Agenda item

The Board considered a report of the Senior Commissioning Manager, Joint Commissioning and Continuing Health Care and Joint Commissioning Manager, North of England Commissioning Support that gave an update on progress regarding the North East and Cumbria Fast Track programme (for copy see file of Minutes).

The Senior Commissioning Manager advised that the North East have a higher than average number of beds and had been selected as a fast track area.  Joint working between CCGs and the local authority are taking place and a regional plan had been developed, as well as local plans.  There were three parts to the regional plan – Early Intervention, Crisis Resolution, and Workforce. Beneath the Regional Plan separate localities have submitted their own plan. The Durham plan is to be delivered in partnership with Darlington and focuses upon the development of accommodation based services as an alternative to hospital admission.

The workforce element of the plan aims to encourage robust leadership across all sectors and Positive Behaviour Support (PBS) as the approach for managing challenging behaviours.

A view was expressed by a member of the Board that some independent sector providers charge premiums for care and as such should be responsible for their own leadership programmes.

The Senior Commissioning Manager went on to advise that it was proposed to invest in enhanced community support services and would include more of a 24/7 cover. 

The Head of Adult Care, Children and Adults Services, DCC informed the Board that the details around funding were yet to be worked through.  She added that she would continue to make representations about the understanding around costings and the challenging timescales.   She advised that the principles were sound but that it would take time to get it right and that there were risks associated with a quick turnaround.

The Chief Executive of Tees, Esk and Wear Valleys NHS Foundation Trust agreed that people with learning disabilities, autism and challenging behaviour should lead as full a life as possible within the community. He also recognised that there would be significant cost pressures on the NHS and local government. The national Clinical Director has provided evidence that shows that proportionately people with learning disabilities were up to 400% higher in the North East than in other parts of the country and a high percentage of those individuals had a mental health need.  He advised that TEWV supported the programme but had significant anxieties and emphasised the specific needs of individuals and the financial risks.

The Head of Adult Care, DCC advised that there was a risk register and re-iterated that there were challenges around the programme.  She confirmed that the changes were about giving people a better quality of life but that the transformation needs to be implemented carefully and funded adequately.

In relation to the timescale, the Corporate Director of Children and Adult Services asked if NHS England were conscious of some of the risks and the rapid escalation of the work that needs to be carried out.  The Associate Director of Clinical Networks and the Clinical Senate, NHS England advised that the Regional Clinical Director was ensuring that people were made aware of the changes.  He would take a strong message back to the NHS England Board.

The Director of Primary Care Development and Engagement, DDES CCG said that the CCG fully support the programme especially where changes are affected locally, with primary care at the centre.  The Senior Commissioning Manager informed the Board that specific needs of cohorts would be reported locally to each CCG.

In relation to the individuals identified, the Senior Commissioning Manager informed the Board that numbers were fluid and can change with people being admitted and discharged.  In terms of projections, she advised that children were being supported at an early stage with care provided in the community, where possible.  She went on to explain that the plan would need to be amended from a 5 year to 3 year plan in terms of the timescale to implement changes.

The Senior Commissioning Manager informed the Board that the Regional Scrutiny Committee were looking at the implications of the changes and she said that she would give an update at a future meeting.

The Chairman thanked the Senior Commissioning Manager for her report.

Resolved:

(i)            That the plan, in particular the Durham and Darlington Locality Plan which was embedded in the North East and Cumbria Fast Track plan be supported and agreed. 

(ii)          That the North East & Cumbria Fast Track - proposed trajectories attached at Appendix 5 be noted.

(iii)         That regular updates on County Durham’s progress in relation to Fast Track implementation be received.