Agenda item

6.1  The Chair stated that delayed discharges of care continue to be a key pressure on the local system and so he had asked NHS NEL to provide an overview of how the additional £200m (national figure) discharge fund announced in January was being spent as well as the previous £500m (national figure) ‘winter pressures’ funding which was now annual and so had an established process around its use.

6.2  He welcomed Clive Walsh (CW), Director of Performance, NHS NEL.

6.3  Members gave consideration to the report: Q4 22/23 Discharge Funding and 23/24-24/25 National Delivery Plan for Recovering urgent and Emergency Care Services.  CW took Members through the report in detail which covered: £200m discharge funding for Q4 22/23; National Delivery Plan for Recovering Urgent and Emergency Services; 5 ambitions within the Plan; and Funding

6.4  The Chair asked whether national guidance on this funding stream dictated what gets passported through to councils. CW replied that on NEL’s  share of the £600m they had identified how much they could usefully spend on step-down capacity. NHS NEL used £900k of £7.1m and remainder went to the 8 local authorities on a fair shares formula. On the new money (c.£600m) next year, c. £20m should come to NEL and 50% of that would go directly to local authorities as early as possible in the next financial year. Use of the balance will be a discussion between NHS and councils via the Better Care Fund process. He added that there were national constraints on how the BCF money can be used.

6.5  The Chair asked what discussions were going on with councils on a long term strategy to sort out delayed discharges of care, such as building more local accommodation for step-down type solutions for adult social care to reduce the need for expensive residential placements. CW replied that those conversations were taking place at both ICS and Place level. One example was that they might use some of the money to look at the division of nursing and residential beds between inner and outer NEL to examine whether more capacity could be created in Inner. Historically this was a problem due to the comparative cost of land (inner vs outer) and the nature of the properties needed for residential care. ZE added that patterns do exist in north east London and everyone finds it difficult to find places especially for patients with dementia or ‘behaviour which challenges’. They know there are gaps and in some cases where there are a relatively small number of places, the nature of the need and the local care market varies. It all needs to be looked at via a strong local lens. She added that the allocation of most of this money is via the BCF so the decision making is joint between local authorities and the NHS. There is a need to understand what overall demand and capacity is across particular footprints and unfortunately  people will end up in out of borough placements when the system is under great pressure.

6.6  The Chair asked about the financial argument for ‘invest to save’ here and the gains to be had from patients not in residential care being able to claim their housing benefit, which would contribute to costs.  Cllr Masters sought clarity on how the funding formula was applied. CW clarified the formula adding that competition may arise because of variations but Place leads and directors of Adult Services are involved in the details.  ZE explained more about the two components of the funding.  Around half of NELs share c. 14m went directly to local authorities and was allocated according to government funding criteria i.e. the standard formula similar to the Public Health grant, that funding formula does take account of the historic measures of deprivation. City and Hackney despite having a younger population got more under this measure. The remainder of the funding was distributed via NHS NEL and it was therefore decided to focus more on older people, because levels of deprivation had already been taken into account in the local authority funding allocation. They also looked at where delayed discharge needs varied and took account of the need to work across the ICS to make sure that a fair formula was applied and that all parties understood it. The additional January funding because it was rushed had to be decided on very quickly and they had to decide on it on the basis of what was going to work best in the circumstances, as there was a very short window in which that money could be spent.

6.7  Cllr Khan asked what processes were in place to ensure the funding is used for care packages. CW replied the usual ones.  There were locality based groups that involved the Place Directors and council staff and together they looked at and jointly planned the care pathways of the patients being discharged.  He added that overall, although there was additional funding, it must be remembered it is in the context of significant funding constraints on local authorities and on the NHS and this had to be factored into it. At the end of March they will look at how many additional care packages they have made with this cash injection and do an assessment of additional flow through the hospitals and the impact of that funding and try and reconcile all of that.

