David Watts, Director of Adult Social Care,
City of Wolverhampton Council, and Andrea Smith, Head of Integrated
Commissioning, Wolverhampton CCG, presented the report on care
pathways for the frail elderly and highlighted the key points.
David Watts referred to the importance of
ensuring that care pathways were good in the city. There were several different drivers for health
and social care, a key document being the NHS Five Year Forward
View which stated that areas should have a plan for integrating
health and social care by 2020. He
referred to the Better Care Fund (BCF) Programme which was the
primary way to implement change through the more efficient use of
resources. The programme was currently
being refreshed and had yet to be signed off. That delay had primarily been caused by the delay
in published guidance from the Department of Health, which had
become available on 4 July 2017. Once finalised, the Leader of City
of Wolverhampton Council would be asked to sign it off.
He referred to several projects underway which
aimed to avoid emergency admission to hospital and Delayed
Transfers of Care (DTOCs) and he asked
Andrea Smith, Head of Integrated Commissioning, to highlight
Andrea Smith referred to the following
with Frailty Programme. This
was in the BCF Programme, with several work streams to support
primary and secondary care. GPs were
taking part in a pilot scheme looking at patients using a Frailty
Index to identify those most in need.
By using Care Management Plans, it was hoped to allow the elderly
to remain at home for longer.
Redesign of Community Services Programme. This was in the BCF Programme, with all services
being provided to ensure the right services in the community
setting and the right support.
Avoidance Programme. This
was both proactive and reactive; community nurses worked
proactively with GPs to look at high risk patients and those
frequently using services. The Rapid
Intervention Team worked reactively with nurse based teams in the
community supported by Social Care teams.
David Watts referred to the following
Discharge to Assess
Programme. As from the beginning of
2017 it had become part of the BCF Programme as it was considered
that it covered the whole system. A
pilot scheme using Discharge Hubs and improved initial assessments
had been introduced on four wards at the Royal Wolverhampton
- Six-month extension of Home Assisted
Reablement Programme (HARP).
- Additional Stepdown/Very Sheltered Housing or Extra Care.
- Hospital Discharge Demand Management
- Hospital Discharge Voluntary Sector
The above projects were part of additional
Adult Social Care. £6.4million would be available this year if three
conditions were met. Firstly, stabilising the local care sector,
secondly relieving press on the NHS locally by getting more people
home safely and quickly,and thirdly helping to deliver the
challenges for health. Spending was
controlled by the BCF Programme Board and the A & E Delivery
In response to questions from Panel members,
officers stated the following:
- Improvements had been made to the
assessment process already. The issue
related to where an assessment was taking place, given that
assessments would often require several visits it was better to do
an initial assessment in the hospital and then further assessments
when the person had returned home.
- It would depend on the type of
adaptation required as to whether this would or could be done
before a person left hospital. Under
the Small Adaptations Grant stair lifts and other minor adaptations
could be completed quickly and it was hoped to pilot the scheme in
other areas. If a person was unable to
return home as adaptations were still required alternative
accommodation would be found.
- Efforts were being made to work with
other authorities; however, it was not proving
- The NHS was made aware that delays
occurred when Wolverhampton was dealing with people transferred
from other hospitals. Based on the
performance indicators used, the service was in an extremely
challenging position. However,
improvements had been made during the past year, for example in the
number of delayed days during the month, which had fallen from 600
to 400. Other indicators in the
dashboard required assistance from other bodies, including GPs and
the ambulance service working together better.
- It was important to ensure
transparency and have efficient methods of data collection to avoid
- It was important to remember that
outside events could influence figures, for example when ambulances
were diverted to Wolverhampton from other areas.
- It was unclear why there had been a
spike in the figures for the number of delayed days last November
2017; however, NHS delays were more pronounced than social care
delays as perhaps more people were unwell.
- One project related to hospital
discharge and would bring together data and information from health
and social care to ensure that a care package was in
place. Also, to ensure the correct
support to GP practices, services were now aligned to the CCG
footprint based around GP clusters.
- To help the sick and vulnerable to
be prepared if they required hospital care a
Red Bag Scheme had been successfully piloted in residential and
nursing care homes and had seen a huge reduction in discharge
times as important patient information
is available when a person is admitted which will help reduce
delays in diagnosis and treatment. It was hoped that the scheme
could be introduced in Wolverhampton and extended to include
vulnerable people in their own homes and it was hoped to have that
in place by October 2017.
- The Adults Budget Working Group
looked at the Transformation Programmes. The Secretary of State has recently announced that
a penalty of up to 10% of the budget (£640,000) would be
imposed if targets were not reached.
That would require Wolverhampton achieving a 36% improvement
against performance measures by September which would be very
difficult to achieve. Seven of the West
Midlands authorities would require an improvement of more than 60%
which showed the scale of the task.
- Wolverhampton had a good health and
social care system and it was difficult to be required to have
those discussions on trying to meet this trajectory even though the
system was working well and the NHS and DCLG would receive feedback
that it had proved disruptive.
- The link to the BCF guidance was
available to be circulated to the Panel. The information including the
dashboard which provides information
about six key performance
measures - for example, the proportion
of older people (65 and over) who were still at home 91 days after
discharge from hospital into reablement/ rehabilitation services.
The information is used to track if current performance is on
target for reducing the number of delayed hospital attributable to
social care. There was concern the table does not capture all the
complexity of the factors beyond the control of the local authority
which can affect its performance against the published
- Wolverhampton had been ranked 117
out of 150 but based on current
evidence the situation is improving
Members of the Panel welcomed the comments and
responses from officers and stated that the main priority should be
to ensure patient welfare rather than trying to achieve unrealistic
Department of Health targets
David Watts suggested that as the Department
of Health would be reviewing the current progress of the dashboard
in October 2017, if there were any areas of concern they could be
considered at the Panel’s meeting on 25 January 2017.
- That a link to the Government
guidance on the BCF be circulated to the Panel.
- That an update report on the
performance of Wolverhampton against six performance measures
detailed in the Local Performance Measure performance dashboard is
be submitted to the meeting on 25 January 2018.