Agenda item

Purpose: To receive an update from the Head of Adult Social Care on the latest delayed transfer of care (DTOC) figures which are social care related at the Royal Berkshire Hospital.  

The Committee considered a report (Agenda Item 4) regarding social care related delayed transfers of care from the Royal Berkshire Hospital (RBH).  Mrs Jan Evans (Head of Adult Social Care) introduced this report and explained that this was a major issue the previous summer when it was very difficult to control the number of delayed discharges from the Royal Berkshire Hospital. This had been caused by a lack of available social care resources coupled with very high demand for services.

To help alleviate the problem the NHS Berkshire West provided in-year funding to support 20 care beds outside of the acute hospital setting, of these, 18 beds would remain until the end of March 2011.  Provision had been made in the 2011/12 budget to ensure a sufficient number of community placements in the future.

Mrs Evans described how typically people were kept in their own homes for a much longer period and the elderly often became much frailer. In the event of a hospital admission this often resulted in greater concerns about the individual’s ability to live independently afterwards and delays resulted when a care home placement needed to be found.

Sam Otorepec (NHS Berkshire West) described how the Primary Care Trust was looking into reablement measures within the hospital setting to allow patients to regain their mobility and independence. It was also explained how new Government money was now available for measures to prevent inappropriate hospital admissions and to ensure patients were more quickly discharged from hospital.

Mrs Evans described the opportunity to use ‘Extra Care Housing’ schemes as a genuine alternative to residential care places using the development of the old Waring Court site as an example. However, this type of accommodation was not suitable for those that required frequent nursing support. 

It was described how residential care places were at capacity within West Berkshire and further dementia care services were also required. It was acknowledged that the District needed another new-build care home facility to meet future demand and discussions were now commencing to develop this capacity.

The Council was also considering purchasing care home placements out of area, for example in Wiltshire, in order to meet the demand. However, this was not always popular with patients or their families. 

It was explained that West Berkshire Council had been fined by the RBH and North Hampshire Hospital as a consequence of delayed transfers of care. Previously, there had been a local agreement not to fine local authorities as the Delayed Discharges Grant was instead invested into community based services. However, this agreement was no longer in place locally. The NHS Berkshire West Primary Care Trust helped this year to provide additional funding to meet the need for community placements to ensure patient care was not compromised.

Currently there were only two delayed discharges at the RBH attributable to social care; one was waiting a nursing home place and the other a care home placement.

Members asked about the views of the other health organisations involved in caring for older people, including the Ambulance Service, Accident and  Emergency doctors, General Practitioners, etc.  It was explained how the biggest healthcare costs were for provision of services at acute hospitals.  A lot of work had been done on modelling doctor referral patterns and considering alternative care pathways to prevent inappropriate hospital admissions.  

A discussion took place about the nursing homes and care homes that made the highest number of emergency calls. Work had been done to ensure nursing skills were improved, to provide nurses with greater skills and confidence to deal with end of life patients. 

RESOLVED that the update regarding delayed transfers of care at the Royal Berkshire Hospital be noted.