Apologies for Absence
Apologies for absence were received from Councillors Glynis Smith and Councillor Sean Gibbons.
Declarations of Interest, if any
There were no declarations of interest made.
RESOLVED: That the minutes of the meetings held on the 29th September 2022 be agreed as a correct record and signed by the Chair.
[A period not exceeding 20 minutes for
Statements from up to 5 members of the public on
matters within the Panel’s remit, proposing action(s)
which may be considered or contribute towards the
future development of the Panel’s work programme].
The Chair read the following statement;
Today the Panel will be receiving an update from Doncaster and Bassetlaw Teaching Hospital. As part of work of the Panel, we are always looking for the lived experience of those impacted by the services delivered from the Council and its partners.
I have been contacted by Mr Mills, who has raised the following points through a journal he has updated on a weekly basis dating from early July to this current day. It relates to his caring responsibilities and an individual’s journey from being admitted to DRI following a fall. This continues to be an ongoing issue.
From the journal, I would like to raise the following key points and concerns;
• Admission and discharge issues.
• Experience of ambulance waiting times of 8 hours following a fall and concern around the length of time around admission and triage.
• Not able to accompany patient in the triage area where they were alone for 2-3 hours (worried about patient who is elderly and felt confused and alone).
• Reference made to the length of time taken for patient to be discharged from her first admission to hospital, which was already extended from the original Care Plan due to the lack of home carers available. It was noted that a private home care was eventually arranged to facilitate the discharge.
• Constant pressure needed for medical staff to investigate medical issues against advice of an earlier discharge, whilst health condition worsened and length of hospital stay extended and still goes on.
• Problems with communication and sharing information – Mr Mills found that there was an inability to share systems and information (demonstrated through medical staff not able to access digital information provided by ambulance staff), Mr Mills needed to repeat case histories of patient to various member of medical staff and was not updated promptly when the patient experienced a further fall whilst at hospital.
• Hospital Liaison Service – a need for clearer accountability and neutrality.
The Chief Executive of the Doncaster and Bassetlaw Teaching Hospital and Director of Health and Wellbeing asked to receive a copy of the journal.
The Panel received a presentation from the Chief Officer of Doncaster and Bassetlaw Teaching Hospitals, which outlined the following areas;
· Urgent and Emergency Care
· Ambulance Data
· Transfer of Care
· Elective, Cancer and Diagnostics
· Finance in Month Five
· Winter Planning
· Health and Wellbeing
· Estates and Infrastructure
There was a discussion held and the following areas were highlighted;
Treatment of Carers in Hospital – Members expressed an interest in hearing about the treatment of carers in Hospitals, when there for the person they were caring for. It was noted that the Carers Action Plan had been considered at a recent meeting.
The Chief Executive had explained that it had been challenging to support the role of carers during the pandemic but acknowledged the value of carers and the support they provide to patients. It was continued that the D&BHFT was supportive of the Carers Statement 22-25 and would do their best to implement it. It was commented that the role carers had in taking burden of caring staff and contribution they make was recognised.
It was viewed that at present, it was about maintaining the right balance and minimising the number of people in ward and department areas to maximise the ventilation and space whilst also prioritising carers. Reference was made to the role of the Deputy Chief Nurse as lead in this area, who would also help and support carers and families, as well as addressing challenges. Mention was made of the PALS service, which served as a conduit with carers and loved ones and that Hospitals endeavoured to take the necessary steps to ensure it was a positive relationship. It was recognised that there could be issues around communication and not being able to access patients.
Ambulance/Handover Waiting Times – Concerns were raised about the length of time people were left waiting for an ambulance and of the handover period (upon arrival at hospital) which was seen to be increasing. It was noted that there was the potential to be more efficient if the Departments were more co-located. It was explained that the challenge was that the Department was originally designed for 200 patients a day, however, on a busy day this now reached over 400. The Panel heard how building work had been undertaken to make the system more efficient and improve the flow but that they continued to be challenged on busier days.
It was explained that the problem was around bed bases and having to sustain flow when ambulance peaked at certain times of the day. Members heard how there tended to be certain patterns during the day when an ambulance was called for, then on arrival at the hospital it would takes around 2 hours to process a patient. Members were informed that the problem was how there were no immediate beds, and therefore patients would have to wait somewhere. It was noted that there was a need to balance where it was the safest and sometimes that this was with the ambulance crew or ... view the full minutes text for item 19.
