Agenda item

Step Up, Step Down

To receive an update on the Step Up, Step Down project. (20 mins)


James Burgess, Better Care Fund Programme Manager provided an update on the Step Up, Step Down (SUSD) scheme.


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


·         Members were reminded that the Better Care Fund had created a local single pooled budget to incentivise local government and the NHS to work more closely together around people, placing their wellbeing as the focus of health and care services.  The Council and the Clinical Commissioning Group (CCG) had to jointly agree how the money would be spent.

·         The SUSD scheme was one of the eight Better Care Fund projects. 

·         James Burgess explained what was meant by SUSD.  Step Down was for those who were medically well in hospital but were not ready to return to their former home or level of independence.  Step Up was for people experiencing a sudden and severe change in need, and who required a period of intensive support and rehabilitation to avoid the need for a hospital admission or permanent placement in a residential or nursing home.

·         SUSD was based at the Alexandra Place Extra Care scheme with 24 hour 7 day a week staffing and one dedicated additional day staff.  There were one 2 bedroom and two one bedroom fully equipped and furnished flats with walk in showers and adapted bathrooms.

·         It was noted that the flats were intended for a maximum stay of 21 days in order to complete reablement required and to avoid bed blocking.  However, the 21 day period could be exceeded if the individual circumstances necessitated this.  Although the flats were rent free residents had to provide their own food, with the support of staff if needed.

·         Councillor Soane asked whether anyone who had gone into Step Up had then been admitted to hospital.  James Burgess commented that they had not and that there had not been that many admitted as a Step Up.  Some admitted to Step Down had been admitted to hospital for a short period before being discharged back to Step Down.

·         Councillor Blumenthal questioned whether 3 units were enough and if it were likely that more would be required as the Borough’s population aged.  James Burgess stated that when the scheme was initially piloted it had been thought that 8 units would be needed.  However, performance was kept under review.

·         Members enquired whether the units were as busy as they could be.  James Burgess stated that there were peaks and troughs in their usage.  Nevertheless, there was an increased focus on getting people back into their own home where possible. 

·         A ‘deep dive’ review would be undertaken 2016-17 to ascertain whether there were more cost effective ways of delivering SUSD units and the optimum staffing levels for SUSD.

·         Members were updated on performance of SUSD from July 2015.  It was noted that 37 people had used the service for a total of 698 days.  The total cost of the service had been £109,706; rent, staffing and utilities.  339 days in hospital had been saved and 25 admissions to residential care homes avoided.  The estimated health benefit was £155,350 and the estimated net Council savings were £91,568.

·         Councillor Jones asked how the Wokingham scheme compared with other areas.  The Committee was informed that Reading had a discharge to access scheme whilst Bracknell had a similar scheme with 6 units.  Councillor Miall questioned whether Wokingham residents would ever use facilities based in another local authority.  James Burgess commented that the Better Care Fund funding was based around locality. 

·         In response to a question from Councillor Soane regarding satisfaction levels, James Burgess stated that people were asked to complete a questionnaire on leaving SUSD and results had been largely positive.  Councillor Blumenthal asked whether any constructive criticism had been received.  She was informed that some people had commented that the flats were not very homely.  Whilst improvements had been made infection control was important which did give the flats more of a clinical feel with the furnishings.

·         Councillor Dolinski questioned if there was ever pressure from families to keep a person within the SUSD and was informed that this had not been an issue.

·         Councillor Loyes asked how many people had been turned away from the units.  James Burgess indicated that this data had only been collected since January and that he would provide the information to the Principal Democratic Services Officer to circulate to the Committee.  People could be turned away for a number of reasons such as the units were full or because SUSD was not suitable for the individual.

·         James Burgess outlined some of the barriers that the SUSD service had faced.  These included the slower integration of the WISH service (the integrated short term team) which had meant that the service had been mainly used by the out of hospital social work team. 

·         Wokingham as an area performed very well in preventing delayed discharges from hospital, meaning less demand for the service than expected. 

·         Members were notified that the lack of dedicated medical support had meant there had been lower acceptance of the service from health staff as an alternative to a hospital admission.  In addition access to the service was not currently 7 days a week.

·         The Better Care Fund was undertaking a review of all its current schemes in September and the following options for SUSD would be considered:

Ø  Maintaining the current 3 units which would be primarily used for Step Down to facilitate complicated discharges from hospital;

Ø  As the WISH team became more integrated increase the medical support available for SUSD to increase the numbers of Step Up admissions;

Ø  Trailing the siting of 7 Step Up beds at Wokingham Hospital.


RESOLVED:  That James Burgess be thanked for his presentation.

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