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.

In Wirral, the need to establish services to reduce avoidable hospital admissions and facilitate more timely discharges had already been identified and the use of the Better Care fund had been successful in reducing unplanned admissions in 2015/16 by 5%, which was above the target set of 3.5%.

However, during that same period Wirral University Teaching Hospital’s Accident and Emergency Department had experienced an increase in attendance of 4.5% and those people who had been admitted were sicker and had more complex needs.

Councillor Moira McLaughlin referred to the key findings set out in section 4 of the report which highlighted welcome developments, set against areas of challenge and these findings determined the task and finish group’s nine recommendations detailed in the report.

Councillor Moira McLaughlin informed that funding and organisational arrangements were clearly central to helping to deal with the current situation and Members were aware of the work being carried out to bring together funding and the skills of health and social workers in integrated teams, based in locality hubs. This work was set to continue to be developed and it had progressed further since this report had been completed. The first two recommendations addressed this with a requirement to strengthen the governance arrangements for the integrated service with clear lines of responsibility and accountability, and also a recommendation to explore ways to change the current method of allocating funding for the acute sector with the aim of re-distributing available funding into “out of hospital” services.  There was work underway on this too.

The task and finish group had also highlighted, in its report, the absolute essential requirement of ensuring quality in commissioning service.

The task and finish group had understood, from what it had heard, that those services in place needed to be the most appropriate in order to reduce the pressure on the hospital and re-focus activity in home based settings but also that, as circumstances change, the commissioning ability needed to be able to respond quickly to develop different services.

Councillor Moira McLaughlin reported that there was more work to be done to promote awareness among the professionals who made the decisions on care and treatment about what alternatives were available to hospital care, and also amongst the general public, in respect of the range and value of community based services.

As was always the case, communication between different organisations and professions was crucial to making sure that care and treatment was safe and effective, and the work being done to introduce the single patient record was recorded.  The Committee wanted to see this extended and would monitor progress.

The task and finish group’s final recommendation related to the development of a performance management framework that accurately measured how well the plans were working.

Finally, Councillor Moira McLaughlin informed that during the time that the task and finish group was carrying out this study, Members had seen some really excellent examples of collaborative working, with some imaginative developments in service delivery which really were making a difference.  They had also clearly seen the immense strain that both health and social care were under and they understood that, although there was a need to work in different ways to support people, the service was simply in need of more funding.

Councillor Chris Jones responded thanking Councillor Moira McLaughlin and everyone else who had been involved for their hard work.  She informed that this was an example of challenging scrutiny where difficult questions had been asked.

Councillor Phil Davies also thanked all concerned for their excellent piece of work and informed that the move to a single health and care system for the whole of Wirral was definitely the way forward.  He also informed that the Cabinet looked forward to further reports on how it was progressing  and that the Government needed to put more money into these vital services as they were completely underfunded.

RESOLVED: That

(1)  the contents and recommendations of the Scrutiny report ‘Avoiding Admissions’ be noted; and

(2)  the recommendation that an update report on the implementation and impact of the recommendations be presented to the People Overview and Scrutiny Committee by March 2017, be supported.