Agenda item

(Indicative timing: 2.05pm – 2.50pm)

By way of introduction, attention was drawn to a number of areas within the Agenda Report, mainly that the NHS nationally continued to be under significant pressure as a result of the COVID-19 pandemic and in Worcestershire, the two acute hospitals were experiencing significant delays in urgent care and in ambulance hospital handover delays. 

Traditionally, Worcestershire had a high number of people admitted to long term care after a hospital stay which was not compliant with national guidance where the expectation was that 95% of people would be discharged home, with only 45% of those requiring some support.  The different discharge pathways were explained alongside some of the challenges experienced.

The level of scrutiny and activity undertaken to try to improve the situation locally was outlined, including plans to progress the recommendations made by NHS England and Improvement.  It was noted that the challenges around COVID-19 remained and some of the work had stalled at times due to the impact of COVID on staff absence. 

The Council had provided support through an Integrated Intermediate Care service, which had recently been extended as it had been proven to help with admission avoidance and also provided speedier discharge from hospital.

A further pilot project, providing an enhanced level of domiciliary care was also showing good promise.  Up to 4 discharged patients could be taken each day, discharged a day earlier than expected and have up to 4 days of reablement support at home, with an option to increase to 10 days.     

Members were invited to ask questions, with the following key points being raised:

·         In relation to the high numbers of people admitted to long term care from hospital and how the County compared to other local authorities, national data would be provided to Panel Members after the meeting

·         Individual circumstances could affect the pace of discharge, such as personal choice, a change to a care package or a wait for certain service

·         When asked how well partners were working together on discharge planning, it was reported that protocols could be improved.  The two main issues for the Council were the timely booking of patient transport and the organisation of medications to take home.  Criteria led discharge was being piloted locally, a concept which was successfully established in other areas

·         Delays due to necessary home adaptations did occur as need was not always known in advance, however, small purchases could be authorised by the Onward Care Team to avoid further delay.  Asked if a patient could go home without the required adaptation, it would depend on the individual circumstance and support available

·         In relation to ambulance hospital handover delays, the situation was not straightforward although it was suggested that some system processes could be strengthened

·         Workforce pressures throughout the health and social care system remained, despite market forces supplements being applied.  There was a particular lack of therapists which impacted on discharges

·         A Member asked whether sufficient detail was received from the hospital about patients waiting for discharge to be informed that it differed across departments.  Needs were assessed to establish what was required to keep people independent for longer

·         The Integrated Intermediate Care Team had made a significant impact on patient outcomes and improved flow through the hospital.  Adult Social Care was an integral element and a review had been carried out.  It was agreed to share the review findings with the Panel

·         Members agreed that it would like to see further data on the numbers of patients discharged with Council support to establish any trends.  In addition, a request was made that future reports include both numbers and percentages in order that Members could better understand the situation  

·         For clarity, a patient tracker provided oversight to system partners enhancing communication and discharge planning.  Although formal meetings were held twice weekly to track patient progress, daily ward rounds occurred.  The Patient Tracker was an excellent improvement as it was a live patient record that all relevant partners could access

·         The situation locally was reflected nationally, with the Health Overview and Scrutiny Committee aware of the work undertaken by Worcestershire System partners in association with national experts.  There was stronger partnership working between health and social care organisations than previously

·         Internal and external scrutiny and resource was committed to making the improvements necessary and there was a process to escalate matters if required

·         A Member compared the figures from May and June 2022 in both simple and complex discharges and commented on the change from one month to the next.  The Panel was informed that it was not unusual to see figures fluctuate from week to week.  Historically, a number of patients would be re-admitted to hospital within 90 days of discharge, however now rehabilitation was much better and social workers were not seeing huge numbers of problems once discharged

·         Neighbourhood Teams were praised for their work in admission avoidance, alongside other developments such as doubling up on care in order that someone could stay safe at home for longer.  The NHS had also introduced ‘virtual wards’ whereby equipment was taken home to record and monitor the recovery of a patient

·         It was agreed that a further update be provided at the next Meeting, 28 September 2022.