Agenda item

To receive the Wokingham Integrated Partnership Better Care Fund Annual Plan 2021/22 presentation.

The Board received a presentation on the Wokingham Integrated Partnership (WIP) Better Care Fund Annual Plan 2021/22.

During the discussion of this item, the following points were made:

·       NHS England had released the submission template in September, and the final version had been agreed on 16th November, following the agreement of the Chair of the Wellbeing Board.  It was essentially a formalisation of the Plan and budget agreed earlier in the year.

·       During the development of this annual return the Integration Team had liaised with colleagues from the CCG, BHFT, RBH and the other West of Berkshire Local Authorities.  Overviews were shared with all the WIP partners at delivery group (operational managers) as well as Leadership Board (Senior managers).

·       The return submitted to NHS England had been judged to be sound.

·       All the minimum financial contributions had been met as had all of the national conditions.

·       Some of the services currently funded by the Better Care Plan were highlighted.

·       Lewis Willing, Head of Health and Social Care Integration, informed the Board of targets identified.  The first, admission avoidance, was a change to the target around Non-Elective admissions.  A target around Length of Stay had replaced the target around Delayed Transfers of Care. 

·       The unplanned hospitalisation for chronic ambulatory care sensitive conditions aimed to get to the heart of the work of the Better Care Fund, and ensured that the partnership was supporting people in the community who would not necessarily require hospitalisation.

·       With regards to Length of Stay, the percentage of in-patients, resident in the area, who had been an inpatient in an acute hospital for: i) 14 days or more ii) 21 days or more as a percentage of all inpatient, was monitored.

·       The targets were very challenging but achievable.  NHS England were keen to keep levels of performance high, especially as during the pandemic, unplanned hospitalisations and length of stay were very low. As such, they had pressed to ensure that targets were challenging.

·       Other targets around discharge to normal place of residence, residential admissions and reablement, were highlighted.

·       Due to Covid, the performance was very good against the long-term placements piece.  Fewer placements than in a normal year were being made, and the Partnership had challenged itself to drop from 12 placements per month to 9.6 placements.

·       Each local authority was required to complete a narrative plan.

·       It was noted that Housing would become more involved in the discharge process.

·       Councillor Hare questioned how it was ensured that patients were being discharged at the right time.  Lewis Willing referred to the targets of keeping people in hospital no longer than 14 and 21 days so that they did not become ‘stranded’ or ‘super stranded’ in hospital, and the target that people were still at home 91 days after having been released from hospital.  The Reablement team helped people to stay independent in the community.

·       Councillor Hare noted that the 91 day target was the ‘Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services’.  He commented that sometimes those under 65 also required additional support to recover.  Lewis Willing stated that the Better Care Fund was aimed primarily at supporting older people but people of all ages would be supported as required.  Colleagues in Adult Social Care had regular discussions with the Royal Berkshire Hospital to ensure that discharge was being undertaken correctly.

·       Katie Summers emphasised that there were several meetings a week to review those individuals who were classed as medically fit for discharge.  The UEC Board also actively monitored readmissions rates to understand and respond to any issues identified.

·       Katie Summers thanked Lewis Willing for the hard work that he had put into designing the Plan at short notice.

·       The guidance suggested a need to have a focus on Covid recovery in the 2022/23 plans.

·       Martin Sloan, Assistant Director Adult Social Care Transformation, and Integration, emphasised that the Royal Berkshire hospital regularly checked their readmission rates for ‘failed discharges.’  In addition, the social work team, whenever they were supporting a discharge and the person was readmitted, would log this with RBH.  RBH would then review the patient to ascertain the learning required to reduce readmissions.

·       Dr Milligan commented that Dr James Kent was undertaking a piece of work around early discharge.  During Covid there was a big push to discharge patients as quickly as possible, but this had not always been possible if there had not been enough carers in the community.  When people were released from hospital even one or two days early, they might require double up care, which was sometimes difficult to find.  Even though the national team were requiring specific standards, consideration had to be given at a local level to ensure that residents received the best outcomes and that the care they required was available.

RESOLVED:  That the presentation on the Wokingham Integrated Partnership (WIP) Better Care Fund Annual Plan 2021/22 be noted.