Agenda item

The Monitoring Officer to report on any questions, representations or statements of case received.   

Questions received after despatch of the agenda are attached.

Five questions were submitted by Mrs Chandarana, as follows:-

“Re: Social Services responsibilities under the Community Care (Delayed Discharges Etc.) Act 2003 (LAC (2003)21 Circular)

1.    Can the Assistant Mayor for Adult Social Care (ASC), the Director of Adult Social Services (DASS) or the Relevant Officer confirm that?

The Council has a responsibility to work with the UHL NHS Trust to identify the causes of delayed transfers of care within the City and assess the appropriate intervention and investment needed to tackle them.

Re: DTOC - Awaiting Residential Home Placement or Availability in Leicester UA (DOH data)

2.    Can the Assistant Mayor for ASC, the DASS or the Relevant Officer confirm that?

Leicester UA has had the biggest increase in the number of bed days lost due to delayed transfers of care attributed to patients Awaiting a Residential Home placement or availability per month from April 2011 to August 2013 compared to every one of its closest fifteen comparator councils - CIPFA’s nearest neighbour comparators (Per 100,000 Population).

3.    Can the Assistant Mayor for ASC, the DASS or the Relevant Officer confirm that?

Leicester UA had the highest number of bed days lost due to delayed transfers of care per month attributed to patients Awaiting a Residential Home placement or availability in both July 2013 and August 2013 compared to every one of its closest fifteen comparator councils (Per 100,000 Population).

4.    Can the Assistant Mayor for ASC, the DASS or the Relevant Officer confirm that?

In August 2013 a total of 249 bed days were lost due to delayed transfers of care attributed to patients Awaiting a Residential Home placement or availability, this reason accounted for 18% (the second largest proportion) of all bed days lost. Hence nearly 1 in 5 of all bed days lost due to delayed transfers of care in Leicester attributed to patients Awaiting a Residential Home placement or availability.

Re: Statutory Guidance – ‘Guidance on the Statutory Chief Officer Post of the Director of Adult Social Services’

5.    Can the Assistant Mayor for ASC, the DASS or the Relevant Officer confirm that?

The Assistant City Mayor for Adult Social Care is accountable and hence, responsible for preventing unnecessary use of healthcare resources.”

It was noted that, as neither Mrs Chandarana or her representative were able to be at the meeting to present the questions, Mrs Chandarana asked that they be withdrawn.  However, the Chair stated that, due to the level of interest in the matters raised through the questions, she would like the response to be given at this meeting.  This would then be sent to Mrs Chandarana in writing and she would be able to ask further questions at a future meeting if she wished.

The Director of Adult Social Care and Safeguarding then gave the following response:-

“I shall respond to questions 1 and 5 first.

I confirm that the Council, through the Director, has a clear responsibility to work with University Hospitals Leicester (UHL) NHS trust, to identify the causes of delayed transfers. However delayed transfer of care responsibilities are not confined to acute (UHL) hospital settings and therefore we also work with our other NHS trust, the Leicestershire Partnership Trust (LPT), notably in relation to transfers from inpatient mental health facilities. LPT is classed as a non-acute hospital setting for the purposes of delayed transfers.

The Council is also required to ensure clear political accountability for the effectiveness, availability and value of social care services, with the aim of preventing the unnecessary use of healthcare resources. In Leicester this is provided through the role of Assistant Mayor for Adult Social Care. However accountability is different to responsibility for action, which rests primarily with Council officers.

I also confirm that there are robust mechanisms in place to ensure that issues relating to delayed transfers of care are actively addressed. Specifically there is the multi-agency discharge group, which is identifying blocks and solutions to discharge delays. There is also a strategic weekly meeting of chief officers to look at acute care issues, including delays, attended by the Director for Adult Social Care. Examples of the impact of partnership working include:

·         Equipment, for use within the community, can now be accessed on the same day, 7 days per week

·         Engagement with care home managers and their representative bodies to improve the timeliness of care provider assessments

·         Package of care delays are reducing due to the bridging of services through the Integrated Crisis Response Service.

·         The actions put in place over Christmas - telephone support in addition to normal referrals has expedited decisions and earlier discharge

·         Social Care teams have supported the ‘super weekends’ to test 7 day working

·         Social Care has actively engaged in the escalation and capacity planning process, which includes supporting flow through the emergency pathway.

As the joint Health and Wellbeing and Adult Social Care scrutiny meeting heard during its recent review, social care is actively engaged in the winter planning process to support resilience through the peak Christmas and New Year periods. Our engagement is described by partners as positive and constructive.

I will now respond to questions 2, 3 and 4.

