Agenda item

To consider a verbal report on the production of care plans to support patient discharges from hospitals.

11:15 – 11:45

The presentation (previously circulated) and verbal reports for Localities and Hospital Discharge Procedures were taken under the same business item. The presentation highlighted the feedback received to date and the statistics on the uptake of the new Localities Service. 

Information was shared regarding the additional areas currently under development as part of the Service, which included workforce planning.  Details were given on the Single Point of Access (SPoA) Service which had recently been launched, including the different assessments available as part of the Service.  Both the Localities and SPoA services supported the planning for hospital discharges and supported carers. 

In response to members’ questions, officers advised that:

·        from the 1 December 2014 a single 16 page integrated nursing document would be introduced in all BCUHB hospitals.  This document would detail the patient's 'journey' all the way through from admission to discharge and would include all relevant information to assist  and improve the discharge process at the end.  This document had been developed to improve the quality of information available to all stakeholders, including the SPoA Service, after it became evident that community hospitals possessed far superior quality information on patients' journey's through hospitals than acute hospitals;

·        senior leadership was now being introduced into community hospitals and the Health Board was exploring the viability of changing the 'named doctor' led discharge process in community hospitals to be a multi-disciplinary led process.  Further work was required around this idea;

·        the Welsh Ambulance Service NHS Trust (WAST) had an effective model in place called the Paramedic Pathfinder - which aimed to deliver the appropriate level of care at the appropriate time.  Efforts were currently underway to try and bring the WAST into the SPoA Service as it was felt that this particular work would complement the services already available under SPoA;

·        more work was needed in order to strengthen working links with the independent sector;

·        the Localities Service was a flexible service aimed at meeting people's needs and supporting their independence in an effective, less process-orientated and seamless way between Health and Social Care, and vice-versa;

·        multi-disciplinary teams were now operational in all A&E Departments.  These teams were on hand to shared expertise, information and signpost patients and carers to all services available to them;

·        all but one GP surgeries in Denbighshire were engaging with the SPoA Service;

·        Denbighshire residents receiving hospital treatment in out of county hospitals would also have the same access rights to the SPoA Service as those who were receiving treatment in-county.

·        individuals could self-refer themselves to the SPoA Service.  Other people could refer people to the Service with the individual's permission.  The only time the individual's permission was not required for referral to SPoA Service was if there were safeguarding concerns;

·        as with any fledgling service there would be teething troubles.  Once these had been worked through the concept had the potential to be a very good service for both the individuals needing it and practitioners, as it brought together key aspects of health and social care services and made them all accessible via the initial contact with the service;

·        officers agreed that a copy of the SPoA leaflet and business card be made available to all county councillors via the internal mail system, this would enable councillors to promote the service to residents in their areas;

·        Learning Disability referrals to the SPoA Service tended to be young people being transferred from Children’s Services to Adult Services;

·        The SPoA Service would give consideration to service-user’s preferred language for communication.

It was agreed that a report on the progress made with the establishment of the SPoA Service be scheduled into the Committee's forward work programme in twelve months time.