Agenda item

Representatives from Pennine Acute will report at the meeting.  Report attached.

Gill Harris, Chief Nurse, Pennine Acute NHS Trust attended the meeting to provide members of the Committee with an update in relation to concerns raised with regards to delayed discharge.  An accompanying report had been circulated to Members which provided information in relation to; the current process to manage delayed discharges the reasons for delays and the current actions that are being taken to address the issues.

The Chief Nurse reported that there are two measurable types of delayed discharge.  The first group are the Delayed Transfers of Care (these are externally monitored) DTC and the second group are those that are defined as Medically Fit for Discharge (MFFD).

Members considered the types of delays; the proportion of patients delayed across all hospital sites, the number of MFFD by site and the distribution of medical MFFD and DTC by local authority area and hospital site.

The Chief Nurse reported that the reason for the delays are multi-factorial and community and Local Authority partner organisations are working with the Trust to develop and implement solutions.

The Chief Nurse reported that at North Manchester General Hospital all staff are involved in the discharge process form acute, community and local authority as they work as an integrated team based on the same site and are line-managed on a daily basis by one Trust Manager.   

The Chief Nurse reported that it is the Trust’s aspiration to have single site discharge, a northeast sector discharge group meets regularly to discuss these issues and monitor progress.

Those present were given the opportunity to ask questions and make comments and the following points were raised:

In response to a Member’s question, the Chief Nurse reported that seven day working needs to be provided in the Acute hospital as well as Primary Care and Social Care.  The way services are commissioned, how GPs interact with the Acute and primary care sector, the role of district nursing are all issues that need to be considered.  The Chief Nurse reported that some staff that currently work within the Acute sector may need to transfer and work in the community.

With regards to communication with families of patients with regards to a person’s discharge; the Chief Nurse reported that this can be very problematic, family members are often reluctant to have their family member discharged when they still appear unwell.  The Chief Nurse reported that the staff must ensure that they communicate effectively with patients and their family members and explain the increased risk for a patient if they remain in an Acute hospital setting.

Members expressed concern in relation to the high number of delayed discharges attributed to social work issues.  The Chief Nurse reported that the Trust is looking to develop a site based system for allocating social workers.  Therefore, if a patient requires a social worker, the social worker will be allocated from the hospital and not the Borough in which the patient resides.   The Trust would also like to explore the necessity to undertake a social work re-assessment of the patient, if the patient has been admitted for less than 72 hours.

Members asked for further clarification in relation to the number of operations (elective and non-elective) that have been cancelled as a result of delayed discharge.  The Chief Nurse agreed to provide this information.

In relation to District Nurses, the Chief Nurse confirmed that Pennine Care NHS Foundation Trust is commissioned to provide district nurses.  There are significant challenges in relation to the provision of this service this is multi-factorial; the age/demographic make up of the current cohort of district nurses, number of vacancies, problems in recruitment and the different models of care provided. 

It was agreed:

1.   Pennine Acute NHS Trust would provide the Joint Committee with a report in relation to the number of operations cancelled as a result of delayed discharge.

Information will be provided at a future meeting of the Joint Committee in relation to the social workers pilot