The Board to receive a joint verbal update from Lisa Redfern, Strategic Director of Social Care (LBHF) and Toby Hyde, Director of Transformation, Imperial College Healthcare NHS Trust.
Minutes:
Lisa Redfern and Toby Hyde provided a joint, verbal overview of a study underway looking at collaborative work between the Council and health partners in response to the Covid-19 pandemic.
Lisa Redfern said that the study was interviewing key officers from the wider health and social care systems, highlighting successes and identifying lessons learned. The report was likely to look at the following:
1. The development of testing capacity – Imperial had addressed resource challenges at North West London Pathology through advice and guidance on how testing could be expanded and the use of robotic technology. Residents should receive quicker and improved access to testing, which had been woefully slow nationally.
2. Testing in care homes – The Council and health partners had put in place quicker and improved testing for residents and staff who had found it difficult to access local testing. Nine specialist teams had worked together on this. Since early April, residents had been tested four times. Staff recognised the need to deal sensitively with those residents suffering from long-term conditions such as dementia despite working at pace. Testing was implemented that would not have been otherwise available, improving outcomes for residents and staff.
3. Additional support for care homes – Community-based teams had been strengthened. The NHS and community voluntary organisations had played an important role in strengthening resilience within the community.
Toby Hyde commended the work of the Council, health partners such as the CCG and local community and voluntary organisations in response to the pandemic. The interviews were revealing three things:
· Everyone had been clearly motivated by a collective sense of purpose to overcome the institutional barriers which had frustrated those who been trying for many years to develop integrated ways of working that would benefit residents.
· The importance of pre-existing, trusting local relationships, which had enabled a swift and proactive response to the pandemic without the need for a process of checks and balances at every step of the process. Frontline staff had led this work, facilitated and supported collectively by partner organisations.
· New ways of working were now firmly embedded. This meeting of the Board being held virtually was an example. Key to the new working was the removal of historic financial barriers, although some of this might prove transient. There were important lessons about the extent to which financial barriers could be used as an excuse rather than an enabler of change within the local health and care system, particularly considering how finances worked across the system. We needed to adopt a taxpayer mindset rather than think about organisational finances.
Mark Jarvis echoed earlier comments, particularly with reference to the active involvement of the CCG, many of whose staff had been redeployed and which had worked closely with the Council and care homes, taking a whole systems approach. Cllr Coleman acknowledged the work of the CCG and mentioned that the Council had offered free car parking for NHS and social workers.
Cllr Coleman sought clarification regarding financial barriers. Toby Hyde explained that the mindset adopted during the pandemic was to approach issues as a shared endeavour and make the best use of available financial resources and expertise. Previously, due to the complexity of financial structures, there was a separation of health and social care funding which made collective working difficult. It was hoped that new ways of working post-Covid-19 would overcome barriers such as those associated with hospital discharge. Financial structures made it difficult to discharge patients who had spent long periods in hospital and who did not require ongoing medical care. This was not an issue specific to H&F. Reconfiguring this practice would make better use of taxpayer resources in addition to being beneficial to individuals and their families.
Lisa Redfern agreed. She noted that even with an approximately 50% reduction in discharged patients, there had been a “can do attitude” within the wider health and care system. Despite initial difficulties with the NHS struggling to comply with “national diktats”, multi-disciplinary teams had gone into care homes. After becoming aware in early April that care home residents were being discharged from hospital without being tested, the Council had had no alternative but to close care homes to new admissions. It had then tested all residents and all staff, including those that were asymptomatic. It was recognised that this action was unusual. Some staff had been reluctant about testing because of the potential loss of income so the Council had guaranteed them up to £200 pw if they had to self-isolate. Lisa Redfern said there was no national protective ring around care homes and that, following central government failings, the Council and its partners had taken local action which had saved lives.
RESOLVED
That the report be noted.