Agenda item

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 was continued that work was being undertaken in the flow team with Place partners trying to ensure that admission to hospital was the least restrictive option for patients and be very proactive with discharge plans.  Members were informed with support from the three Integrated Care Boards (ICBs)  that they had commissioned an extra 4 additional beds in County Durham (with a ‘Good’ CCQ rating’), had an existing good relationship with the organisation and as a flow team, could go and visit those patients to undertake quality and assurance visits.  It was explained that although those beds were further away, the facility was a better resource than ones were closer to Doncaster.  Member heard that maximum use was made of crisis beds, operated by Rethink, and there was an option to offer a fifth bed with 72 hours’ notice required to mobilise staff.

It was explained that sometimes additional beds were avoidable, and sometimes could mean inefficiency as more transfers were required.  It was considered that it should be more about how quickly we can get people back home.  It was explained that in Doncaster, more people were moved into care homes than compared to comparative Councils.

Embedding New Home from Hospital Service for Simple Discharges– Clarification was sought on which Voluntary Community First organisation had taken this contract.  Members were informed that the Homes from Hospital contract had been recently won by Sheffield Churches Council for Community Care (SCM4Cs).

Mental Health (Children and Younger People) – Members heard that there was support in place for younger people (in particular CAMHS).  Regarding the winter months, Members heard that there was a crisis line in place, which operated 24/7 and could be accessed by children, younger people and families out of hours.   It was hoped that there would be a dedicated CAMHS Crisis line in the future.  It was added that efforts were being made to recruit as many staff into the CAMHS service although it was commented that this had been a challenge. Members were told that there was a CAMHS Encore Manager and one Practitioner that worked across the Emergency Department.

It was noted that with People Focused Group (PFG) there was a dedicated building for CAMHS that was close to the hospital and with staffing in place was currently waiting on a date to open.

It was explained that there had been a single point of access for families throughout the winter period, with requests for support triaged for urgency within 24 hours.  In terms of recruitment, it was stated that efforts had been maximised in recruiting posts, in particular for Crisis and Intensive Community Support Teams which would take pressure off of other services.  It was explained that this service was currently Monday to Friday 9am to 5pm and there was a target to have a dedicated line 7 days a week by January 2023 before being open 24/7 once the right staff is in place.  Members were informed about a number of specialist CAMHS services that included intellectual disability team, eating disorder services and dedicated Looked After Children team.   It was reported that a sustained increase in neurodevelopment referrals was being picked up, but would continue with a digital offer for neuro-assessments for ADHD over winter.  Finally, Members heard that there had been signposting through the CAMHS website to support services and online resources such as Kooth and Young Minds.

Cost of Living – Concern was raised around the wider work being undertaken to address the Cost of Living crisis.  Members expressed interest in how this data was being gathered, how it would help to identify who was being impacted, and how we were connecting with those people.

It was recognised that many people were being impacted in different ways and it was important not to narrow this information down prematurely.  It was explained that the authority was aware of those who were eligible by being in receipt of certain benefits and support.  Members heard that there was greater focus on what partnership working looked like.  It was outlined that the authority was working with Citizens Advice Bureau (CAB) and network of Voluntary and Community groups and the CAB was already in contact with a number of services to deliver training around providing appropriate responses. 

Reference was made to information being circulated to Doncaster residents and it was hoped that a number of people affected would self-identify as it was commented that often, when direct support was available, that eligible individuals did not come forward.

STEPS - Members expressed concern whether STEPS was in a better position of being prepared for increases within the system resulting from the faster processing of applications.

It was explained that efforts had been made to increase productivity within this area through investment made in staffing.  It was outlined that care hours had increased and had delivered on average this month 142 hours (more than other months during the year) and was 40% higher than the highest month last year.  It was continued that the second part was about increasing efficiency around assessments, before care was put in place by end of November there would be 62 people per week, rather than 48 people per week.  It was noted that when an individual was considered medically fit, then it was found they were not following an assessment, meant that the authority could get across more people and more discharges, It was noted that the biggest issues for STEPS would be getting people moving across to domiciliary care after their STEPS support has finished. 

Additional Funding – In reference to funding, Members heard that there had recently been national confirmation of the Adult Social Care Discharge Fund, to be allocated via Local Authorities and the South Yorkshire Integrated Care Board.  It was explained that the plan for Doncaster would be to support the adult living wage for care workers and fund this before the national uplift; the Local Authority was planning to ask for a written undertaking that the money would be passed onto staff.  It was recognised that the key issue was to offer more attractive starting wages, and then it was more likely that those people entered into a social care profession.

RESOLVED That the Panel resolved to note information received regarding partnership plans to ensure Doncaster people receive joined up health and social care over this winter so they are able to recover quickly from any period of ill-health.

ecover quickly from any period of ill-health.