Agenda item

7.1

The report which provided an update regarding the review of the Sheffield continence service 2019 and related recommendations was presented by Dr Zak McMurray.

7.2

Dr McMurray advised that he was representing the ICB, as colleagues who were directly responsible for the matter were on annual leave or engaged as a result of the Junior Doctor’s strike. 

He explained that a restructure had led to a loss of staff.  The stated aim of the restructure had been to decrease bureaucracy but in fact it had increased it.  He expressed his disappointment that the improvements in Continence Services had not so far been progressed.  As there was no extra money available, changes would have to be funded by improvements in efficiency and productivity or by the taking of difficult decisions regarding where current funding should be invested.  He suggested that the ICB and Sheffield Teaching Hospitals could come back to the Sub-Committee in the new year to have a wider conversation.

7.3

A question had been received from Paul Sugars, who attended the meeting to ask the question:

“The context to my questions is the lived experience of my 87-year-old father-in-law and his family of continence services in Sheffield since his discharge from the Royal Hallamshire Hospital (“RHH”) to his own home late last month for end-of-life care and how that experience evidences progress against the recommendations made by this committee in its 2020 report into continence services across the city, in particular those at paragraphs 4.3.5 and 4.4.5 encouraging better feedback from service users and improvement in waiting for continence assessments respectively.

My questions are as follows:

1.    Why could the Continence Service only offer an assessment several weeks after hospital discharge and given the patient’s continence needs are unchanged irrespective of the care setting, why could his continence assessment not have been performed prior to discharge from RHH?

2.    Why, following assessment, is there a further significant wait for the provision of continence wear? Is this aspect of the service outsourced and if so, what are the contractual service level agreements governing the service and how can they be improved?

3.    Given the inability of the Continence Service to promptly undertake an urgent assessment of the patient’s needs, the 7-days’ continence wear provided upon discharge was clearly insufficient. In view of the ‘person-centred care’ principle described in the 2020 report, who determines that 7-days’ continence wear is sufficient for patients and on what factual basis is such a determination made?

4.    Confronted with the certainty that continence wear would quickly run out, the family has purchased a supply at its own expense, which will almost certainly need to be repeated given the timelines quoted by the Continence Service. This clearly contravenes the principle that Continuing Health Care be provided free at the point of delivery to qualifying patients. Who will reimburse the family for this and how?

5.    Despite repeated requests to RHH that community-based care bodies such as the Continence Service be part of the discharge planning, none attended any of the meetings. What is standard practice for the involvement of community services in planning Continuing Healthcare hospital discharge and if they are not part of the process, should they not be so?

6.    Given that the Scrutiny Committee has previously raised concerns about hospital discharge and made recommendations in 2020 on how to improve outcomes, why is it that similar problems continue to occur, in contravention of the principle of ‘person-centred care’?”

 Dr McMurray responded as follows:

• He would ensure that a full written answer was provided to Mr Sugars. 
• He agreed that the situation described was not acceptable.  It would be necessary to investigate whether the circumstances had arisen due to a one-off mistake or whether there was a wider issue with staff not following the relevant pathway. 
• He was not sure whether any mechanism was in place for reimbursement but felt that it would be worth colleagues having a conversation with the provider. 
• He also agreed that the cost of getting the service right first time was less than the cost of getting it wrong and then having to rectify the error. 
• It was possible that pressure to discharge patients from hospital had led to the service not being as joined up as it should be.
• Conversations were underway at the Health and Wellbeing Board regarding where money should be invested.  Currently the NHS prioritised a medical model, rather than supporting wellbeing in the community, which if done properly could avoid many hospital admissions altogether.

Members expressed disappointment that no progress had been made since the last report to the Sub-Committee.  They thanked Mr Sugars for attending to ask his question.  It was noted that it was not only people in end-of-life care who were users of continence services and who were therefore adversely affected when it failed.  It also affected people with learning difficulties.  A particular concern was regarding inequity, as not everyone would be able to afford to purchase items for themselves and continence was an issue that was known to affect mental health, self-esteem, dignity and quality of life.

Members agreed that the matter should be addressed with greater urgency and agreed that a further update should taken place in the new year.

7.4

RESOLVED: That the Sub Committee notes the update.