Councillor Abdullahi, as Chair
of the Health Scrutiny Panel welcomed colleagues from Enfield CCG,
North Middlesex University Hospital (NMUH) and Barnet, Enfield
& Haringey Mental Health NHS Trust (BEHMHT) to discuss this
issue.
Bindi Nagra (AD Health Housing
and Adult Social Care) introduced the report which gave a summary
of the current performance and reasons for delayed transfers of
care, it also provided a summary of schemes which are part of the
Integrated and Better Care Fund, that is being used to reduce
delays in hospital.
Jon Newton (Head of Service
Older People & Physical Disabilities) presented the report
which highlighted the following
- Data
shows generally good performance for Enfield.
- There
is an inbuilt two month delay in NHS England providing performance
data. Information for September would be available
shortly.
- The
Enfield Health and Wellbeing Area had been set a target, by NHS
England, of no more than 20.6 DTOC (Delayed Transfers of Care) per
day from July 2017. Data is for people
who have not moved on from hospital 24 hours after the notice to
discharge is issued.
- There
are many reasons for delay which can be Social Care delays Health
delays or Joint delays. It was noted
that a situation where a delay occurs due to family choice, would
be categorised as a health delay.
- Health
and social care partners work together to implement the High Impact
Change model (HICM) to manage transfers of care.
- From
April 2017, more funds had been provided through the Improved
Better Care Fund (iBCF)– for meeting adult social care needs,
to reduce pressures on the NHS.
- The
iBCF has supported schemes to reduce delayed transfer of care
- which includes ‘Discharge to
Assess’. This means people can go home and be assessed from
there, rather than in hospital. An assessment agreement is needed
with the CCG, and the person would continue obtain help/ support at
home .
- Data
shows both LBE and ECCG met their target for Quarter 1 and are also
on target for Quarter 2.
- The
good joint working with the BEHMHT has helped to enable adults with
mental health needs to have appropriate support to enable people to
move out of an acute setting into the community.
- The
Mental Health trust had estimated that approximately 1:20 patients
with mental health issues in hospital did not need to be in an
acute setting.
The following issues/ questions
were raised
- When
asked about specific targets for each element of DTOC it was
pointed out that not all areas have specific targets – there
are challenges for example in some cases there is a need for
helpers who may not be available at weekends.
- The
report had stated that one of the three main causes for delay in
mental health is ‘access to housing’. It was stressed
that the close working we have with other organisations is
important in this area – in particular, for those people who
have ‘no access to public funds’.
- Councillor Neville said it appears from the table that
performance for DTOC is going in the right direction although it is
still too high. Although it was not possible to say how much
additional money had been spent on this problem it was stated that
£1.2 m in the Better Care Fund had been allocated for
‘high impact changes’ e.g for assessment at
home.
- A
question was raised regarding DTOC - one of the reasons given for
this in the summary at Appendix A is ‘delay awaiting public
funding’ what is this?
Bindi Nagra pointed out that the reasons for delay are complex,
people would not be delayed because of a lack of money, this
category is often used as an ‘umbrella’ and may be
because someone is waiting for a nursing home.
- One of
the categories refers to ‘further non-acute NHS care’.
It was explained that this may be where a person who may have been
in an accident with an acute injury, may have recovered to the
point that still requires further NHS treatment such as
rehabilitation and needs to move to another hospital for specialist
treatment where a bed may not currently be available. It was stated that 5 extra ‘rehab’
beds were now available at the Magnolia Unit.
- ‘Patient or family choice’ stated as a reason for
DTOC – This may be where a clinician has stated that a person
is ready to go home but the patient or carer either do not agree
they are fit or do not agree with care choice the person is
assessed as needing.
- It was
asked if it is expected that the situation would improve when the
Strategic Transformation Plan comes into effect? It was thought that this should be
beneficial as it should enable people to work together more
effectively, hopefully breaking down organisational
boundaries.
- It was
confirmed that some people with mental health problems are being
looked after outside the borough (11 people at
present).
- It was
welcomed that the Enfield CHAT (Care Home Assessment Team) had been
working in partnership with Haringey to assist in enhancing health
in care homes.
- Councillor Cazimoglu referred to the DTOC delays for both Health
and Social Services and said that these are often interconnected,
with one impacting on the other. She
said the A & E service at NMUH is under a lot of pressure, with
many challenges. In respect of
GP’s, Enfield is under resourced and this leads to extra
pressure on services. She referred to her concerns regarding
demands for the forthcoming winter.
- When
asked if any additional plans had been made to meet the winter
demands, it was stated that plans are underway, and are further
ahead than this time last year.
- It was
noted that future proposals re Care Closer to Home Integrated
Networks (CHINS) would facilitate health and social care
professionals working as a team for individuals. Councillor Levy
said it would be useful to see what is being proposed for this for
the future. It was confirmed that
members of CCG, council officers and mental health care
professionals meet to discuss and progress issues/cases weekly
.
- It was
pointed out that a person may be admitted with a physical problem
but this may also lead to mental health issues emerging that need
to be addressed. This is often the case for elderly patients who
become disorientated. It was agreed that this was a complex issue
and it is necessary to remember that a person may be ‘in
crisies’. We must not lose sight of the human cost and the
need for good communications between services is
essential.
- Apart
from targets/ performance figures given, it was asked if there was
any ‘soft data’ and/ or any further issues members
should be aware of? Doug Wilson
referred to the necessity for us to be able to look at early
intervention to identify tangible things the authority can do to
prevent people having to go to hospital. As part of this we are
working closely with the voluntary sector.
- It was
asked what measures are used to ensure that patients are not being
discharged too early from hospital in a drive to ‘free
up’ beds? It was answered that there were assessment surveys
carried out and figures would show numbers of people who are
re-admitted. Also people who are re-admitted would return to the
same consultant.
- Councillor Abdullahi referred to a ‘dementia
strategy’ which had been developed when it had been realised
that a lot of people were being discharged to social care. This
included the development of ‘pathways’ and the setting
up of a memory clinic. It was stated
that there was a lead consultant for this area and a dementia nurse
in position.
- A
member of the public referred to older people being discharged from
hospital, the need for carers to be able to spend a reasonable time
with them and the advantages of siting care homes near parks where
people would be able to be part of the community. Councillor Cazimoglu referred to the care home
strategy and mentioned that Enfield has one of the highest number
of care homes in London. She mentioned that carer’s visits
are for a minimum of 30 minutes and that LBE does not commission 15
minute visits.
NOTED
Members noted the
report.
Councillor Levy thanked
officers and representatives from ECCG, NMUH and BEHMHT for their
attendance and input.