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Agenda item

Health and Social Care Dashboard

To present the Dashboard and highlight any emerging issues.

Minutes:

The Board considered a report (Agenda Item 9) concerning the health and social care dashboard.

Tandra Forster began by providing an overview of the status of the Better Care Fund (BCF). The Policy Guidance would be published by the end of November 2016 and would be finalised by the end of March 2017. Some increase in funding was anticipated across the two year BCF, with a 1.79% increase in 2017/18 and 1.9% increase in 2018/19. The number of national conditions had been reduced and would be focused on protecting social care; out of hospital services; and joint plans. More information would be known in the coming weeks.

ASC1 – Proportion of older people (65+) who were still at home 91 days after discharge from hospital to reablement/rehabilitation service: Tandra Forster advised that the target for 2016/17 was 88%, not 92% and so performance was exceeding the target and should be green.

AS2 – Average number of Delayed Transfers of Care per 100,000 population: performance against this target was correctly showing as red against target but was improving. The  reason for the delay was down to difficulties in acquiring home care; this accounted for 70% of delays and recruitment issues was the main factor. Providers were also withdrawing for the market. Delays would continue to be addressed in the following year’s BCF.

Dr Lise Llewellyn asked how West Berkshire was performing in comparison to Wokingham who had set up their own arms-length care provider. Tandra Forster explained that their Wokingham Integrated Social Care and Health (WISH) Team was equivalent to West Berkshire’s Joint Care Pathway (JCP) and they were able to pay more for care. Dr Llewellyn asked if their capacity was any better; Councillor Rick Jones commented that if they were able to pay more they would be likely to be able to acquire more care. Cathy Winfield expressed the view that the difficulty in acquiring care was a recurring theme and it might be worth considering a system-wide solution at one of the Board’s Hot Focus Sessions. Tandra Forster commented that Delayed Transfers of Care was a subject also being considered at the Council’s OSMC meeting on 6 December 2016 and the Board could consider their recommendations at the Hot Focus Session.

ASC2 – Number of assessments completed in the last 12 months leading to a provision of a Long term service: West Berkshire was performing better than the national average for assessments.

Rachael Wardell informed the Board that there was an improving picture across the children’s Social Care Indicators due to the hard work of frontline teams and West Berkshire was bucking the national trend on a number of measures.

CSC2 – the number of child protection plans per 100,000 population: Not only was the number of children on CP plans reducing but the time spent on a plan was reducing. Attention had now turned to monitoring those children who then returned to a CP plan, but no worrying trends had been identified and Rachael Wardell concluded that West Berkshire had become more effective at prevention and this was improving family life.

CSC3 – The number of Section 47 enquiries per 10,000 population: Performance against this indicator was more troubling. A Section 47 Enquiry was a statutory social work responsibility and was an action not taken lightly as it could be a massive interference into a family which might cause harm. The new Multi Agency Safeguarding Hub (MASH) would mean there was a better aggregation of information. Social work teams did not view these indicators as having targets and they sought to ensure that they were doing the right thing by the child

CSC7 – Percentage of LAC with Health Assessments completed on time: A significant amount of work had been put in to turn around performance on this indicator which continued to be very strong. There might be other indicators such as dental health checks which might now need to be scrutinised by the Board.

Paul Jones asked what peer assessment had been undertaken in Children’s Services. Rachael Wardell responded that West Berkshire Council had been quite heavily peer assessed in recent years including Department for Education (DfE) interventions following the Ofsted inspection in March 2015. The six month review would be happening in early December. The new MASH also helped to make safeguarding decisions as there would be input from Thames Valley Police and health colleagues. Cathy Winfield asked where Section 47 referrals came from. Rachael Wardell responded that referrals came from members of the public and from professionals in other organisations – a high number from schools. Social workers made the decision to conduct a Section 47 enquiry if there was evidence to suggest the child was at risk of significant harm. In many cases on receipt of a referral there would be services put in place which could help the child or family but the circumstances would fall short of a Section 47 enquiry. In some circumstances the person making the referral might require additional training or signposting.

AS1 – 4-hour A&E target: Shairoz Claridge explained that while performance against these indicators was showing as amber and red, more recent data was showing that it would be unlikely that the Royal Berkshire Hospital (RBH) would meet the 95% target as winter was approaching. RBH were performing the second best in the area but still not able to reach the target. The local System Resilience Group had been transformed into Local A&E Delivery Boards to focus solely on Urgent & Emergency Care, and attendance at executive level by member organisations was expected. This was a requirement from NHS England of all CCGs. Five improvement areas were identified and a new 999 response programme called ‘Nature of the Call’ was identifying key words and phrases to prioritise emergency responses.

AS5 – Ambulance Clinical Quality: Performance against this indicator was red in July and the CCGs had agreed an action plan with SCAS which was anticipated to improve standards by February 2017.

AS6 – A+E attendances and AS7 – Number of non elective admissions: These levels were both increasing, despite the CCGs being in the top 10 nationally.

CS2 – Mental Health DTOCs: Tandra Forster advised that this was the first time that mental health DTOCs were being reported as there was an increasing focus on mental health so no comparison could yet be made.

Rachael Wardell advised that she had seen un-validated data against indicators up to September 2016 and the dashboard was reporting data as old as July 2016. She suggested that the reporting cycle be amended to enable more recent data to be presented to the Board. Councillor Lynne Doherty suggested that the dashboard was presented with a caveat to state that performance was within a variance. Councillor Graham Jones suggested that this information be something the Steering Group look into.

Alison Foster raised a query regarding patient flows towards hospitals. Shairoz Claridge explained that 60-70% of patients went to the Royal Berkshire Hospital in Reading and of the rest, the majority of patients went to the North Hampshire Hospital in Basingstoke with about 8-10% attending the Great Western Hospital in Swindon. Tandra Forster explained that there had historically been an issue with the level of DTOCs from North Hants. Alison Foster considered the conversion rate from A&E attendances to non elective admissions and asked if there was a risk that people who needed to be admitted were being sent away. Shairoz Claridge admitted that there was always a risk but a lot of work had gone into ensuring patients received the right clinical support before attending A&E. Cathy Winfield added that the CCGs wanted a high conversion rate because it offered reassurance that people were attending A&E for the right reasons. Short stays were sought as they would evidence patients being treated efficiently.

RESOLVED thatthe health and social care dashboard be noted.

Supporting documents: