunity looking at 5-year demand capacity. 
• There is a cost to delivery and existing contracts, but also a saving opportunity from acute bed avoidance and the impact on long term care packages with more individuals better managed in the right care setting. 
• Staffing and workforce issues remain at the forefront of all disciplines, but this collaboration will avoid duplication and release staff for other purposes. 
• The proposed development will be clear on the financial envelope, quality from complementary skill sets of organizations (clinical, service delivery, social care, etc.) but the area of greatest concern consistently remains around work force and competing against acute hospital staff recruitment.
• Training and staff development in a holistic and individual approach with new projects and innovation will attract staff and allow them to upskill and access new career pathways with additional qualifications and retain them to avoid turnover.
• Assumptions with regards to growth in people living longer have been considered and will be monitored and managed.
• The immediate challenge is moving a large body of currently acute setting patients to manage them in better care settings and thus stabilize the numbers.

Members noted that they were impressed with the hard work, direction, clear plan for future, joint up working, safeguarding, and avoiding duplication.  The Chairman congratulated the collaboration and looked forward to receiving the finance details in March 2020. 

RESOLVED

That the Committee:

1. Noted and supported the project approach and developments as set out in this report.
2. Will receive a further update in March 2020 prior to an anticipated Executive Member decision to approve creation of the service (subject to consultation).

The Vice-Chairman left the meeting at 10:57.