Purpose

Proposed decision:
 
Approve the expansion of the Kent
Enablement at Home Service and support activity transfers to enable
the safe decommissioning of the Discharge to Assess Service and
delegate authority to the Corporate Director Adult Social Care and
Health to take other relevant actions, including but not limited to
finalising the terms of and entering into required contracts or
other legal agreements, as necessary to implement the
decision.
 

Reason for the Decision:

 
It is the ambition of Kent County Council
(KCC) for the people in Kent to have home-based care and support
services, in line with Home First principles and KCC’s Making
a Difference Every Day Adult Social Care Strategy.

 
Discharge to Assess Services enable the council to deliver
towards this ambition. The pathway relates to people being
discharged from hospital with home-based support; all people
needing such support should be offered reablement and
rehabilitation and, where necessary, time for assessment and future
care planning. This includes people whose package of care is being
restarted after lapsing during their hospital stay.

 
The
Discharge to Assess service supports people who need ongoing care
and support.  It is essential in
ensuring people recover at home following discharge from hospital
and are supported until further assessment can be undertaken if
required. It alleviates blockages in patient flow through the
system and prevents unnecessary delayed discharges; as such, it is
essential that any new model of service delivery adequately
supports both the process and the person.

 
The
Discharge to Assess service contract was commissioned by KCC and
forms part of Discharge Services, for people discharged from
hospital who need support to recover at home. Across Kent, there
are a few services that align with the pathway, commissioned by NHS
Kent and Medway and other health partners.

 
In
December 2023, the Discharge to Assess service was overspent
against the KCC budget. A decision was made to extend the current
contract by nine months, to 30 September 2024, to allow time for an
alternative model to be agreed and mobilised.

 
A new
model has now been agreed between KCC and the Integrated Care Board
(ICB). Time is needed to implement this. The new model will provide
an integrated enablement and rehabilitation offer. The new proposed
model will build capacity to create one simpler pathway and will
help people in hospital return home faster whilst supporting
recovery and retaining independence. The service will deliver
reablement, personal care and support nutrition, while also
monitoring the person’s condition. They will also contribute
to an overall plan of care in their own home. The new team will
work in a therapeutic way with oversight from therapists the aim
being to assess the long-term care needs at home.

 
The new
model will differ from the current offer of a 7-14 day support
period, to an offer of up to six weeks. This will lead to an
improvement in outcomes anticipated by moving this service in
house, as there will be more continuity of provision for people on
their discharge from hospital.
It is
proposed that the activity from the Discharge to Assess Service
will transfer over to KEAH in a phased way to allow recruitment of
additional staff.  Recruitment will
commence in February 2024. 

 
The
recruitment schedule for Kent Enablement at Home (KEaH)Service
assumes no staff will transfer over from the current Discharge to
Assess provider.

 
The
proposed decision supports Priority 4 of Framing Kent’s
Future – New Models of Care and Support and objective 2 of
Securing Kent’s Future in delivering savings from identified
opportunity areas to set a sustainable 2024/25 budget and
MTFP.
 

Other options considered and discarded:

 

Undertake a Competitive Tender – Co-design a
completely new service with experts by experience.
This
will take time, circa 12 to 18 months. The current service is
over-spent against the budget and is likely to continue to be so
for the duration of any service re-design. This will impact on the
council’s financial deficit. KEaH already contribute to the
Discharge to Assess model.  Across Kent,
there are a few services that align with the Discharge to Assess
pathway. This option will not address the disparate approach to the
Discharge to Assess pathway. Commissioners are looking for a fully
integrated enablement and rehabilitation offer and a simpler
pathway that is easier for prescribers and people who use
it.
 

Current Provider - Direct Award a new contract to
the incumbent provider.
The
incumbent service is over-spent against the budget and costs are
likely to continue to increase. This service is financially
unsustainable for the future.
 
 

Decision

Decision:
As Cabinet Member for Adult Social Care and
Public Health, I agree to:
a) APPROVE the expansion of the Kent
Enablement at Home Service and support activity transfers to enable
the safe decommissioning the Discharge to Assess Service; and
b) DELEGATE authority to the Corporate
Director Adult Social Care and Health to take other relevant
actions, including but not limited to finalising the terms of and
entering into required contracts or other legal agreements, as
necessary to implement the decision.