Agenda item

To consider information from the North East and North Cumbria Integrated Care Board (NENC ICB) in relation to this scrutiny topic.

The second evidence-gathering session for the Committee’s ongoing review of Reablement Service focused on a submission from the North East and North Cumbria Integrated Care Board (NENC ICB).  The NENC ICB Head of Commissioning and Strategy gave a presentation to the Committee which covered the following:

·         What is Intermediate Care?

·         Types of Intermediate Care

·         Intermediate Care – Context

·         Better Care Fund (BCF)

·         National Condition 2 – Enabling people to stay well, safe and independent at home for longer

·         Stockton-on-Tees BCF Governance

·         BCF Metrics

·         Intermediate Care Framework

·         Community Rehabilitation and Reablement Model

Beginning with an overview of how ‘intermediate care’ was defined and what it involved, it was explained that ‘reablement’ was one of the four main types of care offered within this short-term support model (alongside home-based, bed-based, and crisis response care).  Reablement support was delivered in someone’s own home or usual place of residence, and endeavoured to help individuals recover skills, confidence and maximise independence.  It was most commonly delivered by social care practitioners.

National ‘Hospital discharge and community support’ policy had placed increased demand / pressure on ‘step-down’ intermediate care services, with significant national and regional focus on ‘Discharge to Assess’ (rather than assessments in hospital) and early discharge (once a patient did not meet the criteria to reside) to support acute hospital pressures.  To support this approach, the Better Care Fund (BCF) was used as a mechanism to bring NHS services and Local Authorities together to tackle strains faced across the health and social care system and drive better outcomes for people – this was underpinned by two core objectives; 1) to enable people to stay well, safe and independent at home for longer, and 2) provide people with the right care, at the right place, at the right time.  Reablement services were one of the Stockton-on-Tees BCF schemes to meet this first objective, a metric of which was ‘the proportion of older people who were still at home 91 days after discharge from hospital into reablement or rehabilitation services’.

The BCF framework required ICBs and Local Authorities to formulate a joint plan (owned by the Health and Wellbeing Board) which was governed by an agreement under section 75 of the NHS Act (2006).  A BCF Delivery Group, in conjunction with a Pooled Budget Partnership Board (PBPB), had oversight of the delivery and monitoring of this plan, reviewing current schemes and agreeing future proposals / business cases – this involved several operational working groups / forums to support transformation (including the ongoing partnership around SBCs Powering Our Future-related reablement developments).

Bringing the presentation to a close, the NHS England good practice guidance for ICBs (commissioners and providers) titled ‘Intermediate care framework for rehabilitation, reablement and recovery following hospital discharge’ was referenced.  This document outlined what ICBs needed to do jointly as a health and care system to plan, design and deliver services, with considerations around demand, capacity and expectations.  Finally, the community rehabilitation and reablement model was highlighted which demonstrated an individual’s journey from admission to an acute inpatient / virtual ward, admission for rehabilitation in the community, delivery of rehabilitation interventions and, where required, transition for long-term / ongoing needs.

The Committee opened its questioning by asking if there was any flexibility in the duration of the existing six-week reablement offer and to what extent the 91-day metric was being met locally.  The NENC ICB representative confirmed that the reablement service was available up to a maximum of six weeks but that, in some cases, an individual required support for a lesser amount of time.  As far as the national metric was concerned, around 86% of people were still at home 91 days after discharge from hospital into local reablement or rehabilitation services (this placed Stockton-on-Tees as the third best performer in the North East and second only to Middlesbrough within the sub-region).

Continuing with the theme of data, Members sought clarity on priority area 4 (improve data quality and prepare for a national standard) of the NHS England good practice guidance for ICBs.  In response, the Committee heard that the development of a standardised dataset would aid the identification and evaluation of the best ways in which individuals can achieve independence.  The intermediate care offer can vary across different locations, though the local priority was very much on people gaining and maintaining independence for as long as possible.

The Committee asked about the virtual ward model and how this was operating across the Borough.  The SBC Director of Adults, Health and Wellbeing (in attendance for a subsequent agenda item) stated that whilst local performance was just behind the national average, it compared well against other regional areas.  In related matters, it was also confirmed that high-level BCF metrics were considered by the Stockton-on-Tees Health and Wellbeing Board on a quarterly basis.

A query was raised as to whether the ICB received any feedback on the local reablement service from partners or the public – Members were informed that it did not as this was delivered through SBC (it was noted that the ICB was not permitted to hold patient-level data).  Discussion ensued around the importance of the relationship between services and those accessing them, a crucial link which can ensure any issues were raised and addressed in a timely manner.  The Committee fully endorsed engagement with service-users and those with lived experience in terms of shaping the present and future offer.

Referencing the recent expansion of the Borough’s reablement offer, the Committee questioned whether the ICB supported this development.  Assurance was subsequently given that the ICB supported SBCs proposal to bring the service in-house.

Returning to the NHS England good practice guidance, the Committee asked how the NENC ICB was addressing the recommended actions (up to March 2025) stated within this document.  Members heard that a gap analysis had been undertaken against the intermediate care framework as part of the SBC Powering Our Future work, and that monitoring of developments relating to intermediate care services was conducted at the IBC place sub-committee, with the local Health and Wellbeing Board having oversight as part of BCF-related updates (the regional Integrated Care Partnership (ICP) also existed to check and challenge the status quo).  Members emphasised the important role of scrutiny in holding services to account.

AGREED that the information presented by the North East and North Cumbria Integrated Care Board be noted.