The Leicester, Leicestershire and Rutland Clinical Commissioning Groups (CCGs) submit a report describing the Community Services Redesign project to date, setting out the future model that the CCGs will commission, describing what impact that will have on the care people receive and what that will mean to other parts of the health and care system in Leicester, Leicestershire and Rutland, as well as the next steps in the CCGs’ work on community health services. The Commission is recommended to consider the report and comment as appropriate.
The Leicester, Leicestershire and Rutland Clinical Commissioning Groups (CCGs) submitted a report describing the Community Services Redesign project to date. The report set out the future model that the CCGs would commission, describing what impact that would have on the care people received and what that would mean to other parts of the health and care system in Leicester, Leicestershire and Rutland. The report also outlined the next steps in the CCGs’ work on community health services.
Tamsin Hooton, CCG Director Lead for Community Services Redesign, introduced the report, making the following points:
· Adult community health services in Leicester, Leicestershire and Rutland were being reviewed as they had not been commissioned to work with other health care providers in a way that was consistent with how health care would be provided in the future;
· Some of the perceived deficits it was hoped to address included services for people in crisis and the capacity of community nursing services;
· A new model of care had been developed, based on feedback, which showed that a lot of services were not seen as being joined up;
· A new model of home-based care had been designed, comprising of three parts: neighbourhood community nursing and therapy services, Home First services and Locality Decision units;
· As part of this, investment was being made in greater GP capacity through Primary Care Networks;
· The key change in the first phase of introducing the new model would be the reorganisation of teams within the Leicestershire Partnership NHS Trust (LPT) by the end of 2019 and increasing capacity through to early 2020;
· A system transformation working group had been established and included various partners, such as University Hospitals of Leicester NHS Trust (UHL); and
· The success of the redesign would be assessed by a steering group comprised of various partners looking at the impact that the redesign had on people’s experiences, including whether they were able to stay at home, and the impact on community hospitals.
Rachel Bilsborough, Divisional Director Community Health with LPT, advised the Commission that the redesign was being co-produced by health care professionals, Healthwatch and patients, carers and users. Service users would be the same people as previously and they would have the same needs, but the care received would be changing under the redesign. The LPT Board would consider the proposals on 30 August 2019.
Members noted that the service already had a strong relationship with the City Council and this would be built on through the redesign, but Council staff would remain working for the Council. Ms Hooton also noted that the City Council’s Adult Social Care service had been very engaged in the redesign of Community Services, helping with things such as the testing of new models.
The Commission noted that a significant workforce challenge would be in the number of therapy staff employed, as this currently was lower than national averages. In addition, integrating therapy services and acute social care could be problematic, as people were being discharged to go home for assessment to be undertaken there, but therapy services had not yet moved to that model.
Retention of staff was a problem in some parts of the city. This also was affected by the national shortage of Band 5 registered nurses and problems regarding the supply of newly qualified nurses, the latter relating at least in part to changes in the number of training places available and the availability of bursaries. Suggestions of how people could be incentivised to work in the city, or assistance with doing this, therefore would be welcome.
It was noted that District Nurses often had problems parking near homes they were visiting. This could be problematic, as they often had to carry equipment in to the homes. The Commission noted that a scheme allowing parking in restricted areas for people in this situation had been tried previously, but had not been successful. However, it was suggested that discussions on possible options for such a scheme could be held.
Members noted that consultancy support had been provided by Deloitte. This had been sourced by NHS England and offered as a support package to work on some areas of the service redesign. Funding also was provided by NHS England. Deloitte’s involvement in this work had now ended.
The Commission recognised that this was an evolving service model, but queried how it would be assessed whether the new service design was successful. In reply, Mr Sacks explained that a set of outcomes had been identified, but some of these were reliant on other organisations, such as social care performance indicators.
1) That the Scrutiny Policy Officer be asked to liaise with members of this Commission to establish a small “task and finish” group to consider how parking problems being experienced by Community Services providers can be addressed; and
2) That the Leicester, Leicestershire and Rutland Clinical Commissioning Groups be asked to report back to this Commission in one year on how the redesigned Community Services are evolving.