Council and councillors

A discussion on the future of Community Healthcare in Rutland to be introduced by the Chair.

The Chair of the Board introduced the discussion on the future of community health care in Rutland and gave a presentation (appended to the minutes) which outlined the current situation, how that position was arrived at, and next steps to be taken. The Chair stated that the slides were his personal views having being a Councillor for 10 years and having chaired the Board for 2 years.

During the discussion the following points were noted:

·         John Morley, Director for Adult Social Services and Health asserted that there had been some tremendous work going on and that there was much to build on going forward.  The Council staff and health colleagues were passionate about improving health care in Rutland and work had been focused on prevention, integration and people living at home independently.

·         Leicestershire Partnership Trust (LPT) and RCC had jointly funded a manager to oversee an integrated team of RCC social workers and LPT practitioners, who were based at the Rutland Memorial Hospital in Oakham and who worked together to get people out of hospital and safely back at home. This team moved Rutland from 134^th to 1^st in the country in this field, and this had been maintained during the crisis. The number of people going into care homes during the Covid crisis had fallen by 80% so the team worked with ever increasing numbers of patients to help them stay safely in their homes.

·         The Rutland Primary Care Network (PCN) was formed in 2019 and worked together so that all patients regardless of which surgery they attended, got a similar experience. A unique experience in Rutland was the work of the RISE team which acted as a bridge between primary care and social care and was an excellent example of good integration. The RISE Team had worked to identify and follow-up with patients who may not have been on a national shielding list but who the GPs had concerns about. The team had also worked with the GP practices to co-ordinate vaccinations and Dr. Fox was able to report that by tomorrow (13^th January) all care home residents would have been vaccinated.

·         The PCN’s vision was to bring in more patients, volunteers and voluntary organisations to further co-ordinate and integrate services. Patient groups already existed and together with the input from the Rutland Health and Social Care Policy Consortium there was already a very clear and consistent steer that the PCN hoped to build on.

·         Concerns were expressed that those with the greatest need were often those whose voice did not get heard. John Morley pointed out the importance of capturing social care as well as health needs and felt that it was important that one voice did not eclipse the other. Dr Underwood from Healthwatch Rutland said they were happy to help out with reaching this group and build on their existing links as they had done a lot of recent engagement with those groups that were hard to reach; people with cognitive impairment, disabilities and the aged. They would also be particularly mindful of reaching residents that were digitally excluded.

·         When looking at the future of community healthcare in Rutland, Dr Fox felt that what was needed was a clear vision of what health and social care outcomes were wanted for Rutland as well as what people said they wanted. In addition a prevention focus, for both mental and physical issues, needed to run through everything that was put in place; asking what could people do for themselves and how they could be helped to achieve this. There needed to be a clear vision of the outcomes rather than, for example, just the mechanics of where a clinic was located. Councillor Walters agreed that the infrastructure would be a consequence of the objectives identified.

·         Many Rutlanders not involved in health or social care, for example men who were reluctant to ever visit a doctor, may not have thought that a consultation on health applied to them but it was important that their views were also captured. Although this approach might have sat more within the vision of the Future Rutland Conversation that recently went before Council, Councillor Harvey felt that time for an open, organic conversation should be allowed before solutions were looked for.

·         Councillor Walters suggested that the Future Rutland Conversation project would be more strategic and that the Board would want to go into more detail.

·         Healthwatch had undertaken some recent work that showed that the three most consistent concerns expressed by residents were; issues accessing GP surgeries either by telephone or getting an appointment, transport difficulties in accessing healthcare, and wanting care that was closer to home.

·         As an example of where efforts should be focussed, Dr Fox took the issue of not being able to get through on the phone to the GP practices. Many different approaches had been tried; more phone lines, more people answering them, different formats etc but none had solved the problem. Therefore, instead of simply putting in yet another layer of service there needed to be a better understanding of why people were calling in, and a move towards greater prevention to make sure that the only people calling in were those who had a medical need that needed a GP response.

·         Ms Dewar felt that more creative ways should be considered when engaging with people so that a much more meaningful response could be given. This could include asking them to consider different scenarios and what they would want to do if they ever found themselves in a particular situation.

·         In terms of allocating responsibility for roles John Morley spoke about the Integrated Development Group (IDG) which had recently been set up and which sat underneath, and answered to, the Health and Wellbeing Board. The group looked at the delivery of services and achieving better integration. Around the IDG there was the CCG, Social Care, the PCN, and LPT all of whom were in a position to make decisions to improve integration based on what the IDG proposed.

·         In response to a question on whether ultimately it was the CCG who were responsible for the health care of residents who were registered with a Rutland GP practice, Fay Bayliss, Deputy Director of Integration for the CCGs stated that it was the CCG’s absolute ambition to deliver a Rutland Plan collectively and that they were committed to having consensus about what was important and how to shape the Plan. In addition the Plan should go beyond even health and social care to look at wider determinants such as housing and education. Ms Bayliss wished to move away from talking about who had the final say and to stress that it was all about collaboration.

·         Due to Covid pressures no timetable had been put in place yet but Ms Bayliss stressed that once the priorities were identified, important milestones would be put in place and progress monitored against them. It was a shared intention to continue to have conversations and keep the momentum going so that information on where the group had got to would be shared.

·         Dr Underwood suggested that someone, of the group’s choosing, sat on the IDG to make sure that the patient’s voice was represented. Dr Fox felt that Healthwatch was ideally placed to do this as their remit was to find and amplify the patient’s voice. Ms Bayliss supported this and also suggested that, as was the practice in other integration groups, the option to have a lay member as Chair of the group was also considered.

·         Councillor Walters asked how the residents who lived in Rutland, but were registered at a practice in Lincolnshire, fitted into this plan and whether neighbouring CCGs that crossed borders worked together.

·         Although the PCN’s borders were different from RCC, the CCGs, and other organisations, Dr Fox reassured board members that the Rutland PCN worked with other PCNs across borders and in particular worked very closely with the Stamford Primary Care Network. Ms Bayliss also commented that the LLR CCGs had recognised the challenges of out of area patients for example, issues regarding mental health services and looked after children, and so were absolutely sighted on working across county borders and had developed a specific role to work on this.

·         Mr Hindson felt that Rutland was a model example of integrated services that was highly collaborative, and referenced the Strategic Partnership Board work being done on trauma and its long term impact.

·         Inspector Danvers commented that any new health plans affected the Police operationally as often if patients could not get through to the medical services they rang the Police. There was a particular challenge around the out of hours service and directing people to access the relevant medical and mental health services.

AGREED ACTIONS:

1.    Dr Fox from the PCN, John Morley from RCC, Dr Underwood from Healthwatch and the Chair, Councillor Walters, would work together on a communication and engagement strategy that would capture the widest possible range of views from residents across the County, including those registered at a practice out of county, and report back to the Board.

2.    A representative from Healthwatch would be appointed to the Integrated Development Group (IDG) to represent the public voice.

3.    The IDG would drive work forward and would update the Board on a broad timeline once priorities had been identified.