LD Dom Care Forum
Held at Crossroads Care Home 30th October 2018
These are notes (not minutes) and reflect the opinions and understandings of those present
Christine chaired the Forum.
The meeting was also attended by Susan Bracefield (Director of Operations) and Chloe Parr (Finance Directorate Delivery Manager), both from RCHT who were present to discuss Winter Pressures planning with Providers.
Susan introduced herself and Chloe and outlined that the RCHT are writing a more granular Winter Pressures plan and are looking for input and support from the social care sector.
It was noted that overcrowding in ED is a huge issue and that currently across the whole system (not just RCHT), there is a deficit of 64 beds. This will not improve if nothing is done and there is no scope to magically build 64 more beds.
If the average patient stay can be reduced by half a day, or if daily admissions into the system were reduce by 11 patients, it would negate the 64 bed deficit immediately.
Susan informed the meeting that at any one time, RCHT has around 100 patients medically fit for discharge, however around 50% cannot be discharged for a variety of other, non-medical reasons.
Susan outlined the work RCHT are doing to create spaces in the hospital to setup satellite pharmacies (for example having one in the discharge lounge) to reduce the discharge delays caused by people waiting for medication. They are also looking at better preparations for discharge so that a day before discharge, medication etc is all ready and does not cause last minute delays.
RCHT is trying to mitigate against “just in case” admissions, so junior doctors in A&E are no longer able to admit patients directly and all admissions have to go through a consultant. Consultants in ED have been increased from 2 to 3 to facilitate this.
Urgent treatment centres (like the one at West Cornwall Hospital) will be replicated at RCHT and Bodmin, staffed by senior GP’s, doctors, and advance nurse practitioners.
There was a tacit admission that RCHT have a tendency to try and cure or treat problems that patients have been living with for years. For example, patients may be admitted for a minor ailment, but the patient is not discharged while staff try to address a longstanding problem that doesn’t need to be addressed. All the while the patient is blocking a bed. Susan informed the meeting that RCHT are trying to change the culture so that staff deal with the issue causing the admission and to try and get people home faster.
Providers did raise the issue that staff in ED do not always have access to any prior knowledge of patients when they are admitted. For example, ED staff do not automatically know when a patient is receiving a package of care at home, and social care providers would be able to provide useful background information on that patient and have sometimes been involved in the admission. Equally there is a lack of information from ED to social care providers upon discharge.
Cornwall Partners in Care did put forward some ideas on how to improve discharge communication between RCHT and social care a while ago, but nothing seems to have come of it.
It was noted that GDPR could hamper the flow of information. For example, if a Provider calls RCHT to check on a patient that they provide care for, they are told by RCHT staff that they cannot share that information).
A discussion took place around the available capacity not being visible to RCHT as a number of care providers have not joined the DPS system. There is plenty of capacity to assist with discharging patients is available, however they are being excluded from helping.
Providers put forward some examples of where the current system is working against reducing admissions. One noted that they would be more than happy to sit with a poorly patient in their own home overnight to avoid an emergency admission, however there is no-one available to agree the funding to allow Providers to do this. Providers reported similar occasions where they have taken the decision to do exactly this in order to prevent an admission and after the event were told by commissioners that it was the Providers decision and that no back dated funding would be made available. This, along with the lack of flexibility in the system means that Providers cannot make sensible decisions and are hamstrung by the system.
A discussion took place around a secure email address that would allow Providers to share information and communicate with RCHT around admissions and discharges. Susan thought that this should be entirely reasonable and will look into the feasibility of setting something u p via the RCHT flow team.
It was noted that brokerage were often not fast enough at getting packages onto the DPS system and this is causing some delays in discharges.
The meeting discussed equipment and how it can be hard to get it to Providers as well as how hard it can be to get it collected.
A discussion took place around specific training to help social care providers get their patients back home faster. One example was training social care staff on peg feeding. Susan is happy for Providers to access this, both general RCHT training as well as patient specific training.
It was noted that care homes are able to access a direct phone number to bypass the 111 screening and get through directly to a clinical person. Can domiciliary care providers get access to this too?
The meeting closed at 12:00