Agenda item

To note receipt of the Discharge Grant from NHS England.

Linda Jackson reported that the Hospital Discharge Fund for 2022/23 was part government funding to support social care discharge announced in July 2022 help support timely and safe hospital discharge and avoid patient delays.  The report (page 55 of the Agenda pack) outlined details of the amount of a two part allocation of £500 million nationally, of which £16 million was allocated to the NWL ICS.  Of the national allocation, £40 million was allocated to social care and had H&F received £765k, and a further £8.6 million was allocated to the Integrated Care Board (ICB).  Plans about the  fund allocation were developed with the support NWL health colleagues.  It would be shared between domiciliary care, reablement services, step down and residential care. At a local level, there would be funding for residential care homes that required improvement and further support to help achieve improved Care Quality Commission ratings.  Detailed figures were contained in the report. 

Linda Jackson highlighted a concern that the programme did not sufficiently address the provision of “step up” preventive work in H&F which contributed significantly towards ensuring that residents did not need to go to hospital.  Sue Roostan elaborated on the operational aspects of the fund reporting that Linda Jackson would be co-ordinating a fortnightly meeting to monitor the delivery and expenditure of the programme.  Rob Hurd commented that there were two key objectives to address immediate needs, but the monitoring and assurance process could develop an evidence base to inform future provision.  Releasing the funds was imperative given that it covered a short period of winter provisioning, and both health and social care partners had signed off on the agreement. Councillor Coleman concurred that it was important to analyse the impact of this work to understand the delivery of future provisioning and that this could be considered further by the Board.

Merril Hammer commented that the issue of funding extended beyond the scope of ensuring sufficient pay for health and social care staff.  It was about retaining and sustaining expertise and knowledge within the staff workforce.  Care staff were able to find more lucrative opportunities in areas such as retail. Lisa Redfern acknowledged that there were significant national difficulties in achieving a fair cost of funding for social care and that this had been widely recognised without resolution. Overall, funding was insufficient to meet increased costs, accentuated by greater acuity of care and complexity of need, with more people leaving hospital that required support at home. This would not be adequately resolved without societal acceptance of the need to fund social care. In addition to the introduction of a Living London Wage (LLW) in H&F, career progressing development initiatives were available to all care staff.

The Board explored the need for a financial resolution that fundamentally addressed the core issues facing councils about how they managed and delivered social care support, both prevention and intervention, to help reduce the need for hospital based treatment. Linda Jackson reiterated that it was important to understand what was meant by “increased complexity of care” and although the borough performed very well on addressing discharges, and offered an excellent reablement services, more could be achieved with further funding.  In response to a point of clarification from Jim Grealy, Linda Jackson explained that discharges were largely from acute trusts, however, there was a small percentage of cases that had mental health needs. Such cases were more likely to be subject to delayed discharges given the combined complexity of both mental and physical care needs.

Maria Connolly commented that having a holistic approach that included a sustainable staffing model was important. Deteriorating illnesses and complex need meant that people often rebounded back to acute care settings. Linda Jackson explained that the council’s response to government had advocated for funding for years two and three. An assurance framework for a combined health and social care workforce was required to support the development of a sustainable programme of discharge funding that could intervene to prevent a revolving cycle of illness and treatment.

Councillor Natalia Perez asked if cost of living issues had been considered in planning to improve workforce recruitment and retention.  There were a number of local initiatives such as the Cost of Living booklet, which also contained a separate booklet outlining health and wellbeing tips and advice, provided by the council to support residents, and key workers in the borough, in addition to ensuring a LLW to the social care workforce.                                                                                               

RESOLVED

1.     That the Health and Wellbeing Board agreed the planned total expenditure and the proposed schemes for 2022-23; and

2.     That the Health and Wellbeing Board receive an end of year report outlining the outcomes of each scheme and the difference it has made for residents of H&F.