Agenda item

To provide an update on the work of the Integrated Care Partnership on their priority around Rapid Discharge.

Dom Hardy (Chief Operating Officer of Royal Berkshire Foundation Trust) gave a presentation on the ICP priority around Rapid Community Discharge (Agenda Item 12). Key points from the presentation included:

·         The scheme sought to ensure that patients were discharged from all hospital settings as soon as they were ready.

·         It applied national guidance that was introduced (with additional funding) in April 2020.

·         It included a Discharge to Assess approach – rather than patients waiting in hospital to be assessed, patients were discharged to their own home with assessment preformed there.

·         The scheme covered all of the Berkshire West Local Authorities, Berkshire Healthcare Foundation Trust and Royal Berkshire Foundation Trust.

·         It focused on four pathways:

o   0 – patients with no ongoing care needs

o   1 – patients in need of domiciliary care

o   2 – patients needing rehabilitation in community hospital beds

o   3 – patients requiring residential care

·         Benefits included:

o   Improve outcomes for patients around infection, independence, mental health and muscle conditioning

o   Equality of support when leaving hospital.

o   Opportunity to make decisions away from a hospital setting.

o   Avoids delay for self-funders who find it challenging to source alternative support of who are concerned about the cost of care.

·         At Royal Berkshire Hospital, there had been a marked reduction in the number of patients waiting more than 7 days and those waiting more than 21 days for discharge.

·         Challenges to sustaining this model were:

o   Sustainable funding

o   Unintended consequences (e.g. high level of care need at discharge)

o   Capacity constraints in the care market

o   Increased numbers of patients awaiting discharge on a daily basis.

·         The scheme would remain in place until the end of 2021-22 –discussion about extending it were ongoing within the ICP.

Dom Hardy asked how the Board could help to tackle current issues in the care market.

Councillor Jo Stewart noted the benefit that everyone received the same level of support when leaving hospital, but observed that this posed a huge challenge for the care market. She indicated that work was ongoing with partners in the ICP and work was underway in relation to care recruitment. While she accepted that getting people home as soon as possible supported their recovery, she did not wish to see the problem pushed from hospital to domiciliary care.

Dom Hardy indicated that he worked closely with Andy Sharp and his team. He was pleased at the commitment to continue to work on this issue, since the aim was to achieve the best and safest place for all residents, which was usually their own home. He felt that the more domiciliary care capacity could be increase the better it would be for everyone.

Councillor Adrian Abbs supported the approach, but asked who set the target and why it had been set for April 2020.

Dom Hardy explained that it was an internal target for Royal Berkshire Hospital and was used to challenge their teams.

Councillor Abbs asked if there was any pressure to change the target at that time due to Covid.

Dom Hardy confirmed that this was not the case and that it had been adjusted due to the sharp fall in admissions and the benefits that were being delivered.