Agenda item

This report has been requested to provide the Committee with an update on the outcome of the 9 December 2014 Care Quality Commission Inspection visit, information on Winter Pressures and measures in place to deal with these at the hospital, together with an overview of the current position on delayed discharges from the Council’s perspective. 

Discussion:

The Chairman reminded Members that there were three topics of focus for this meeting which were as follows:

• An update on the outcome of the 9 December Care Quality Commission (CQC) inspection visit
• Information on winter pressures and measures in place to deal with these
• An overview of the current position on delayed discharges from the Council’s perspective

CQC inspection visit

The Acting Chief Executive, Medway NHS Foundation Trust gave an update on the CQC inspection and referred to the 18-month implementation plan, which would be considered at the 29 January 2015 meeting of the Trust Board.  He stated that there were five themes in the plan, each owned by a lead Board member (shown in brackets below), which were:

• Leadership and management, (Acting Chief Executive) 
• Workforce (Director of Workforce)
• Emergency flow (Chief Operating Officer)
• Data quality and governance (Director of Health Informatics & Director of Corporate Affairs)
• Quality improvement (Chief Nurse/Medical Director)

On the first assessment of progress against the Implementation Plan he estimated 80% of the actions predicted had been delivered.  The CQC had still expressed concerns about the flow of patients through the hospital and the use of additional areas of the hospital to cope with the demand.  They had also put forward the need for the acute Trust to work more closely with partners across health and social care in an attempt to reduce demand and improve discharge planning and flow.  A visit by the Emergency Care Intensive Support Team had helped in suggesting ways of improving flow through the hospital from A&E to discharge.

It was stated that funding had now been received for the refurbishment of the Emergency Department, which was good news for patients and staff.  In response to a question the Chief Operating Officer, Medway NHS Foundation Trust stated that it was likely the refurbishment would take around 18 months to complete. 

In response to a request from Members the Acting Chief Executive, Medway NHS Foundation Trust undertook to share the Implementation Plan with them to enable the Committee to monitor progress.

Winter pressures

The Acting Chief Executive, Medway NHS Foundation Trust then set out detail about the winter pressures and pressure on the system during the past six weeks which had been felt nationally but particularly in Kent.  He explained the measures, which had been necessary during that period including the cessation of elective surgery but emphasised that all urgent surgery including cancer treatment as well as day surgery had continued as normal.  There had been a large increase in frail elderly being admitted during that period and stated that the level of acuity, which is not routinely measured, had been unprecedented.  The aim was to ensure that the frail elderly did not remain in hospital longer than they needed to particularly as evidence showed that for patients over 75 who are bed bound they lose 10% of muscle mass per week which equates to a year of aging.

Reference was made to the success of embedding of MedOCC into the hospital.  The Chief Operating Officer, NHS Medway CCG stated that MedOCC had been based alongside A&E for a number of years but in November 2014 moved to a 24/7 service.  On average 25% of people who walk through the A&E door are navigated to the MedOCC service to be seen.  The CCG had received confirmation in its budget allocation that some “winter funding” allocation was in its baseline for 2015/2016 and had taken an immediate move to gain agreement from the Medway and Swale Executive Programme Board that the MedOCC service should remain 24/7 for 2015/2016 as a key priority area; this was agreed.  The CCG was continuing to take forward the longer term urgent care commissioning plans which would take this into account.

The point was made that often the public presented at the hospital because of being unable to see a GP promptly or because a call to NHS 111 had prompted the patient to attend a hospital.  The Chief Clinical Officer stated that the commissioning of primary care was the responsibility of NHS England.  He referred, however, to NHS Medway CCGs plans to jointly commission with NHS England and stated that these plans would be brought to the Committee at a later date.

The Healthwatch Medway representative referred to work undertaken with users of the hospital in an attempt to gain patient experience which was independently verified and agreed to share this data with the Committee and the hospital.

Delayed discharges

The Chief Operating Officer, NHS Medway CCG stated that there was an increasing interest and understanding nationally around patients who are “medically fit for discharge” as opposed to a “delayed transfer of care” which was a definition that was nationally reported against and much lower than the “medically fit for discharge”.  The CCG had been made aware that in other areas of the country local health and social care economies had been asked to produce a plan that significantly reduced these numbers and it was understood that this would be requested of all areas.

In response to Member concerns about the content of paragraph 5.7 of the report, the Acting Chief Executive, Medway NHS Foundation Trust stated that the Trust did have powers to evict patients but that this would be unlikely to be used.  The view was expressed that should a patient remain at the hospital for such a long period unnecessarily this would have a detrimental effect on other patients’ human rights as they would be unable to be admitted to the ward.

The Interim Deputy Director, Children and Adult Services referred to the work of the Integrated Discharge Team and stated that the number of cases for social care staff so far this year equated to more than the previous full year.  Even with the creation of the Integrated Discharge Team it was not possible to meet the demand.  She did, however, point out that some people received reablement packages and could reduce readmittance rates.

The Director of Children and Adult Services reminded the Committee that Medway Council had not received any funding from the government in the last allocation of £25m to assist with delayed transfers of care attributable to adult social care nationally.  This was “a good news story” in that it signified that there were not significant delayed transfers of care in Medway attributable to adult social care.  However, those authorities that did not receive funding from that allocation, including Medway, had since lobbied the government and she was able to announce that a letter had just been received from the Department of Communities and Local Government releasing a further £12m which equated to £120,000 ring-fenced money which had to be spent by the end of March.  This money could not be put into reserves and would not be a recurring figure but would enable the Council in consultation with the CCG and Acute Trust to put in place some of the initiatives in the Better Care Fund to see how delayed transfers of care could be improved.

The Chief Clinical Officer, NHS Medway CCG stated that it was likely there would be pressure nationally for the system to work better together to deal with delayed discharges and patients who are medically fit for discharge.

In response to a suggestion put forward relating to guidance for the public about what the hospital expected from them in terms of behaviour the Chief Clinical Officer, NHS Medway CCG explained that there was already something in the NHS Constitution which covered a number of the areas of expectation from the public as far as attendance at hospital was concerned.

Further to a question about the training of staff in care homes to avoid their residents being unnecessarily transferred to the hospital at the end of their lives and the Chief Clinical Officer, NHS Medway CCG referred to training which was being funded by the CCG to help these staff to be empowered to keep the patients in the care home.

Decision: 

(a)   The Acting Chief Executive and Chief Operating Officer from Medway NHS Foundation Trust were thanked for their attendance and report; and

(b)   The Healthwatch Medway representative undertook to share with the Committee and Medway NHS Foundation Trust their findings in relation to patient experience at the hospital.