Agenda item

5.1

The Committee received a joint presentation of Michael Harper, (Chief Operating Officer, Sheffield Teaching Hospitals), Phil Holmes, (Director of Adult Services, Sheffield City Council) and Peter Moore (Director of Strategy and Integration, NHS Sheffield Clinical Commissioning Group (CCG)), on reducing delayed transfers of care in Sheffield.

5.2

The item was introduced by Phil Holmes, who suggested that the Committee should take the presentation as a background paper and indicated that last Winter, Sheffield was not in a good position with regard to delayed discharges from hospital.  He added that plans were now being put in place for this Winter for people to have the right to treatment and leave hospital when appropriate.  He also commented that there were issues both inside and outside the hospitals which had resulted in the poor performance last Winter.

5.3

Peter Moore reported that, last Summer the system in Sheffield had become full and, following meetings with the three relevant organisations, those being the Sheffield Teaching Hospitals Trust, the Sheffield City Council and the Sheffield CCG, a task team had been set up from last September and the delays had been reduced before Christmas, but the system had then filled up again.

5.4

Michael Harper indicated that there was now a changed focus on patients in hospital who didn’t need to be there, together with the right level of care post-hospital.  In relation to Sheffield being identified as one of three hotspots, alongside Cumbria and Fylde Coast, this was because, at the relevant time, Sheffield had a similar number of patients in hospital (90) who didn’t need to be there, as those authorities.  The present position was that Sheffield now had 52 such patients, with the emphasis being on moving to a ‘why not home and why not today’ attitude.  He added that there were three main routes out of hospital, these being home, home with support and intermediate care to assess, and that success in keeping delayed discharges to a minimum relied on partnership working between the three aforementioned organisations. 

5.5

In relation to the issues behind the problem, Phil Holmes stated that one-third was related to a lack of care in the community, one-third was about a route out of hospital not being clear and one-third was about assumptions on the care home requirement.  He added that the issues were about human rights and interests and that the system would be severely tested this Winter. 

5.6

Members made various comments and asked a number of questions, to which responses were provided as follows:-

·                All reablement services were provided by the public sector, namely the Sheffield City Council and Sheffield Teaching Hospitals, and there were no plans to outsource these services.

·                There were 154 intermediate care beds in Sheffield and access to these was arranged through the relevant hospital.  There were also intermediate care services which provided additional support and all these services were covered by the Care Quality Commission.  Consideration was being given to increasing the number of these beds for access by the Primary Care Service.

·                The key was how organisations and staff worked together, so that capacity and skills were in the right place to provide an improved system of intermediate care.

·                Work was being undertaken on getting assessments right to ensure that people were fit to leave hospital and go home or into residential care and it was important to strike the right balance.  It was important to consider what was normal for any particular patient and there was a movement from assessing people in hospital to assessing people in their own home to facilitate this.  Families could also be supported to provide a last chance for a patient to live at home and it was recognised that some patients may return to hospital.  The Council would hear about any unsafe discharges, and experience of this was very rare in Sheffield, with more concerns being expressed about people getting infections in hospital.

·                A written summary could be provided to any questions submitted by email by Councillor Douglas Johnson, for circulation to the Committee.

·                The Accountable Care approach was based on people’s experiences and this needed to be extended. 

·                The aim was to try to simplify a complex solution, but at least the problem could now be articulated.  It was accepted that Winter would be a challenge, with the test being the number of patients in hospital.  It was important to note that the organisations involved were regulated by different bodies, with no single point of regulation and different motivations and it would be necessary to step outside this framework to obtain solutions.

·                There were two important elements in making progress on reducing delayed discharges from hospital.  The first of these related to the role of the hospital in the process, putting into practice the ‘why not home why not today’ questions, as well as getting people fit and planning for what was to happen when they were fit.  The second element related to the three routes out of hospital already mentioned at the point of fitness and these were managed outside the hospital.  It was possible for change to be demonstrated, in that six months ago patients were waiting for long periods before discharge and now this was no longer than one week, with no significant issues being reported.

·                The figures for re-admission were one of the metrics considered by the Delayed Transfer of Care Programme Board. 

·                Nationally, Accident & Emergency attendances were increasing but were down in Sheffield last year. 

·                The Programme Board was looking at external factors such as the use of step-up beds and links with urgent care.

·                Work in the localities was presently at an early stage in terms of preventative work and ensuring that people weren’t kept in hospital for social reasons. 

·                Early assessment and care was important in relation to decompensation, which was where patients became more frail as a result of being in hospital.

·                Earlier that week there had been 52 people in hospital who didn’t need to be there and now there were 46.  This needed to be down to 40 during the Winter to be sustainable.  In reducing delayed discharges, it was important to hear people’s experiences.

5.7

RESOLVED: That the Committee:-

(a)       thanks those attending for their contribution to the meeting;

(b)       notes the contents of the presentation, officer comments and responses to questions; and

(c)        requests that, in relation to reducing delayed discharges from hospital in Sheffield:-

(i)        officers work with Sheffield Healthwatch in order to understand what was happening in the communities and ensure that the third sector be presented with all relevant information;

(ii)       details of any complaints be shared with the Committee;

(iii)      appropriate emphasis be placed on the quality of life issues in the community such as food and heating;

(iv)      Phil Holmes (Director of Adult Services) meets with the Chair of the Committee, Councillor Pat Midgley, to assess the present situation; and

(v)       a short update report be presented to the Committee in Spring 2018.