Agenda item

Mrs Susan Manion advised that a formally agreed performance framework for the IJB was still under construction.  She was keen to ensure that the future report would including monitoring and actions across all of the health and social care remit.  She was further keen to collectively address delayed discharges and ensure duplication was removed.  Mrs Manion further reported that the move to the 72hour target would take place on 1 July.

Dr Angus McVean commented that he was keen to see data on readmission rates (especially those presenting 2 or 3 times in quick succession) as potentially those discharged too quickly could be readmitted if their problems had not been resolved.  Mrs Evelyn Rodger advised that she was very mindful of the potential issues of discharging patients too early in their care pathway and a focus and attention was being paid to readmission rates to ensure patients were not being disadvantaged. 

Mr Alasdair Pattison commented that work was being progressed in identifying the 2% of the population in Borders who were high resource individuals to ensure they were appropriately resourced in the community to prevent admission and readmission. 

Cllr John Mitchell enquired where the 2% figure originated.  Mr Pattinson advised that it was a percentage taken from national data and he was keen to view the profile for the 2% in Scottish Borders and reasons for admission and readmission. 

The Chair suggested that the arbitrary 72hour target wasn’t necessarily best for the patient.  Mrs Rodger advised that in terms of the target, it was no different to the Accident & Emergency (A&E) target, in that it was a proxy measure for how the system was behaving.  In terms of data intelligence in Scottish Borders, she advised that Scottish Borders had the lowest number of care packages, and the message received from Health Improvement Scotland was that health and social care wasn’t functioning as well as it might in Scottish Borders.  She advised that currently there were 5-6 patients who could not be moved to where they needed to be for their care needs due to delayed discharges in the system.  Mrs Rodger suggested the IJB might want to see the trajectory to get to 72 hours and then a regular update on progress against the target.

Mrs Manion advised that the trajectories for future delays had yet to be confirmed and she suggested identifying what the likely impacts were going to be for the proposals in the action plan. 

Dr Stephen Mather commented that there were areas of concern in regard to care home placement and patient choice for care home placement.  He suggested a key measure of success for the IJB was to make a difference to delayed discharges and enquired if the ICF could be used to specifically target delayed discharges and improve care at home and choice of care home placement to make a tangible difference to individuals. 

Mrs Manion reiterated that the ICF would be funding a range of initiatives which were in the action plan for delayed discharges, such as reablement, access to home care, rapid resource and other initiatives sitting within the context of the ICF. 

Cllr Jim Torrance reiterated that it was a whole system approach that was required as historically there had always been an issue with delayed discharges in Scottish Borders, due to a lack of social care availability; lack of residential care nursing home placements; pressure on beds in the Borders General Hospital; and potential readmissions.  He reminded the IJB that Waverly House had been purchased for the provision of fast tracking people and that facility had been blocked with long term clients and he emphasised the need to ensure there were appropriate services and equipment available to people to safely return to their own homes.

Mr David Davidson suggested he would be keen to see a detailed list of the obstacles to see what the interconnections were and whether they were assumed to be real or not.  He was also keen to know the current status against the 72 hour target.

Mr Pattinson commented that it was a complex arrangement to manage people through the health and social care pathway and that delayed discharges were managed at the margins.  Progress had been made in terms of occupied bed days but it was becoming more difficult.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the report.