What is keeping frail Calderdale patients stuck in hospital awaiting discharge?

At the Calderdale Council Adults Health & Social Care (AHSC) Scrutiny Panel meeting at 6pm on Tuesday 11th August 2015 in Halifax Town Hall, Councillors need to get to the bottom of a report from the Director of AHSC on Delayed transfers of care and reablement.

The Report says that Calderdale is one of the worst-performing Councils in the country, in terms of all delays in discharging patients from hospital. But when it comes to talking about why, and what the Council’s Adults Health & Social Care directorate is doing about it,  the Report is written in code and is as clear as mud.

Calderdale and Kirklees 999 Call for the NHS want to know what’s going on.

Patients with social care needs who no longer have any medical need to be in hospital are stuck there, because there’s nowhere for them to get reablement  once they leave hospital.

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NHSE (NHS England) has told Calderdale and Huddersfield NHS Foundation Trust (CHFT) to reduce the percentage of occupied bed days attributed to delays.

In the Work Plan document that the Council has uploaded along with the report, it says that

“The reablement service was transferred on a pilot basis to CHFT in 2011.”

Is this why NHS England is holding CHFT responsible for delays in discharging patients, when you’d think that it was the responsibility of the Council’s Adults Social Care services to make sure patients needing social care on discharge have somewhere to go?

The Report says that one of the problems causing patients to be stuck in hospital lies in the nursing home and social care “markets”, where there is “insufficient capacity” to provide the “right kind of care to meet all needs”. But there is:

“a multi-agency group working together to build market resilience under the leadership of the System Resilience Group”.

This is where it becomes impossible to find out from the Report what is actually going on, and why patients in need of social care can’t get it when they are medically ready to leave hospital, and so are stuck there.

Councillors, please answer these questions

Does that coded statement, above, mean there aren’t enough companies providing nursing homes and social care, now that the Council has cut just about all its own staff and facilities?

And is it the case that Care Quality Commission inspections that have found substandard care in some Calderdale nursing and intermediate care homes?

Have some been closed pending improvement?

And are some under some kind of special measures?

If so what are they?

And has this reduced their ability to take patients with social care needs on discharge from hospital?

Please can we have clear information about all CQC inspections of nursing homes and social care in Calderdale?

Particularly in the light of this recent national report that £4.6bn cuts to social care budgets in the last five years have broken the adult social care system, which is turning good people into bad carers, with regulators receiving more than 150 complaints about abuse every day.

And then –

Who are the multiple agencies that are “working together to build market resilience”?

Why is it their role to build “market resilience” for nursing homes and social care?

What is “market resilience” in this context anyway?

And what can these agencies do to make the nursing home and social care “markets” more “resilient”?

And why has the report used code that is impossible to understand?

And maybe the whole idea of privatising adults social care and intermediate care wasn’t so great in the first place?

Next lot of questions – changes to the indicator for measuring patients who are totally independent following reablement

What was the reason for changing the indicator for effectiveness of reablement (which measures the percentage of patients who are totally independent following reablement) in 2014/15, so that it gives results that are around 50% better than the previous indicator would have given?

Who changed the indicator?

Did this involve a change to the definition of what “totally independent” means?

And if so, what was the change?

And who decides whether patients have become “totally independent”? And how?

Doesn’t this change make comparisons between 2013/14 and 2014/15 completely meaningless?

Questions about services that have been invested in to reduce delays to hospital discharge

What is the Intermediate and Transitional Care service? Who runs it?

What is the Support at Home Service? Who runs it?

What evaluation is being done to see if the Staying Well programme reduces and helps to manage delayed transfers of care/hospital discharge?

Is the Hospital Avoidance Team the Social Care Coordinators at Calderdale Royal Hospital A&E, who are supposed to stop emergency hospital admissions for patients who come to A&E because they need social care support rather than medical care, by co-ordinating “ access to low level, short term support to facilitate the return home, followed up by securing a full assessment through the Locality Support & Independence Team.”?

By how much have these different services reduced delays to hospital discharge?

Question about the Report’s Conclusions

Particularly the conclusion that:

“The shift of resources upstream to prevent people being admitted to hospital and to build resilience in our communities is a vital, long-term component of the plan to ensure sustainability for the whole system.”

Where is evidence that this is working to help reduce emergency hospital admissions and delays to hospital discharge for people who need social care?

How does this sit with the recent unanimous decision of the full Council that they want evidence that this “shift of resources upstream” – ie the Care Closer to Home scheme – is going to work, and that consultation on proposed cuts to acute and emergency hospital services and the switch to planned and unplanned care hospital sites shouldn’t go ahead, until and unless there is such evidence?

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2 comments

  1. Good analysis Jenny. I agree those questions are significant. They have devised a ‘new indicator’ of effective reablement which is showing that people are doing much better on achieving independence than they would have done on the old measure (59% vs 40%). It’s the old ‘child poverty redefinition’ lark. This new approach is just hiding the rationing process they are starting. Moving the goalposts so the problem gets smaller. There’s not enough money being provided to meet the needs. That’s the bottom line.
    Are you putting those Qs in?

    Like

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