Agenda item

Julie Gonda, Interim Executive Director, Communities and Wellbeing attended the meeting to provide members with an update in respect of delayed discharge within the Borough.  The Presentation contained the following information:

Delayed discharge is a high profile issue and key measure for the Greater Manchester Health and Social Care Strategic Partnership Board, the number of patients that’s discharge is delayed is reported weekly.

There has been a steady increase in delayed discharge patients, from a low in May 2017.  Quarter four 4 reporting in 2016.17 showed Bury had nearly 1600 patients who experienced a delay in being discharged from Pennine Acute NHS Trust.

The Interim Executive Director reported that trajectories are being developed for this year to assure the GM team that they can be achieved.  Delayed transfer of care targets have been established which would hopefully see the reduction in numbers by half by quarter 4, 2018/19.  The GM Hospital Discharge Standards will underpin the operations of how these targets can be achieved.  GM HSCP have agreed 3 Hospital Discharge Standards that all 10 areas are expected to implement, Discharge to Assess, Patient Choice, Trusted Assessment.

The Interim Executive Director reported that the following schemes have been put in place to reduce the number of delayed discharges;

·         Integrated discharge teams at FGH and NMGH

·         Additional re-ablement capacity is in place, focussed on the south of Bury to support issues at NMGH

·         Implementation of the Care at Home tender on a neighbourhood basis

·         In discussion with agencies re D2A beds for social care assessments

·         D2A beds have been put in place for Continuing Health Care Assessments

Members discussed concerns in respect of patient choice and problems this causes with regards to delayed discharge.  The Interim Director reported that it costs over £1000 per night to keep a patient in a hospital bed, not only is this not the most effective use of resources, it is not the most appropriate place for a patient who is ready to be discharged.  Together with partners, the Council are looking to provide some interim beds to ease the pressure on the acute hospital. 

In response to a Member’s question in respect of new targets for reducing the numbers of delayed discharges, the Interim Executive Director reported that the reduction targets were not achieved in 2016.17 and the targets will continue to be difficult to achieve going forward.

The Interim Executive Director reported that she would expect discharge planning to begin from the date of admission.  The discharge must be appropriate to the patient, the support received needs to be standardised and of a high quality.  Social workers are now employed in the Trust seven days a week and will assess patients from neighbouring Boroughs to assist the discharge process.

In response to a Member’s question, the Interim Director reported that NMGH does see patients with more complex long term conditions than FGH, NMGH serves an area of high deprivation this combined can make discharge planning more problematic.

In response to a question from the Chair, the Interim Director reported that delays in discharge for children operate under different guidance, problems in delayed discharge are few and usually occur when children have complex medical conditions.

With regards to more beds and services provided in the community, the Interim Executive Director reported that monies from the Transformation Fund will enable the development of services in the Community.  The direction of travel across all of Greater Manchester is to smaller hospitals with more services provided in a non-acute setting.

The Interim Director reported that providers will only be contracted to provide work in the community if they have been assessed at good or above by the Care Quality Commission.

In response to a Member’s question, the Interim Executive Director of Resource and Regulation reported that a new tender process for the provision of adult social care is being devised, the revised tender will see a move away from a task focused service to a more person centred focused approach.  

     It was agreed:

That a further update in respect of delayed discharge will be considered at the next meeting of the Health Overview and Scrutiny Committee scheduled to take place on the 14^th November 2017.