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South Ayrshire Health and Social Care Partnership

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South Ayrshire Health and Social Care Partnership South Ayrshire Health and Social Care Partnership REPORT Meeting of South Ayrshire Health and Integration Joint Board Social Care Partnership Held on 2 February 2017 Agenda Item 6 Title Delayed Discharges Summary: The report provides the Board with detail on the current position for South Ayrshire in relation to Delayed Discharges from Hospital Care. The report highlights the current pressures and action being taken to improve the position within the current resources available. Presented by Tim Eltringham Director of Health and Social Care The Board is asked to: Note the contents of the report. Approve the range of action being taken. Request a report on progress in April 2017. Implications checklist – check box if applicable and include detail in report Financial X HR Legal Equalities Sustainability Policy X ICT Directions required to NHS Ayrshire & 1. No Direction Required X Arran South Ayrshire Council, or both 2. Direction to NHS Ayrshire and Arran 3. Direction to South Ayrshire Council 4. Direction to NHS Ayrshire and Arran and South Ayrshire Council 1 SOUTH AYRSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP INTEGRATION JOINT BOARD 2 February 2017 Report by Director of Health & Social Care DELAYED DISCHARGES 1. PURPOSE OF REPORT 1.1 The purpose of this report is to provide the Board with current information and analysis of the position in relation to Delayed Discharges from hospital in South Ayrshire. The report outlines the recent pattern of delayed discharges and the reasons for them. The report also provides an update on the work being undertaken to manage down the number of delays within the resources available. 2. RECOMMENDATION 2.1 It is recommended that the Integration Joint Board: Notes the contents of the report. Approves the range of action being taken. Requests a report on progress in April 2017. 3. BACKGROUND INFORMATION 3.1 As the Board will be aware the term delayed discharge is used to describe hospital care being provided to an individual after the time for which they are clinically fit to leave hospital. 3.2 Seeking to minimise any delay to discharge has been a key policy driver for the last 15 years. It is generally recognised that hospital care is likely to be more expensive than alternative forms of care. In addition, once treatment is complete hospital care is less likely to meet the individual’s needs for ongoing care and support in the most effective manner. 3.3 The definition of a delayed discharge is as follows: “A delayed discharge is a hospital patient who is clinically ready for discharge from inpatient hospital care but continues to occupy a hospital bed beyond the ready for discharge date.” 3.4 The number of delayed discharges is seen as a key indicator of the success or otherwise of integrated service planning and functioning of the health and social care system in a Partnership. Data is collected and reported monthly based on a detailed 2 set of criteria and definitions. The Delayed Discharges Definitions Manual July 2016 summarises key aspects of policy and data collection: Partnerships have previously worked towards discharging patients from hospital within a maximum time period of 6 weeks, reducing to 4 weeks then 2 weeks in April 2015. However a focus on maximum delay drives activity towards reducing the lengthiest delays, at the expense of facilitating the discharge of those closer to being able to go home. Two weeks is not ambitious enough for the majority of people who should be able to return to the community within 72 hours of being ready for discharge. It is very clear that being delayed in hospital can be harmful and debilitating – and in the case of older people, can often prevent a return to living independently at home. Reliably achieving timely discharge from hospital is an important indicator of quality and is a marker for person centered, effective, integrated and harm free care. Older people may experience functional decline as early as 72 hours after being clinically ready for discharge and the risk increases with each day delayed in hospital. This increases the risk of harm and of a poor outcome for the individual and further increases the demand for institutional care or more intensive support at home. It is important that discharge planning starts as early as possible in the patient’s journey. Key agencies such as social work, housing and community support, along with the patient’s main carer, should be involved as early as possible in this process. Professionals should agree a planned date of discharge with the patient and family supported by agreed criteria that will demonstrate readiness for discharge. The Ready for discharge date (RDD) is the date on which a hospital inpatient is clinically ready to be discharged from inpatient hospital care. This is determined by the consultant/GP responsible for the inpatient medical care and where a multi-disciplinary team, in consultation with all agencies involved, agree that the individual’s care needs can be further assessed or properly met outside a hospital setting. Where the patient remains inappropriately in a hospital bed, no longer receiving treatment but merely waiting for an appropriate place in the community, then they should be classified as a delayed discharge. 