Agenda item

32.1     The Committee considered a report outlining the findings of the Care Quality Commission (CQC) Area Review and the local Action Plan developed in response. It was noted that the Social Care Institute for Excellence had supported the development of the plan and that its implementation would be overseen by the Health and Wellbeing Board (HWB) via quarterly progress reports.

32.2     The following points were made in response to questions:

·         The review of the HWB will be led by the Chief Executive and will need to take account of wider relationships, including with the Sustainability and Transformation Partnership, Health Overview and Scrutiny Committee and East Sussex Better Together governance arrangements. The review will include opportunities for existing HWB Members to give views and consideration of issues such as the representation of providers and the balance between inclusiveness and focus. An initial report is expected by July.

·         The rate of A&E attendances from care homes is comparatively good in East Sussex. It was recognised by CQC that work with primary care on this issue was at an early stage. CQC’s proposed improvement relates to the nature of the market and ensuring a system wide approach to development which includes primary care.

·         Particular areas of focus in relation to the care home market are capacity and quality, which are interlinked as the department does not make placements into poor quality homes. A change in the focus of CQC inspections has led to a change in the Quality Monitoring Team’s focus away from monitoring towards supporting improvement. CQC noted an improvement in quality but also identified more to do and there will be a workshop to look at how the continued progression of this work. An increase in fees has stabilised market capacity but further development will be led through the agreement of a bedded care strategy for the health and social care system. The key Adult Social Care (ASC) challenge is nursing rather than residential care.

·         Performance on delayed transfers of care (DTOCs) has improved further since the CQC review and most recent data shows all Better Care Fund targets being met. Given pressures in the NHS, the focus now is on using transitional beds purchased from the independent sector to ensure people who are delayed are not waiting in hospital beds. However it is still essential to ensure onward flow from transitional beds otherwise any gains are lost. The department has had to deploy additional staff at all levels to maintain performance in light of very heavy pressures in recent weeks. This has also involved going beyond those people who would normally fall within the ASC remit to expedite discharge.

·         People placed in transitional beds are still able to exercise choice in choosing their onward placement. A more challenging issue is where the patient or their family want a person to stay in acute hospital bed when they are medically fit. A ‘Let’s get you home policy’ is in place to help manage expectations and there will be further communications around this. The most complex situations are where people lack capacity. The actions outlined in the plan reflect CQC’s recommendation that a more robust approach should be taken in relation to patient choice.

·         There was a significant impact on management capacity in ASC and other agencies in preparing for the CQC review. However, the self-assessment was a useful exercise and was made easier by the maturity of partnerships in East Sussex compared to elsewhere.

·         CQC’s recommendation in relation to admissions criteria was based on a variation they found between different establishments around the county. The system’s view is that the criteria are clear for each site but pressures and caseloads are different. CQC wanted to see more consistency and the action will address this.

·         The Rapid Response Service (in High Weald Lewes Havens) and the Crisis Response Service (in the East Sussex Better Together area) represented one of very few areas where CQC identified slight differences between how services are delivered across the county. The largely common approach to service delivery reflects common structures in place across the county such as the ASC team structure and Health and Social Care Connect (HSCC). The action will review and address the consistency issue in crisis response – plans were already in place but were not yet fully developed at the time of the review.

·         There are differences between the Connecting 4 You and East Sussex Better Together programmes but both have the same objectives in terms of outcomes. The primary difference is on the approach being taken to achieve outcomes and the different organisational contexts. System wide governance will be looked at as part of the HWB review.

·         There will be a communications and engagement effort coming out of the review in terms of encouraging appropriate referrals to services and take-up of newer services, but the role of HSCC is also key in funnelling referrals to the right service. Work is also ongoing to develop the East Sussex Community Information Service (ESCIS), Locality Link Workers and OneSpace as tools for practitioners to use to signpost to available services.

32.3     RESOLVED to note the report.