Agenda and minutes

To approve as a correct record the Minutes of the meeting held on 23 November 2015.

The minutes of the meeting held on 23 November 2015 (copies of which had been circulated) were approved as a correct record.

Councillors and officers to declare any interests which they have in any of the items on the agenda for the meeting.

Councillors and officers were invited to declare any interests which they had in any of the items on the agenda for the meeting.

The following interest was declared:-

Personal Interest

To consider a report of the Corporate Director for People.

The Panel at its meeting on 28 October gave approval to holding three themed meetings based around the three strands identified during the scoping of the Review.

The second of these meetings is based is based on the ‘speed of discharging’ theme.

Representatives from Borough Care and the Stockport NHS Foundation Trust have been invited to attend the meeting to assist and advise the Panel.

The Panel is recommended to comment on and note the report.

Officer contact: Vincent Fraga on 474 4401 or email: vincent.fraga@stockport.gov.uk

With the consent of the Panel this item was considered in conjunction with Agenda Item 3(ii) – ‘Current Issues’ (see Minute 3(iii) below).

The attached guidance from the National Institute for Health and Care Excellence (NICE) covers the transition between inpatient hospital settings and community or care homes for adults with social care needs. It aims to improve people's experience of admission to, and discharge from, hospital by better coordination of health and social care services. The guidance contains seven recommendations, and each recommendations includes a number of suggested actions. The tools and resources section includes a baseline assessment tool and a costing sheet. There are also a number of links to other guidance.

A representative of the Corporate Director for People submitted guidance from the National Institute for Health and Care Excellence (copies of which had been circulated) which covered the transition between inpatient hospital settings and community or care homes for adults with social care needs.

The guidance aimed to improve people's experience of admission to, and discharge from, hospital by better coordination of health and social care services. The guidance contained seven recommendations, and each recommendation includes a number of suggested actions. The tools and resources section included a baseline assessment tool and a costing sheet.

RESOLVED – That the report be noted.

To consider a presentation from Mark Fitton (Interim Head of Older Peoples Service, Stockport Council) in relation to how the current system operated; various roles and responsibilities; and the issues, challenges, risks and opportunities.

Mark Fitton(Interim Head of Older Peoples Service, Stockport Council) and Vincent Fraga (Head of Service for Market Development, Quality & Commissioning ,Stockport Council) attended the meeting and made a presentation in relation to how the current system operated; various roles and responsibilities; and the issues, challenges, risks and opportunities.

The following comments were made/ issues raised:-

·         Part G of the Care Act 2014 came into force in April 2015 and superseded most of the piecemeal legislation relating to the transfer of care from hospitals.

·         The aim of the legislation was to facilitate the joining up of services provided by the NHS and other providers with an emphasis in integration.

·         It was noted that the Act allowed the NHS to seek reimbursement for delays in the transfer of care of up to £130 a day where this could be attributed to factors external to the NHS.  It was stated that regular meetings took place to establish why delays had taken place.

·         The NHS Foundation Trust did not currently pursue reimbursement from the Council for delays that could be attributed to Adult Social Care.

·         It was commented that the timescales for the transfer of care could be challenging, particularly for the patient and their family who needed to make quick decisions in respect of future care provision.

·         Effort was made not to make permanent care arrangements following a patient’s discharge from hospital to allow for an additional period of time for patients and their families to make long term care arrangements.

·         Although the Care Act did not regulate the hours during which a patient could be discharged, in Stockport agreement had been reached between the Council and the NHS Foundation Trust to aim to discharge patients within reasonable working hours.

·         There can be difficulties around obtaining consensus around the discharge of particular patient into community care which can be amplified during periods of pressure at the hospital.

·         The Care Act introduced a responsibility on the part of the Council for managing the market which included capacity and supply.  However, it was incredibly difficult for the Council to manage capacity in a private market which made it difficult to meet demand.

·         There was a view that the role of the Discharge Co-ordinator needed to expand to provide additional capacity to cover those wards not already captured.

·         One of the features of the local health scene was that there was a higher proportion of patients that were admitted after attendance at hospital than there were in other acute trusts with approximately 23% nationally opposed to a rate of 30% locally which placed additional pressure on discharges.  It was noted that the rate of attendance at hospital was not significantly different to the national picture.

·         It was commented that over a twelve month period, the number of permanent residents at facilities run by Borough Care that had been admitted directly from hospital was 17% which was considered a significant proportion.

·         For end of life care, hospital was seen as a last resort unless there was a need for medical intervention.

·         Approximately a third of patient discharges from hospital were delayed.

·         There was an acknowledged shortage in Elderly Mentally Infirm (EMI) beds within the Borough, a shortage which had been made more acute following the block purchase of beds from one provider by the University Hospital of South Manchester NHS Foundation Trust.

·         It was difficult to attract nurses into the EMI sector and as a result there was a move amongst providers to reduce provision in this area.

·         A combination of a number of factors such as long term sickness, little to no escalation capacity in the Foundation Trust and challenging provision in the residential care marketplace was producing a bottleneck in facilitating a smooth discharge process.

·         There needed to be a better dialogue between the Foundation Trust and partners within the residential care sector.

·         There needed to be improvements in the planning and commissioning of  ...  view the full minutes text for item 3.(iii)