Agenda item

Funding source

NHS Greater Manchester ICB Contribution

£20,755,612

Disabled Facilities Grant

£2,343,87

Improved Better Care Fund (iBCF)

£11,187,623

Hospital Discharge Fund

£2,573,295

Total

£37,525,524*

Joint working on the delivery of the integrated contract for residential and nursing homes.

The focus of the work was to refresh the commissioning and contracting arrangements in place for residential and nursing homes supporting Oldham residents, made possible by HSC partners coming together with clear priorities.  Whilst predominantly the arrangements are for in-borough provision, they also cover out of area placements supporting Oldham residents.  The approach has provided clarity to internal staff and also external partners such as providers of care.

Carers

The Carers team is jointly HSC funded through the BCF and has seen a significant increase in the identification of hidden carers, including individuals who do not identify themselves as carers.  As such more information, advice and support has been offered. 

2022/23 saw a coproduction refresh on the Carers Strategy with a number of focus groups being held encouraging wide participation from a variety of stakeholders.

Care Home market

During 2022-23 the care home market has become increasingly fragile nationally, with Oldham not exempt from this.  A number of providers have approached commissioners advising about considering to deregister from nursing provision or moving away from general nursing to moving towards specialist provision such as Mental Health. We are seeking to address this by reviewing our care home rates, and in particular nursing fee rates, which will have longer term implications for us from a funding perspective enabling us to meet the needs of the Oldham population.

Discharge to Assess

The 'Discharge to Assess' process places additional pressures on an already stretched social care resource.  This can result in reviews not taking place as quickly as the system would wish.  It can also place pressures on community health services such as GPs and Therapy teams where people are placed in short term placements away from where they are normally registered. The Oldham health and social care system is currently exploring opportunities for block booking 'Discharge to Assess' beds in one or two locations which may streamline the review and therapy inputs but more resource/support is required in this area.

The BCF Plan required four key metrics to be measured and reported on, summarised in the table below

Metric

Planned

Actual

Commentary

Avoidable admissions - Unplanned hospitalisation for chronic ambulatory care sensitive conditions

1,160

Local estimate is 1,113

Oldham are on track to achieve this due to the number of avoidable admissions services in place. The Urgent Care Hub managed over 70,000 patients with a 96% success rate of keeping them out of hospital. Community HSC services have also significantly contributed to the achievement with existing and newly developed pathways for patients, including reablement, 2 hour rapid response service, and district nursing care. Extensive work across health and social care has taken place with care homes in order to better manage patients and enable them to stay in their own place of residence.

Discharge to normal place of residence (from acute setting)

92.3%

90.8% for 12 months to Feb-23

We have seen a decrease in patients returning to their normal place of residence due to two main factors:

1. the emphasis on D2A has resulted in patients being discharged earlier to a D2A setting in order to best establish their needs without being in an acute hospital bed. These patients often do return to their usual place of residence, but the extra move within their journey has an impact on this metric.

2. the acuity of patients presenting and subsequently being discharged from hospital. Oldham are seeing an increased number of patients who are sicker or more advanced in their illness than in previous years and so their destination once treatment has taken place is often needed to be long-term care and/or hospice care.

Residential admissions – (Rate of permanent admissions to residential care per 100,000 population (65+))

681

590

Actual rate is better than planned, and this equates to 229 permanent admissions to residential care of people aged 65+

Reablement – (Proportion of older people who were still at home 91 days after discharge from hospital into reablement services)

93.3%

88% - of 108 people 13 didn't stay at home.

To meet target an additional 8 people would have needed to stay at home for 91 days. The acuity of people at the point of discharge is significant and this is having an impact on this measure.