Agenda item

To consider information in relation to this scrutiny topic from:

·       NHS North East and North Cumbria Integrated Care Board

·       North Tees and Hartlepool NHS Foundation Trust

The second evidence-gathering session for the Committee’s review of Stockton-on-Tees Adult Carers Support Service featured contributions from the NHS North East and North Cumbria Integrated Care Board (NENC ICB) and North Tees and Hartlepool NHS Foundation Trust (NTHFT).

NHS NORTH EAST AND NORTH CUMBRIA INTEGRATED CARE BOARD

Responding to the Committee’s lines of enquiry, a report was presented by the NENC ICB Head of Commissioning, Community & UEC containing the following:

·       The NHS, under the Health and Care Act 2022, was legally required to involve unpaid carers in decisions about the care and treatment of the individuals they supported.  This included participation in the planning and delivery of care, as well as in discharge planning from hospital settings.

The current NHS long-term plan highlighted best practice in identifying carers and providing them with appropriate support (including encouragement to record whether someone was a carer in their GP record).  For primary care (General Practice), the Care Quality Commission (CQC), as part of its inspection framework, looked at how effectively carers were supported (including involving people in decisions about their care and that this was responsive and personalised to their needs).

·       Whilst NENC ICB did not have any direct responsibilities in this area (there was no ICB strategy as such, as it did not have direct responsibility for the commissioning of services), it could demonstrate collaborative work at a local level with Local Authority and ‘system’ partners to support the adult carers agenda.

The ICB Local Delivery Teams worked in collaboration with Local Authorities in the development of Better Care Fund (BCF) plans, which specifically included reflections on, and services for, carers.  These plans were developed based on local need across each Local Authority and the ICB collaborated to support the design of these plans.  The ICB was a member of each Health and Wellbeing Board, plus it held Place Sub-Committees where there was the ability to discuss health and social care challenges and opportunities (acting as a forum for partnership working).

·       Locally, the NENC ICB / ICP Joint Strategy specified a key programme aim of ‘working to identify and support more people who are providing unpaid care within the region’.  This was a challenge as some individuals often did not see themselves as a carer / fulfilling a caring role.

·       Looking ahead, carers, and their role across health, would be picked up in emerging Neighbourhood Health Plans which were being led by Local Authorities.  The ICB would again collaborate and contribute towards these plans, and had a requirement to pull together a population health improvement plan which would reflect local Neighbourhood Health priorities amongst a range of other ICB priority areas.  For now, from a NENC ICB perspective, it was felt that Stockton-on-Tees did a superb job around the whole carers’ agenda.

Reflecting on the report, the Committee considered the influence of the NENC ICB in relation to those providing unpaid care and wondered whether the organisation was somewhat detached from patients / carers.  Members were reminded that the ICB did not commission carer services, nor did it have a regulatory capacity.  However, it was able to promote / encourage the promotion of carers (e.g. noticeboard displays in general practices) and did work collaboratively with operational teams to ensure clinical pathways included considerations around carers.

Noting the ‘We Care You Care’ link within the covering report for this item (which highlighted Newlands Medical Centre in Middlesbrough achieving carer-friendly status), the Committee queried if any data existed for primary care services within the Borough which demonstrated how many carers had been identified (as a proportion of its patient list) by a particular practice.  This would be followed up with relevant personnel after the meeting.

NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST

The NTHFT Head of Patient Flow, supported by the NTHFT Associate Director of Nursing Experience & Involvement, gave a presentation which addressed several lines of enquiry it had received from the Committee.  This included:

·       What roles / responsibilities in relation to adult carers?: Under the Care Act 2014 (England), NTHFT had specific responsibilities in supporting the identification of adult carers when providing short-term treatment to patients (i.e. people who provided unpaid care to someone with identified care needs).  These were met through communication with / involvement of carers at every stage of the journey (with the patients’ consent), recognising carers as partners in care, and through education and training (e.g. moving and handling / medication administration).  Discharge planning (a line had been added to the ‘assessment of need’ document to recognise carers) and supporting carers within the hospital environment (e.g. signposting / referral for further assistance (including to the Adult Carers Support Service), meal vouchers, John’s Campaign) were also important features.

