Agenda item

This item has been placed on the agenda at the request of the Chair.

Following representations made by Healthwatch Stockport, the Chair has invited representatives of Stockport NHS Foundation Trust, Stockport Clinical Commissioning Group and the Council’s Adult Social Care Service to discuss the current pressures facing urgent and acute care in Stockport, and the pressures on discharge from hospital.

Attached is some information on Delayed Transfers of Care provided by Healthwatch that had been supplied by the Public Health Service.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

A representative of the Democratic Services Manager reported that this item had been included on the agenda at the request of the Chair.

The Chair reported that he had received representations from Healthwatch Stockport expressing concerns about the deterioration in performance at Stepping Hill Hospital in relation to the 4-hour admission target and the potential impact this had on patient care. In light of these concerns he had agreed to include this item on the agenda.

David Kirk and Gavin Owen, of Healthwatch Stockport, attended the meeting to outline their concerns. They acknowledged the positive relationship they had with health and social care partners who kept them informed of performance issues, but stressed that they remained concerned that there were system-wide problems in the Urgent Care provision that were impacting on patient experience and care, and putting unnecessary pressure on staff. These problems were not solely within the responsibility of the Foundation Trust but were connected to issues around delayed discharge (DETOC) to intermediate care and other nursing facilities.

Data from the Council’s Public Health Intelligence Team and NHS England was also provided to highlight the issues.

Mark Chidgey (Director of Provider Management at Stockport Clinical Commissioning Group) on behalf of the Chair of the System Resilience Group (SRG), acknowledged the worsening Emergency Department performance at Stepping Hill Hospital but stressed that partners on the SRG were working to address this and related health system-wide issues. He confirmed that external agencies had been engaged to provide root-cause analysis of the situation and provide recommendations that the SRG would consider.

Mark Fitton (Director of Operations, Adult Social Care, Stockport Council) reported on work to address nursing care bed and assessment capacity that was impacting on DETOC, including empowering frontline staff to make decisions that would speed up discharge. A wider review of community bed capacity was also underway.

James Sumner (Chief Operating Officer, Stockport NHS Foundation Trust) confirmed that delayed discharge was the biggest challenge facing the Trust, and was impacting on the elective admission capacity within the hospital. He emphasised the need to prevent avoidable admissions wherever possible, as well as way to improve processes within the hospital that impacted on ‘internal flow’. He acknowledged the short-term pressure on health and social care partners but stressed that the Stockport Together programme was the longer term solution to these challenges.

Councillor John Pantall (Executive Councillor for Independence & Wellbeing, Stockport Council) emphasised the complexity of the interplay of different organisations and other factors and the need for a holistic solution.

The following comments were made/ issues raised:-

·         Clarification was sought on the role of the System Resilience Group (SRG) and its capacity to effect change. In response it was stated that the role of the SRG was to bring all partners together to develop and monitor system-wide solutions and to take collective responsibility. It was emphasised that the root analysis was seeking to understand the reasons for the deterioration in performance in Stockport, and to understand the particular challenges for this economy.

·         In relation to the data provided by Public Health on the reasons for DETOC, further information was sought on the reasons for the high percentage of delays caused by patient or family choice (61.2% in 2015/16 to date). In response it was stated that wherever possible professionals tried to avoid having patients making long term choices about care while in an acute setting. Adult Social Care did seek to help patients make timely choices. It was also acknowledged that that there was a delicate balance between seeking to discharge and moving a patient too quickly to an inappropriate setting that prompted a further move that could be disruptive to care. The issues with capacity in community care settings needed to be addressed, including supporting some care homes to improve the quality of provision to create capacity. It was suggested that improved advocacy provision may assist patients and carers to make more informed choices.

·         Further clarification was sought on statements about empowering staff. In response it was stated that it had been observed that there was often an over-reliance on senior managers to take decisions, but that by empowering staff to take decisions and find solutions this would help improve the timeliness of decisions. It was also recognised that there needed to be greater engagement with clinical staff to seek their input into developing solutions.

·         It was commented that delays in discharge could be caused by delays in accessing pharmacy services. It was acknowledged that this could be a factor but it was suggested that this could also be caused by delays in completing paperwork and prescriptions. Healthwatch, during their work on discharges, had identified duplication of processes and discussions as a cause of some delay.

In response to a question about what actions were needed in the next month to improve performance, the following were identified:-

(1)       Collective action to reduce delays within the hospital, through empowering staff and creating capacity

(2)       Improving hospital processes, such as modifying ward rounds

(3)       Admission avoidance and reducing length of stay.

The Chair summarised the discussion by acknowledging the concerns raised by Healthwatch; noting that the SRG was engaged in work to identify the causes of delays to admissions and discharges and to identify solutions; recognising that there was an issue with capacity and quality of community care beds; the need for improvements with processes and hospital flow.

RESOLVED – (1) That the update urgent care and delayed discharge be noted.

(2) That Ann Barnes, Mark Chidgey, Mark Fitton, David Kirk, Gavin Owen and James Sumner be thanked for their attendance and participation.