The Panel received an overview from the Director of Adults, Health and Wellbeing and Acting Director, Strategy and Delivery, NHS Doncaster CCG, NHS South Yorkshire ICB, Doncaster Place.
The following areas were raised as part of the discussion;
Urgent Community Response And Pathways - Members were informed that this was about referring to a set of responses set in the community. The aim being when there was someone in the community who had an urgent and acute need that they could be treated in the community, and could receive a response within 2 hours and ongoing care over next couple of days to keep them at home. Members were reminded that historically this was the Rapid Response Team, which focused on treating respiratory patients. It was explained that the challenge was to now expand and work was underway to take this forward to increase the number of pathways. It was acknowledged that an expanded workforce may also be required which may mean it takes time to be established. It was explained it was about creating a one team approach through investment, forming a dynamic workforce providing a wraparound care within the home.
Additional Beds – The Chief Executive of D&BFTH told Members that there was a plan in place which saw additional beds implemented in October. With regards to options for any further beds, it was outlined that there was one hospital based area in Doncaster that had the potential space, although the likelihood was that it would not be made available because it would rely on temporary staffing which was already stretched. Members were told that there would be an impact on Elective Care due to the current pressures whereby emergency cases were having to take the place of planned surgery at times. It was continued that the plan would be to transfer activity from planned elective inpatient care to planned day case care and therefore change the balance because day case care would not need that overnight stay and were carried out in different facilities. It was commented that in winter, elective and emergency services increased, particularly in orthopaedics and there was also a rise in general surgery admissions. Members were told how there was not much additional acute capacity to open and that was why virtual wards had become so important.
Members were informed about transfer of care beds, where someone could go whilst they were waiting for their social care package, that was ready to return home and did not need acute care. It was explained that 16 of those beds had been commissioned, which were now in place across Doncaster. It was noted that efforts were being made to understand how such work was freeing up acute beds, and efforts were being made to look across the board to see what could be done and create the right kind of support and the right flow.
Mental Health - Members were informed that RDaSH was seeing an unprecedented demand for mental health inpatient beds. It ... view the full minutes text for item 20.
The Panel gave consideration to a presentation, which described the current planning processes underway across NHS South Yorkshire and within the Doncaster Place.
· The National Context
· What is the Ambition?
· What is the Ask?
· The South Yorkshire Approach
· Integrated Care Strategy Engagement
· Our Emerging Vision for the Strategy
· Shared Outcomes
· System Enablers – Building Blocks
· Questions to Consider
Health of our Doncaster Population/Cost of Living Crisis – Concern was raised around the huge pressures families were facing and it was questioned, what was being done in Doncaster to support its most vulnerable. In addition to what had been discussed during the meeting, reference was made to what was taking place in Primary Care, which was looking at how they could be more proactive with those that were vulnerable. It was explained that this may involve going out and to see those that were known to be vulnerable at home.
It was added that a challenge around the Integrated Partnership Care Strategy was about how it would add value and look at different perspectives, moving away from repeating what had been asked through various other strategies. It was explained that what had emerged was an appetite around support for early years (0-5 years).
JSNA – There was a brief discussion about the healthy life expectancy for Doncaster women as reported in the recent JSNA. In terms of the Doncaster plan, it was explained that there was already a set of plans and pieces of work in place across health and care. Members heard that the Doncaster JSNA would be revisited and challenged to ensure that the Doncaster plan had the appropriate responses in place on issues such as women’s healthy life expectancy.
Reference was made to health inequalities and healthy life expectancy across the borough. There had been a recent presentation at Health and Wellbeing Board about what investment from the Integrated Care Board (ICB) would experience the biggest benefit. It was recognised that there was a need to consider how resources could be freed up from existing system to be sent further downstream, for example, early years of children. Examples of targeted investment, included lung cancer pathway and the use of a bus to carry out CT scans to identify this at an earlier stage so it can be treated at a curable stage.
There was a brief discussion about the Health and Wellbeing Strategy and how it would look to take account of the issues around women’s healthy life expectancy and should influence the further planning work that will be undertaken. It was added that as a publicly accountable board, the Health and Wellbeing Board would continue to look at this issue.
It was noted that taking into consideration the work that had been done around Early Help already, there was a need to build on what we have in place already although this would need revisiting. It was explained that the principle across South Yorkshire would be for partners to come together to support families and children ... view the full minutes text for item 21.
The Senior Governance Officer presented the Scrutiny Work Plan that
had recently been agreed by the Overview and Scrutiny Management
Committee and the Council’s Forward Plan of Key Decisions.
RESOLVED: That the update be noted.