To consider a report by the
Adults, Health and Well-being Cabinet Member and the Chair of Betsi Cadwaladr University Health Board on the above.
Minutes:
A progress report was submitted against the main recommendations
of the From Hospital to Home Scrutiny Investigation
- Part 2.
The Cabinet Member for Adults, Health
and Well-being gave the background and Committee Members
were given an opportunity to scrutinize the contents.
During the ensuing discussion the following points were highlighted:
(a)
In response to a comment
made regarding the lack of GPs and
nurses in Gwynedd, especially in the Dwyfor and Meirionnydd areas, the Chief Health Officer
for Gwynedd and Anglesey explained that this was a national problem and in north
Wales this was more of an issue in the Wrexham
area. It was further noted that the Health Board had received funding in the sum of £4.9m from the Welsh Government for Primary Care that would enable
the establishment of multi-agency
teams around GPs to include nurses, additional therapists, offer audiology out in the community
as well as additional pharmacists. In terms of GPs, that
action would be taken to
try to get the youth to return to their communities as part of the Outstanding GP Development Programme. They had managed to attract five back to the Health Board with
two doctors working in Gwynedd - one in Nefyn and the other in Caernarfon. It was trusted that more youth could be attracted and this
would be an opportunity for them to work part
time as a GP and for the remainder
of their time they could specialise
in a particular field.
(b)
There was praise for the additional nurse at Botwnnog together with the pharmacists and people trusted them. It was added that
there was a need to collaborate with the third sector and there should be no deterioration in the service.
In response, the Chief Health Officer for Gwynedd and Anglesey noted that there
was a good relationship with Mantell Gwynedd and through the funding received from the Welsh Government it was trusted that they
could implement a Social Prescribing scheme with the third sector.
The Corporate Director gave an
assurance that a better understanding had by now developed
between the Council and the third sector and different ways
of collaborative working
had to be considered. The Care Challenge
project working with communities was mentioned and it was noted
how important it was in all the integrated work that the third sector was a key part of the integrated team.
(c)
The importance
of advertising and giving a better understanding especially to older people of the Advance Nurse Practitioner
scheme.
In response, it was explained that there was work to develop the above scheme during the next 2 / 3 years. It was recognised that it needed to be promoted especially to GP surgery reception staff. It was also ensured that
a specific article would be prepared for the local press
together with social media about
the Multi-agency Teams. It was trusted that more than one model could be trialled where nurses may visit
and undertake visits to homes and the scheme had been trialled in
Pen Llŷn since January. The development would be good news.
(ch) In
response to a comment made regarding a vulnerable person going home from hospital
to another vulnerable
person, an assurance was given that the Health Board was trying to develop a Discharge to Assess scheme where it
would be ensured that individuals were assessed within
a day or two of having returned
home.
The Corporate Director added that there should
be collaboration as part of the process to ensure that individuals
receive care. It was further noted that
the recruitment of home carers caused concern
in some areas
and these jobs should be promoted to attract young people.
(d)
An observation was made
that there was possibly pressure to move persons out
of hospital into their homes, and
in some cases
this was premature and should it
not be ensured that there was a bed for them in community
hospitals to convalesce before they returned
home.
In response, the Chief Health Officer for Gwynedd and Anglesey explained that collaboration was important and specifically with the Integrated Teams to ensure care of individuals within communities.
The Corporate Director added that more work was required regarding support for non-paid
carers.
(dd) In
response to an enquiry regarding arrangements at Ysbyty Alltwen, it
was recognised that this had been a success despite the Health Board and
the Council having different governance structures. It was trusted that they would
proceed in the next few months
to extend the Integrated Teams.
(e)
The Cabinet Member for Adults and
Health noted that the situation in this field
was critical in terms of financial resources and therefore
the way of addressing the problems had to be adapted. It was recognised that there was a great deal to be achieved in different ways
in order to get a better result
for individuals.
(f)
In response to an enquiry regarding 'step-up - step-down' beds at Plas Pengwaith, Llanberis and other care homes,
the Head of Adults, Health and Well-being Service explained that arrangements were being made
to change the nature and geographical split of the provision as the previous arrangement had not been totally successful.
(ff)
The Corporate
Director explained, referring to a letter sent to Albert Heaney, Director of Social Services, Children and Families,
expressing concern about the problems in terms of provision
of private nursing homes and also
in the recruitment of nurses to work there. It was trusted that they would
be able to report back to the Committee on this issue
with options for consideration in around May.
(g)
The Corporate Director referred further on the contact made with
Margaret Flynn (author of
the Winterbourne Report) and her experience would be discussed further with the Champion for Older People,
Champion for Carers, Councillors Beth Lawton and Angela Russell along with one member
who had personal experience. It was suggested that Councillor Elin Walker
Jones, Autism Champion, should
be part of the above discussion.
(ng) In
terms of retaining nurses, it was explained that the number accepted by Bangor University was not sufficient. Some nurses were
lost when they specialised in a particular field, as well as a result of bureaucracy. It was trusted that by changing
the model and the way of working that paperwork
would be reduced to enable nurses to give more care to patients. In addition, nurses
tended to favour jobs in Hospitals rather than in nursing homes. It was recognised that there was a piece of work to be undertaken regarding this to see how the profile
of the Home Care Nurse could be raised.
Resolved: (a)
To accept, note and thank the officer
for the report.
(b) To approve that the work was developing and to continue to work jointly with
the carers to promote and advertise the arrangements of the Multi-agency Teams (ANP)
(c)
To programme follow-on work on the organisation
of Ysbyty Alltwen together with
a career in the care field at the Annual Workshop of this Scrutiny Committee
that will take place on
28 April 2016.
Supporting documents: