Feb 2017 @ The Bridge Centre

1. Voluntary Sector
Networking Event
8 February 2017
Bridget Cameron
Assistant Director – Commissioning,
Stoke-on-Trent City Council

2. Outline of the event
• Welcome and housekeeping
• Guest speakers - overview of service delivery,
patient experience and new initiatives
• Opportunity to network
• Any questions - please complete the question slip
• Round table discussions
• Summary of any questions and closing comments

3. Why are we here?
• Challenges faced across the local health and social care
economy
• Ageing population - multiple co-morbidities being the norm rather
than the exception
• Availability of care provision is a local and national struggle
• We need alternative ways to meet the needs of people with an
assessed need and those who need early help and support

4. Funding Opportunity
Additional funding has been committed through
the unique partnership arrangements with:
• University Hospital North Midlands (UHNM)
• NHS Stoke-on-Trent Clinical Commissioning
Group (CCG)
• Stoke-on-Trent City Council

5. Purpose
• We recognise the valuable support which the voluntary
sector provides to individuals in the city and need your
help and support to continue to work collaboratively
• New opportunities to work together innovatively and
creatively; two areas which we want to really focus on
are:
• Preventing hospital admission
• Supporting timely discharge from hospital

6. Current position
• Non planned admissions to hospital for the over 65
year olds accounted for 13,700 admissions,
equating to 81,000 bed days at cost of £29.4
million (2015/16 full year)
• Annually the City Council deals with over 3,000
hospital based social care assessment referrals
(equating to 60 per week)

7. Current position
• During the second half of 2016 the number of people affected
by a delayed discharge doubled to 100 per month
• During 2016 delayed discharges were attributed as follows:
• 57% - NHS
• 26% - Social Care
• 16% - both NHS/Social Care
• The biggest specific delay was awaiting the right care package
and home set up (attributable to NHS and Social Care)

8. Enablement and
Discharge to Assess
Ian Clarke – Age Well
Commissioning Manager
Age Well Commissioning

9. Care and support provided by the
City Council
• Increased enablement/long term support
provided by the City Council to support the
independent sector and meet unmet demand.
• Recruitment of 216 front line staff without
destabilising other parts of the system to
provide approximately 3,500 hours of support
per week.

10. Care and support provided by the
City Council
• Work with the Voluntary and Community sector
to maximise individuals networks to provide a
holistic offer to meet individual need.
• Enable introduction of Discharge to Assess and
create new capacity into the system.

11. Discharge to Assess
Aligned with community health services in Stoke-on-Trent (Palliative
Care and Intermediate Care) to:
1. Offer Enablement approach to people going home
2. Maximise staffing resource and skill’s available
3. Multi-Disciplinary Assessments outside of the hospital
4. Duplication and cross referrals reduced
5. Streamline home and bed based pathways – three Localities
(Leek/Moorlands, Newcastle and Stoke-on-Trent)
6. Early identification of long term support options
7. Provide admission avoidance

12. Domiciliary Care
Scott MacDonald –Commissioning
Manager
Age Well Commissioning
Sally Woolliscroft – Acting Senior
Commissioning Officer

13. Domiciliary Care
Retender and Redesign
2017
Contact email:
“Domiciliary Care – Voluntary Sector
Consultation” to
electronic.monitoring@stoke.gov.uk

14. Hospital Discharge
Paul Astley – Project Officer
Feb 2017

15. Context –
Much Change in the Local Health Economy
• NHS Five Year Forward View;
• Proposed Sustainable Transformation Plan;
• Locally, proposes a community based model focussing on
holistic (whole person) care including mental health;
• Patients increasingly treated at home rather than in
hospital;
• Patients and staff as equal partners in care;
• Increased community urgent care.
• My Care My Way (care closer to home);
• Pressures on social care nationally;
• Aging population.

16. Our Work related to Hospital Discharge
Projects –
• Hospital Discharge Project (2015);
• Investigated the experiences of frail elderly whilst being discharged;
• Big Conversation Events – (STP);
• Workshops with the public exploring ways to implement STP’s’
• Community Hospital Beds Report;
• Comments from the public about what they perceive as risks and benefits.

17. Frail Elderly Discharge (2015)
• 29% of respondents said they didn’t find it easy to talk to doctors and nurses
about their care;
• 26.9% of respondents disagreed that staff spoke with them or their carer to
discuss what would happen when they got home;
• 28.8% say they didn’t get clear instructions about their medication before
they left hospital;
• 15% reported not knowing what would help they would receive when they got
home;
• 5.5% reported not having support from friends and family when they got
home.
Study completed in partnership with the Royal Stoke University Hospital.

