Joint Report of the Director of Health and Care and the Accountable Officer, Staffordshire and Stoke on Trent CCG’s.
The Committee considered a joint report of the Director of Health and Care and the Accountable Officer, Staffordshire Clinical Commissioning Groups (CCGs).
The Director of Health and Care, Mr R Harling and the Senior Commissioning Manager for Staffordshire CCGs, Ms Gemma Smith attended the meeting to present the report and answer questions.
The Director of Health and Care summarised the report and informed the Committee that there had been both a national and local move to get people out of hospital and cared for in their own homes or in their local communities. There was national best practise on how this could be achieved and ‘Discharge to Assess’ was one of the models of care suggested. It was explained that the model required the following services and functions:
· A ‘Track and Triage’ service to accept complex referrals from the wards, determine whether they need ongoing reablement and support, determine the most appropriate setting [home or bed], and make the necessary arrangements to put interim care in place.
· Home First services to providereablement and support at home. These include intermediate care, palliative care,night sitting and reablement.
· Community beds for people who are unable to return home for interim care. These require a Trusted Assessor function to enable timely transfers, as well as GP and rehabilitation cover to ensure active therapy and avoid deconditioning.
· Active management of Home First services and community beds to ensure that people move on.
The Discharge to Assess model had been working in the North of the County for approximately 12 months and had seen reductions of delayed discharges of 50 %. This model of care now needed to be rolled out to the rest of the County. Critical to the rolling out was the development of the track and triage service and the CCG’s have to commission an additional 4200 hours per week of reablement Home First services.
Discharge to Assess to support Queens and Good Hope hospitals remained under development and there were ongoing issues with Delayed Transfers of Care (DTOC). The position was however, was getting better and it was hoped that the following developments would see significant improvement:
· Home First,
· commissioned hours increasing
· an agreement of funding and,
· the development of standard opening procedures for transfer of people from Queens and Good Hope into Community beds at Robert Peel and Samuel Johnson hospitals.
Discharge to Assess to support County Hospital was close to maturity. Support for Walsall Manor, New Cross and Russell’s Hall hospitals remained under development. Improvements to date include the County Council commissioning an additional 732 hours reablement Home First services per week, and New Cross hospital using non-recurrent funding form the Better Care Fund (BCF). There had also been a modernisation of the Track and Triage service to manage Community beds in care homes in the South of the County.
The Director of Health and Care informed the Committee that there was still a delay in getting people home from New Cross and Cannock Hospital. The Senior Commissioning Manager explained that roll out of improved services would continue to take place prior to Winter 2019 and joint commissioning of services between the CCGs and Social Care should improve discharge rates.
A Member of the Committee asked what the targets were for the South of the County; were they SMART and how would they be monitored. They also asked a question on the Disabled Facilities Grants and if they were available from three sources; what is being done to ensure that these were being coordinated and the funds spent wisely. In response, it was explained that there were targets set through the commissioning process e.g. a specific number of beds available in the South. It was then for the providers to supply these and have the support services such as staff to run them. Assurance was given that targets and contracts were closely monitored. Disabled Facilities Grants was a priority for the partnerships.
The outcomes and savings from the Discharge to Assess model were requested. It was explained that the data collected may not be in the same as previously so may not provide a reliable comparison, and that it is difficult to make accurate estimates of savings.
A question was asked on the level of preparation before elective surgery to plan for an early discharge post surgery. In response, the Committee was informed that there was early discharge planning, but more can be done and organisations where learning all the time.
Several questions were asked on the recruitment and retention of care workers. It was explained that providers try to incentivise with training packages, wages and retention bonuses, the Council could encourage and facilitate these but could not offer them directly because they are not Council employees. The Sustainability Transformation Plan (STP) was looking at ways to improve recruitment and retention in the longer term, including working with schools and colleges for future planning. Further questions were asked on the encouragement given to young people to become the care provision.
The quality of care homes was questioned, particularly with the increase in demand for good quality beds that may be commissioned by the CCG following the North Staffordshire consultation proposals: how could a higher quality of care and appropriate capacity and levels of staffing be assured? The Committee was reminded that the outcomes of the consultation could not be pre-empted, but work was already underway to improve standards. The procurement and letting of contracts would include long term monitoring and quality assurance. The Chairman reminded the Committee that the Joint Staffordshire and Stoke on Trent Health Scrutiny Committee was due to meet on the 13 February and the 11 March 2019.
A Member asked how aspirational the 80/20 (80% of discharges for acute hospitals which should be simple and timely and 20% complex and requiring further support) and 70/30 (70% should receive reablement and support at home with fewer than 30% requiring a community bed) targets were and how close we were to meeting these. In response to the question, it was explained that the 80/20 and 70/30 were based on current practice and aspiration. Royal Stoke was running at 82/18 and approximately 70/30 with the County Hospital having higher proportions of complex and bed based discharges. The figures reflect local demographics and frailty as well as clinical practice and risk management.
Home First services were having a positive effect on delayed discharge figures in the South of the County. Members requested information on the numbers of admissions to each of the out of county hospitals from the South of the County for both planned and urgent care.
RESOLVED: That the following information be requested:
a) The outcomes and savings from Discharge to Assess.
b) Numbers of admissions to each of the out of county hospitals from the South of the County for both planned and urgent care, and the numbers of delayed discharges for each of the out of county hospitals.