Agenda item

There is an ambition to move to a more integrated and efficient model for hospital discharge and intermediate care in Buckinghamshire to improve patient outcomes and experience.

This item provides Committee Members with an opportunity to review the new model and examine the improvements being delivered.

Presenters:

Jo Baschnonga, Programme Director Health & Care Integration

Jenny Ricketts, Director of Community Transformation, Buckinghamshire Healthcare NHS Trust

Papers:

Presentation attached

The Chairman welcomed Cllr Angela Macpherson, Cabinet Member for Health & Wellbeing, Craig McArdle, Corporate Director for Adults & Health, Jo Baschnonga, Programme Director for Health & Care Integration and Jenny Ricketts, Director of Community Transformation, Buckinghamshire Healthcare NHS Trust.

During the presentation, the following key points were made.

·       During the Covid pandemic, helping patients to return home as quickly and safely as possible was critical in order to reduce infection.  Nationally a model called “discharge to assess” (D2A) was mandated with an allocated funding stream.

·       In Buckinghamshire, at the peak of the pandemic, there were 180 D2A beds and 11,000 hours of temporary home care.  This was acknowledged as an unsustainable model in the long-term.

·       The ambition was to move to a more integrated and efficient model for hospital discharge and intermediate care to improve patient outcomes and experience.  The new model would be underpinned by the “Home First” approach, integrated services around patients and partnership working across the system.

·       D2A bedded pathway closed at the end of March 2023 which had freed-up 140 care home beds.

·       Three new care home hubs had been opened with a fourth due to open in July.  These were for people with complex health needs that prevents assessment within 4 weeks and not appropriate to wait in the acute hospital setting.

·       A new integrated discharge team was launched in June to help patients on the wards to plan their discharge and review referrals for discharge pathways.

·       Olympic Lodge was being used to manage surges in demand with 547 patients admitted between October 2022 and May 2023 of which 457 were able to return home and the average length of stay was 10.4 days.

·       Chartridge ward, a 22 bedded ward at Amersham Community Hospital, would be re-purposed into a new intermediate care hub with an onsite multi-disciplinary team.

·       Intensive inpatient rehab would be available at Buckingham Community Hospital (14 beds) and Waterside Ward at Amersham Community Hospital (21 beds).

·       Development of Community diagnostic hubs was being discussed which would offer essential diagnostics from a local site.  Residents had stated that they prefer to visit a local site for diagnostics rather than visit Stoke Mandeville or Wycombe Hospitals.

·       “Hospital@Home” would allow patients to receive acute care monitoring and treatment at home.  For example, patients with respiratory conditions were having their oxygen levels monitored virtually.

·       Urgent Community Response (UCR) had supported around 10,200 patients.  The national response target was 70% within 2 hours.  In Buckinghamshire, the UCR response was 86% within 2 hours.

·       Onward Care was a data driven, tech enabled service that aimed to help stabilise frail people at high risk of readmission.

·       An ambulatory frailty same day emergency care services had been introduced in the Emergency Department.

·       Marlow and Thame Community Hubs were providing ambulatory services for vulnerable and frail adults.

·       Three big conversations had taken place in Aylesbury, Thame and Marlow to show residents the services available.

·       An Admiral Nurse had been recruited to support people living with dementia to stay independent longer and to support the people caring for them (starting in September).  There were plans to recruit a second Admiral Nurse.

·       The first “Health on the High Street” pilot project had just been launched.  Unit 33, Friars Shopping Centre, Aylesbury provided services, including blood pressure checks, services for children and immunisations.

During the discussion, Members asked the following questions.

·       A Member referred to the strength of public feeling when the in-patient beds were removed from the Chartridge ward and the Community Hospitals at Thame and Marlow and said that it felt as though health partners had come full circle and were now putting intermediate beds back.  The Member hoped that lessons had been learnt in relation to listening to the needs of local residents.  In response, Craig McArdle explained that forecasting demand for intermediate care was very challenging and acknowledged that engaging and consulting with residents was very important.

·       In response to a question about a communications and engagement plan for “Health on the High Street – Unit 33” and also future expansion plans, Jenny Rickets confirmed that a plan had been developed and would be implemented in due course.  In terms of expansion plans, the launch of the one in Aylesbury is part of a pilot so once evaluated, then there will be discussions around expanding to other centres.

