Agenda item

(a)       That the report be noted;

(b)       That a further update report be submitted to the Committee in six months time; and

(c)        That the GP locality lead be invited to attend a future meeting of the Committee.                          

The Intake and Reablement Service Manager introduced the report to provide Members with an update of the progress of Enhanced Care at Home in Flintshire. 

She detailed the background to the report, explaining that the scheme had been launched in North West Flintshire in September 2013 and that some areas had been learned from a scheme which had been undertaken in Denbighshire.  A number of patients had been admitted to the scheme, mostly from General Practitioners (GPs) in Flint, and work was still ongoing with GPs in Holywell.  The service was now fully staffed with an Advanced Nurse Practitioner (ANP), a number of band five nurses, social workers and administration support in post. 

The Intake and Reablement Service Manager explained that the referral process to  enhanced care which was either a ‘step up’ from home or ‘step down’ from hospital.  She detailed the process involved and said that most people were on the scheme for a week or two and to date, 26 patients had been admitted to Enhanced Care.  During their stay in Enhanced Care an assessment was carried out by the ANP and a decision was reached on whether the patient would be discharged to reablement or to their home.  The total budget for Flintshire was just under £1m and this had been toploaded in the North West Flintshire budget to support a vehicle to transport equipment to support people in their own homes; the budget for Holywell was £385,447.  The Intake and Reablement Service Manager detailed some of the feedback that had been received from families who had been admitted to Enhanced Care.        

            In response to a question from Councillor Hilary McGuill about whether the service was working, the Intake and Reablement Service Manager said that she felt it had been successful so far but added that she would welcome Holywell GPs being more engaged with the service.  She added that the lead GP had been visiting colleagues and it was hoped that this and the positive feedback that had been received from those admitted to Enhanced Care would encourage them to take part.  The issue had also been raised at the Strategic Partnership Board meeting attended by the Director of Community Services. 

            Councillor McGuill sought clarification about when weekend assessments would commence and also asked what happened to the patients after the end of the two week period.  The Intake and Reablement Service Manager responded that an assessment was carried out and as a result of this, some patients may require reablement and then additional assessments would identify whether discharge to home was appropriate or whether the patient required further reablement or admission to hospital.  She felt that weekend assessments would be considered when an additional two ANPs were in post. 

            Councillor Stella Jones asked for further information on the financial costs and queried whether those not able to pay for the Enhanced Care would be admitted to hospital.  She felt that Betsi Cadwaladr University Health Board (BCUHB) were under increased pressure to empty beds, which were mostly occupied by elderly people, and that sending patients home after two weeks in Enhanced Care could result in them needing additional care which would provide its own financial burdens.  In response, the Intake and Reablement Service Manager said that people could remain on Enhanced Care for up to four weeks and reablement for a further six weeks, both at no charge to the patient.  There would be social care support in both teams and assessments would be undertaken to ensure that the patient received as many benefits as they were entitled to.  At the end of the ten weeks, a financial assessment would be undertaken to identify how much the patient could pay, but the Intake and Reablement Service Manager reminded Members that the current maximum charge was £50.00 per week. 

Councillor Jones also asked whether the money was in place if there was a significant increase in numbers requiring the service.  The Head of Adults Services explained that monitoring of financial situation for Enhanced Care and reablement services would be required. He noted that there were many occasions where people were more dependent following an admission to hospital than they had been prior to one and that enhanced care aimed to overcome this potential impact of a hospital stay.  He said that regular monitoring would be undertaken but said that there were benefits to supporting people in their own home. 

The Chair asked for further information about the numbers of patients who had used the Enhanced Care service either as ‘step-up’ or ‘step-down’ patients and queried how many had been re-admitted if they had come from hospital and how many had moved into residential care. 

Councillor Dave Mackie concurred with the comments of Councillor Jones that BCUHB needed to discharge patients from hospital to free up beds.  He said that it looked like a lot of support for a few people and queried whether they would receive more support in hospital.  He added that it was important that BCUHB did not see the service as a cost cutting measure.  The Intake and Reablement Service Manager said that most people did not want to be in hospital and that communication from the team was that patients were much more positive about Enhanced Care at home.  The Head of Adults Services said that work was ongoing to try to change the point of delivery of care to more community based care rather than in hospitals.  This would require significant work around monitoring of resources to ensure that the opportunity for community care was an option. 

Councillor Peter Curtis raised concern that BCUHB could view the scheme as either a way of unblocking beds or reducing costs and would therefore discharge patients who should be in hospital.  On the issue of cost, he said that many patients would be on a fixed income which could result in them not being able to pay for additional care resulting in a two tier system where some patients could pay and some could not.  He said that it was important to find out why the Holywell GPs were so reluctant to take part in the scheme as all of the Flint GPs had signed up.  The Intake and Reablement Service Manager said that the issues raised would need to be explored with BCUHB. 

Councillor Cindy Hinds queried whether there would be additional cost to the Council following discharge from Enhanced Care.  The Intake and Reablement Service Manager said that some of the patients may have needed support anyway but they would try and stop patients going into hospital if possible.  She added that it was important that the patients were well enough before being discharged.  The Head of Adults Services said that there was a need to consider the impact of costs but it was important to ensure the best outcome for the patient. 

The Director of Community Services said that the Strategic Partnership Board offered a good opportunity to discuss the success of the scheme by sharing the positive feedback that had been received.  He said that it was important that the service did not result in a negative impact on resources for Flintshire County Council so monitoring was essential. 

Councillor Marion Bateman asked when the scheme would be extended to the rest of Flintshire and the Head of Adults Services said that he expected discussions to take place in March or April 2014.  Councillor Bateman also said that it had been suggested at the previous meeting of the Committee that local GPs be invited to attend a meeting to discuss issues.  The Chair suggested that the GP locality lead be requested to attend a future meeting.  Councillor McGuill asked for information on the numbers of patients who had been readmitted and what amount of success there had been with patients with chronic illnesses.  The Head of Adults Services advised that he would look into the figures requested by Councillor McGuill.

In referring to the paragraph 4.01, the Chair suggested that additional recommendations should be included for a further update report to be submitted to the Committee in six months time and that the GP locality lead be invited to attend a future meeting. 

RESOLVED:

(a)       That the report be noted;

(b)       That a further update report be submitted to the Committee in six months time; and

(c)        That the GP locality lead be invited to attend a future meeting of the Committee.