A ‘Carers Charter’ (visible in the main University Hospital of North Tees entrance) had also been developed by the University Hospitals Tees (partnership between NTHFT and neighbours South Tees Hospitals NHS Foundation Trust) to demonstrate its commitment to carers of all ages – this was being reinforced with staff and patients.

·       How does the Trust identify carers?: This was achieved via the nursing admission process, involvement / discussion in discharge planning, and during inpatient care episodes.  However, as noted earlier in this meeting, people did not always recognise themselves as carers, and the Trust needed to keep asking this throughout contact with services as an individual’s situation may change.

·       How aware are Trust staff of the local Adult Carers Support Service offer?: Awareness of the local offer was aided / promoted through the Integrated Discharge Team, as well as the Frailty front-of-house service and staff operating within the Trust’s elderly care wards.

·       Feedback regarding Stockton Carers service: Positive feedback from the Home First Team, the Discharge Clinical Care Co-ordinator, and the Frailty Co-ordinator was relayed.  It was noted that, for some individuals, the local carers service had prevented additional care packages from having to be implemented.

·       Working with SBC with regards the local carers support offer – how does this operate; is this effective; is there anything that could strengthen current arrangements?: Partnership working included carer identification and liaison, the supply and promotion of information / advice / guidance, education and training for hospital teams (staff forums, team meetings, preceptorships), and transition and discharge support (involving regular liaison with team leads).  Trust staff had given positive feedback about existing arrangements with SBC, and some had benefitted personally from the local service (recognising that they needed to look after themselves in order to carry out their own role).  Moving forward, continuous education around the local offer was required, as was a need to think about how the Trust’s community services / teams were targeted in relation to carers, particularly given the number of people involved in a caring role was likely to continue increasing.

·       What are the implications for NTHFT of the new 10-Year Health Plan for England in relation to support for carers?  What plans are / will have to be in place to fulfil any obligations?: The new ‘Fit for the Future: 10-Year Health Plan for England’ advocated stronger NHS support for unpaid carers, although there were no specific targets.  From a local standpoint, future planning would be undertaken across the University Hospital Tees footprint (as opposed to an individual Trust perspective), with promotion of the Carers Charter, input from those with lived experience, and a tightening-up on the identification of carers to be developed.  Assurance was given that the NTHFT Director of Nursing was well sighted on carers-related issues.

·       Any views on key areas of future focus relating to this scrutiny topic (e.g. existing challenges that need to be?: Continued promotion across all health and care services, including primary care, to promote the identification of carers and signposting to available support.

The Committee began its response by focusing on the Carers Charter and the need to embed this across the Trust (particularly given carers knew much more about the person they cared for than professionals).  NTHFT officers gave assurance that this was promoted widely via the Trust’s various communications mechanisms and was highlighted as part of staff inductions.  It was intended for the charter to also be included within future workforce training.

Continuing with the communications theme, the Committee was pleased to hear that the Trust was listening to carers and expressed interest in seeing any public-facing literature that NTHFT was using to raise the profile of carers within hospital settings.  To maintain staff awareness of the help available for local carers, Members also suggested increased presence from Adult Carers Support Service personnel on wards.

NTHFT was asked how it would go about incorporating lived experience into its carers-related work.  Members heard that a Patient Involvement Facilitator was working across University Hospitals Tees, and that an ‘Involvement Bank’ was giving patients and carers an opportunity to contribute to the future development of services.  ‘Experience of Care’ meetings (involving local Healthwatch) also enabled input and reflection from patients and carers.

SCOPE AND PROJECT PLAN

The next evidence-gathering session would focus on submissions from both Eastern Ravens and Mobilise, along with further feedback from carers on their views / experiences of the current offer and any areas for improvement.  Members were also reminded of the intended forthcoming visit to the LiveWell Dementia Hub (date / time to be confirmed following this meeting).

AGREED that information provided by the NHS North East and North Cumbria Integrated Care Board and North Tees and Hartlepool NHS Foundation Trust for the Committee’s Scrutiny Review of Stockton-on-Tees Adult Carers Support Service be noted.