Joint presentation by Sue Jacques, Chief Executive of County Durham and Darlington NHS Foundation Trust and Stewart Findlay, Chief Clinical Officer, Durham Dales, Easington and Sedgefield CCG.
Minutes:
The Committee received a presentation from the Chief Executive of County Durham and Darlington NHS Foundation Trust (CDDFT) and the Chief Clinical Officer of Durham, Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG) about an Integrated Community Hub Model (for copy see file of Minutes).
The Chief Executive of CDDFT advised that by introducing an integrated community hub model it would keep people well and that they would benefit from being at home. The model would be introduced in the next financial year and work was ongoing with GPs, trusts and local authorities to ensure that wrap around services were available. She offered to provide Members with a list of services from each Community Hospital facility and who provided them. She went on to highlight the context within the presentation.
The Chief Clinical Officer, DDES CCG highlighted the following:-
· Integrated hub model – including wrap around services and single points of access
Councillor Temple was advised that SPA refers to Single Point of Access for GPs to access community nurses.
Councillor Huntington said that someone needs to have overall control and asked how this was decided and who it would be. The Chief Clinical Officer explained that it would depend upon the hub. The person in control could be a social worker, lead community nurse, practice nurse or a GP. The service wrapped around the patient and was very patient focused.
Referring to the SPA abbreviation, Councillor Nicholls said that this type of wording was confusing for people. The Chief Clinical Officer agreed that they could do better and confirmed that the main contact for a patient was with their GP. The Director of Integration, CDDFT advised Members that nothing was yet written in stone. The aim was to have a slicker and smoother system.
Mrs Hassoon asked if this would fit in with Specialist Community Providers and if one point of contact who would carry out a care plan and where would this work be picked up. The Director of Integration said that it would be the most appropriate professional. The Chief Clinical Officer advised that this would depend on the needs of the patient. There was a need to get teams working locally. He confirmed that there would be one assessment but that it would need to be more involved.
With reference to hubs, Councillor Bell asked where they would be and if transport and other issues had been addressed. The Chief Clinical Officer confirmed that this would include Barnard Castle as community nurses already work directly with GPs now.
The Chief Clinical Officer continued with the presentation, highlighting the following:-
· Community hub vision
· Out of Hospital Strategy
· Why we need to do it
· What will be different for our populations?
· What will be different for our workforce?
The Chief Executive, CDDFT concluded the presentation by explaining:-
· Community Hospitals
· Where are we now?
The Chairman thanked the officers for their presentation.
Councillor Crathorne agreed that it was better to get people home more quickly, especially older people and those with disabilities. She asked if the Trust were working with independent providers to ensure that appropriate care would be given at home. The Chief Executive, CDDFT advised that they do this and said that work was underway to look at what the community hospital could provide in terms of a care package, especially as the private sector was under stress. The Trust had also considered looking at providing geriatricians working within primary care. The Director of Integration added that they already had an Intermediate Care Service and that the CDDFT were working within an intermediate care capacity. She informed the Committee that by investing in enhanced intermediate care could prevent people needing longer term care. She also referred to the reablement service that could prevent re-admission into care.
Councillor Huntington agreed that the Community Hospital could provide crucial care however was concerned that there was never enough car parking provision. She also expressed concern about social workers and asked if we had enough staff, as she was also aware that there were not enough GPs. She further asked if people would receive the correct training as an important part of the success of the hub. She felt that reception staff needed further training around confidentiality. The Chief Clinical Officer said that the shortage of GPs was being addressed and the CCG were looking at how to make the offer more attractive. The hubs would ensure that appropriately trained staff were in post allowing the GPs to concentrate on the job they were best at.
The Chief Executive added that places in medical schools had increased however it would be 6-10 years before any professionals emerge from that arena. She said that they were trying to ensure that this was the place were people wanting to come and work and that they would be given an opportunity to carry out a portfolio of work, perhaps working in the community.
Councillor Huntington re-iterated her point about the lack of confidentiality in reception areas and that some staff require proper training. The Chief Clinical Officer advised that they did try to drive up the quality offered and asked Members to report any specific problems. With regards to the point about social workers the Chief Executive explained that social worker roles would be well defined and would be kept under review. As the early stages progressed this would be monitored and there may be a need to re-invest in community provision. The Director of Integration advised that there had been no indication to suggest that there was insufficient provision in this area. Social workers would work across more than one hub and would be based much closer to localities. She also touched on the voluntary sector, adding that social workers back in the community would align with the voluntary sector through the hubs.
With regards to parking, the Chief Executive explained that this would be looked into.
The Head of Planning and Performance Strategy said that we were all good at making things complicated and suggested that we should be simplifying systems. He believed that by doing this it would free up a lot of capacity and that by simplifying things it would alleviate a lot of stress, worry and waste currently in the system. He hoped that we did not lose the fact that the user/patient was at the centre.
Councillor Nicholls appreciated that this was a difficult task and said that the changes needed to be worthwhile. He added that it was important for the community to become involved.
Councillor Bell expressed concerns at the under-utilisation of community hospitals. He stressed that multiple NHS providers had pulled out and that there were empty wards at the Richardson hospital. He also commented that there were a number of care homes in the Barnard Castle area. The Chief Executive advised that the demand for services at the Richardson hospital reduced as Darlington CCG had commissioned care in the town. She added that it was important to offer an enhanced level of care and get the patient reabled and back into the community. The facility at Darlington only takes patients for a 2 week period and therefore Richardson hospital still receive patients from that facility. With regards to the care homes the Chief Clinical Officer advised that where they could not be sufficiently staffed then there would be an opportunity for people to attend the community hospitals that could offer some services. The Director of Integration added that there was a project plan and engagement plan in place that links with the leads in the CCGs and Patient Reference Groups. The Chief Clinical Officer added that this was also part of the engagement strategy for the STP.
Following a question from Councillor Temple regarding the closure of the inpatient ward at Shotley Bridge Hospital, the Chief Executive, CDD FT confirmed that it was anticipated that the necessary remedial works would be completed at the end of January 2017 and the inpatient ward would be expected to re-open in February 2017. Staff and patients had been temporarily moved whilst works were underway.
Mrs Hassoon asked how the multi-specialist assessments would be paid for if there was a funding shortage. The Chief Executive advised that there would be a more efficient way of doing things and a natural direction of travel. The Chief Clinical Officer said that 90% of healthcare was delivered in a community setting with only 10% of the funding. He said that there needed to be a shift in funding as changes took place.
Resolved:
(i) That the presentation be noted.
(ii) That information about the services provided at each Community hospital be circulated.