The Committee considered a joint report of the Chief Executive and the Director of Adults and Communities, the purpose of which was to present an update on the Adults and Communities Department’s performance for the year 2022/23. A copy of the report marked ‘Agenda Item 12’ is filed with these minutes.
Arising from discussion the following points were made:
i. A Member shared his recent experience of a family members stay in hospital and raised concerns about the lack of discussion with hospital staff prior to discharge regarding their reablement needs. He suggested that a critical factor that had not been but should have been considered early on was the level of capacity and ability of the person prior to their stay in hospital. The Member suggested that this would provide a baseline to assess a person against to help determine what support was needed to help an individual’s return to that level of independence wherever possible. The Member further suggested that hospital staff should be preparing patients days before their return home as part of their care in hospital to reduce the amount of support, if any, the patient would subsequently require. The Member commented that it was only after his family member had been discharged from hospital that these discussions had been held with the Homecare Assessment and Reablement Team (HART) by which time their condition had already deteriorated resulting in more home care support being required. It was suggested that holding these discussions and providing early support would help avoid the need for long term dependence on costly local authority adult social care services in a number of cases. The Committee thanked the Member for sharing their personal experience which provided an important way of identifying issues within the system that needed to be improved.
ii. The Director commented that it was the view of the Council that if part of medical treatment included a period of recovery, that should be part of the whole NHS treatment pathway, and should not be seen as separate, as recovery was as important as the treatment itself. However, the Director said that the sheer number of people waiting for hospital treatment placed intense pressure on the NHS to free beds. This had been particularly so since the Covid-19 pandemic when a number of operations had been cancelled. To achieve the most effective long-term outcome for patients, they needed to be helped more whilst in hospital. However, this was not the most efficient approach for the NHS as this would mean beds could not be released as quickly as needed for the large number of patients waiting for treatment.
Members were assured that the treatment pathway
across the whole system of Health and Social Care was being looked at and
improvements were being made. The Council was working collaboratively with the
NHS, which was now funding the expansion of the Authority’s reablement service
considerably. At present the service did
not have capacity to assess all patients before they left hospital.
Approximately 20% of people currently left hospital and went straight to home
care without reablement support. The
added funding from the NHS would help to address this and ensure everyone got a
reablement assessment before leaving hospital in future. Avoiding a person’s dependency on long-term
home care was primarily in the patients best interest,
as well as avoiding more costly home care services.
iv. Members noted that the Department was developing a pilot aimed at getting support workers into the hospitals to work more effectively with the patient particularly regarding their reablement needs, before they are discharged. Members acknowledged that this would be easier to do in community hospitals and most difficult in an acute hospital where treatment was fast-paced and where there were bigger queues of people waiting for treatment and therefore greater demand on bedspace.
v. Regarding out of County hospitals, there tended not to be link workers on site in the same way as in County hospitals, simply because there was not the resource to have people on site in every hospital. There should, however, be contact and information forwarded on a patient to the Authority in a timely way in order for a link worker to meet the patient and family prior to discharge. It was noted there tended to be better communication with some hospitals than others.
vi. A Member noted that a positive example of community working, was of a parish council who had stepped in to help with funding for Hathern library which also acted as a small community hub. The Cabinet Lead Member noted the innovative work in museums and libraries, and increased footfall which was higher in some places than before the pandemic. A letter had been sent from the Director and herself thanking libraries and museums staff for all of their work.
vii. A Member noted that statutory guidance stated a review of care plans should be undertaken every 12 months but that the Council did not complete all such reviews within that timescale. The Director advised that under the Care Act there was no time limit for carrying out initial assessments, but that reviews should be conducted every 12 months, but to the best of his knowledge this had not been tested in the courts. He added that the Department had a 76% review completion rate within the required 12 months which was considerably above the national average of 55%, but assured the Committee that the Department would continue to aim to achieve more subject to resources. A Member queried if, amongst the 24% that did not receive a review, if reasons were known, for example, refusal to have a review. It was noted that the information on non-reviews was not captured.
That the report on the update of the Adults and Communities Department’s performance for the year 2022/23 be noted.