Agenda item

To receive a report from Bindi Nagra, Assistant Director Health, Housing and Adult Social Care.

Councillor Abdullahi, as Chair of the Health Scrutiny Panel welcomed colleagues from Enfield CCG, North Middlesex University Hospital (NMUH) and Barnet, Enfield & Haringey Mental Health NHS Trust (BEHMHT) to discuss this issue.

Bindi Nagra (AD Health Housing and Adult Social Care) introduced the report which gave a summary of the current performance and reasons for delayed transfers of care, it also provided a summary of schemes which are part of the Integrated and Better Care Fund, that is being used to reduce delays in hospital.

Jon Newton (Head of Service Older People & Physical Disabilities) presented the report which highlighted the following

• Data shows generally good performance for Enfield.
• There is an inbuilt two month delay in NHS England providing performance data. Information for September would be available shortly.
• The Enfield Health and Wellbeing Area had been set a target, by NHS England, of no more than 20.6 DTOC (Delayed Transfers of Care) per day from July 2017.  Data is for people who have not moved on from hospital 24 hours after the notice to discharge is issued.
• There are many reasons for delay which can be Social Care delays Health delays or Joint delays.  It was noted that a situation where a delay occurs due to family choice, would be categorised as a health delay.
• Health and social care partners work together to implement the High Impact Change model (HICM) to manage transfers of care.
• From April 2017, more funds had been provided through the Improved Better Care Fund (iBCF)– for meeting adult social care needs, to reduce pressures on the NHS. 
• The iBCF has supported schemes to reduce delayed transfer of care -  which includes ‘Discharge to Assess’. This means people can go home and be assessed from there, rather than in hospital. An assessment agreement is needed with the CCG, and the person would continue obtain help/ support at home .
• Data shows both LBE and ECCG met their target for Quarter 1 and are also on target for Quarter 2.
• The good joint working with the BEHMHT has helped to enable adults with mental health needs to have appropriate support to enable people to move out of an acute setting into the community.
• The Mental Health trust had estimated that approximately 1:20 patients with mental health issues in hospital did not need to be in an acute setting.

The following issues/ questions were raised

• When asked about specific targets for each element of DTOC it was pointed out that not all areas have specific targets – there are challenges for example in some cases there is a need for helpers who may not be available at weekends.
• The report had stated that one of the three main causes for delay in mental health is ‘access to housing’. It was stressed that the close working we have with other organisations is important in this area – in particular, for those people who have ‘no access to public funds’.
• Councillor Neville said it appears from the table that performance for DTOC is going in the right direction although it is still too high. Although it was not possible to say how much additional money had been spent on this problem it was stated that £1.2 m in the Better Care Fund had been allocated for ‘high impact changes’ e.g for assessment at home.
• A question was raised regarding DTOC - one of the reasons given for this in the summary at Appendix A is ‘delay awaiting public funding’ what is this?   Bindi Nagra pointed out that the reasons for delay are complex, people would not be delayed because of a lack of money, this category is often used as an ‘umbrella’ and may be because someone is waiting for a nursing home.
• One of the categories refers to ‘further non-acute NHS care’. It was explained that this may be where a person who may have been in an accident with an acute injury, may have recovered to the point that still requires further NHS treatment such as rehabilitation and needs to move to another hospital for specialist treatment where a bed may not currently be available.  It was stated that 5 extra ‘rehab’ beds were now available at the Magnolia Unit.
• ‘Patient or family choice’ stated as a reason for DTOC – This may be where a clinician has stated that a person is ready to go home but the patient or carer either do not agree they are fit or do not agree with care choice the person is assessed as needing. 
• It was asked if it is expected that the situation would improve when the Strategic Transformation Plan comes into effect?   It was thought that this should be beneficial as it should enable people to work together more effectively, hopefully breaking down organisational boundaries.
• It was confirmed that some people with mental health problems are being looked after outside the borough (11 people at present).
• It was welcomed that the Enfield CHAT (Care Home Assessment Team) had been working in partnership with Haringey to assist in enhancing health in care homes.
• Councillor Cazimoglu referred to the DTOC delays for both Health and Social Services and said that these are often interconnected, with one impacting on the other.  She said the A & E service at NMUH is under a lot of pressure, with many challenges.  In respect of GP’s, Enfield is under resourced and this leads to extra pressure on services. She referred to her concerns regarding demands for the forthcoming winter.
• When asked if any additional plans had been made to meet the winter demands, it was stated that plans are underway, and are further ahead than this time last year.
• It was noted that future proposals re Care Closer to Home Integrated Networks (CHINS) would facilitate health and social care professionals working as a team for individuals. Councillor Levy said it would be useful to see what is being proposed for this for the future. It was  confirmed that members of CCG, council officers and mental health care professionals meet to discuss and progress issues/cases weekly .
• It was pointed out that a person may be admitted with a physical problem but this may also lead to mental health issues emerging that need to be addressed. This is often the case for elderly patients who become disorientated. It was agreed that this was a complex issue and it is necessary to remember that a person may be ‘in crisies’. We must not lose sight of the human cost and the need for good communications between services is essential.
• Apart from targets/ performance figures given, it was asked if there was any ‘soft data’ and/ or any further issues members should be aware of?  Doug Wilson referred to the necessity for us to be able to look at early intervention to identify tangible things the authority can do to prevent people having to go to hospital. As part of this we are working closely with the voluntary sector.
• It was asked what measures are used to ensure that patients are not being discharged too early from hospital in a drive to ‘free up’ beds? It was answered that there were assessment surveys carried out and figures would show numbers of people who are re-admitted. Also people who are re-admitted would return to the same consultant.
• Councillor Abdullahi referred to a ‘dementia strategy’ which had been developed when it had been realised that a lot of people were being discharged to social care. This included the development of ‘pathways’ and the setting up of a memory clinic.  It was stated that there was a lead consultant for this area and a dementia nurse in position.
• A member of the public referred to older people being discharged from hospital, the need for carers to be able to spend a reasonable time with them and the advantages of siting care homes near parks where people would be able to be part of the community.  Councillor Cazimoglu referred to the care home strategy and mentioned that Enfield has one of the highest number of care homes in London. She mentioned that carer’s visits are for a minimum of 30 minutes and that LBE does not commission 15 minute visits.

NOTED

Members noted the report.

Councillor Levy thanked officers and representatives from ECCG, NMUH and BEHMHT for their attendance and input.