18. Frail Elderly Discharge – Analysis
• Encouraging Patient Participation
• Use of Advocates;
• Use of technologies such as ‘flo’- Increasing confidence in IT?
• Understand the health literacy levels of patients;
• Check understanding of patients and carers;
• Social Prescribing – empowering patients;
• Training for hospital staff;
• Information hubs for things like LTC’s & Self Care.
“How can care be patient centred
without patient participation?”

19. Com Hosp Beds Survey - Story
“We thought that the care arranged for my father was more than adequate. I
needed a break. We went on a three night holiday. Two hours after arriving we
had a call from Care Call to say that my father needed support. We were 93
miles away. It was a Friday night and therefore Care Call contacted the over-
stretched ambulance service to attend and help him back into his bed. This was
fine until he needed to use the toilet again later in the night.
The carers attended and sorted out the issue on Saturday. Between Friday night
and Saturday 10.00pm I had made or received 34 phone calls. There was no-one
available to add an extra visit at 10.00pm. The emergency duty team could not
locate any help. I phoned the care company who I was paying privately - they
couldn't send anyone because they needed authorisation. The Emergency Duty
Team finally said they had a solution and I was to phone the District Nurse
administrator who very kindly said they 'would do me a favour' and send out two
district nurses to put him back into bed. They were unable to get him into bed,
sent for the ambulance and he was taken to A and E. He spent one night in A & E
followed by two nights in Leek. We cut our holiday short. On Tuesday he was
sent home - no improved care facilities and the same pattern followed one day
later . . . . . . . ”

20. Com Hosp Beds Survey - Story
Services Involved
-----------
Informal Carer/Family (Mediator);
Dom Care Workers;
Care Call;
Ambulance Service;
Emergency Duty Team;
District Nurse Administrator;
District Nurses;
Accident & Emergency;
Community Hospitals.
Where does the VCSE Sector fit within this?

21. Finally . . .
Essential Reading . . .
• My Care My Way;
• http://www.northstaffsccg.nhs.uk/my-care-my-way
• Sustainable Transformation Plans
• http://www.twbstaffsandstoke.org.uk/
• Stoke-on-Trent Clinical Commissioning Group - Frail Elderly Care Strategy
• http://www.stokeccg.nhs.uk/strategies
• Big Conversation Events Report – (STP);
• http://www.healthwatchstokeontrent.co.uk/wp-content/uploads/2016/12/Big-Conversation-
Events-Report-FINAL.pdf
• Community Hospital Beds Report;
• Forthcoming - Comments from the public about what they perceive as risks and benefits.

22. Voluntary Sector
Grant Funding
Rebecca Bowley
Strategic Manager – Age Well
Commissioning
Stacy Sharman, Local Matters
Team Manager

23. Prevent hospital admission
/ support hospital
discharge
Prevent the isolation of
older people & people with
disabilities
Funding Purpose
New Voluntary Sector Grant Funding
Programme
Existing Small Grants Scheme
(£450)
Proposed – Community Investment Fund
Supporting Families
Thriving Places
Strong Communities

24. New Voluntary Sector Grant Funding Programme
2017 - 2018
• Partnership between LA, CCG and UHNM.
• Specific aim of supporting admission avoidance &
timely discharge from hospital.
Scheme 1
Grants up to £10k
(Indicative pot £100k)
Scheme 2
Grants up to £100k
(Indicative pot £400k)

25. Criteria – Voluntary Sector Grant
Funding Programme
• Demonstrate how the initiative will prevent hospital admissions and/or support
timely discharge from hospital. New idea or expansion of current service.
• Describe how the initiative will be delivered - particularly interested in
collaborative and partnership approaches and 7 day services.
• Demonstrate what contribution your organisation(s) will make to the initiative e.g.
funding, staffing, transport, use of buildings.
• Describe the expected impact e.g. added value, geographical area covered,
number of people supported.
• Explain how outcomes will be measured and how the key learning from the
initiative will be shared.

26. Timescales - Voluntary Sector Grant
Funding Scheme
Activity Expected Timeframe
Launch date By end of February 17
Closing date for
submissions
31 March 17
Decisions communicated 29 April 17

27. Proposed Community Investment Fund
Fund objective Minimum and maximum
award
Maximum
funding
period
Start-up –local project that will lead to
a lasting legacy in the community
£2,000 - £10,000
Plus training & support
from the Local Matters
Team to develop the idea
1 year
Large project –larger scale project
which has the potential to deliver
significant improvements in an area
and reduce demand on council services
£10,000 - £50,000 3 years

28. Proposed Themes
Supporting families to fulfil their
potential:
Play & learn activities for families with
children under 5
Thriving places & communities: Investing in strong, thriving
communities & sustainable local
economies
Strong communities where people
live their lives well:
Building strong community networks &
prevent loneliness

29. Contact Details
rebecca.bowley@stoke.gov.uk
stacy.sharman@stoke.gov.uk