Agenda item - Section 75 Better Care Fund Quarterly Report - March 2016

7.1       John Child introduced this report, explaining that it focused on Delayed Transfers of Care (DTOC). Denise D’Souza told the Board that DTOC were increasing nationally and resulted from issues across the system rather than just delays in Adult Social Care. Locally, we are trying to minimise delays, but workforce remains a very big problem.

7.2       Dr George Mack enquired if this could be resolved by using a ‘hospital at home’ model? Dr Beesley explained that a new care model of home care has been introduced. This is community-based, but consultant-led. In order to work effectively the model needs buy-in from the hospital trust and progress to date on this has been slow. However, there is now a commitment from Brighton & Sussex University Hospital (BSUH) to move forward.

7.3       Councillor Barford stated that while DOTC was a priority, patient safety is paramount as is having family input into decisions – factors which increase complexity and potentially also delays. Dr Beesley agreed but noted that it was important to recognise that hospitals were very bad environments for frail patients and it was much better for the frail to receive home assessments. Denise D’Souza stressed the importance of family involvement, although this can increase delays. Conversations about discharge must begin much earlier in the hospital stay.

7.4       John Child clarified that on the graph on p39 of the agenda ‘Housing - Patients Not covered by NHS & Community Care Act’ referred to delays into supported accommodation for people with mental health conditions, rather than for DOTC relating to social care packages. Denise D’Souza added that there was also a significant problem with discharging mental health patients back into non-supported housing, particularly for people who had lost tenancies whilst in hospital.

7.5       Fran McCabe asked where the discharge model was explained to patients and families. Dr Beesley agreed on the need to re-think communications on this as well as the information provided for people when admitted to hospital. The CCG is working with Healthwatch on this project.

7.6       Cllr Page queried whether the resources are available to solve the problem of DOTC or to arrest the decline in performance. Denise D’Souza acknowledged that there had been some significant increases in DOTC but this was from very low base figures. These delays were never due to funding, but to problems with provision. Brighton & Hove was a very high user of residential care. While Independence at Home had made savings it had not reduced capacity: down-time had been cut by using split shifts and other means.  Workforce was a big issue in care, hence the 2% precept. Increases had happened in the support sector, but there was the need to reduce the use of residential care and to simplify pathways. 

7.7       RESOLVED – that the report be noted.