Agenda item

This report outlines plans to reduce delayed transfers of care to improve the patient experience, reduce length of stay, and improve flow through our hospitals.

Councillor Vaughan welcomed Dr Sarah Brice, Director of Integrated Care and Geriatrician, Rebecca Campbell, Head of Discharge and Mick Fisher, Head of Public Affairs.  Rebecca Campbell explained that the service cared for people with challenging and complex needs, helping them navigate clinical care pathways, discussing treatment options with family members and liaising with the Community Independence Service (CIS) colleagues.  Dr Sarah Brice recognised that tensions existed between hospital provision and ASC, particularly in terms of handover and responsibility but that recent developments had ensured increasing collaboration and co-operation, in what was a difficult financial climate. 

Bryan Naylor expressed concern about treatment he had recently received at Charing Cross hospital, which he described as disgraceful.  He explained that he was one of several patients receiving treatment on the same ward and that he had seen patients being discharged prematurely.  Dr Sarah Brice apologised for his experience, recognising that the system did not work perfectly.  She indicated that they were keen to ensure that the service improved and were working hard to resolve a number of challenges. 

In response to a question from Councillor Morton, Dr Sarah Brice explained that they had a facility where patients could be supported as they continued treatment outside a hospital setting, with a view to progressing support for those with long term conditions, back in the community.  She explained that they would utilise beds carefully, ensuring that patients were properly assessed outside the ward.

Jim Grealy commented that the report needed to be more complex and offered an incomplete picture. He enquired about the category of people being discharged, referring to page 14 of the report.  He recognised that there was a lack of specialist staff but held no confidence that the aspirational outcomes expressed in the report would be forthcoming.  In response, it was noted that a further, more detailed report could be provided, together with an update.

Councillor Carlebach commented that it was essential for patient welfare, to be clear on who was responsible for their care, treatment and future support, particularly at different stages of the clinical pathway.  Rebecca Campbell responded that they had focused on the delays but could provide greater detail on the patient journey, how they could anticipate late discharge protocols, and how they worked closely with doctors and nurses, sharing information with patients.  Dr Sarah Brice explained that the hospital was working at high capacity, with often complex cases. Extended hospitalisation could lead to challenging pressures for patients and families, with difficulties in making adjustments at home. 

Councillor Carlebach's second point related to sheltered housing contact, and the importance of housing officers engaging with colleagues and residents, which could be further improved.  It was noted that development work around clinical services was on-going, allowing information to be shared across the service, by for example, ward based social workers. Social workers now accompanied clinicians on ward rounds, embedded the process, receiving information about a patient’s treatment care and progress.  Cross communication facilitated improved care for patients. This was a pilot project, a process which began on the ward with the patient being seen by social workers, CIS and clinicians, which they planned to continue to roll out. 

Lisa Redfern welcomed the positive comments about integration but queried the data source as she did not recognise these figures as the agreed and formally recognised set of figures. Referring to an incomplete sentence in the section 4 of the report, it was reported that 37% of delays for ASC related to residential and nursing placements, however there was no figure in percentage terms given the NHS’ delayed-discharges to which a much higher proportion of delays were attributable to. Given the improvement in recent ASC figures, it was noted that this presented an unbalanced view.  Rebecca Campbell agreed and offered to provide further detailed information, acknowledging the importance of ensuring that accurate figures which reflected the current picture fairly.  Councillor Coleman observed that the report gave the unfortunate impression that the responsibility for delayed discharges lay with the Council, when actually, the majority of delays arose from the NHS. 

Continuing, Lisa Redfern referred to page 13 of the Agenda pack, Tables 5-10 and observed that it was misleading language to refer to just Hammersmith & Fulham and that there would have been a more balanced perspective to have included a clearer reference to Hammersmith and Fulham CCG, not the Council.  The importance of getting the language right was noted.  Dr Sarah Brice indicated that it would be possible to provide data according to the CCG rather than on a borough by borough basis.  Following a request from Councillor Coleman, she confirmed that in future, reports would be quality checked collaboratively to ensure accuracy of information. 

Councillor Vaughan welcomed the improvement but observed that there was a general issue in terms of handing off responsibility for patients, particularly in terms of mental health.  He enquired what steps the Trust was taking to improve how they currently worked with other NHS colleagues to identify delays.  Dr Sarah Brice explained that non-ASC placements, with complex and challenging mental health cases meant that there were issues with the transfer of care.  This was a challenging cohort of patients, which did not easily fit the rehabilitation unit option, who were not quite ready to go home and still required care, with longer delays resulting. 

Bryan Naylor commented that he was encouraged by the responses given by the Trust, however, when problems arose, it was often patients who experienced the difficulties. The shortage of qualified nursing staff, with an understanding of the discharge process remained a concern.  Dr Sarah Brice acknowledged the on-going concerns regarding nursing training, recruitment and retention, particularly in geriatric nursing, which was not a traditionally popular speciality.  She observed that there was a need to be more imaginative about the discharge process, given the impact of not having sufficiently experienced and qualified staff.

Councillor Vaughan briefly recapped the discussion, noting the following key points:

·         More detailed information required about complex areas;

·         Closer collaboration between ASC and health colleagues would be helpful in understanding the process better;

·         Improved understanding of patient’s experience of the discharge process and the related issues; and

·         That a joint report, including input from the CCG may be helpful to ensure that all partners would be better sighted on the issues.

RESOLVED

That the Committee note the report.