The short answer is that all 3 statements can be confirmed as technically correct. However, these headline statements do not convey the complexity of the delayed transfer data, which, if further explored, gives a much clearer picture of the local situation regarding delays attributable to patients awaiting a residential home placement. I do need to provide a level of detail in my answer, in order to assist the questioner (Mrs Chandarana) and the Scrutiny Commission to understand the actual issues that lie behind the high level performance, to avoid misleading assumptions being drawn.

The questions have been produced using nationally published data from NHS England. The statistics presented in the questions do not distinguish between delays attributable to social care, delays attributable to the NHS or to both organisations – it reflects all delays. Therefore some of what is presented is outside of the Council’s responsibility, for example delays relating to people who are eligible for 100% continuing healthcare arranged by the NHS.

The statements also present delayed transfers of care from all settings, including from non-acute settings. Although the questioner has drawn a focus on delays from UHL acute settings, through the first question, it is important to note that delays from LPT are the more significant feature of the statistics. This is particularly relevant when looking at the reasons for any delays related to ‘awaiting residential home placement or availability’.

Specifically regarding question 2, it is the case that Leicester had the highest increase in beds days lost for this reason compared to the 15 other CIPFA comparators, if calculated over the full period, although the monthly variation is considerable. I would confirm that this is largely due to a significant increase in bed days lost during 2013 /14.

During 11/12, Leicester had the 3^rd highest number of delays for this reason; during 12/13 Leicester was ranked only 11^th highest of 16.

The significant majority of lost bed days relate to delays within non-acute care settings and primarily from adult mental health wards. For the period April to November 2013, of those residential care-related delays attributable to social care, only 12 of 1,103 lost bed days related to UHL acute discharges. This is just 1%.

Of that 1%, they were attributable to process delays. It is usual for the care home to visit the patient to make their own assessment of the home’s ability to meet needs, given Care Quality Commission expectations that a home must be satisfied that it can do so before admission. Some providers have small staff teams and delays occur in waiting for the manager, or a senior carer, to be available to complete this assessment visit on the ward. The other reason for delay occurs whilst families select a preferred home from those available to them. Statistically, delays from acute hospitals are not attributable to there being a lack of available placements.

Given this local picture of delays from non-acute, adult mental health settings, we have worked closely with LPT to understand the barriers. It is the case that these lost days relate to a small number of complex individuals, who have lengthy delays due to the specialist nature of the placements they require. Adult Social Care is engaged in the discharge arrangements for these individuals, so we know that this includes people with chronic, challenging mental health needs, which can be combined with forensic (criminal) issues such as convictions for arson, physical or sexual assault.

It is therefore the case that, once a residential placement is assessed as needed and the ‘delayed data clock’ starts ticking, it can take some time to identify a suitable placement. This requires careful clinical judgements on the safety of any given setting, the potential provider’s thorough assessment of suitability, taking into account their other residents (for example it may not be possible to place in a setting with female or older residents) and the development of risk plans to facilitate a placement. It is the case that some placements are not readily available in Leicester, being so specialist. In terms of the increase during 13/14, we know that observations about adequacy of discharge arrangements, from the coroner and other inspections, have meant that there is a heightened level of caution by all professionals in ensuring that things are right before a placement is agreed or made. 

With regards to question 3, I would note that Leicester did have the highest number of bed days lost for this reason during July 2013 and August 2013 but did not have during April June, October or November of that year.    

With regards to question 4, this also draws on a specific month of data, August 2013. The monthly variation in the percentage of delays for this particular reason is between 8% and 20%. The average percentage for April to November 2013 is 14%. As previously noted, these relate almost entirely to non-acute delays.

Given the causes behind the delays being discussed tonight, I can confirm that a number of actions have been taken with the support of the Assistant Mayor. This includes the creation of a new Health and Social Care Co-ordinator post for adult mental health wards, to assist with discharge planning; it also includes a continued focus on developing services which prevent admission to mental health wards, such as crisis teams, and services which promote accommodation options on discharge, such as supported living for adults with mental health needs. We continue to work closely with all partners on all aspects of the discharge agenda.

In summary, I would confirm that delays relating to residential care availability occur very rarely for people awaiting discharge from UHL, and the issue lies with discharges for people with mental health needs in LPT beds. I would also confirm that, whilst correct, the statements in questions 3 and 4 are based on selectively drawn data, which does not give the full picture of local issues.

I apologise for the length of this response; whist the questions have asked for simple confirmation, it would be misleading to the Commission to not provide the detail that lies behind the data, so that a fuller understanding of the nature of the issues being presented can be taken.”

RESOLVED:

That the Director of Adult Social Care and Safeguarding be asked to send this response to the questioner, (Mrs Chandarana), in writing.