Agenda item

30 minutes maximum for this item.  Questions may be submitted to be answered by the Scrutiny Committee or Council officers who are attending the meeting as witnesses, on any item that is within the scope of the Committee. Please see the procedure (below) for the submission of questions.

Question from Mr David Ingham:

“Following my Aunt’s hospital discharge into domiciliary care last year on 04-01-22 and her hospital readmission on 02-02-22, catching covid and passing away 2 weeks later I’m drawn to government promises over the weekend concerning patient discharge.

I note the ICB “Preparing for Winter” report presented to Scrutiny on 21-11-22.  Minutes indicate that members asked for further information and to be kept informed.

Since that meeting, nurses and ambulance services have striked. More are planned. Junior doctors could become involved. Winter admissions appear higher than expected due to flu/covid. Chesterfield Royal has featured on national news.

Whilst unsure of the NHS/PVI sector situation, within the Councils Adult Social Care and Health department despite 15.1 million being spent on agency cover from 2020 to 31-08-22 and 18.4 million on staff overtime (FOI 2245) its departmental sickness levels have continued to rise to unprecedented levels.  

Given the incredible pressure on the NHS, ASCH and PVI providers how can the Committee work to ensure that against this highly complex back drop, any hospital discharges reliant on in-house or PVI Domiciliary/Care Home provision is undertaken appropriately and critically, individuals are supported thereafter in accordance with post discharge expectancies/review periods.  

Reply from the Chairman of the Improvement and Scrutiny Committee - Health

The Improvement and Scrutiny Committee – Health is responsible for the scrutiny of any major health service transformations proposed by the local Integrated Care Board that will affect local patients and service users.

The Committee has, over many years, offered challenge to the way services are provided and this has extended to the joint provision of services with the Council’s Adult Care Services.

Very recently, the Committee undertook a review of Section 75 Agreements (a mechanism for joint funding and provision of services between the NHS and Adult Care) and the Committee is particularly committed to maintaining a level of scrutiny on services where patients receive care from multiple organisations – including the discharge process.

The Committee considers this to be especially pertinent at this current time now that the local Integrated Care Board – and its facilitation of joint working between partners - has been formalised.”

A supplementary question was asked by Mr Ingham:

“I understand the need to prevent bed blocking due to the medical needs of others and on ethical grounds.

I note the additional £200 million for the NHS to secure  care home beds to support discharge. I haven’t seen any reference to domiciliary support.

Discharged individuals will have various conditions. In 2018 my own mother was discharged from hospital for temporary care  into a Care Home. She had complex needs which the family understood. It was mothers wish to return home and was already in receipt of domiciliary support.

It still took a meeting involving my mother, DSO, Social Worker and myself at the Care Home to facilitate her return home. The Care Home genuinely believed if she returned home under domiciliary support it wouldn’t work and she would end up returning. They were incorrect.

My mother was lucky – she had me to provide support - I was a strong ethical advocate fighting in her interests.

I am concerned that not everybody being discharged into Care Homes will have family available to support them.

How can the Scrutiny Committee ensure that individuals discharged into Care Homes are effectively supported by professionals to return home where appropriate – both medically and ethically?”

Response from the Committee Chairman, Cllr. Jean Wharmby:

“The Improvement and Scrutiny Committee – Health is committed to challenging the local Integrated Care System in providing health and social care for Derbyshire residents.  Integrated Care Boards were formally established across the country in July 2022 and they are tasked with developing integrated care strategies.

The joint provision of local NHS and Adult Care Services is the key element of the local Integrated Care Partnership Strategy and the Improvement & Scrutiny Committee – Health will continue to monitor service provision against the Strategy’s objectives.

This includes the hospital discharge process and the ongoing provision of care and support to patients leaving hospital settings.”