·       In response to a question about whether the services at “Unit 33” were free of charge, Jenny Ricketts confirmed that the services were free at point of use.

·       A Member asked about the environment at the Olympic Lodge and what its primary use was during the surge period.  Jenny Rickets explained that Olympic Lodge was in its second time of being used as a surge facility this year and it contained individual rooms with access to therapy support which was located close to Stoke Mandeville Hospital.  547 people who were medically fit for discharge had used the Olympic Lodge and it had worked extremely well leading to better mobility and improved patient outcomes.

·       Olympic Lodge was due to re-open in October 2023 until March 2024.

·       In terms of key performance indicators, Buckingham University had undertaken a study around this, in terms of Olympic Lodge and found that 10.4 days was the average length of stay compared to 11 days when it first opened.

·       Members requested to see the KPIs which were being used to measure the effectiveness of the hospital discharge process and use of intermediate care provisions.  The Chairman asked for these to be included as part of the system winter plan item coming before the Committee in October.

·       A Member asked about the work being undertaken with GPs to help reduce hospital admissions and re-admission rates to hospital.  Jenny Ricketts explained that weekly meetings took place with GPs in Marlow as part of a multi-disciplinary team and regular conversations took place with the Swan Practice in Buckingham.  Regular meetings also took place with the District nursing teams.  It was acknowledged that GPs were an integral part and it was important to work closely with them.

·       A Member referred to the loss of services at the Marlow Community Hub, including x-rays, blood tests, some cancer treatments and ultrasounds.  Jenny Ricketts explained that there were challenges around staffing the cancer treatment services at the hub and there was a national tendering process ongoing in terms of retinal screening but she stressed that the Trust was looking at putting extra scanning facilities into Marlow and out-patient services were still taking place with surgeons keen to get more of the services back into the hubs.  There was no specific date for this.

·       A Member commented that it would be good to know what the plans were for similar hubs across the county.  The Committee was aware of the services available at Buckingham, Marlow and Thame.

·       In response to a question about the location of the care home hubs, Jo Baschnonga explained that the current locations were defined by referral areas and identifying the right homes.

·       Healthwatch Bucks were undertaking a patient experience project and would be working closely with Jenny Ricketts as part of this.

·       In response to a question about transferring patients between Hospitals, Jenny Ricketts explained that there were a few transport schemes available including Age UK and, in some circumstances, taxis were used to bring people into the community hubs for appointments.

·       In response to a question about the timescales for delivering the digital plan, Jo Baschnonga explained that the long-term plan was to share patient information across the system but the digital transformation work was being undertaken in phases with learning and testing being part of this process.

·       There was a recognition that escalation beds were needed every winter and having the surge beds in one place would be beneficial.  The aim was to ensure there was stable bed provision.  Lessons were learnt from last year when 180 beds spread across the county made it very challenging in terms of managing length of stay.  Testing a new model in care homes in specific locations would provide better support for the system.

·       A Member suggested that an information sheet would be useful to show what intermediate provision is provided across the county with a brief description of what the offer was at each place.  This could then be used by the Select Committee as part of its evaluation of the provision.

Action: Jo Baschnonga/Jenny Ricketts

·       A Member commented that community beds enabled the patient to be close to their family and friends and the location of the care home hubs and intermediate care hubs may not mean the patient was close by.  Craig McArdle responded by saying that the plan was always to get the patient home as quickly as possible and the key benefits with the new model was the wrap around therapeutic services available at the hubs and the fact that the resources were not too spread out and could be used more effectively.

·       A Member asked about GP follow-up care if a patient was placed in a care home which was not within their local area.  Would the patient need to re-register with their GP once they returned home?  Philippa Baker said that she would look into this after the meeting.

Action: Philippa Baker

·       A Member requested age profiling data and information on length of stay outcomes.  It was agreed to look at this after the meeting to ensure more meaningful data was provided.

·       A Member asked about the impact of patient discharge on the South Central Ambulance Service and the resulting impact on 999 response times.  Jenny Ricketts explained that the Trust works very closely with the ambulance services and measuring the impact was important and was evident through the reported handover delays.

The Chairman thanked all the presenters and the Committee agreed that evaluating the effectiveness of this new model of intermediate care needed to come back to the Committee in due course.  Reporting on the key performance indicators would be included as part of the winter system plan item coming to the Committee in October.