Agenda item

Mr Rob McCulloch-Graham gave an overview of the content of the paper and advised that the pressure on the Borders General Hospital at present was at a critical level. Work had been expedited to discharge patients and find extra care home and residential home placements.

Mr McCulloch-Graham clarified that the winter plan was the Joint Winter Plan which involved all partners: NHS Borders, Scottish Borders Council and SB Cares.

Cllr Shona Haslam sought clarification on the difference between a boarding bed and a discharge to assess bed. Mr McCulloch-Graham commented that in the acute setting if the hospital was running out of capacity in a department they would move patients to another ward, which was often not appropriate to that patient’s condition, although they still received the appropriate care and assessment required.

Mrs Tracey Logan commented that in order to assist social work and health professionals in the discharge of patients from the acute sector, she was keen for the Health & Social Care Integration Joint Board (IJB) to issue a policy direction so that staff could be up front with patients on admission to say their expectations should be that they would not stay in a clinical setting if it was not required. She further commented that she was keen to make Crawwood a more homely setting for people to be discharged to with the intention that the environment would assist in people’s reablement and outcomes, taking pressure away from the acute sector and care homes.

Mr Tris Taylor suggested the consultation phase should not wait until the Spring, given the pilot could be utilised to glean user feedback to facilitate change in behaviours and evidence positive outcomes for people. Mr McCulloch-Graham agreed that evidence should be gathered at the pilot stage to feed in to the consultation process. Mr Taylor further enquired if it was a change to both social care and NHS processes. Mrs Logan confirmed it was.

Mrs Linda Jackson sought assurance that carers would be fully involved in the process. Mr McCulloch-Graham confirmed that it was essential that carers were involved, especially at part of the assessment to leave the hospital.

Mr Murray Leys commented that consultation would be directed through the Public

Partnership Forum which was the IJB’s formal process.

Mr John Raine advised the IJB that the Borders General Hospital had been under severe strain the previous day and indeed that morning. He commented that it was a challenge to move any patients who no longer required medical care out of the acute setting. However it was especially difficult with certain groups of patients such as those in the Department for Medicine of the Elderly (DME), who due to their length of stay became used to certain routines, a user friendly environment and activities. Often the patient was reluctant to leave and the family were reluctant to aid the discharge.

Mr McCulloch-Graham further commented that the IJB would need to specify what it expected to receive for the funding it commissioned and how success would be measured. The primary expectation was to reduce the number of stranded patients and a performance measure would be required.

Mr Colin McGrath enquired about the adaptation of vacant properties owned by both Scottish Borders Council and NHS Borders to assist in the discharge of people to supported living environments. Mrs Logan commented that work with Housing Association partners on extra care housing and the older peoples housing strategy was nearing completion and contained a comprehensive strategy on the provision of extra care housing for those with dementia.

Mrs Carol Gillie highlighted to the IJB that the discharge to assess policy was about discharge to assess from all NHS facilities including the Community Hospitals.

Cllr David Parker commented that given the major issue with stranded patients it was

fundamental that a policy change be directed and Crawwood be refurbished to assist the proposal. He suggested any further delay would lead to unrealistic pressures on services and patients. He also suggested that the consultation be done in tandem with the pilot asking patients and families for feedback as they passed through the revised system.

Cllr Haslam commented that the opening of Crawwood and other facilities in the community would require close monitoring to ensure they did not end up as another place for people to become stranded. Mr McCulloch-Graham assured the IJB that a publication had been put together for patients and their families on admission to hospital which clearly advised that whilst they would receive medical treatment in the hospital their recovery and assessment would take place outwith the hospital setting. He further advised that there was a need to ensure packages of care and vacancies in care homes were available to aid the movement of people out of the secondary care setting and into the right community environment for them as individuals.

Mr McCulloch-Graham advised the IJB that Crawwood had only given permission to operate as an assessment function until the Spring of 2018 and he was keen to demonstrate by that time that there was a longer term plan. He further spoke of the challenges in attracting people into the care profession.

The Chair concluded that year on year the acute and community hospitals contained a number of stranded patients during the winter period, who had been admitted with acute illness and then awaited assessment and were unable to move to another facility or move back to their own home. He commented that in 2017 there were on average 41 stranded patients in the wrong place each week and the IJB had the opportunity to make a difference to those patients and direct the Health Board and Local Authority to manage patient flow better through the discharge to assess policy.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD approved the issuing of a Direction to NHS Borders and Scottish Borders Council to introduce a policy of Discharge to Assess.

Under this new “Direction” the HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD requested the Health and Social Care Partnership to provide a detailed and costed proposal to the IJB for the introduction of such a policy over the winter period of 17/18.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD further requested that a review of the methodology be undertaken in June 2018 and a report brought to the IJB with further recommendations based on the experience of the first six months of “Discharge to Assess” practice.