6.8  Cllr Sweden asked whether the same constraints on this funding will apply next year; about provision of therapy input in step-down offer and about the need to upskill care staff. CW replied that they were already talking to councils and potential private or third sector providers of step-down care about what might be feasible and the lead times for that. They would like to increase the general provision of step down care because they noted that there may also be a suppressed demand within the hospitals.  On therapy, the challenge is that there is a national shortage of both Physios and OTs and so the focus is trying to get them to work in NEL in order to better support the various reablement pathways they are trying to build. The Virtual Wards will also help with this.  He added that they have a deficit in NEL in neuro rehabilitation and one focus in the coming year will be on expanding the amount and quality of neuro rehab and this will require high levels of therapy input. On upskilling care staff, he stated that there was a national discussion on how to retain care staff in the sector and enable them to gain greater skills and so better remuneration. ZE added that in two of the boroughs they were doing pilot work on training domiciliary care workers to do tasks that might otherwise be done by health professionals so that they can make additional payments to them and provide more integrated care and they wanted to share best practice on this.

6.9  Cllr Patrick suggested that the targets in the National Plan were not very ambitious. CW replied that this criticism had been widely expressed. In January the Category 2 ambulance response times in London had been better than in December but nevertheless ambulance strikes and the drop in volumes meant that the average in January was 38 mins. He added that it would take a long time to get that down to 30. On the ‘76% seen in ED’ target, the Homerton had been fairly consistently achieving 80 to 85% and was at the upper range. The 76% target was going to be particularly challenging for hospitals. He stated he remembered the introduction of the 98% target and that had been brought in in a phased way over several years. There were 5 ambitions in the plan which they had discussed including on speeding up discharge and allocation of funding and on virtual wards.  In March they would work up their response to the National Recovery Plan and that would be put in the public domain and he’d be happy to have a discussion on that if useful.

 0  ACTION:

NHS NELs response to the ‘National Delivery Plan for Recovering Urgent and Emergency Services’ be added to future work programme.

ACTION:

Director of Performance NHS NEL to share a note on the updated hospital discharge funding formula when available.

6.10  Cllr Khan asked how NEL ICS determines how BCF money is distributed. CW replied that assuming the rules don’t change and that NEL area receives c £20m for this next year, then £10m will go directly to local authorities and £10m through BCF and discussions between NHS and the councils at locality level will take place on how best to apply that. It is yet to be confirmed but it will be a joint decision making as part of the Better Care Fund process.

6.11  The Chair asked how NHS 111 might be improved and what the national intentions for it were. CW replied that it was re-iterated in the National Plan that patients be encouraged to contact 111 first to be guided but it was not fleshed out in detail. Many in Primary Care continue to be concerned about breaking the link between the patient and professionals who know the patient and their history best.  He added that currently there was a lack of clarity about what the national intentions are around 111.  In NEL they have an NHS111 contract with London Ambulance Service until July and they had agreed that it would be extended for a further two years until there is greater clarity on what the national intentions are.

6.12  Cllr Masters asked about the very poor satisfaction levels with NHS 111 in Newham. CW replied that satisfaction levels were poor both locally and nationally and they were doing a lot with LAS on how they could improve and looking at the possible model for the future. He explained that when it was introduced nationally they had certain expectations about volumes of calls however these have been greatly exceeded. So they have ‘sized’ the service in a different way to the actual volume of calls and there is a need to totally recast it to offer a better service to patients. He added that you can see the difficulties by looking at the number of abandoned calls, which remain very high. 

6.13  The Chair stated that he would like the Committee to return to the issue of NHS 111 in a future meeting. He echoed Cllr Masters concerns re satisfaction levels adding that a key problem was that you can’t speak to clinicians. There used to be an excellent bespoke service in City and Hackney and he added that it would be interesting to understand if there was greater scope locally to do some more bespoke commissioning and whether the model could be altered to put clinicians at the first point of context rather than a complex filtering system driven by an algorithm. 

  ACTION:

‘Improving the performance of NHS 111 across NEL’ to be added to the work programme.

6.14  The Chair thanked CW for his report and in-depth answers.

 RESOLVED:

  That the report be noted.