3.5 This advice is used, alongside other planning and policy guidance to inform the approach being taken by the Partnership to reduce delayed discharges. 4. REPORT 4.1 Historical Summary The definitions outlined in the previous section are used to collect data on delayed discharges over time. Historically, South Ayrshire has tended to have relatively low numbers of delayed discharges. However, over the last 18 months there has been a deterioration in the position. The graph below details the pattern of delays over that period. 3 Delayed Discharges in South Ayrshire 2015-16 70 60 Other 50 Healthcare Arrangements 40 Awaiting place availability in a care home 30 Awaiting funding for a care home placement 20 The chart shows that focussed activity to reduce delayed discharges in the early part of 2015 Patients waiting to go home resulted 10in a reduction to very low numbers over the summer of 2015. That reduction in delayed discharges was, in part, associated with a rise in the number of people requiring care home placements. The chart below illustrates the rise in the number of care home placements made in early 2015. 0 Community Care Assessment Reasons Number of funded care home placements in South Ayrshire April 2014 to November 2016 920 900 880 860 840 820 800 780 760 4 740 720 Jul-15 Jul-16 Jul-14 Jan-16 Jan-15 Jun-14 Jun-15 Jun-16 Oct-14 Oct-15 Oct-16 Apr-14 Apr-15 Apr-16 Feb-15 Sep-15 Feb-16 Sep-16 Sep-14 Dec-14 Dec-15 Aug-14 Aug-15 Aug-16 Nov-15 Nov-16 Nov-14 Mar-15 Mar-16 May-15 May-16 May-14 The rise in care home placements in early 2015 resulted in significant budget pressures which in part were responsible for the projected overspend in 2015/16. At the IJB Meeting in October 2015 the Board approved a recovery plan which included a plan to reduce the number of care home places on a phased basis. The pattern of delayed discharges from November 2015 to July 2016 illustrates the impact of restricting the number of funded placements. Throughout the first 6 months of 2016 the number of delayed discharges steadily increased, with the vast majority being for reasons of lack of funding availability. In August 2016 the IJB agreed to the release of slippage funding from both the Delayed Discharges Funding and the Integrated Care Fund to resource additional placements in the light of concerns about the rising number of delayed discharges. The release of this funding led to a levelling off of the number of delays and a reduction in September. Since then, however, the number of delayed discharges has seen a rise. This rise has been associated with the lack of capacity within the care home sector. In essence all of the care home places which are available are now occupied. 4.2 Current Number of Delays As at 22 December 2016, South Ayrshire had 62 delayed discharges. Delays are broadly divided into two groups: Standard delays and “Code 9” delays. The latter are particularly complex situations where there may be the requirement for legal activity under the Adults with Incapacity Act, for example, in order to properly arrange for a hospital discharge. The table below summarises the numbers of delays in these two categories by hospital location. As the table shows, the majority of delayed discharges are currently at the Biggart Hospital. Delay Type Hospital Location Code 9 Standard Delays Ailsa Hospital 2 4 Ayrshire Central Hospital 1 2 Biggart Hospital 1 31 East Ayrshire Community Hospital 1 1 Girvan Community Hospital 0 6 University Hospital Ayr 2 9 University Hospital Crosshouse 0 2 Total South Ayrshire Delays 7 55 5 The current reasons for delays are summarised in the table below: Hospital Location Code 9 Awaiting Non Awaiting Awaiting Awaiting Awaiting completion of Availability of Place Place completion of procurement or Assessment Funding Availability in Availablity in social care provision of Residential Nursing arrangements to equipment Home Home live at home Ailsa Hospital 2 1 1 0 2 0 0 Ayrshire Central Hospital 1 0 1 0 0 1 0 Biggart Hospital 1 5 13 2 9 1 1 East Ayrshire Community Hospital 1 0 0 1 0 0 0 Girvan Community Hospital 0 4 2 0 0 0 0 University Hospital Ayr 2 2 2 4 1 0 0 University Hospital Crosshouse 0 1 0 0 1 0 0 Total South Ayrshire Delays 7 13 19 7 13 2 1 The table shows that the majority of delays are still associated with care home provision.
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