Agenda item

22.1     The Director of Adult Social Care and Health introduced the report highlighting the following:

·                There has been a consistent pattern over time in that East Sussex performance is below the national average for all delayed transfers of care (DTOCs) but better than the comparator group of authorities delays attributable to social care. In this East Sussex is consistently better than both the national average and the comparator group for DTOCs.

·                There has been a significant deterioration in performance over the last year which reflects national and regional trends.

·                Reasons for delays change week to week but there are some key areas which are the biggest contributors overall to social care delays:

o   capacity in the independent sector – home care: recruitment challenges particularly affect home care and areas with high levels of employment where there are other, less demanding, jobs available at similar wage.

o   capacity in the independent sector – nursing care: this shortage is partly due to fee constraints but also because the market has historically been based around residential care. Population needs have increased but the sector nationally has not yet adapted to providing higher level care. Local response is to develop the ‘care home plus’ model and in-reach from community health teams.

·                As part of winter plans the local NHS has agreed additional investment in two initiatives:

o   block purchase of independent sector beds in the Eastbourne and Hastings/Bexhill areas to enable easy access to these beds.

o   recruitment of generic health and social care workers to be based in locality teams which will also help in pulling people out of hospital promptly.

·                An Operational Executive Group oversees use of bed capacity on a weekly basis and provides integrated management, reflecting the direction of travel towards accountable care.

22.2     The following additional points were made in response to the Committee’s questions:

Independent sector capacity

·                There are issues with services pulling out of providing placements at local authority prices – the department is negotiating fee increases in the context that providers are requesting a significantly higher increase than the budget allocated in the Council’s medium term financial plan.  Providers are impacted by increases to the National Living Wage. Ultimately, the level of fee increase impacts on the number of placements the department can provide, as the budget is fixed.

·                The department is working to support small providers via Support with Confidence and the purchasing unit, and working with the Councils for Voluntary Service to change their offer to include support for very small businesses via community resilience work.

·                The main challenges with home care relate to complex packages of care required for people leaving hospital with higher needs and it tends to be larger agencies which can provide these packages. The department is looking at ways to pay for care differently which would simplify the process for providers.

·                There have been care home closures in the county for both finance and quality reasons, or because they no longer provide the services needed. There have also been new entrants to the market but these tend to be outweighed by those leaving. The department does work to stimulate the market and has to take innovative approaches. For example, the development of a new home in Ringmer which will provide ASC with a set number of beds providing the higher level care needed at ASC prices, achieved by providing land incentives.

Hospital and intermediate care capacity

·                Issues with hospital capacity are largely because there aren’t appropriate services to support people in the community, leading to the acute hospital becoming the default option. If prevention and community care were improved it is likely that there would be enough hospital beds. Local plans are focused on avoiding the expansion of beds rather than reducing their number.

·                If the cost of home care goes above a certain level a process is triggered to work with the client and family to move to a more cost effective way of delivering care which may be residential or nursing home care.

·                Community bed capacity and the use of independent sector bed capacity will be reviewed as part of East Sussex Better Together (ESBT). This review will enable the right levels of capacity to be provided in different settings in the future.

·                There is an issue with uneven geographical spread of NHS community beds across the county. Investments will be from a shared budget under ESBT in the future. In High Weald Lewes Havens area the potential for joint funding is being discussed.

·                The pooling of resources with health across the ESBT area and joint Strategic Investment Plan enables a shift of resource from acute to community services which would not be achievable if the local authority was working alone.

Service developments

·                Reablement hours have increased over time and the Joint Community Rehabilitation (JCR) service is linked into locality teams.

·                The intention has consistently been to work with people from the point of admission to plan discharge but additional capacity is needed to do this fully. This is the driver behind expansion of the Hospital Intervention Team (HIT), alongside working with families, carers and communities.

22.3     The Committee noted the dual challenges of managing performance now across a stretched system alongside achieving transformation so that care is provided very differently in three to four years time. The Lead Member for Adult Social Care commented on the close daily management of DTOCs by the ASC management team working with health partners. He advised the committee that ASC management has permission to innovate and find solutions in the interests of clients and this results in the positive comparative performance.

22.4     The Committee RESOLVED to note the report.