Agenda item

(Report to follow)

Report ECHS19069

The Board considered an update in relation to the Delayed Transfer of Care (DToC) performance.

‘Managing Transfers of Care’ was one of the four National Conditions in line with the vision for integrated care, that were included in the 2019-20 Better Care Fund Policy Framework, published on the 10^th April 2019. It was surmised that: ‘A clear plan for improved integrated services at the interface between health and social care that reduces Delayed Transfers of Care (DToC), encompassing the High Impact Change Model for Managing Transfers of Care. As part of this all Health and Wellbeing Boards adopt the centrally-set expectations for reducing or maintaining rates of DToC during 2019-20 into their BCF plans’.

Bromley had reflected the national reductions, and exceeded the proposed trajectory for the 2018/2019 period. There had not yet been a performance trajectory issued for 2019/2020, however there was a commitment to further improving performance against national figures.

With regards to local and national performance, nationally there was an overall increase in DToC figures for the first quarter of 2019/20. Bromley had followed this trend and the figures for Health DToCs, although higher than previous months, were still lower than in the same quarter of the previous year. For April, and part of May 2019, the elevated position was attributed to several complex patients, both in and out of borough, requiring specialist placements.

Whilst managing delays well within the borough, Bromley also faced the challenge of managing patients placed outside of the borough. In April, 156 out of 186 total bed days were attributable to Bromley patients in out of borough hospitals which Bromley did not have social work staff based in. For May, it had been 169 out of 246 total bed days. To reduce these figures, a number of Trusted Assessors pilots had begun with neighbouring boroughs, which would allow their Social Workers to carry out assessments on Bromley’s behalf, and vice versa.

A Board Member questioned why there had been such an increase from 9 NHS bed days in April, to 103 NHS bed days in May. The Operational Service Manager – Bromley CCG said that the national database showed the reasons for these delays. The increase had been due to a combination of there being fewer delays in April for patients transferring to nursing homes and residential homes, and complex patients, including mental health patients and young people, needing to be placed in May. During May, one complex patient had equated to 30 bed days. Board Members noted that it would be helpful to know how many patients the information on the number of bed days related to.

In response to a question, the Operational Service Manager – Bromley CCG said that the 31 bed days listed for both NHS and Social Care reasons had been for one Oxleas patient with mental health issues. The patient needed 24 hour health care, and could not be discharged until a bed became available in an appropriate setting. It was confirmed that this had now been resolved. The Director: Adult Social Care advised the Board that occasionally there were patients that it was a struggle to find placements for, and although being located in an acute bed was not ideal, it was sometimes necessary to limit the number of times a patient was moved. A Board Member queried how it was possible to have patients with delayed transfers of care for both NHS and Social Care reasons. The Director: Adult Social Care responded that they were using the national definitions of where responsibility sat, and a small number of patients required joint care packages of support. It was agreed that these definitions and an example of a case would be provided to Board Members following the meeting.

In response to a question, the Operational Service Manager – Bromley CCG confirmed that delays were counted on a weekly basis, and that the “clock started” once a patient was medically fit for discharge. The Estimated Date of Discharge (EDD) was a prediction of when a patient was going to be medically fit for discharge – both clinically fit, therapy fit and socially ready. The EDD was set by the Multi-Disciplinary Team (MDT), and if it was changed, it was their decision to do so. A Board Member asked what happened if a patient in a hospital bed was declared medically fit for discharge, and then became deconditioned or sick. The Director: Adult Social Care responded that patients would be placed on and off the list, depending on whether they were well enough to leave hospital. These patients would be monitored closely, and reviewed by the Multidisciplinary Team before being placed back on the list when they were ready.

A Board Member highlighted that some of the data relating to delayed transfers of care were cases that could not be controlled, and asked if it was known how many of the bed days were attributed to the Princess Royal University Hospital (PRUH). The Operational Service Manager – Bromley CCG responded that the national database recorded this information, and only a few of the bed days were attributed to the PRUH. Another Board Member asked if trends were being considered to identify problems in the system that contributed to the delays. The Director: Adult Social Care responded that she was now responsible for Commissioning Services, and would be looking to align services, look at trends and fill any gaps. Work would be undertaken with the CCG to make sure that the right services were commissioned. The Chairman suggested that at the end of the year, a small group of Board Members, including Councillor Mary Cooke and Councillor Judi Ellis, could meet with the Director: Adult Social Care to discuss the information on the DToC that was required by the Health and Wellbeing Board to ensure it met its statutory duties.

RESOLVED that the update be noted.