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 is requested from the Joint Strategic Commissioning Group.

 
Recommendation 5 – Promotion of community services

 Wirral Clinical Commissioning Group and Wirral Borough Council, as commissioners of services, will place greater emphasis on promoting community services among the public and professionals.  Increased priority will also be given to changing the awareness and behaviours of the public and professionals in order to encourage greater usage of the range of services aimed at preventing unplanned hospital admissions.

Recommendation 6 – Implementation of alternative referral pathways

Wirral Clinical Commissioning Group and Wirral Borough Council, as commissioners of services, will work with all service providers, including North West Ambulance Service, the 111 service and GPs, in order to ensure full engagement in the new referral pathways.

Recommendation 7 – Responding to changing requirements for services

Wirral Clinical Commissioning Group and Wirral Borough Council, as commissioners of services, will ensure that community services are introduced on the basis of best practice, insight and analysis of need. This will ensure that services will remain responsive to changing community needs, reinforced by the use of formal contract mechanisms to expand or reduce contracts as appropriate.

Recommendation 8 – Communication of data

The Healthy Wirral programme’s work to improve the communication of patient data between health and care providers in order to create a single patient record is fully endorsed. The Wirral Care Record will ensure that the use of the single patient record is spread to as many providers as possible at the earliest opportunity. Feedback on the implementation and the impact of the Wirral Care Record is requested to a future meeting of the People Overview & Scrutiny Committee.

Evaluating the effectiveness of services

Recommendation 9 – Performance management of community services

 Wirral Clinical Commissioning Group and Wirral Borough Council, as commissioners of services, will give a high priority to the effective performance monitoring of the various community services, including the use of both qualitative and quantitative data. The monitoring will include performance comparisons with geographical and statistical neighbours. Opportunities will also be explored to report across organisations in an integrated way and consideration will be given to the wider role of scrutiny across partners.

Resolved - That

1)  RECOMMENDATION TO CABINET - that the “Avoiding Admissions” Scrutiny Review and recommendations contained within be endorsed; and

2)  an update report regarding the implementation and impact of the recommendations be presented to the People Overview & Scrutiny Committee in approximately six months (that is, by March 2017).