Agenda item

The Committee considered a joint report of the Corporate Director Adult and Health Services, Durham County Council and the Director of Integration, Durham County Council/North Durham and DDES CCG that updated members on progress to date in relation to integration of health and social care across County Durham (for copy see file of Minutes).

The Director of Integrated Community Services gave an overview of the continued work on Health and Social Care Integration through County Durham’s established tradition of strong partnership working.  She demonstrated examples of successful integrated working between Tees, Esk and Wear Valleys NHS Trust and Durham County Council through the development of Intermediate Care Plus, 0-19 Pathway and Mental Health and Learning disability services.

The Director of Integrated Community Services explained that there were further opportunities for integration that focused on primary care through community service models, wrapped around services and integrated commissioning functions.  She added that the concept of integration was featured heavily in the programme nationally for the next five years for intermediate services.   

The Director of Integrated Community Services further explained that the Teams Around the Patient (TAP) model had been introduced with 13 teams working across the County.  The TAP worked with frail and older people with long term illnesses to enable them to remain living independently in the community.  The TAP had received positive outcomes since October 2018 in reducing the length of stay in hospitals for older people and the number of elderly people having to be placed in care homes.  She added that there had been encouraging feedback from staff, GPs and service users and carers for the TAP. 

The Director of Integrated Community Services informed the committee that in 2019 saw the emergence of Primary Care Networks (PCN) to build upon primary and co-ordinated care that covered areas that were consistent with the already established TAP’s.  A Clinical Director for each PCN helped influence the area in which they worked as a set of principles were established that were to be adhered to in order to deliver services within the community seamlessly.  The PCN covered 100% of the population of Durham and were already an advanced organisation as a partnership between General Practice, Community Providers, Mental Health Providers, Social Care, the Voluntary Sector and other primary care providers such as pharmacists, dentists and opticians and would drive up the quality of care for their population supported by the CCG.

The Director of Integrated Community Services highlighted that the Health and Wellbeing Board had a statutory duty to promote integration.  She added that Durham, Sunderland and South Tyneside were working more closely as part of the central integrated care partnership (ICP).

The Integrated Management Board formed part of the governance structure.  In addition, Commissioning functions had been integrated between Durham County Council and Durham Clinical Commissioning Groups which had been agreed by both Cabinet and the CCG and would be implemented from April 2020.

Referring to the recent new Government and changes to the Cabinet, Councillor Robinson asked what the future held for the integration of health and social care services.

The Chief Clinical Officer responded that integration of services would remain for the foreseeable future as the way forward, however he could not comment on how the new Government or Cabinet would influence the integration.

Councillor Robinson wanted to know if assurances would remain that the Durham Pound would be safe or if it would be required to fund developments at St James Cook hospital.

The Chief Clinical Officer gave Tees Esk and Wear Valleys NHS Trust as an example of how it had been done as a separate statutory body.  Budgets would be looked after by CCG’s unless different governance arrangements were made.

Councillor Bell congratulated the Head of Integrated Strategic Commissioning on her new role.  Following a report to full council to create the post he wanted to know if the post was funded by the County Council, the NHS or whether it was a hybrid of both.  

The Head of Integrated Strategic Commissioning confirmed that the post was a joint appointment funded by both the Local Authority and the NHS.

Councillor Bell asked if the Teams around the Patient (TAP) were evenly distributed throughout the County. 

The Head of Integrated Strategic Commissioning explained that each TAP had their own budget that was based on the population of the area and weighted towards areas of deprivation distributing them evening across the County.  These budgets historically were administered through the local authority but were now being used and invested differently and were influenced by the needs of the community.  She added that the budgets were monitored and every contract would be reviewed to see what was being offered but it would be a long process.  

Councillor Bell requested that a further report be submitted to Committee to show how things were progressing with the TAP’s.

Councillor Jopling notified the Committee that the “Durham Pound” was difficult to monitor as the bigger the Clinical Commissioning Group became, the harder it would be to observe.

Councillor Henderson was pleased that the District Nurses and Social Workers were now based at Richardson Community Hospital in Barnard Castle but was disappointed that this issue had been raised at a subgroup five years previously with no action taken.

Mrs Hassoon informed the committee that she had attended a meeting on the  national reduction of bed days programme and wanted to know if this would affect the proposals for integrating services.

The Director of Integrated Community Services notified the committee that if a hospital bed was in the best interests of the patient then they would have it.  It was felt that it was easier to rehabilitate a patient in their own home if they didn’t require acute care resulting in moves to reduce the number of patients in hospital beds.

The Head of Integrated Strategic Commissioning reiterated that the reduction in patients in hospital beds would offset costs across systems.

Councillor Crute in relation to costs requested to know how spends would be monitored and what Government systems were in place within the PCN and CCG structures to direct performance indicator figures.

The Director of Integrated Community Services stated that at present each statutory body was responsible for monitoring their own budgets and performance indicators.  She noted that this created duplication.  She added that to move forward professionally the Integrated Care Board (ICB) would be looked at sitting below the Health and Wellbeing board to act as the main point of contact, being responsible for both the budget and performance indicators.  She added that the ICB did receive performance indicators and did oversee the broad budget but that there was a difference in overseeing and taking responsibility for them.  She explained that Authority for this had not been dissolved to the ICB as yet.

Councillor Crute was concerned that if this was not carried out correctly then how would issues be highlighted or show if the process was working right.

The Chief Clinical Officer highlighted that this was an opportunity to do things right.

Councillor Robinson thought that this Committee should be overseeing the process and used to scrutinise the process to ensure it was done properly.

Councillor Temple commended the work relating to the reduction in delays at getting patients back into the community.  He was surprised in the breakdown in the PCN numbers for his area. He wanted to know why Derwentside’s population was summarised for each PCN.

The Chief Clinical Officer informed the committee that the Primary Care Network came together under the General Practices to work out skills. There were larger networks across the County than Derwentside which worked well but individuals had responsibility for smaller areas. 

The Director of Integrated Community Services stated that in appendix four of the report that showed the summary of delayed transfers of care there was an error with the figure.  She noted that it should read that “Between April – October 2019 County Durham, compared to all single tier and county councils was ranked 6 out of 151, on the overall rate of delayed days per 100,000 adults population across England” instead of 6 out of 15.

Councillor Quinn was concerned that the integration of systems was talked about 20 years ago and wanted to know if this was ever going to happen.

The Chief Clinical Officer agreed that integration had been implemented 20 years ago with GP services losing District Nurses and Health Visitors.  He noted that integration was the way forward with professionals providing positive feedback with services coming together once more.

The Director of Integrated Community Services informed the committee that the integration of the Mental Health and Learning Disability services in 1998 had been successful and still remained in place to date. She thought there were no reasons why this could not be done again with primary care services.

The Chief Clinical Officer commented that Tees Esk and Wear Valleys NHS Trust had focussed on integration wrapping Mental Health services around Primary Care services.  He added that it was proposed to extend this integrated model to North Durham to include Mental Health Services, and dentists along with voluntary services.

Councillor Robinson agreed that it worked successfully in the 1980’s with nurses being based in Community centres with doctors referring patients to them.

Resolved

(i) That the report and the progress made to date in respect of integrated working in County Durham be noted.

(ii) That an update report be received in May 2020