The Cabinet considered the Avoiding Admissions Scrutiny Review report that informed that Wirral had made really good progress in avoiding Hospital admissions. Key commissioning activity in relation to the Better Care Fund had enabled the development of schemes that were evidencing real impact and progress in establishing a sustainable seven day community offer. The 3.5% target for non-elective admission reduction had been overachieved for 2015/16, but there was still more to be done to ensure the quality, consistency and sustainability of these services.

A task and finish group had been established by Members of the former Families and Wellbeing Policy and Performance Committee to undertake a scrutiny review of the actions being taken to strengthen community based services which were intended to reduce the demand for acute services and thereby reduce hospital admissions. The report documented the findings of the Members and the conclusions which had been drawn.

The review looked in detail at demand drivers and the responses that had been put in place to strengthen the urgent care system.  This was a comprehensive approach that had led to nine important recommendations being made across the four strategic themes. The report also included a summary of the evidence base on which those recommendations were based, for consideration by the Cabinet.

The Cabinet noted that the recommendations made by the task and finish group were welcomed by Adult Social Care and the Clinical Commissioning Group (CCG).

Councillor Moira McLaughlin, the Chair of the former Families and Wellbeing Policy and Performance Committee introduced the report of the task and finish group.  She informed that this work was in response to the impact an increasing ageing population with greater health and care needs was having on local services and concerns over whether the service currently on offer were the right ones to avoid increased strain on the acute health service by helping to reduce demand there and provide alternative community based services.

Councillor Moira McLaughlin reported that it had been a lengthy study which had involved evidence gathering from a very wide range of service providers and in a number of different settings.  Councillor McLaughlin put on record her thanks to all those who had given the task and finish group the benefit of their knowledge and experience.  She also thanked Alan Veitch, the Scrutiny Support Officer and her colleagues Councillors Bruce Berry, Alan Brighouse, Treena Johnson and Denise Roberts, along with Karen Prior, Chief Executive of Healthwatch who had joined the task and finish group, for the work they had put in to producing the report.

Councillor Moira McLaughlin referred to page 3 of the report which set out the key issues to be addressed in the review and drew attention to the concentration of the review on understanding the demand and reasons for the increases in it.  Members had considered how funding was currently allocated, whether the services in place were the right ones and whether or not they could be rapidly changed or adapted to meet a changing situation.  ...  view the full minutes text for item 48

The Chair of the People Overview and Scrutiny Committee introduced the report of the Avoiding Admissions Task and Finish Group that set out the findings and recommendations arising from a Scrutiny Review of the actions being taken to strengthen community based services, which were intended to reduce the demand for acute services and thereby reduce hospital admissions.

The Chair expressed her thanks to Alan Veitch, Scrutiny Officer for his dedicated support in progressing the review and the preparation of the summary report. She further expressed thanks to Councillors Berry, Brighouse, Johnson and Roberts, and Ms Karen Prior of Healthwatch Wirral for their involvement in the review, evidence gathering and preparation of the summary report.

Members involved in the review expressed their enjoyment in working on such a challenging and complex review, and highlighted a number of the issues involved in addressing the challenge of reducing admissions. They informed the Committee that they had met with witnesses throughout the course of the review, including representatives from a significant number of health and care provider organisations, including some care homes and carer and patient representative groups.

The Committee noted the content and endorsed the recommendations within the “Avoiding Admissions” Scrutiny Review, namely that:

Governance and funding

Recommendation 1 - Developing one system with shared governance

Wirral will move to be an Accountable Care System by 2020 in line with national requirements. Wirral Clinical Commissioning Group, in conjunction with all partners are encouraged to continue to strengthen the culture of collaboration and partnership working which will lead to the ultimate development of a single health and care system for Wirral, the achievement of which will require a single pooled budget. This will require the establishment of appropriate governance arrangements with clear lines of responsibility and accountability and robust pathways minimising duplication. Opportunities should be taken to achieve incremental steps towards achieving an Accountable Care System by 2020 and report on progress to scrutiny on an annual basis.

 
Recommendation 2 – Funding of acute hospital services

In order to further develop services in the community, Wirral Clinical Commissioning Group and partners are requested to continue to explore the opportunities arising from commissioning within a cost envelope as an alternative to the Payment by Results tariff model. 

Service quality

Recommendation 3 – Service quality and a person-centred approach for community services

The Director of Adult Social Services and Wirral Clinical Commissioning Group, as commissioners of community services, are requested to ensure that adequate system capacity, service quality and a person-centred approach are embedded within all such contracts. An effective monitoring measure of the integrated care system should continue to be developed, appropriate to the changing commissioning structures.

Developing the right services

Recommendation 4 – Admission prevention

Wirral Clinical Commissioning Group and Wirral Borough Council, as commissioners of services, will continue to further develop the concept of preventative services to reduce unplanned admissions through the improved outcomes of public health initiatives, the development of robust community services and the encouragement to promote self-care. Annual feedback  ...  view the full minutes text for item 19