Agenda item

The Panel will receive a presentation on this item from Simon Sethi, Chief Operating Officer, Royal United Hospitals, Bath.

Simon Sethi, Chief Operating Officer, RUH and Dr Veronica Lyell, Clinical Lead for the RUH Older People’s Unit gave a presentation to the Panel, a copy of which will be available as an online appendix to these minutes, a summary is set out below.

Elective waiting times – RUH within the region

·  RUH performing 10% more elective activity than before COVID to help recover waiting times.

·  Focus on diagnostics: 20% more MRI, 30% more CT and >50% more endoscopy.

·  Currently have no one waiting over 104 weeks with 115 waiting over 78 weeks.

Electives and winter – 300 operations impact

·  Lost capacity due to bed pressures. Currently no joint replacement operations taking place due to bed shortages.

·  Removing winter pressures would increase orthopaedic capacity by at least 22% and up to 48%.

·  Temporary Modular Theatre plan for Circle Bath Clinic for February 2023.

Urgent Care – remains significantly challenged

·  462 – Number of ambulance handover delays over 60 minutes on average each month

Current position on NC2R for the RUH

·  Regression analysis indicates NC2R (Non-Criteria to Reside) accounts for 62% of the reasons RUH struggles to offload ambulances.

·  Integrated Care Board and Council working closely together to improve this area.

·  Average wait to access a reablement bed once referred in BANES? 15 days

·  Average wait to access reablement at home once referred in BANES? 16 days

Councillor Liz Hardman commented that it was recognised that the problems regarding ambulances not being able to discharge their patients was due to bed blocking. She referred to the report and highlighted that currently there are 40 patients waiting to be discharged from the RUH and that this is because of problems with reablement not being able to take place. She asked what needs to happen to unblock the situation.

Simon Sethi acknowledged the importance of getting people home from hospital where possible, but said that there was gap in domiciliary care provision.

The Director of Adult Social Care added that there was a gap in terms of staff hours and that the Council and the RUH have been working on developing their own in house domiciliary care agency known as United Care BaNES. She said that they were looking to provide an additional 1,000 hours by November 2022.

She stated that this is an important issue to address as for every day that a patient stays that is longer than necessary the outcomes will not be as good. She added that she was aware of the RUH Pathway Escalation Team that has a focus on recovery and therapy.

She said that work was also ongoing within the Ambulance Service with regard to decisions about where best it is for a patient to be taken for treatment.

Councillor Paul May asked for an explanation of the different patient pathways.

Dr Veronica Lyell replied that the pathways are set out as follows:

·  Pathway 0 – No additional support required

·  Pathway 1 – Intermediate care and reablement services provided in their own homes.

·  Pathway 2 – Short term residential care within the independent and community sector.

·  Pathway 3 – Long term nursing care within the independent sector.

Councillor Joanna Wright asked if any thought had been given as to whether staff should continue to work 12 hour shifts at the hospital.

Dr Veronica Lyell replied that this was a typical nursing pattern and that it had been a decision that had been supported by staff.

Real harms of delay

Two examples were outlined to the Panel.

Molly: Less fit than she used to be, daughter lives quite a distance away, receives meal deliveries and neighbours visit regularly. She falls one day and fractures her pelvis. After receiving treatment and a short stay in hospital she is able to walk a few steps with the aid of a frame.

She is unable to raise her legs though to enable her to get into bed by herself or in/out of the bath and will need help at home. She finds it increasingly difficult to rest in hospital due to the noise and becomes muddled due to the lack of sleep.

She starts to become vague when talking with staff and family members, resistant to help and has started to wet the bed overnight. It does not appear suitable for her to stay on Pathway 1 and needs to be moved to bedded care through Discharge to Assess.

Derek: He has dementia and is visited by carers several times a day. He does fall over quite a lot and the carers feel that he should not be at home. Family have been looking for a care home for him, but have not found one yet.

