Community Health & Social Care Commissioning Norwich Locality Provider Forum The Costessey Centre, Longwater Lane, Norwich, NR8 5AH. Tuesday 4 February 2014 Item Minute Action 1. Welcome, Introductions and Additional agenda item. 1.1 Following introductions, Mick Sanders welcomed everyone to the. Minutes of the Meeting held on 5 November 2013 1.2 The Minutes of the held on 5 November 2013 were agreed as a correct record. 1.3 Matters arising from the Minutes: (4.4) James Elliott (NCCG Operations Lead) and/or John Mallet (Project Domino) would be approached to attend a future. Future (3.1.2) The Integration Transformation Fund, had been renamed Better Care Fund. This would be covered in more detail in item 3 below. (3.3.5) The selection process for Better Care Awards was now complete. More information available from Norfolk Independent Care and feedback at next. 3.0 Commissioner Updates: 3.1 Norwich Clinical Commissioning Group s Older People Clinical Action team (CAT) 3.2 The Chairman introduced Dr David Goldser, a local GP from St Stephen s Gate Medical Practice, Chair of the CCG s Older People s Clinical Action Team (CAT) and member of Norwich CCG Governing Body. DG explained his various roles in the community, the local commissioning focus to his work and federative commissioning arrangements across the wider health community. 3.3 The strategic goals and demography of the locality were provided together with an overview of the health inequalities and challenges facing the CCG. This included significant deprivation in certain areas of the city where some people were living on average seven years less than those in higher socio economic classes, and where many were illness free in that period. To address these issues, the work of the Older People s CAT includes: Integrated case management 1
Services for people with dementia End of Life Care Medication and Patient Review Service Falls Prevention Reducing Excess Winter Deaths Voluntary up-streaming of projects 3.4 3.5 3.6 3.7 3.8 Integration of health and social care services is now a major pillar of NHS policy, the focus of which is patient centred care and sustaining self-care. The recent launch of the Integration Transformation Fund (now renamed Better Care Fund) provides a single pooled budget for this purpose. It places increased responsibilities on health and social care to work more closely together in an integrated way. A significant part of the CCG s budget will move into social care this year with the aim of keeping people well, at home, and reducing unplanned hospital care. DG went on to explain the CCG s plans for shared primary care across practices to enhance services for older people including those with long term conditions (LTC s). Work is in train to focus work streams around the existing four NCHC localities, each of which have a population of around 50,000. The vision is to shape, enhance and deliver integrated services in these localities which will include community health and social care, mental health services, re-ablement through more co-ordinated packages of care, which in turn should enable quicker discharges from hospital. With a target of 15% reduction in hospital admissions, primary care plans to invest to save by the introduction of services across seven days per week. The CCG is also looking at how it can work more proactively with the voluntary sector and other providers to contribute to the provision of care in the community. There are also plans to improve technology, access to a single patient record and electronic care plans. In furtherance of these aims, the CCG wishes to be more proactive in delivering primary care in care homes; this includes medicines reviews and pharmacy support and, for palliative care, working with providers to promote greater patient choice in the care home setting. A provider gave an example of a resident in a local care home who had been in and out of hospital four times in the last eight weeks; she gave an account of how this had led to deterioration in the resident s condition. Acknowledging this, Dr Goldser stated that good domiciliary care is crucially important to helping keep people at home. He went on to explain that the Better Care Fund is key to making the improvements necessary to develop systems which will address some of the problems identified and for GP s to have the confidence to endorse patients staying at home. He went on to suggest that hospitals are also part of the solution as they are paid less if re-admissions are too frequent. TO offered to meet with the questioner after the to look at the detail of the case. 2 TO
3.9 3.10 3.11 3.12 3.13 3.14 On behalf of Providers, Jo Ardrey thanked Dr Goldser for making time to attend the forum. She was particularly pleased to hear his views around domiciliary care and the CCG s aspirations for working together. This view was echoed by many of those present along with enquiries as to what processes would be put in place to make this happen.. Following a question relating to the Better Care Fund and recommendations for more focus on telehealth, Maxine Haydon (Smart Telehealth) suggested that 90% of people surveyed were in favour of such equipment and she offered to work with the CCG if pilots were of interest. Bruce Rumsby (OP CAT Programme Manager) offered to meet with the questioner to consider this. It was suggested that lots of partners were needed for the discussions that would now ensue to develop the work identified by DG and the right mechanisms needed to be set in place to allow dialogue and trust to flow. Responding to a question around the CQC s registration criteria, DG confirmed the CCG was keen to consult with