Agenda item

(19:00-19:30)*

For the Committee to consider and scrutinise the local response to the national Hospital Discharge Policy and the Home First approach.

The Committee received an update from Principal Officer for Planning and Quality Assurance who presented the report on the Home First Programme, including an update on Better Care Fund, concerning the new hospital discharge service and the changes, activities and learning yielded from the patient experience.

The main points of the presentation were as follows:

•         The Better Care Fund planning and reporting has been paused during the COVID pandemic.

•         The new national discharge policy and operating model commenced on 19 March 2020 in response to the pandemic. The model facilitates hospital discharge when a patient no longer reaches criteria to stay in hospital. New and additional care would be fully funded by the Government during this period and the hospital discharge process would operate from 8am-8pm 7 days a week, working in a multi-disciplinary capacity.

•         The hospital discharge policy and model changed on the 1 September 2020 and since then the Home First Programme had been implemented across Dorset.

•         From the 1 September, the Government has funded care support for up to 6 weeks after discharge. This would continue up until 31 March 2021. However, it is expected that the Discharge to Assess model will continue beyond 31 March 2021 and any additional funding would sit within the Better Care Fund framework for the next financial year.

The operational lead for BCP Council on Home First explained to the Committee that:

•         Pressures continued to be extremely high on hospital staff.

•         The three areas that take the patient through discharge and recovery are the Hospital, the SPA (the Single Point of Access) and the One Team. This takes the patient being discharged through their journey of discharge, recovery and any further help required.

•         There are 5 Cluster teams working across Dorset, for example Bournemouth and Christchurch are Cluster 1 and Poole is Cluster 2. Within this model there are lead experts across health and social care and they look at the discharge process of all those leaving hospital and specifically where in their discharge journey enhancements can be made, for example mutual aid, mapping assessment needs, what data should be collected and learned from, how we can learn from individual, personal journeys and how best to align people to requisite services.

•         The situation is changing hourly. Critical care, making sure there is enough critical care capacity and staff, are extremely pressured and only a small percentage of patients are not COVID related.

•         In the Discharge to Assess model, there are 4 pathways – patients will go through one of the four pathways. Pathway 0 is for those who do not require any social care. This will account for 50% of discharges. Pathway 1 (45%) is where those discharged require support at home. Pathway 2 (4%) will need a rehabilitation or short-term care in a 24-hour bed-based setting. Pathway 3 (1%) will require ongoing 24-hour nursing care, often in a bedded setting. Long-term care is likely to be required for these individuals.

The Head of Community Services for Dorset Healthcare Trust contributed and explained that:

•         Echoing the Operational Lead for BCP Council on Home First, the Head of Community Services for Dorset Healthcare emphasised they had never known a time where all services had worked better together. Things were extremely difficult, but all partners were working together and not in silos.

•         It was hoped that the Home First Programme and Home First Board, set up across all organisations, would evaluate the changes mandated by Government orders but also create a clear vision on how services should be run, learning from the good practice which has been developed.

•         It was expected that in 6 months’ time the situation will be quite different however it was heard that this was a journey would evolve over time.

The Manager of Healthwatch Dorset explained the patient experience of going through the Discharge to Assess service. The main points were as follows:

•         Insights had been gathered from patients throughout June 2020.

•         21 phone call interviews were held with a mixture of patients, family members and carers.

•         Responders were incredibly understanding of pressures on the system and why some parts were very swift and may have felt rushed.

•         The main learning from this survey was that carers and users wanted more information and assessment/contact details in order to help them feel supported.

•         Engagement meetings on Home First had been held and it was hoped that further phone call surveys could be conducted to see what the process is like currently and whether there had been any improvements or areas that could be improved.

The Committee asked several questions following the presentation. Answers were provided by the Operational Lead for BCP Council on Home First and the Head of Community Services for Dorset Healthcare. The questions and responses included:

•         A committee member asked if the teams were now formed and working in a singular approach. The Committee heard that the teams felt the process was well formed and embedded now; the Clusters were aligned to the acute hospitals and the multi-disciplinary teams were in place. Further evaluation at a later date would be beneficial to improve the service. The contentious point of the process at present was that there is no choice of discharge destination which would be the case in normal times, however communication on this must be clear and reflect the national mandate.

•         The Chair asked how many individuals have been discharged and readmitted within a short timeframe, for example within a week. It was heard that hospitals gather readmission rates and that this figure could be obtained and circulated to the Committee. It was explained that there had not been an increase in patient deterioration or incidents since the process started due to the services being wrapped around the patient once they are discharged. This includes a follow up within 24/48 hours to prevent an individual needing to go back into hospital.

•         The Chair asked about the cost to the Council of Scheme 2 and what the additional costs involved would be. The Committee heard that this could include additional staffing, additional roles and the hours of service involved.

RESOLVED that the Committee requested a report in Autumn 2021 on the outcomes of and learning from the implementation of full Home First approach across the Dorset Integrated Care System.