Agenda item

This paper provides an overview of MCH’s current position of community health services provision.

Discussion:

Members considered a report which provided an overview of Medway Community Healthcare’s (MCH) current position of community health services provision.

The following issues were discussed:

·     Flow and discharge - there were comments that this remained a challenge and reference was made to reports of people being sent home without the right care package. MCH advised no patients were left at home without any health provided care. The cause of the problem was lack of providers and in house staff providing packages of care which were delaying discharges from Medway Maritime Hospital and MCH was working with partners to address this. Another challenge was on occasions patients remained in community beds longer than they should. There had been an improvement in flow and discharge, but it was not at the pace MCH would like, this was Kent and Medway issue not just local and the system were looking at ways to address this together.

·     Feedback – in response to a request, an undertaking was given that future reports would contain cases of negative feedback and what had been done to try and resolve these.

·     Contact by phone - Reference was made to long delays in getting in contact with some MCH services by phone. MCH advised there had been problems with the new call centre, but the service had been improved and was closely monitored.

·     Increase in waiting times for services – how MCH wasaddressing recruitment issues was questioned. MCH advised that there were only two key services whereby vacancies were problematic , community nursing and nutrition and dietetics. The community nursing service vacancy rate had improved slightly from 40% to 38%.  MCH were moving from large locality-based nursing teams to smaller neighbourhood teams, with the aim of improving outcomes for patients and working conditions for nurses. This was expected to help with recruitment. MCH was also looking at its back-office teams to see what roles could be released from clinical staff. In response to a question whether these smaller teams were more impacted by the high vacancy rate, MCH advised the model encouraged teams to work through problems themselves and the teams could be quite creative, such as more flexible shifts. MCH were looking at whether this model could be embedded across the organisation and an event with stakeholders was planned to highlight the benefits of the model. MCH would welcome a site visit from Members to better understand how the teams worked. The goal was for the teams to work closely and where possible base themselves with GP services. 

·     Sickness levels – in terms of whether levels were a concern, MCH advised that sickness levels were relatively stable, but higher than ideal. Stress and anxiety were the two main causes of sickness. How the health and well-being of staff was supported had been reviewed and staff had been made aware of what help was available and had issued a brochure of support in place so staff could access any support they feel appropriate.

·        Clinical assessment waiting times - in response to a question whether waiting times were back to pre-covid levels, MCH advised that performance had significantly improved, now down to 8-10 weeks on average but waiting times needed to reduce to 6-8 weeks.  The necessary infection control measures were impacting on waiting times, but schedules had been reviewed to reduce waiting times where appropriate. The average waiting times for  urgent appointments was 2 weeks and 8-10 weeks for routine appointments.

·        Diabetes clinics – in response to whether the group sessions had been paused, Members were advised that virtual one to one consultations had remained throughout the pandemic and group sessions were now restarting.

·        MedOCC – concern was expressed that people were attending urgent treatment centres as they knew they would be seen face to face on the same day. Whether this was being fed back to GPs was questioned. MCH advised that the reasons for this were being looked at by the CCG. Although primary care was operating beyond pre-covid levels, some people perceived it as being closed and were aware that if they went to the Emergency Department they would be seen or referred to MedOCC. MCH were working with the CCG on the root causes of this and how primary care could be supported. 

·        Urgent response – an assurance was sought that the admissions being avoided were not being re-referred later and appearing in the figures. MCH commented that they were confident very few people were readmitted.

·        Care packages – reference was made to a situation where an elderly person who did not believe they needed help had been told before their discharge from hospital that a care package was needed and then told when they returned to home that one was not needed by the individual requiring care. MCH advised that problems could arise where a person who had capacity said they did not need an agreed care package and they had revisited how therapists communicated with individuals and advised staff to use more discretion in involving family members.

Decision:

The Committee agreed to note the report.