Agenda item: 3 Social Services and Housing Scrutiny Committee 9 November 2010 Report by the Head of Adult Services Royal Alexandra Hospital 1. Purpose of the Report. 1.1 To briefly update Scrutiny on the progress with the new model of care resulting from the closure of inpatient beds at the Royal Alexandra Hospital (RAH). 1.2 To alert members to other significant issues arising since the last report that the Council needs to address to respond to the closure of inpatient beds. 1.3 To update Scrutiny on any actions and outcomes that have been undertaken to address the issues raised previously. 2. Executive Summary. 2.1 In the week beginning the 20 July 2009 the new Betsi Cadwaladr University NHS Health Board (BCUHB) made the decision to close inpatient beds of the wards of the Royal Alexandra Hospital. This decision has prompted very significant discussions and proposals for new services in north Denbighshire. These have profound implications for the Council and the local community in Rhyl. 2.2 The report therefore updates members regarding the Home Enhanced Care Service (HECS) since its inception in July 2010 and the proposals regarding an extension of the project unit June 2011. 3. Scrutiny Outcomes 3.1 Members consider the report and use the contents as the basis of further discussions with representatives from the BCUHB. These discussions to raise concerns regarding the impact of the closure programme of the inpatient beds at the Royal Alexandra Hospital has for Denbighshire County Council and the wider community of Rhyl. 4. Background and Current Situation. 4.1 At Scrutiny on the 29th April 2010 senior managers from the BCUHB attended and responded to concerns raised by members and it was agreed 1 that they should attend a further Scrutiny to keep members apprised of progress. 4.2 Social Services officers have continued to support the regular meetings within the project structure and in addition monthly meetings have been facilitated, jointly with Conwy, for social care professionals supporting the new model of care. 4.3 As a result of meetings between Senior Officers of the Council and BCUHB colleagues a transfer of funding (£100,000) was agreed in recognition of the impact of changes on the Council for the period August – December 2009. Further funding was sought for the period January 2010 until implementation of the new model (July). Further funding has not been forthcoming. 4.4 Funding for 1.5 social workers for Denbighshire (plus funding for 0.5 social worker for Conwy) was agreed for a six month pilot period scheduled to end in December 2010. For the pilot to be extended, the same amount of funding is required. A further £6,700 was agreed to support the provision of community equipment to Denbighshire and Conwy clients via Denbighshire Community Equipment Store (CESI) for the pilot period. (See 5.1) For the pilot to be extended, the same amount of funding is required. 4.5 Since the start of HECS the 1.5 Denbighshire social workers have accepted 51 referrals for assessment. Even when social worker input is declined a visit takes place and basic information and advice is given and contact details left for future reference. To date there have been no referrals for Conwy Social Services. As a result of the social work assessments the following outcomes during the HECS period have been identified. Work is underway to identify outcomes post the HECS intervention period. 2 Outcome Number Declined social worker input 9 Advice and Information 32 Deceased 3 Readmitted to hospital 5 Referral to Red Cross 6 Referral to Cross Roads 4 Referral to Response & Rehabilitation Service 3 Referral to Macmillan Nursing Service 1 Referral to Reablement Service 3 Referral to Gofal Short Term Befriending Service 1 Referral to Community Mental Health Team 1 Referral to First Contact Team 1 Referral to Older Peoples Team (N) 3 Carers Assessment completed 1 Existing package of care 4 Referral to Welfare Rights Unit 3 Tele care 5 4.6 Whilst each intervention will be defined by the needs of the service user the estimated intervention time per service user (taking into account assessment meetings, including travelling, responding to eligible needs, follow up visits and recording) has been calculated as an average of 5 hours. 5. Impact of HECS 5. 1 Impact re Community Equipment Stores Integration (CESI) and HECS: There have been 59 requests to CESI (from 7th July – 29th October). In addition to this work, 20 referrals to replace equipment issued from Colwyn Bay Hospital for people living in Denbighshire (e.g. walking frames etc.) to facilitate the discharge have been received. This has impacted on delivery, collection and cleaning times as well as ensuring administration for the effective tracking of the equipment in line with legislation. To date there have been no referrals after 5pm, although the Service operates until 6pm. It is understood, most requests for equipment from HECS require morning delivery to enable HECS staff to visit in the afternoon. For the same money, the Operational Manager has suggested that the HECS work be integrated into the general workload and that the 4 hour response standard remains but the Service will try to accommodate morning deliveries wherever possible. This will need to be approved by the CESI Partnership Management Group as there might be an implication for the delivery times standard for other equipment, which will need to be monitored during the extended pilot period. 