Verbal update from Will Blandamer, Executive Director Health and Adult Care, Adrian Crook, Director of Community Commissioning and Councillor Tariq Cabinet Member for Health and Wellbeing.
Minutes:
Will Blandamer, Executive Director, Health and Adult Care provided a verbal update on the operation of the urgent care system over the recent winter period. The Committee is sited on the current pressures which include, ambulance waiting times, access to emergency services, and recognising that the number of NHS patients across the country declared critical incidents. As background, Bury will have further information provided in the March Health Scrutiny, however, the operation and transformation of our urgent care system is overseen by an urgent care Board Chaired by Dr Kiran Patel with all partners attending. In addition operationally, there is a daily system wide bronze command meeting at 8:30am and all relevant agencies and departments are connected to this.
Overall Bury’s position as viewed by the emergency department and colleagues from the Northern Care Alliance there has been a continued reduction of levels of attendances of admissions at Fairfield General Hospital compared to historic trends which is believed to be attributed to the operation of neighbourhood team working, urgent treatment centre at the hospital and frailty arrangements offering same day emergency care. This demonstrated our attendance avoidance schemes are working well, however, at times Fairfield General Hospital were stretched and resulted in beds on corridors and ambulances waiting outside however, emergency beds were planned and used. Ambulance turn-around times at Fairfield General Hospital are consistently good and are some of the best in Greater Manchester as is colleagues tremendous effort in the emergency department at Fairfield on the percentage waiting in Accident and Emergency.
There is a current focus on the no reason to reside numbers or those who are medically fit in hospital and are waiting discharge. We have a relatively good average length of stay and have been able to move patients along appropriately and quickly, but there is still more work to be done.
Whilst there has been and continues to be challenges Will Blandamer was pleased to report that Fairfield General Hospital was never at an opal 4 level (agreed emergency level) over the Christmas period.
Bury continues to work with Greater Manchester to support demand and Will wished to thank the work of the Northern Care Alliance have done in the Emergency Department and across the Hospital to support the quality of the services available. In Bury the greatest pressures were felt across the community, and specifically in primary care. To mitigate the worst effect of this we stood up an acute visiting service working across both groups of primary networks to provide additional support to colleagues and a paediatric respiratory clinic was also stood up seeing up to 90 patients a day and has more recently been extended to all patients. Bury also accessed some Greater Manchester wide surge monies to increase primary care capacity in the Borough.
Finally Will Blandamer wanted to recognise that Fairfield Hospital is not the only Hospital that supports Bury residents, we have connections with North Manchester and Manchester MFT and work with them to discharge to Bury appropriately.
Adrian Crook, Director of Adult Social Care provided an overview of the current pressures in his service. The system as a whole including social care remains very pressured and demand is extremely hight, especially to support discharges and workforce is not in abundance. We are an integrated care partnership which means the NHS and its partners are working with the Council. We have more than doubled the size of our step-down capacity which is our home care provision. We have built recovery focused services to try and get people as rehabilitated as possible and we now have 120 recovery-based beds as opposed to previously having 60 one year earlier. We had previously 70 people support on our rehabilitation care at home which is now over 100 people. Our rapid response unit is now seeing 370 people a month where previously this was around 50. Despite this, admissions to hospital are lower however the needs mean that they are staying longer. The Government has announced 500 million pounds in November 2022 300 of this will go to local NHS systems and 200 to the Council which equates to 1.9 million for Bury. From this we bought more recovery beds, recovery home care and we expect around 300 additional people to benefit from that care between now and the end of March 2023. In addition, we have enhanced primary care which is under huge pressure, in November 2021 they did 65,000 appointments whereas November 2022 they did 8500 appointments. We have invested in the acute visiting service who visits people who are housebound to try and keep them well and stop them needing hospitals. We have also partnered with Oldham Hospital to do same day emergency care for older adults.
Adrian Crook advised that more details on what he has updated on will go to the Health and Wellbeing Board on the 26th January 2023 and this can be circulated to Committee members and the member of the public in attendance.
Councillor Tariq, Cabinet Member for Health and Wellbeing wished to highlight the funding around discharge. On the 17th November members will be aware that the government announced a 500 million pound discharge fund to be spent on patient charge and free up hospital beds. Of this, 300 million pounds was allocated to integrated care boards, so in our case that is NHS Greater Manchester and 200 million pounds was allocated to local authorities. We were allocated 1.9 million pounds which needs to be spent by the end of March 2023 which also has conditions from the department of Health and Social Care and specific around this fund is that it is to be held in a pooled budget and must be agreed by the Health and Care Partners and signed off by the Health and Wellbeing Board. Councillor Tariq highlighted that he felt care workers need a pay boost and a long term fully funded plan by the government, urgent national attention on this matter to ensure social care is sustainable moving forward, support for unpaid carers as we have an aging population and workforce challenges to be addressed. Councillor Tairq wished to applaud social care workers for the work they do to support vulnerable people.
Councillor Birchmore asked who the same day discharge is aimed at. In response Will Blandamer confirmed this is about where appropriate, supporting older residents to not be admitted to hospitals by using other support instead.
Councillor Moss asked if our links to Manchester, with North Manchester moving into another trust would be affected. Will Blandamer assured member the next item on service reconfiguration will pick up the relationships with different hospitals and Bury residents.
Councillor Hayes asked for clarity on where the 120 recovery beds are based. Adrian Crook, Director of Adult Social Care advised the beds are in a care home, but the care home has staffing and therapy inputs that are focused on people recovering. We buy them in blocks and theses are all over and have doubled recently. In addition, we do also do care in hospitals and people’s home.
Councillor Walsh questioned the average waiting time for discharge from hospital to intermediate care support. In response Adrian Crook advised that depending on the level of care needed the wait increases, if you need no support, it’s the same day, if you need a reablement package its 1-3 days, if its to a care home bed 3-5 days this figure does change depending on demand and flow, but these are the average. However, if a person requires a nursing home provision that deals with cases such as dementia, then sadly it is longer.
Councillor Harris questioned the process for the reablement team and Salford Hospital discharge. Adrian Crook did advise more work needs to be done with Salford to avoid cases needing to be referred through Salford Social Services then to Bury.
Discussions took place regarding the placement of the recovery beds. Members were advised that existing space in care homes have been bought to use as rehabilitation beds.
In conclusion Councillor Tariq Cabinet Member thanked the Northern Care Alliance for their dedicated and hard work over the winter period.
Councillor FitzGerald thanked officers for their contribution to the meeting.