Agenda item

The Board received an update on progress with development of the Better Care Fund (BCF).

Councillor Vaughan asked for clarification in respect of hospital discharges and how they could impact on A&E waiting times. Mrs Bruce responded that work was in progress locally to develop a new integrated Community Independence Service (CIS), which would help people with good care at home when they might otherwise need to be in hospital. CIP would reach into hospitals to pro-actively discharge people. CIP had been developed in the BCF and was integral to the aims of Whole Systems Integrated Care (WSIC). It would be rolled out in the three boroughs.

There had been an upsurge in winter pressures over the previous six weeks, and additional money there had been additional money to support delayed discharges. Work was also in hand to standardise discharge protocols and policies across the three boroughs.

Dr McGoldrick added that it might be necessary to use interim residential care or intermediate beds to prevent delayed discharges. Funding had been allocated at the beginning of the year and CIP was also contributing. 

Ms Jones stated that NW London had invested significantly in intermediate beds. Many patients were in their late 90s and 100s and likely to have complex health and social care needs. Whilst A&E attendances were fairly stable, the length of stay had increased for non-elective patients. The CCG had been expanding transitional care facilities for these patients for sometime. Intermediate beds were provided at CLCH sites and Imperial, and also out of borough if necessary. Hammersmith beds could be offered to other boroughs, if there was spare capacity.

Mrs Bruce stated that there was a correlation between GP availability and elderly patients going to A&E. Providers were struggling with the complexity of needs and a lack of nursing bed provision. For example, there people in their 100s with dementia, who social workers had only met for the first time when admitted to hospital. Increasing demand and complexity had reduced beds and increased the need for joined up health and social care.

Dr McGoldrick noted that A&E was the place of choice for some people. H&F CCG had invested in GP practices evening and Saturday opening, out of hour’s services and the 111 service. There was good access to GPs and hospital appointments could be booked on the same day.

Dr McGoldrick suggested that the CCG and Council could work together to, for example, advertise seven day services. There tended to be an increase in A&E services between 4pm and 7pm by younger parents with children.

Ms Jones stated that A&E attendances were being analysed, but there was not one answer for the surge in attendance.

Mr Lines suggested that community pharmacies should be used as a point of access and signposting.

Mr Christie stated that there was a high churn of 25-35 year olds in the borough and information could be provided to estate agents, and also to schools and the voluntary sector housing.

RESOLVED THAT:

The Board noted the report.