care homes and residents and examples of pilot arrangements were shared. Stella Shackle (Healthwatch) suggested the old ways of working in community hospitals held value in that if a professional sees someone three days per week they will notice if their health is changing. She suggested reviewing how the 54 resources across the community are used in future. Acknowledging this point, MS offered a to explore this further. Adding to this, DG explained that the CCG CAT s would not be continuing in their present form beyond April owing to some restructuring in the CCG to accommodate the changes identified above. Therefore further information to follow regarding how to engage in future. Concluding this item, MS thanked DG for his most welcome contribution. He reminded Providers that the CCG had proactively engaged with Providers since its inception through a number of their senior officers attendance at these s. They were, he said, on a journey themselves as the NHS re-shapes and he expressed his thanks for their continued support. BR MS MS/TO 4.0 Help At Home Commissioning Project: 4.1 Helen Read, Commissioning Manager from the Central Integrated Commissioning Team, provided information regarding the Help at Home Project (now renamed Home Support Project Commissioning Home Care for the future) which aims to deliver a model of domiciliary care for Norfolk. 4.2 The project will address key challenges such as: How will health and social care meet the demand for Home Care in future (20% increase anticipated year on year) Innovate to move away from the purchase and delivery of timed talks Give service users more control and choice Incentivise independence 3
4.3 The project timetable: Jan April 2014 : Engage, involve and consult May 2014 May 2015 : create, test and evaluate a new service model in pilot areas June 2015 - January 2016 : procurement of future services February 2016: Transition/implementation 4.4 HR explained that she is keen to hear Providers views and she invited comments from the floor. Responding, Phil Wells (Age UK) sought clarification on whether the voluntary sector had been consulted as this had not been apparent in the presentation. He made reference to the network of community agents provided by Age UK as a possible resource. He suggested that the process of developing this change would be challenging and that more co-ordination with the Better Care Fund would be necessary. 4.5 Jo Ardley suggested that the public needs to know about this change soon. She also stressed that getting the package of care right for individuals is very important and, done well, saves in the long run. (Example provided.) 4.6 Helen Read acknowledged these points and agreed to take them back. She confirmed that the voluntary sector would be consulted in due course and invited providers to contact her with further comments on: helen.read1@nhs.net 01603 223151 All 5.0 Home Care Direct Services for Providing help with Personal Budgets 5.1 Bruce Adams, who was due to present this item, was unable to attend owing to travelling issues. Agreed to defer to future agenda. Future 4.0 Review of Provider Forum Terms of Reference 4.1 TO invited the Forum to break into groups to consider: The existing Terms of Reference and possible updates How to improve the form and function of the s Suggestions for future agenda items 4.2 Five groups of approximately six participants were formed facilitated by Bruce Rumsby, Colleen Hubbard, Emma Cliffe, Jo/Sharon from Westminster Care and Chris Carter. It was agreed that the feedback from the groups would be disseminated and circulated to members with the minutes of this and reviewed in the Spring. 4
5.0 Other Business 5.1 Better Care Fund: MS advised that he was proposing to bring an agenda item to the next on the Better Care Fund (formerly Integrated Transformation Fund) and an item on how Providers can help to reduce hospital admissions. agenda 5.2 NCC Budget reviews: Having previously sought Providers confirmation that they had taken part in the Norfolk County Council budget review consultations, TO advised that the matter goes to Full Council for a decision next week. 5.3 Arising from this, reference was made to the 12m proposed cut from Personal Budgets (Social Care) and 3m of that saving being reinstated back into the main budget. A Provider queried how those adjustments would affect the end result. Responding, TO explained that this proposal (from Cabinet) was still just that and until Full Council makes its decision next week, very difficult to speculate. However, he suggested that the Resource Allocation System (RAS) would determine the strength of the reduction. Providers went on to propose an agenda item for the next to examine how NCC s decision will apply weighting to things that are not pure care, as this will ultimately impact on what Providers can deliver. 5.4 Query on EQIA Assessment: A Provider questioned the application of the EQIA (Equalities Impact Assessment) on the proposed NCC cuts, stating the view that NCC s assertion that there would be no gender impact (as a result of the cuts) was incorrect given that women (as historic carers) were likely to be majorly impacted because it was currently unclear who would do the care work when funds are withdrawn. Addressing this point, MS asked the questioner to write in regarding the EQIA if she felt this warrants a review as commissioners were still trying to find a solution to this problem themselves. 6.0 Meeting Close / Items for next / Networking 6.1 The following dates for Provider Forum s in 2014 (Norwich Locality) were noted: Tuesday 13 May 2014 Tuesday 12 August 2014 Tuesday 11 November 2014 Meeting close 4.30 pm 5