This verbal update reports on the recent developments regarding hospital discharges and how this process is managed to ensure that the correct protocols are in place and that they are followed. These include areas of staff accountability, transparency, and sound administration.
Minutes:
7.1 Councillor Richardson introduced a verbal update that outlined recent developments on hospital discharges which had been brought to her attention by a resident who had been recently discharged. It would examine the discharge process to understand how this was managed and to ensure that the correct protocols were in place, and areas of staff accountability, transparency, and sound administration. Councillor Richardson welcomed Matt White, Jo Baty and Lucy Allen to provide the update.
7.2 It was explained that Matt White had previously worked across the three boroughs service (H&F, WCC and RBKC) and had returned in an interim capacity covering hospital discharges. There were checks and balances on the system to monitor people going through the discharge to assess process and within this different were levels of assurance. The process was multi-disciplinary involving different relationships and cost sharing between health and social care teams. There had been an impact on discharge success caused by Covid and this had changed the process significantly. An emergency process had been implemented at that point but more recently, there had been a slow down which offered some breathing space ahead of the winter pressures. This offered a timely opportunity to review services across all three boroughs. More recent developments included working with Charing Cross Hospital discharge leads to review and share learning when mistakes occur.
7.3 Councillor Richardson welcomed the assurance that reviews were undertaken to review errors which serve as checks and balances, offering accountability to patients and their families and about who was consulted about care, including family members, to ensure that clear information is provided was essential. Matt White explained that following Covid the service had updated its documentation with information about new arrangements. It was recognised that having a family member in hospital resulted in a chaotic time for family members so there was a great deal of information and leaflets offered to support them. In response to a follow up question, Matt White outlined how the homeless pathway operated which also incorporated additional homeless support services offered by providers such as Imperial and St Mungos. Key to the success of this was clear communication. Jo Baty added that H&F, Social Care colleagues participated in a weekly discharge meeting, including officers from hospitals, reablement, commissioning, brokerage, homeless and finance teams. This ensures that the right, focussed support is being provided to residents and that any areas of concern are tackled promptly with agility.
7.4 Councillor Amanda Lloyd-Harris commended the work being undertaken and asked how a homeless person could be helped when they were fit to be discharged but you were aware that they were not necessarily well enough to be in the community by themselves. Matt White explained that adults with capacity had the right to choose to leave, if they were fit to be discharged. There were street medical services that could support a homeless person on discharge, but the golden rule was that a person with capacity has complete autonomy over decisions about their care. Where a person does accept medical help, this can be a gateway to onward pathways leading to long term change away from homelessness.
7.5 Lucy Allen briefly provided a Community Independence Service (CIS) perspective and mentioned that their aim was to support people so that they did not have to into hospital in the first place. There was a considerable amount of collaborative work that supported more complex need in the community with a multiagency approach. This recognised that hospitals were not best placed to aid recovery. Lisa Redfern added that that services like the CIS were critical in preventing unnecessary hospital admissions and also facilitating reablement care following discharge. This would be a key area of focus of work for the ICP, particularly given the elective care backlog resulting from Covid and the currently high rate of discharge and related high pressures. This was a long-term issue and would be exacerbated by winter pressures with increased acuity of need. In closing Matt White explained that on his return to this area of work in 2020/21, he had never in his thirty years of work in social care experienced the level of demand and pressure that arose in during this period. He commended outstanding health and social care staff who had made a fantastic commitment to support patients in the most challenging of circumstances.
7.6 Councillor Richardson commended Matt White and his colleagues for their dedication and looked forward to receiving further updates on the service and how it progressed.
RESOLVED
That the committee noted the verbal report.