Agenda item

Delayed Transfers of Care in Lancashire

Minutes:

The Chair welcomed Sue Lott, Head of Service Adult Social Care (Health); Emma Ince, Interim Director of Transformation and Design, NHS Chorley and South Ribble CCG and NHS Greater Preston CCG; Ailsa Brotherton, Director of Continuous Improvement; and Faith Button, Deputy Director of Operations, Lancashire Teaching Hospitals NHS Foundation Trust.

 

The report presented described improvements to hospital discharge arrangements and performance during the last year since the Health Scrutiny Committee had met in January 2018. It was noted that last winter was extremely challenging nationally for the NHS, followed by a similarly highly pressured summer period in 2018, due to the heatwave. The health and social care system was heading into the next winter season in a pressured position. However, the focus would remain on reducing delays across all Lancashire hospitals and to achieve good outcomes for Lancashire residents.

 

The report set out a number of key actions the NHS and the County Council had implemented or were developing since the January meeting of the Committee. Latest data for Lancashire (August 2018) showed that the overall level of Delayed Transfers of Care (DToC) had significantly reduced over the last 12 months, showing a 31.9% decrease overall.

 

A number of points were raised by members, a summary of which is set out below:

 

·  Concerns were raised by one councillor about the increase in delayed transfers of care across the Trusts from April 2018 to August 2018. It was reported that the increase in delays was in part due to the long heatwave over the summer months. Lancashire Teaching Hospitals had observed this trend and were working to understand the full reasons for the increase in delays to improve system resilience.

·  Lancashire Teaching Hospitals were following best practice guidance for supporting patients who were admitted on emergency pathways. Patients would now have an expected date of discharge set within 24 hours of admission. If a patient's clinical condition changed then the discharge date would be reviewed.

·  Members welcomed the introduction of the Discharge Charter for Central Lancashire.

·  It was highlighted by one councillor that concerns had been raised with them regarding patients being discharged from hospital too soon. Members sought assurance and requested data on the Trust's readmission rates in respect of this point. It was reported that readmission rates at the Trust were good and that since the introduction of the home first scheme only two patients had been readmitted.

·  It was noted that the Trust had signed up to take part in an NHS Improvement ECIST (Emergency Care Intensive Support Team) programme and had specifically asked to be partnered with Wrightington, Wigan and Leigh NHS Foundation Trust. The first visit was planned for 27 November 2018. The Committee was informed that officers would welcome the opportunity to share the learning from this programme at a future meeting of the Health Scrutiny Committee.

·  A question was asked on whether there was a specific target that the Trust was aiming for on bed occupancy. The Committee was informed that the standard as set by the Department of Health through NHS England was 3.5% of occupied hospital beds. This was to enable the safe planning for patients with complex needs. Ultimately, the aim was for zero tolerance in delayed transfers of care. It was noted that the target set by the Better Care Fund (BCF) for Lancashire was 101.8 bed days per 100k 18+ population and that this target had been exceeded. However, it was important to note that the right outcomes and experiences for patients remained a priority as well.

·  It was recognised that the increase in the Better Care Funding had made a considerable contribution to improve reducing Delayed Transfers of Care Concerns were expressed on what will happen when the funding ceases.

·  A point was also made in relation to service redesign, that NHS partners should include borough councils in the process as they also provide a significant contribution to help keep people out of hospital. It was confirmed that NHS partners will be revisiting this work and would take this point forward.

·  A request was made for information on how the demographics had changed across Lancashire on matters relating to older people and mental health.

·  Clarification was sought on what community equipment adaptations included and whether this related to Disabled Facilities Grants (DFG). It was reported that community equipment adaptations related to smaller adaptations/medical equipment and would not apply to circumstances where someone required a large Disabled Facilities Grant to refit a shower room for instance. It was confirmed a person would not remain in hospital if a large Disabled Facilities Grant such as the example provided was required.

·  It was highlighted that some patients had reported to one councillor that they had experienced lengthy discharge delays because they were waiting to receive their medication from the hospital pharmacy. A question was asked on why prescriptions could not be dispensed by a local pharmacy instead of the hospital pharmacy. It was reported that for most patients the pharmacy process was quite complex. Patient safety and governance was paramount and health professionals were required to ensure that patients were given instructions on how to use their medication whilst at hospital. If a patient left the hospital without their medication then they would be at risk. Officers acknowledged the need for improved turnaround times and confirmed that timescales were being tracked. The Trust's discharge lounge was fully staffed which enabled beds to be freed up for other patients. The hospital pharmacy also operated extended hours.

 

In considering the recommendation, an amendment was proposed by County Councillor Steve Holgate and seconded by County Councillor Azhar Ali:

 

"That the considerable improvement in the reduction of Delayed Transfers of Care across Lancashire over the past year be noted, but that the performance deteriorated since April 2018 up until August 2018."

 

On being put to the vote the amendment was lost.

 

An amendment to the recommendation was proposed by County Councillor Peter Britcliffe and seconded by County Councillor Cosima Towneley:

 

"That;

1.  The considerable improvement in the reduction of Delayed Transfers of Care across Lancashire over the past year be noted.

2.  The staff of the County council and in the NHS whose commitment and contributions to this improvement had been so significant be commended.

3.  A further update on Delayed Transfers of Care be scheduled in 12 months' time for the Health Scrutiny Committee.

 

In considering the third point, there was a consensus from the Committee that an additional update on Delayed Transfers of Care be provided in 6 months' time to the Steering Group. On being put to the vote the amendment was carried. Whereupon it was;

 

Resolved: That;

 

1.  The considerable improvement in the reduction of Delayed Transfers of Care across Lancashire over the past year be noted.

2.  The staff of the County council and in the NHS whose commitment and contributions to this improvement had been so significant be commended.

3.  A further update on Delayed Transfers of Care be scheduled in 6 months' time for the Health Scrutiny Steering Group and in 12 months' time for the Health Scrutiny Committee.

 

Supporting documents: