Agenda item

To Scrutinise a further report regarding arrangements to address pressures across the Health and Social Care system and the impact on hospital avoidance and discharges.

The Director of Adult Services presented the report to provide Members with key Pathways of Care Delays information for Rhondda Cynon Taf residents between April and November 2023, an update on current winter pressures impact on hospital discharges and information relating to the use of electronic whiteboards and sharing of patient’s information to support hospital discharge.

The Director also shared with Members that colleagues from Cwm Taf Morgannwg University Health Board were present in the meeting.

The Director outlined the background to hospital discharge delays as contained within the report explaining to Members that previous assumptions about delayed discharges often focused on limited capacity in social care as the root cause of delays, but there are a mix of other factors that can cause delays in discharging patients from hospital, including challenges accessing other NHS services in the community.

It was highlighted to Members that there has been three different data collections relating to hospital transfer delays which were:

• Delayed Transfers of Care (DToC) which were available from 2004 until February 2020.

• Management information reports on hospital discharge delays from July 2020 to March 2023 (generated and validated only by the Health Boards).

• Pathways of Care Delays introduced from April 2023.

Members were informed that there is a requirement for each Health Board to measure Pathways of Care Delays via a monthly snapshot census on the third Wednesday of the month and, after validation and agreement with social services and wider local government partners, to report this information to the Welsh Assembly Government.

The Director explained that there are a wide variety of reasons for a Pathways of Care Delay and Members were directed to the full list at Appendix 1.

Members were taken through the data analysis information as contained within the report with the Director highlighting an overall downward trend in the number of reported delays for Rhondda Cynon Taf over the year to date and despite having the largest population performance overall is good when compared to wider Cwm Taf Morgannwg activity.

The Director provided an overview of the information provided within tables 2a-d in the report and explained that the top 4 delay reasons in Rhondda Cynon Taf reflect similar themes across Wales and other Local Authorities.

The Director continued the presentation by explaining from the report that an Integrated Discharge Board has been established to take overall accountability for discharge performance across the Health board footprint, including ensuring Pathways of Care Delays are reported effectively, and most importantly implementing an improvement plan to tackle the areas that pose the greatest risk to delay. Members were provided with an overview of the areas of greatest risk for Cwm Taf Morgannwg and action plans as required.

The Director explained to Members the current position with regards to the Pathways of Care Delays data and how Social Services staff have worked closely with the Health Board to expedite discharges especially from Royal Glamorgan and Prince Charles Acute Hospitals as part of an established Gold Command Structure.

The Director also provided additional information as requested at a previous meeting by Members, regarding the use of electronic whiteboards on Hospital wards and sharing of patient’s information to support hospital discharge. Members were provided with an overview of the purpose of the whiteboards in hospitals and the benefits that have been felt to have been received by their introduction from the Health Board.

Members were also provided with re-assurance regarding the transfer of data through the use of the Whiteboards with the Director outlining from the report the methods and procedures in place to ensure effective information management.

A Member queried the data relating to disagreements and asked how these are managed. The Director acknowledged the difficulty in managing these cases but outlined the process of working together with hospital ward staff and managers in the Health Board to have discussions with the families to understand the reasons for the disputes and to try to navigate a solution with the best outcome for the patient. The Officer from Cwm Taf Morgannwg Health Board also confirmed to Members the process of having conversations with families and gave an overview of work being done within the Health Board relating to an integrated discharge policy and procedure. Members were also provided with details of the Optimise Programme which is aimed at supporting hospital staff with practical help around effective discharge. The Officer also highlighted how the Health Board are in line with the new hospital discharge policy recently published by Welsh Government including with guidance given around reluctant discharge.

Another Member questioned whether data is available around how long people have been waiting for discharge. The Director confirmed that the Pathways to Care delays is only snapshot of data on a single day and does not provide a story behind the figure. The Officer from Cwm Taf Morgannwg Health Board also reiterated that the information is only a point in time, and it is not known how long a patient has been subject to that delay as reasons can change day to day. The Officer shared with Members that the Health Board are developing a flow and discharge dashboard which will give an overall view of patient’s length of stay and the value of the hospital stay.

Another Member raised a question regarding the assessment process before discharge and requested further information around care home placements availability within the County Borough. The Director outlined for Members the process of assessment prior to discharge and recognised there are cases where delays occur but generally Social Services ensure needs are met in interim. The Director also acknowledged that the availability of care homes fluctuates which can result in there being periods where some homes are full.  Members were informed that there are times where people are placed out of county but the Director emphasised that the Council would make these as interim placements, and look to facilitate a move at a later date where these circumstances are preferred by families.

The Member also queried about care home fees and the difference between the levels of fees set by the Council and those in Private Care homes. The Director confirmed that care home fees for individuals are set in the policy of the Council each year and follow Welsh Government policy for residential charges. The Director also highlighted that Private care homes can apply their own fees for people that self-fund their care and referenced the influence of market forces in how those levels being set. It is acknowledged that costs for care homes have increased but Director confirmed to Members that the Council is working with providers locally to review their costs of care to consider Council fee setting  accordingly.

Following consideration Members RESOLVED to:

-        Scrutinise the content of the report

-        Request further updates on the data following winter pressures to monitor trends.