To receive a presentation from Rachel Dewar, Head of Community Health Services.

A presentation (appended to the minutes) on District Nursing Services was given by Rachel Dewar, Head of Community Health Services and Tamsin Hooton, Director of Service Redesign and Integration at West Leicestershire CCG.

During discussion the following points were noted:

·         Following a system wide redesign, Community Health Services had been organised into three areas; the Integrated Neighbourhood Team, Home First, and Community Bed Based Care, all of which linked with each other and through a Locality Decision Unit.

·         Community bed based care was strictly for patients who required 24 hour nursing care. Below that level of care was the home first pathway which offered intensive short term care for up to six weeks with integrated health and social care support.

·         The Integrated Neighbourhood Team, which included the District Nurses, worked alongside staff from social care and GP Practices to offer better continuity of care for patients in the community.

·         Rutland and Leicestershire were one of the accelerated sites of the Ageing Well Programme looking at different models to optimise care, including how patients accessed care, how care was dispatched and ensuring rapid reablement services for patients within 48 hours of leaving hospital.

·         There were 25 primary care networks across Leicester, Leicestershire and Rutland (LLR) and the 8 community hubs that sat above these each managed between 3 and 5 of these networks.

·         The East North Hub was based at Melton Hospital but had a satellite base at Rutland Memorial Hospital.

·         Although the Primary Care Networks (PCN) were consolidated into hubs they were still close enough to give a timely response whilst at the same time maximizing the effectiveness of resource.

·         Clinics operated locally in Rutland at the Rutland Memorial Hospital.

·         The new structure only came into place on 1 December 2019 so it was still very early days in which to assess the impact of the changes. However, although there was only 1 full month of hospital data it did show that there had been a dip in admissions which was very encouraging.

·         A workshop would soon be taking place to encourage further interfacing between the Community Health services team and the Rutland Care team.

·         The redesign was about giving the right care in the right setting, looking after people where they needed to be, and reducing hospital admissions.

·         Longer term needs would still be looked after by district nurse services but as there were now more staff, patients would continue to receive care from the same team they had been used to.

·         Councillor Powell asked what difference the reorganisation would make for the patient and how the outcomes were going to be measured.

·         As care would now be organised collectively and jointly throughout their care needs journey, patients could be confident that they were receiving the best care and that they would be getting a quicker response time.

·         The improved service could now provide 7 day therapy and allowed for more patient contact. Waiting times were shorter and this had been evidenced to improve recovery.

·         Readmissions were now being measured to check the effectiveness and quality of community care. From April, in a further attempt to prevent readmissions, more capacity would be put into the service so that there could be a 2 hour response time. GP practices would also be responsive to a situation and liaise more with Community Services.

·         In partnership with Healthwatch, work would be starting on measuring patients’ experience of integrated care.

·         A further report would be bought back to the Committee later in the year to review the outcomes of the new system.

·         Councillor Harvey asked whether patients could receive an am or pm slot rather than having to wait all day and not being able to call until after the 7pm deadline if the nurse had not turned up. Ms Dewar clarified that no-one needed to wait until 7pm and could call the single point of access at any time to get an update.

·         The Service had struggled with missed visits because of capacity issues. LPT had been the first to use an IT system that allowed the care plans of patients to be read which meant that coordinators could understand the nurse skill set required and the availability of staff. This had reduced record keeping and travel time, increased patient contact time and almost eliminated missed visits.

·         Although there had been significant improvements in reliability the service was not at the point where it could give patients a specified time slot, unless it was for a clinical need. Different types of software were being trialled to see if an enhanced service could be provided, for example, a text to say that you were the next visit.

·         Most patients were house bound but for those who were not, an increased number of clinic times would be offered in order to give more freedom to patients.

·         If it was detected that something was not quite working, staff would come together to discuss it and address it. Local staff in the local hubs had input into the service delivery.

·         The service was informed of any Rutland residents that went to Peterborough hospital and needed care on discharge.

·         The redesign of mycare would improve the communication between the hospital and the families of patients receiving end of life care.