Agenda item

7.1  The Chair stated that the purpose of the time was to receive an update from the Group Director AHI on the current status of the latest hospital discharge  funding schemes and how they might impact Hackney. This was an evolving situation and hence it was a verbal report. He added that on 9 Jan 2023 the SoS for Health had allocated an additional £200m discharge fund to Integrated Care Systems nationally. This was publicised as the NHS purchasing additional social care beds. This is on top of a November announcement of what is normally called ‘winter pressures’ funding.

7.2  He welcomed for the item:

Helen Woodland (HW), Group Director Adults Health and Integration

Malcolm Alexander (MA), KONP (who had submitted a question)

7.3  Members gave consideration to a tabled note Questions about Discharge Funding.

7.4  HW gave a verbal presentation and also referred to the additional tabled note.  She stated that the £500m in Nov was part of the now normal ‘winter pressures’ annual funding. There was an established process for this. Hackney was consistently one of the best performers in terms of length of stay and they have well established processes for managing such funding. She explained that they have a small allocation of flats in a Housing with Care scheme which are appropriate for Step-down care and they used this funding to increase that number. They also used it to put in place a team of social workers and OTs and therapy assistants to ensure that people don’t get stuck in ‘step-down’. They work with NHS partners closely on how they manage the flow and what the money is spent on.  The further announcement of £220m nationally was specifically around how to increase the number of residential and nursing beds and this was not necessarily one of the issues faced in Hackney as we rarely have people waiting for that purpose. They had increased the number of beds slightly but haven’t taken a large chunk of that funding as they would not want to put people in restrictive or care home beds who would not need it.

7.5  Members asked detailed questions and the following was noted:

a) Chair asked why Hackney doesn’t have as much of a problem as others re nursing beds. HW replied it was complex but, culturally, our social workers are more comfortable in supporting people back into the community than perhaps elsewhere. We don’t have the option of residential placements as readily available as others so social workers work very hard to develop alternatives.

b) Members asked whether care home staff were equipped to manage the higher acuity of these patients and what happens if patients refuse to move into a care home.  HW replied that they were not using this money for any care home staffing but rather for the Move On team of social workers. Legally they look at the least restrictive option and care homes were last resort.  More often they have the opposite problem in that families are pressing for loved ones to go into residential care as they believe it's the safest option but in any case they never compel.  Occasionally they might have delays in people leaving hospital as they don’t agree with the care plan that has been devised but social workers are highly qualified and experienced and work with the family to find a resolution.  They’ve never had a situation where they had to go to Court of Protection because they felt so strongly that an individual must be placed.

c) Members asked for a diversity breakdown of specialist Move On Team; on cultural competence and intersectionality; on discharging patients with no home to return to. HW replied that she did not have the breakdown on Move On at hand but would provide it. 86% of social workers in Hackney come from local communities and global majority communities and having cultural competence is a core part of  social work training. All practice is designed around personalisation and understanding the needs of an individual and how best to support them.  On the issue of no housing they will on occasion have to support people into temporary housing support on discharge, particularly those with ‘no recourse to public funds’. She added that a growing issue is people who are subject to self neglect or hoarding and their home environment is not suitable for them to return to and so they have step-down flats specifically for this purpose.  They then invest in hygiene services for deep cleans of the original home. She added the reassurance that if a person has care or support needs on discharge from hospital it is the council’s statutory duty to meet those needs and that might also involve providing accommodation of some sort.

ACTION:

Group Director AHI to provide a diversity breakdown of the Move On team staff.

d) Chair asked about additional step-down flats in Hackney and how such spaces come about. HW replied that they don’t purchase them but have nomination rights with our Registered Housing Provider (RP) who own them. Often there will be a high turnover of these flats as older people pass away so they’ve agreed with the RP that voids can be used in the short term for this purpose. These properties are specifically earmarked for this purpose and not from the general needs housing provision. She added that currently they have a sufficient amount.  A couple of schemes which are less popular are often used for this specifically short term purpose when voids occur.

e) Chair asked about ways to support more patients in-borough and how many supported living units would be needed to bring back all out of borough placements. HW replied that they have a significant number in residential care as opposed to nursing care. If they had alternatives in the borough such as ‘extra care supported living’ they believe they could accommodate them in a less restrictive way in Hackney.  If they could build more of those supported living options in the borough that would be better for the residents overall.  On average it would be more cost effective. She explained that the cost of care is built around the individual so it will vary.  Generally, if someone goes into residential care the entire cost of that placement falls on the borough including the ‘hoteling costs’ (food and accommodation) and this comes out of the Council’s ASC budget. If someone has their own tenancy however and their own flat and they can remain in it and within their own community they will be more independent. They will also be able to access welfare benefits which would cover those ‘hotelling’ costs and so these would not be coming out of an ASC revenue budget.

f) Chair asked about the research needed to make an Invest to Save case for future proofing housing regen schemes for adult social care. HW replied that she was hesitant to put a number on the need but a major piece of modelling work needs to be done. There were c. 400 people in residential placements out of borough and if you were going to avoid that flow in future you might be looking at half to two thirds of that which could then be provided locally in various ways.  Obviously a proportion will always need full residential nursing care for a time.

g) The Chair asked about the timeline for this modelling work. HW stated that she’d asked the Population Health Hub to start the demographic modelling work which needs to be done and they are working with colleagues in the Housing and Regeneration team to have this issue built into the capital rebuild model going forward. The Chair commented that the council could in theory invest 5% of the pension fund in this. HE replied that all options were on the table. There was a need to look at this with partners exploring different arrangements but it would certainly have a positive effect on the council budgets going forward. She added that they did not have a timeline yet but they were looking at efficiencies here as part of the Medium Term Financial Plan and this work had been agreed as a Project and there would be a meeting on it the following week.  The Chair asked to be kept informed of developments here.

h) MA from KONP asked about more needing to be done to unblock A&E at Homerton. HW replied that the previous Monday they had only 15 delayed discharges and the majority were out of borough which are much more difficult to discharge. The pressures on the entire system at present were immense.  LA added that the Homerton was a victim of its own success here. Thanks to the efforts of Adult Services teams the flow of patients was extraordinarily good compared to our neighbours.  The challenge was that NE London as a whole was blocked up.  You would wait longer at Whipps Cross and patients were therefore opting for the Homerton.  It was a challenge as patients are in need wherever they’re from and must be served.  She added that the system of escalation they have in place was working well and in the past week things had been exacerbated by some IT problems.

i) The Chair asked LA about the balance of NHS NEL staff working at Place as opposed to central office. LA replied that a decision had not been made yet.  A consultation paper for this had been due two weeks previously.  There was then a change of policy from the DoH as they were looking at the finances so this is awaited. As soon as the allocations are known she could let the Chair know.  The Chair asked why allocations to Place in City and Hackney require guidance from central government. LA explained that this consultation was around the whole staffing structure and not about Place and you can’t just separate out Place staff from central functions because some jobs will be at risk. She added that another aspect here is that the decision making must be delegated down too so it is not just a pseudo allocation and they would be required to go all the way back up the decision tree and down again before a local decision could be made.

7.6  The Chair thanked HW and LA for their detailed answers.  He added that the issue of future proofing for adult social care provision would come back to a future meeting and they could discuss this in more detail.

RESOLVED:

That the report and discussion be noted.