2018/19 Financial Position as at Month 6, September 2018
- Meeting of Commissioning Committee for Mental Health & Older People, Wednesday 28 November 2018 11.00 am (Item 4.)
Chief Financial Officer,Ms Christine Caton introduced the report and explained that in relation to the announcement of the budget, the additional funds allocated for social care was £2.577m for both Adults and Children’s services. This was in addition to Lambeth’s already allocated share of £1.5m.
The Committee heard that:
· Feedback/learning lessons from acute admissions used be put into practice packs but practices struggled to understand what they could practically do to avoid admissions. To help resolve this, focus was placed on monitoring referrals to admissions avoidance services such as Home and Enhanced Rapid Response but the CCG was looking at what else could be done to constructively support practices. The emergency admissions data did not show a volume increase but a cost increase.
· The outpatient follow up overspend was due to the Trust’s under delivery of their plans.
· About 70-80% people a month who were admitted were known to services. Many of the services were geared towards men (such as supported housing) and more focus was required on services towards women.
· The total length of bed-stay which was longer than expected. Many long-stayers had been discharged in one month which was why the report showed a high level of bed days
· The average length of stay should be about 30 days.
· There were a number of reasons why patients were staying in hospital for a lengthy period of time. Some of it was partly due to the breakdown of community offers. Some patients, for whatever reason, would not be able to return to their home environment and sometimes there were issues in relation to supported housing. Work was being done so that a patient’s individual circumstances would be monitored to ensure that something positive was happening everyday.
· A composite action plan would be put in place partly to assist the progress of those who had excessive lengths stay.
· The community offer was not at the level that it needed to be. Medicine was not necessarily a solution for all issues and effort needed to be made to address wider issues.
· Crisis care proposals needed to be outlined. A number of proposed interventions would have a significant impact as in cases of crisis, people headed to accident and emergency services.
· Complexities sometimes increased when dealing with patients who did not have mental capacity.
· There was around 15-16 people at a time who were exceeding the average length of stay.
· Healthwatch had a duty to inform and signpost service users. Part of this involved providing feedback voluntarily given to them by service users. Feedback, either positive or negative, on the Living Well Network was likely to increase as the voluntary sector across Lambeth was more aware of the Hub and was using it to refer potential service users who may be suffering from some kind of distress to the Living Well Hub. The data appeared to show people were attending the Hub when they perhaps should be going elsewhere. Monitoring of phone calls during the year appeared to show negative comments having been received. Of the 48 complaints, 7 had reported particularly poor experience as a result of being signposted to the Living Well Hub.
· The Living Well Hub had reported that if negative complaints were being received, then they needed to be informed about them.
· Housing issues need to be addressed as part of the communal working system that was in place. Some potential solutions could include having a housing officer or having housing surgeries or a job centre plus at the Hub or other appropriate areas.
· Discussions were being held with Healthwatch to have nonintrusive reporting mechanisms which would work for the service user and the service.
· SLaM were looking at detailed information on a regular basis. Lambeth was now receiving regular information on bed usage. For example, the bed manager in Lambeth would be aware of how many people she was responsible for and the people that needed access to this type of detailed data had improved in the last three months. This type of data could be extracted into future reports. Work was being done so that reports could have more detail.
That the Committee note:
1. The latest position on the Better Care Fund as at month 6 (September 2018).
2. The latest position on the aligned Mental Health budgets as at month 6 (September 2018).
3. The latest position on the aligned Older People budgets as at month 6 (September 2018).