Agenda item

Purpose

To update Members (following the Cabinet update in January 2023) on the delivery of the Health and Care Portsmouth vision for developing a local, integrated intermediate care offer to enable patients within Portsmouth Hospitals University NHS Trust (PHUT) to be discharged for assessment of their long term needs outside of the acute hospital (D2A). 

The Cabinet Member noted the report which is for information only and is not subject to call-in.

Simon Nightingale, Assistant Director, Health & Care Services, introduced the report and outlined measures to reduce pressures on discharge pathways. Andy Biddle, Director of Adult Care, noted that the Jubilee Unit was a real success and very much an integrated operation. However, two significant issues with the Discharge to Assess (D2A) pathway, introduced during Covid, needed ironing out. One was financial in that the funding had more capacity than the subsequent local discharge grant and it was uncertain how much longer current funding would last. The other was that people were leaving hospital far earlier with more intensive needs. It took longer for homeless people or those with housing problems to go through reablement so Adult Social Care (ASC) was working with Housing, Neighbourhood & Building Services (HNBS).

Councillor Gosling congratulated ASC on the success of the Jubilee Unit, which was due to Portsmouth already having integrated working in place when Covid started. He had been asked about it at the recent LGA Conference in Bournemouth. He noted delays in returning home were not just amongst the homeless but also when housing was unsuitable so it was advisable to work with HNBS to resolve problems before the winter.

In response to questions from Councillor Heaney, Mr Biddle said it was difficult to measure outcomes. Data was submitted to central government on the number of people in their own homes three months after reablement; ASC was seeing more people going home so it did well on those targets. However, there was work to do with people who dealt directly with discharge, for example, a better knowledge of the domiciliary care available was needed. D2A was the right approach because staying in hospital reduced people's independence and muscle strength. Society had not invested in the foundations in D2A per se to make it a success as there was no national pathway. If society wanted to make D2A an embedded success then it needed to think about prevention and where it spent NHS funding. D2A was successful locally but that was not enough. Mr Biddle would far rather see fewer people going into hospital and a sea change on admission avoidance. Councillor Heaney suggested using other local authorities' experience to build a model that could be applied more widely nationwide.

With regard to boundaries and who was responsible for funding, Mr Biddle said it was cloudy as local authorities (LA) and the NHS had different boundaries. LAs had a duty of care to people who lived in their boundaries but NHS boundaries depended on GP registration so a Hampshire resident could come under the Portsmouth NHS area. If a Hampshire resident had a GP in Portsmouth and was in a care facility in Portsmouth the social care element would be funded by Hampshire County Council. In situations like these the "hand-offs" were very different depending on where people lived as LAs and the NHS operated very differently. Councillor Winnington had experience of boundary issues from his previous employment, for example, Crookhorn was outside the Portsmouth LA boundary but the Crookhorn GP practice was part of the Portsdown Group. He had had considerable experience of complex battles on responsibility for funding but not so much recently.

Officers said that across Hampshire and the Isle of Wight (HIOW) about four weeks of D2A funding was provided. HIOW used its funding to buy beds. From April they had reverted to assessing in hospital so there was no four-week period as in Portsmouth. This had led to performance discrepancies and an inequitable service, in itself an issue. Southampton had four-week periods but were close to moving to more assessments in hospital. Portsmouth could be at risk of a similar situation.

Councillor Winnington said ASC was aware of the danger of D2A becoming "assess to discharge" if funding ran out. Portsmouth had a working D2A model and if it could not run it, no-one could. If funding could be kept it would be outstanding and it would save money too. Despite requests from LAs for a five-year funding plan, central government gave one-off amounts so LAs did not know what they would get. Louise O'Sullivan, Group Accountant, said the Integrated Care Board had given £1.7m for external placements but more placements were needed so ASC was trying to understand what requirements would be and how much funding was needed.

Summing up, Councillor Winnington said it would be interesting to hear other views at an integrated healthcare seminar he was attending the following day in London. He would feedback views as well information from partnership boards at the monthly update meetings with the opposition spokespeople. He also requested a conversation with Jubilee Unit staff on re-naming it on a Sherlock Holmes or Arthur Conan Doyle theme.

The Cabinet Member noted the report which is for information only and is not subject to call-in.