Meeting documents

To receive this report. 

The Committee received a report from the Head of Urgent Care Programme Manager and the Adult and Health Operations Director. 

There has been increased demand across the urgent care system within health and social care services during the winter period for 2016/17 and this remains a persistent challenge for all organisations concerned within the urgent care system. During the winter period the Somerset system has been predominantly in Operational Pressures Escalation Level (OPEL) 2 and 3.  The system has not declared the highest level of alert which is OPEL 4.  Health and Social Care services have worked more collaboratively together than in previous years and are comprehensively planning for winter together. 

A debrief event was held last month to consider the learning from this winter.  Successes identified included: effective use of planning; working well together as a system and becoming more efficient at treating people as they present.  It also highlighted the need to communicate more effectively and to increase performance with regard to discharge to access.  Discharge to access refers to how a patient is moved back to a bed whether that is at home or at a community hospital or nursing home.  Several different methods have been explored and these will continue to be trialled.  Some short-term beds have also been purchased for people who aren’t ready to go home but don’t need to be in an acute hospital. 

Services are still not performing well when compared nationally so there is much more work to do but performance is improving on previous years.  Planning for next winter is beginning now and will also incorporate planning for the Easter period which is another time of challenge.

It was clarified that the Government has announced extra funding for Adult Social Care.  For Somerset this will be £11m, £7m and £3m respectively over the next three years.  This funding will be ring-fenced, primarily to help with delayed transfers of care but more detail is yet to follow.   

The following points were raised during discussion:

·        Is the increased performance due to the fact that this winter was not so bad, with no real flu epidemic?

-        I agree that there has been less pressure on the system but even so some of our near neighbours have been on OPEL 4.

·        What about patients who cross the Somerset border?

-        Numbers have been low this year from Royal United Hospital and we have had good conversations with them.  Collaboration with Weston Hospital has been more difficult but we have recently begun to work together to address this.  There has been a 6% increase in Adult Social Care patients over the winter period.

·        I have heard that Yeovil District Hospital is experiencing a frailty in its system on Saturday afternoons.  Has this affected mortality rates?

-        We haven’t seen any increase of mortality rates.

·        The extra funding only represents investment for one small part of the system when it really needs to be looked at as an entire system.  I hope that it can be used flexibly and not ring-fenced too narrowly.

·        Public Health data shows that healthy life years are not increasing so we need to be cautious and not too optimistic about expecting improvements year on year. 

·        It seems there has been a culture of passing problems from one part of the system to another, for example, primary to acute.

-        The system is not yet well set up enough to care for those patients who do not need treating in hospital but are not able to look after themselves at home.  We do need better pathways.

·        It’s difficult to get a sense of the scale of the problem.  What is the percentage of people in hospital that don’t need to be there?

-        We completed an audit recently at Musgrove Park Hospital (MPH) and we will share this with the Committee.  This is a snap shot of one day at MPH. 

·        It was clarified that extra beds had been purchased at Cookson Court, Yeovil.  These were mainly for reablement. It was emphasised that the culture of the providers of reablement services was very important.  Providers need to encourage patients to become independent.

·        We previously had a convalescent hospital system and this is now called reablement.  A one size fits all system will not work.

-        We need to look at when a social worker is required and when we can use a different member of staff.  We need to use the workforce differently.

·        Can we get a better deal with block purchases rather than spot purchases?  Somerset Care have 200 empty beds across Somerset.

-        We can get a supply of beds at our fee rate at short notice and there is no problem with supply.  We use a mixture of block and spot booking.  We are currently testing different models of care and we know that different places may need different models.

-        We need to change the culture of treatment within hospitals. 

The Committee noted the report.