An update report was requested at the last meeting, to follow, marked:  8

Contact:  Andy Begley, Director of Adult Services, andy.begley@shropshire.gov.uk

Members considered a report, copy attached to the signed minutes, on Delayed Transfers of Care. 

Officers explained that results for Shropshire showed that the number of patients facing delayed transfer of care according to a snap shot survey had stabilised and were slightly better than the previous year.  However, the number of delayed days was increasing, although at a slower rate than the national average. 

Members also noted that the latest available data was for November 2016, and that comparatively small numbers made it appear that there were great fluctuations.  NHS England determined which organisation was deemed to be causing a transfer of care being delayed, the options being the NHS, Adult Social Care or a joint responsibility.  Delays attributed solely to the NHS had seen a decrease whilst those attributed solely or jointly with social care continued to increase.  This was mirrored across the country where social care departments faced budgetary pressures, exacerbated in Shropshire due to the rural nature of the county and above average rate of elderly population.  

Members noted that an unusually high numbers of delayed days occurred in Shropshire during August 2016, accounting for the majority of the annual increase.   The reasons for this fluctuation were unknown. 

It was confirmed that each month as the data was issued the dashboard was circulated to Directors.  The Director also confirmed that he looked at DTOC figures on a daily basis at individual patient level. 

A member drew attention to delays at hospitals, some of which were attributed to people registered with GPs in Wales, but whose social care was provided by Shropshire.  It was confirmed that the data was based on a person’s normal home address.

Members observed that Shropshire was doing relatively well at not increasing patient numbers but that patients in hospital were in for longer. They asked what was being doing to address this.  The Committee were reminded of the work of the ICS team at the hospital and the brokerage service which was now also being used for admission avoidance work.  Avoiding delayed transfers of care was a focus of the entire health and social care economy.  The figures fluctuated constantly, demand was ever increasing and the pressure in the whole system was increasing on a daily basis.  A plethora of initiatives was underway to find ways to reduce stays in hospital. 

Members asked if there were enough care providers in the county.  The Director explained that although progress was good, more providers were needed.  This would be a focus of activity for the year as it had been surprising that the visibility of brokerage had not led to more providers.  Work was underway with Shropshire Partners in Care to identify the reasons for that and to help businesses to develop.

Members wondered if providers were not stepping up due to the costs of training staff.  Officers explained there was a significant issue around recruitment into the care industry both nationally and particularly in Shropshire.  Those who might work in care often turned to retail employment, especially in a rural county where travelling  could be difficult in winter. The Council continued to work with Shropshire Partners In Care on these issues, paid for training for staff and was offering support for collective recruitment initiatives. 

A member asked for a more up to date picture than the November figures were able to provide but this was not yet available.  The Director was able to say that 27 people were awaiting domicillary packages that day, some of which were related to admission avoidance.  He viewed a report every morning first thing and at noon.

The Director commented that the national reporting metric was a blunt tool and did not account for reasons for the delays in the system.  It was important not to just focus on the point of discharge, there were many reasons for delays and differences in organisations managing risk.  The increase was reflective of the demand on the system as a whole. 

A Member referred to the lack of affordable housing particularly in the south and west of the county.  She asked whether this evidence of local housing need for carers would be input into the Local Plan Review. The Director referred to his responsibility for both housing and social care which meant those connections could be made .  He confirmed issues around affordable housing for carers were being considered, along with developing a career pathway.  Members requested that the submission to the Local Plan Review be shared with the Committee. 

Members also felt it important to encourage the education establishments in the county to provide relevant training at the appropriate level. 

Members acknowledged the tremendous pressure Council and NHS staff were working under and the change and improvements which had taken place.  More people were being helped now than ever had been previously. 

The Director welcomed the challenge from the Committee.  He spent a significant amount of time looking for solutions both in the region and nationally, there were many different models of care.  The Committee noted that one region could be performing well one day but not the next.  No configuration had solved the problem to date and other faced the same challenges. 

The Portfolio Holder for Health said it was very interesting to reflect on measuring performance nationally and locally and asked if it might be possible for the Committee to influence how national measures evolved. The Committee noted that the officers raised these issues at both the regional Directors group and the regional Performance Group.  Issues with the way the figures were constructed and informed by a number of different organisations would also be raised at a national level.  

Members agreed the recommendations in the report and wished to add an acknowledgement of the excellent work of Social Care and NHS colleagues in very difficult circumstances.