Agenda item

That Members are aware of the process of Delayed Transfers of Care and how it is monitored and managed each month.

The Chief Officer (Social Services) introduced a report on the role and function of the Delayed Transfer of Care (DTOC) process, the structure of hospital-based social work and its collaboration with Health colleagues.  A DTOC occurred when a hospital patient was fit for discharge to another setting beyond the date agreed by the lead clinician.

The report set out a range of activities to minimise delays to hospital discharge which was a key priority for the service.  Whilst there had been a slight increase in DTOC numbers since last year for people aged over 75, Flintshire’s performance was good across North Wales councils.  Members were told that a breakdown of DTOC categories was available upon request.

The Senior Manager, Integrated Services, Lead Adults provided details on the monthly census involving the collection of data from the three local acute hospitals which would include data from the Countess of Chester Hospital from April.  The slight increase in DTOC figures for this year was due to the rising number of referrals and complex issues involved.

Members were introduced to the Service Manager - First Contact & Locality Services (Janet Bellis) who explained that the majority of people now entering hospital were elderly with multiple health conditions and a diminishing family support network.  Social work teams across the three hospitals were rotated according to areas of high demand, however all three hospitals were often on red alert.  The hospital discharge protocol involved a multi-agency approach to meet people’s expectations to remain at home for as long as possible.

The Chair referred to the DTOC codes appended to the report and requested a breakdown of the reasons for the delayed transfers of the 44 individuals in the current year.  Officers explained that amongst the many DTOC codes, most applied to those in category 2 ‘community care arrangements’, for example housing or home care related issues, residential care placement arrangements etc.  The Chair remarked that the Committee had not received an update on Disability Facilities Grant adaptations for some time.  Officers said that ‘step down’ placements were provided where a delayed transfer had arisen from a person awaiting such an adaptation.

Councillor Mackie praised the officers’ knowledge on the matter.  He said that figures reported by Stats Wales appeared to indicate that most DTOCs involved issues outside the Council’s control and that the proactive approach taken by the Council should be highlighted.  He suggested a future agenda item on activities which helped to keep people out of hospital.

In response to concerns from Councillor McGuill about the challenges of discharging via the Intermediate Care Fund, officers explained the role of the hospital social work teams to facilitate hospital discharge until the person was safe elsewhere.  Where further care was needed, the person was supported by a community-based social worker.  Hospital social worker teams were currently only available during office hours, in line with other social care professionals, although an out-of-hours service was provided by Discharge Liaison teams.

Councillor Hinds referred to the difficulty in engaging a private care company to provide two carers following a hospital discharge.  The Service Manager was aware of a number of dual-handed care packages which were run successfully.  She went on to share details of a project involving Occupational Therapists to establish whether an appropriate level of care could be provided to a person by a single carer with the help of specialist equipment.

Councillor Bateman raised concerns about the process for transferring a patient to the community Occupational Therapist before hospital discharge.  The Service Manager explained that planning meetings were held in the hospital with the patient and their family in advance of the discharge to discuss the transition to continued therapy.  She agreed to follow up a specific case with Councillor Bateman outside the meeting.

Councillor Peers spoke in support of Councillor Mackie’s suggestion for a future report and said that a chart demonstrating patient flow and handover throughout the process would be useful.  The Senior Manager spoke about the need to assess on a case-by-case basis according to the needs of each individual.  Following comments on the aim to discharge people back to their homes, officers explained that this enabled them to make significant, potentially life-changing, decisions in that familiar environment rather than in hospital.

The Chief Officer referred to arrangements with partners in Health to make the system work effectively and efficiently to reduce the number of individuals affected by DTOC.  This was facilitated not only by the availability of ‘step down’ placements but the development of Marleyfield would provide further support.

RESOLVED:

That Members are aware of the process of Delayed Transfers of Care and how it is monitored and managed each month.