3 5.2 Impact on Social Work in the north of the County and HECS: Since the start of HECS the First Contact Officer located in Ysbyty Glan Clwyd has been monitoring community hospital transfers. This has demonstrated that up to September 2010 56 residents who would previously have been admitted to RAH (the majority of whom would be known to Older People Team North (OPTN) being admitted directly into Community Hospitals outside of Denbighshire or in the south of the County. Community Hospital Transfers from Rhyl area ordinarily RAH Colwyn Bay 33 Denbigh 21 Holywell 2 Ruthin 0 TOTAL 56 In addition, OPTN reports a further 30 residents who would previously have been admitted to RAH being admitted directly into Community Hospitals outside of Denbighshire or in the south of the County. Community Hospital Transfers from Rhyl area ordinarily RAH Colwyn Bay 11 Denbigh 9 Holywell 10 Ruthin 0 TOTAL 30 In many/most instances these admissions (a total of 86) will involve Rhyl based social workers travelling out of county/to the south of the county for visits and multi disciplinary meetings to arrange effective discharge arrangements. The impact on staff capacity and travel budgets is significant. Negotiations will be opened to explore funding for a further social worker post to assist with meeting the increased pressures. 6. Outcome of Review Meeting - 25th October. 6.1 A review meeting took place on the 25th October to consider the project at its midpoint. All key partners were in attendance. It was agreed to: • Extend the pilot period for the current GP practices and team for a further 6 months – i.e. 21st June 2011. This will allow for the working through of HR and staffing issues associated with this. • Undertake a 4 week audit of users on the caseload to determine more accurately the workload/visits associated with patient/user care. This 4 4 week audit will be done retrospectively for weeks beginning 27th Sept and 4th October and a ‘live’ audit will be done weeks beginning 1st November and 8th November. A subgroup will meet on 22nd November to review the information collected. • Explore two key areas during the coming weeks: first, whether an on- call system to provide support during the night, via the Health and Social Care Workers, should be established (as an alternative to a duty system) ; and second, what options there are to increase the role of the voluntary sector in providing care under HECS. 7. Implications for Other Policy Areas 7.1 The service provided to replace the inpatient beds at the RAH is relevant across a broad range of Council services, most notably health and well being but also broader regeneration issues. 8. Contact Officer: Head of Adult Services. Tel: 01824 706654. 5 Agenda Item No. 4 Social Services and Housing Scrutiny Committee 9 November 2010 Report by: Lead Member for Health, Social Care and Wellbeing/Director of Social Services and Housing HEALTH AND SOCIAL CARE LOCALITIES: Arrangements for Co-working in Denbighshire 1. Purpose of the Report To present members with information and seek their comments on the arrangements for co-working with the National Health Service (NHS) in Denbighshire. 2. Executive Summary The report, attached at Appendix 1, details the approach for developing integrated health and social care teams in localities within Denbighshire along with the partnership governance arrangements for this approach, as approved by Cabinet on 26 October 2010. 3. Scrutiny Outcomes Scrutiny of the preferred approach for developing and delivering integrated health and social care services in Denbighshire will contribute to the establishment of a cohesive and cost efficient service model which will deliver services that are responsive to the needs of local citizens. 4. Recommendations That the Committee considers the approach approved by Cabinet and comments accordingly. 5. Background Papers • Report to Social Services and Housing Scrutiny Committee 27 May 2010 and the minutes of that meeting. Contact Officer: Corporate Director: Social Services and Housing Tel: 01824 706149 1 APPENDIX 1 REPORT TO CABINET CABINET MEMBER: Councillor P A Dobb, Lead Member for Health, Social Care and Wellbeing LEAD OFFICER: S Ellis, Director of Social Services and Housing DATE: 26th OCTOBER, 2010 SUBJECT: HEALTH AND SOCIAL CARE LOCALITIES: Arrangements for Co-working in Denbighshire 1 DECISION SOUGHT For Cabinet to agree i) the approach to developing integrated health and social care teams in localities in Denbighshire.