The Committee will be asked to receive a report from the three Clinical Commissioning Groups (CCGs) in Leicester, Leicestershire and Rutland that provides an overview of the Community Services Redesign project which looks at the future model of community health.
The Committee is asked to note the progress to date in redesigning community health services and the next stage of the work.
Ms Tamsin Hooton, Director Lead for Community Services presented a report relating to Better Care Together, Community Health Services Redesign. Members heard that the Redesign project was led by the three Clinical Commissioning Groups (CCGs) in Leicester, Leicestershire and Rutland which looked at the future model of community health. Members heard that the CCGs were about to commence engagement exercises and the Director said that she took on board the comments made by Members about the need to feed those comments into the process going forward.
Members considered the report and during the ensuing discussion, the comments and queries raised included the following:
· A Member stressed the importance of working with Adult Social Care services in the three authorities across the LLR. In the past, he had expressed concerns that in relation to the STP there had not been enough joint working. The Director confirmed that they had been working with officers in each of the social care teams in the three different authorities.
· In the report, there appeared to be issues regarding a general lack of confidence expressed by members of the public in the services and a Member asked as to how this could be restored. The Director responded that the CCGs recognised that there had been insufficient capacity around the neighbourhood nursing teams. They wanted to restore that confidence and restore capacity to enable as far as possible, patients’ management by the GP teams. It was only through those teams working better together at a local level, that people’s confidence would be restored.
· It was noted that the LLR had approximately half the number of community physio and occupational therapists compared to the national average. In addition, there had been reports earlier of a shortage of district nurses and a Member commented this impacted on discharges from hospital. The Member welcomed the fact that it was recognised that services were not working as well as they should.
· It was noted that Neighbourhood Community Nursing, as part of the integrated locality teams would work closely with social care and primary care neighbourhoods. These would have approximately 30,000 – 50,000 patients and some surprise and concern was expressed at the size of these neighbourhoods.
· A Member commented that the approach set out in the report made sense, particularly in relation to Home First services as many people preferred to remain in their own home. However, she had concerns as to how this would be managed on such a large level as there was a view that the Home First service and services around community and district nursing system was not working as well as it should.
Officers explained that the primary care networks provided an opportunity to join services such as primary care, district nurses and social cared together in a locality, where there would be a clinical director with a contract for delivering those services. This was part of the national direction of travel and the CCGs response to stop people staying in hospital who should not be there. Members heard that in relation to falling numbers of District Nurses, there was a long-term plan to address this and to support people to stay in their own homes.
· A member said that she recognised that people’s longevity and quality of life were improved where they could stay in their own homes, however there were also associated risks including the pressures that were put on local authorities on social care staff. It was not appropriate for the NHS / CCGs to solve a problem by putting the onus on the local authorities.
· A comment was made that there was a need to factor in those residents in Rutland who were not patients of a Rutland GP, as they were still residents who needed care. Reassurance was also sought that the same level of service would be given, regardless of where people lived in the STP footprint.
· Officers were asked how the number of community beds in the LLR compared to similar footprints in other parts of the country. Officers explained that across the LLR there were more community hospital beds than elsewhere in the country, but there were also Pathway 3 beds, that were short term beds located in care homes. Individuals in those beds were on the way to recovery but still quite fragile and needed additional support before they could be discharged.
· A Member referred to the duty to consult and the Director said that they would consult when they had developed more detailed options as to what the future model would look like.
The Chair drew the discussion to a close and said that a strong case had been made for the changes and they were welcomed. The only way to achieve this would be through better partnership working and this was a very considerable piece of work that put a lot of demands on the NHS, local authority and partners. There would be significant issues in the future if people were discharged from hospitals too soon and there was a need to ensure that only one service was responsible for an individual once he or she was discharged.
The Chair asked Members to note the report and suggested recommendations as follows:
1) that the Committee note the report;
2) that Committee note that better capacity planning is a key element of the redesign model and Members will be carrying out further scrutiny in respect of that;
3) that the Committee ask the CCGs to be mindful of the need for proper engagement with the local authority executive teams and the scrutiny committees;
4) that the Committee ask the CCGs to work closely with the local authorities;
5) that the Committee request there is effective governance to ensure that the service meets the need and is delivered consistently, and for a report on this be brought back to a future meeting to reassure Members.