Agenda item

To follow

The LBB Assistant Director for Integrated Commissioning provided an update to the Sub-Committee on the Single Point of Access (SPA) and discharge arrangements.

On the 19^th March 2020 the government had published its ‘COVID-19 Hospital Discharge Service Requirements’ which stated that unless required to be in hospital, patients must not remain in an NHS bed. The guidance required acute trusts and community health and social care providers to work together to deliver a discharge to assess model that facilitated immediate discharge from hospital with assessment of need taking place in the community.

The guidance outlined four discharge pathways – pathway 0, where patients were discharged home with no further support, was managed by the Trust; and pathways 1-3, where discharge required further support in the community (such as requiring domiciliary care; a rehabilitation bed; or care in a residential / nursing home), were accessed via a Single Point of Access (SPA) for community health and social care services.

Each area was required to establish a SPA and had been provided with some additional funding to do so. The government had also underwritten some of the early parts of the discharge process and since March, the first six weeks of discharge were covered by NHS COVID funds. The SPA was required to:

-  Function seven days a week, 8am-8pm;

-  Provide a single route for all community health and social care services;

-  Accept assessments from hospital staff on the needs of individuals;

-  Use multi-disciplinary teams on the day of discharge to assess and arrange packages of support;

-  Provide timely access to equipment; and

-  Maintain the flow of patients through the pathway, ensuring assessment of long-term care and support needs were undertaken following a period of recovery.

Led by Bromley Healthcare, partners from across the system (the PRUH and King’s College Hospital NHS Foundation Trust; the Local Authority; Oxleas and St Christopher’s), had collaborated resources to form a SPA and worked as a Multi-Disciplinary Team (MDT) to simplify the hospital discharge process. The key features of the SPA were:

-  Discharge to assess (so needs can be evaluated most appropriately);

-  Single referral process (bringing together what was a complex system with multiple discharge pathways into a single, simple process);

-  Clinical triage (nurses and therapists efficiently triage to ensure clients access the most suitable service);

-  Streamlined referral pathways (revised protocols for referral pathways which enabled timely allocation);

-  Welfare calls (management of welfare calls/visits for all clients discharged from hospital, including ED, ensuring safe discharge); and

-  Virtual Multi-Disciplinary Team (partners coming together to provide a whole systems approach to managing a client’s transition).

Data provided on the SPA’s activity between March and December 2020 highlighted the volume of its work, processing on average 576 referrals per month. During this period, around 50% of the patients discharged from the PRUH had been supported through the SPA, with a large number requiring further nursing and domiciliary care. A Member asked for further clarification regarding the columns of percentages listed for each pathway (Table 1, 5^th slide of the presentation). The LBB Assistant Director for Integrated Commissioning responded that the left-hand column indicated the government’s prediction of the percentage of patients that would be discharged via each pathway, while the right-hand column provided the actual percentages for each pathway that had occurred in Bromley. Bromley was operating slightly differently to the government’s expectations, which could partly be due to the borough having an older population.

The benefits of the SPA were that it allowed patients to be discharged from hospital in a timelier and client focused way, with them feeling safe and supported. Bringing partners together had also allowed greater flexibility with pooled knowledge and resources, making them more responsive to the changing needs of patients, as well as the pandemic itself. It was noted that the future of the Bromley SPA needed to be considered – it was a fantastic resource for residents which was working well, but it was “held together” by the additional financial resources provided by the government. Before the end of the pandemic these processes would need to be reviewed, to consider if they could be sustained – learning and development would be taken from the SPA to support future arrangements, but it was a very specific vehicle to support the current crisis.

There were currently no discharge delays, and the SPA was working with healthcare providers to ensure that patients were discharged in a safe and timely manner. A number of patients in the PRUH were very unwell, and as a result were spending longer periods of time in the hospital and required more support at the point of discharge. The LBB Assistant Director for Integrated Commissioning informed Members that he chaired a weekly meeting attended by the agencies and professionals whose teams were responsible for discharge. They reported that the system was working well, however it was not without its challenges, including outbreaks of COVID-19 amongst staff and residents in some care homes. Some domiciliary care agencies were more hesitant about accepting discharges of COVID-19 patients. To help address this, they were working closely with these agencies, and were also looking to increase the number of domiciliary care agencies used in case there were further demands on the system. Members were advised that COVID-19 vaccination programmes for both residents and staff were underway across the borough’s care homes. All local health and care providers were being contacted to organise the first vaccination for their staff by mid-February 2021.

In response to a question regarding the cost of the SPA and discharge arrangements, the LBB Assistant Director for Integrated Commissioning highlighted that the government, through the NHS, were underwriting the costs at the point of discharge for the first six weeks of a patients’ care. During this period, assessments were undertaken, and decisions made as to who would pay for any ongoing care. This speeded up the process and simplified the working process. Similar arrangements had been established across the country, which had worked successfully, and it was anticipated that the government would want to take some learning from these processes. An evaluation of the SPA’s impact was being undertaken locally, to look at how partners could sustain their collaborative effort and the ability to afford it.

The Chairman thanked the LBB Assistant Director for Integrated Commissioning for his presentation to the Sub-Committee.