Agenda item

The Director of Integrated Care (DIC) at North East London Clinical Commissioning Group (NELCCG) updated the Board. The programme began in 2018 and it was being refreshed owing to the move from a BHRUT based system to a borough based partnership model a new approach would be required on delivery mechanisms.  This was a priority as hospital admissions were higher in north east London that in the rest the rest of London suggesting that insufficient support was being given to elderly people at home.

A proposal was developed through the Older Peoples’ Board to refresh the plan and focus on joint activities that would have the most impact. The first phase was to undertake diagnostic work to ensure that plans and decisions were based on the available information in Barking and Dagenham, Havering, and Redbridge. It was expected that the diagnostic work would commence in May 2022 and would last for 14 weeks.

A model of care was drawn up that spanned the pathway from prevention to hospital admission and developed several business cases that enabled the NELCCG to obtain additional funding. The partnership illustrated the importance of connecting health and social care. Covid-19 had impacted the programme and as NELCCG emerges from the pandemic the DIC said it was necessary to refresh the programme to take account of rising health inequalities as a result of the pandemic.

A Frailty Unit had been established at King George and Queens Hospitals, initially as a pilot, enabling patients to be referred to receive a geriatric assessment. The unit meant that patients were more likely to be sent home with support rather than be admitted to hospital as would likely be the case if they had attended accident and emergency.

A national standard for rapid response care was implemented requiring patients to be seen within two hours. 62% of patients were seen within two hours. A considerable investment had been made in the rapid response service and the DIC said that it was expected reported that a business case had been approved to provide support in care homes. Waiting lists increase during Covid-19 and so investment would be made to reduce it as well as greater investment in ‘strength and balance’ services to increase mobility and reduce the risk of the elderly suffering falls that require hospital admissions. The population health management pilot had been launched and there was an opportunity to deep dive into the causes and factors behind falls.

The Board noted that it was important that the final programme should be co-produced with recipients of the services and asked that ‘co-producers’ be used instead of ‘stakeholders.’

In response to questioning, the DIC states that the variance in borough of residents attending ‘strength and balance’ classes was likely due to the fact that the service already existed in Redbridge and was introduced in Barking and Dagenham more recently. Responding to questions relating to dementia, priority will be based on the borough partnership. If Barking and Dagenham delivery board wish to prioritise dementia work then this could be done. In relation to hospital admissions, acuity determines how long a patient will remain in hospital with the doctors being unwilling to discharge patients until they are medically stable for discharge. Regarding catheter clinics, they had not been established yet.

The Chair noted that, whilst Havering had a higher proportion of elderly residents, they tended to be wealthier that elderly residents of Barking and Dagenham and this should be taken into consideration adding that previous funding did not consider deprivation among elderly residents. In addition to this the Chair stressed the need for outpatient services within the Borough.

The Board noted the report.