Agenda item

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·         Part G of the Care Act 2014 came into force in April 2015 and superseded most of the piecemeal legislation relating to the transfer of care from hospitals.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 residential care which involved the Foundation Trust, Council and providers.

RESOLVED – That Mark Fitton and Vincent Fraga be thanked for their attendance and presentation.