Agenda item

For the Committee to receive an update on the outcomes of and learning from the implementation of the full Home First approach across the Dorset Integrated Care System.

The Director of Operations for Adult Social Care introduced and presented the report. The main points were as follows:

·       This was the second update on the new Home First model, following its implementation in January 2021.

·       The Home First model stemmed from the government guidance published in March 2020 on hospital discharge service requirements.

·       The programme would assist in the discharge of hospital patients at the earliest opportunity. This would enable to freeing up of hospital capacity and streamline the discharge process, utilising the right staff at the right time and place when necessary.

·       During 2021, the funding continued to be made available to those with enhanced need or new need of care. This funding stream was anticipated to remain up until March 2022. BCP Council continued to provide a dedicated workforce to implement the programme. The multidisciplinary team worked on a 7-day service that enabled people to take best pathway, bespoke to their needs.

·       The service is aware that their systems were struggling, as was common to the national picture, to get people safely discharged from hospital while maintaining the flow in hospitals. The system struggles periodically at times for those people who do not need further hospital bed respite.

·       The challenges and key actions facing the service were: capacity, beds, nursing home beds, more domiciliary rapid response care, communications strategy.

·       The financial impacts were primarily contained within the enhanced need of care for those discharged. The people leaving hospital on average receive 28 hours a week care, this would then be reassessed and on average reduces to 19.5 hours a week. Community cases are usually 14 hours on average. There was generally a greater need and level for care on those being discharged from hospital at present.

The Committee asked several questions following the report. Answers were provided by the Director of Operations for Adult Social Care:

·       Members acknowledged the brilliant equipment provision service, in particular the speed and level of equipment that was provided to people.

·       The Committee were informed that the service hoped for other family members to be involved in the discharge process discussions, if appropriate. This would enable to service to gather information from the assistance support network that was already there and then factor that into any care provision. Service provision at the point of discharge should be temporary until a long-term plan can be assessed. Members heard that a rapid response from our service if the individual’s plan was not up to scratch would be in place.

·       On the issue of ‘Pathways’, it was clarified that Pathway 2 was for those who would be discharged into a recovery bed, this could be due to a fracture for example, where the individual would receive rehabilitation. Pathway 3 was for very high, complex needs likely for those individuals who would remain in residential care and have longer-term needs. Members were told that these were nationally set definitions.

·       On the issue of performance figures, namely the 250/300 individuals waiting for discharge from hospital, the Committee heard that the average stay for someone in hospital changes all the time, with most of these in UHD hospitals and only some in community hospitals. Additional capacity was being sought along with domiciliary care support to improve this situation. Members were told that this Winter season would be unlike previous Winters and will likely provide great struggles. There was an ongoing dialogue between services and teams to continue to move things forward and free up as much capacity as possible for those people who need to come in. The number of time spent on average in hospital differs for each person and therefore the length of stay is part of the quality improvement and monitoring. Prior to Covid, the average stay would be around 7-9 days.

·       In a workforce context, members heard that the NHS was struggling to recruit staff, particularly therapists. This was impacting on the recovery plans within the community. The Care sector sees staff leaving constantly and therefore pressures were building primarily during the weekend hours and overtime. The pressure wasn’t just on how quickly the service could get people discharged but also on ensuring people’s wellbeing in the plans they require. The workforce in place was working harder than ever to support the higher level of need.

·       The Committee were informed that the BCP situation was reflective of the national picture and that the country was facing higher waiting lists and higher levels of need than before.

·       Members heard that both hospitals in BCP were acute hospitals that specialised in different areas.

·       On the issue of care staff, members heard that BCP are one of the highest fee payers in the country and specifically in the South West. Because the ASC service recognise that carers should get a good hourly rate. Therefore, it is not expected that pay is the issue in staff recruitment.

·       The Committee heard that a recommendation from the ASC service would be put forward for us to receive additional government funding to offset the £1.9million funding awarded during the Covid pandemic.

·       The Committee heard that the readmission figures, within 24 hours of discharge, were being sought by the service in order to circulate for members’ consideration. ACTION still working on this.