Taken to hospital after one fall and has been waiting four weeks to be discharged. Unfortunately, he gets Covid while in hospital and has to be moved to another ward to recover.

Dr Veronica Lyell commented that she was aware of incidents where people have had to wait 10 hours for an ambulance after falling at home and then had to wait a further 8 hours in the ambulance when arriving at the hospital due to the lack of beds.

She added that difficult decisions are taken on a daily basis as to which patients need to stay in hospital and which are able to be discharged.

The Chairman commented that he was encouraged to hear the work with regard to elective care, but was concerned over the availability to provide urgent care to the public.

Kevin Burnett asked if there was any capacity within the system to change the processes to allow patients to be discharged sooner.

Dr Veronica Lyell replied that nurses do try to assess patients at the earliest opportunity so that their stay in hospital can be minimised.

Simon Sethi added that the hospital does need support from the Council to enable patients to be safely discharged in a shorter space of time. He said that £2m was to be invested over the next six months to compensate for the pressures within Urgent Care. This money will seek to open more hospital beds, ask staff to work extra shifts over the Winter period to enable patients to have regular reviews and recruit to a Mobilisation Team that will help patients with reablement whilst in hospital and allow for them to return home needing less / no care.

He stated that there were 70 actions on the RUH Winter Plan and that there is a need to collaborate with the Council on the recruitment of Domiciliary Care staff.

Councillor Liz Hardman said that she welcomed the patient examples that had been shared with the Panel. She asked where the resources should come from to provide the additional support for the RUH.

Simon Sethi replied that it was important to highlight the impact of these challenges and that collaboration work with partners, including HCRG and the third sector, will continue over the coming months.

The Director of Adult Social Care added that they do work closely together and meet every Monday morning to discuss ongoing matters and areas of concern. She said that she too was also concerned over the coming months especially in terms of staff and the pressure they will be under. She explained that where possible they will seek to manage patients within community settings to avoid entry into Urgent Care.

Councillor Paul May asked if there was any particular issue that the Council needs to be mindful of given that the HCRG contract will cease in March 2024.

The Director of Adult Social Care replied that the change from the HCRG contract does pose a possible risk to Urgent Care and so all attempts must be made to stabilise the system as much as possible. She added that a patient’s length of stay in hospital must be cut where possible and that an average of 2-3 days would give the system a better flow.

She also called for Social Care staff to be paid a better wage and for their roles to be professionalised.

Dr Veronica Lyell added that the Hospital@Home scheme supports patients to return home where they will continue to receive care, rather than staying in hospital, even though they are medically unwell and said that this has been seen as a positive piece of work. She added that where possible the Council should look to influence for an increased rate of pay for staff and lobby the Government with regard to the Social Care Cap.

Councillor Rob Appleyard commented that he felt that conversations regarding the discharge of patients should take place as soon as possible to enable a better flow on site.

Dr Veronica Lyell agreed and said that staff are encouraged to start those conversations when deemed appropriate.

Councillor Appleyard said that he believed the RUH were being proactive and that the Government should be lobbied for care staff to receive a good rate of pay.

Councillor Joanna Wright commented that the families of older patients are not always able to be so supportive as they are tired themselves and asked if they were able to receive more support.

The Director of Adult Social Care replied that it can be hard to navigate the system and that work was ongoing with Age UK to provide some support.

Councillor Andy Wait asked if a better rate of pay for care staff could be achieved, would we be able to locally recruit the additional numbers required to help ease the pressure within the system.

The Director of Adult Social Care replied that she believed it would be possible to recruit and retain the staff required if they were supported by a better pay structure. She added that they were also considering approaching international care staff to come and work in the area.

The Place Director for Bath and North East Somerset, BSW ICB said that the Care Coordination Centre also needed to be signposted as an option for certain patients rather than entering into urgent care.

The Chairman thanked Simon Sethi and Dr Veronica Lyell for attending the meeting and said that he would like the Council to work with the BSW ICB to address the pay / career structure for care staff.