To consider a report by the Chairman of the Scrutiny Investigation, Councillor Peter Read, on the above.
Minutes:
a) The Vice-chair chaired the above item in order
that the Chair, Cllr Peter Read, could present the above report and Meinir Williams and Ffion Johnstone from the Betsi Cadwaladr University
Health Board were welcomed to the meeting to respond to the queries / observations of the Scrutiny Committee.
b) The final draft report was presented by Cllr.
Peter Read, Chair of the Scrutiny
Investigation ‘From Hospital to the Home’, that focused on
the arrangements for discharging and transferring patients home from
hospital The Chair thanked Health
Board staff for their excellent cooperation together with the officers of various Council Departments who added value to the Investigation’s results and recommendations.
c) The Members’
Support and Scrutiny Manager
stated that the draft report before
them contained the fruits of the Scrutiny Investigation’s labour that was commissioned by this Scrutiny
Committee and attention was
drawn to the following points:
·
The nature of the report was different to the usual, mainly due to two
reports regarding defective provision and scrutiny work that
became evident in England. Guidance was received to trial different ways of conducting scrutiny investigations to try
and maximise the voice of
the people within the
Service and from the report
it could be seen that there
was more analysis and interpretation
of data leading to the main recommendations
to be submitted to the Cabinet Member
for Adults and Health and the Health Board.
·
An apology was given for leaving out
a reference in the report to a visit made by two
members of the Investigation
to the Ageing Well Centre at Cricieth.
(d) Any observations from the Scrutiny Committee on the main findings outlined in the report would be welcomed and the following points were noted:
1. Whilst accepting that Gwynedd performed well on the whole in
terms of national comparison on the measure of transferring patients in a timely
manner from hospital to the community, it was noted that
problems were manifested during the weekends.
In response, a representative from the Health Board explained
that the weekends proved difficult in the transfer of patients during the summer due to the lack of Social Workers at the hospital over the weekend but this had worked
well over the winter. It was further noted that
work was on-going on the above, however,
the Health Board had more challenges regarding homes unable to receive patients back over the weekend
due to staffing levels as well as the transfer of patients to community hospitals.
2. A
representative of the Health
Board recognised that drafting a care plan was her priority
this year.
1.
The need to collaborate with the Third Sector especially in the areas of Dwyfor and Meirionnydd.
2.
It was agreed that there was room for improvement in terms of discharging patients on the weekends.
3.
That there was a need to reconcile the
arrangements and have a plan to discharge patients, with packs for them to take
home from Bronglais Hospital for residents from the
south of Gwynedd.
4.
Regarding the shortage of general practitioners and nurses it was stated:
·
There was discontent that there was no
compliance by the Betsi Cadwaladr University Health
Board with the written policies and was happening at grassroots level. It was found that there was a new protocol
where a patient is discharged from hospital and if the patient requires nursing
care then the carers are required to find a nursing care home for the patient
within five days with at least one empty bed in one of the homes, although the
home might not be the patient’s first choice.
·
What were the criteria and the qualifications of
nursing staff in terms of intermediate care in residential homes?
·
Concern that hospital staff were not aware of
the discharging policy.
·
Concern that nurses did not attend residential
homes in some areas and doctors were not available either and were dependent on
a locum who did not know the patients.
·
Is the Health Board working with the Colleges
for the recruitment of general practitioners / nurses?
·
That the authority had supported the call to
have a Doctors Training Unit at the University, however, the funding earmarked
by the Welsh Government had been diverted.
·
The importance of the Welsh Language in order
that a patient can choose the language he/she is confident to speak.
The
representative from the Health Board responded to the above by explaining:
·
That the discharge policy was national and the
Health Board had a difficult time to ensure that the patient received correct
care once he/she was out of hospital. It was noted that beds in
residential and nursing homes across North Wales were closing every week and
the situation was critical. The policy stated that if the patient
was anxious to go to a nursing home for a long term then it was necessary for
them to go to a community hospital. It
was recognised that it was not easy to respond to this situation, however, the
wish was for every patient to receive the provision of their choice.
·
That an assessment of the patient would be
undertaken in terms of nursing needs or residential care. In
some cases where not as much nursing care was required, community nurses could
assist but certainly a plan was required to meet the patient's care needs.
·
That the Health Board had met with
Dwyfor/Meirionnydd doctors and had resolved to use some of the money for
recruitment in different ways to try and attract young doctors with the promise
that they would be developed to specialise in different fields be that care
expertise and/or working with specialist consultants. For nurses, it was trusted that they
could work jointly with district nurses and others in the family surgery. Assurance
was given that the above matter was a priority to try and attract more young
health workers into the area.
5. It
was agreed that there was too much bureaucracy,
however, the Health Board representative added that there was good local
cooperation with Social Services and both bodies challenged each other. It
was trusted that through ‘Ffordd Gwynedd’ bureaucracy
could be disposed of and the patient would be central.
(e) Attention was drawn to the main recommendations of the
Scrutiny Investigation as outlined in the report and the following additional
comment was noted:
·
That the recommendation regarding the lack of doctors
and nurses needed to be strengthened as the situation was critical and the
concern was that students tended to study medicine in England and consequently
stayed there once they had qualified.
(f) The
Cabinet Member for Adults and Health and the Chief Executive of the Betsi Cadwaladr University Health Board were requested to
act on the recommendations by drafting a joint Action Plan by July 2015, with
an expected progress report in January 2016.
(g) In response, the Cabinet Member for Adults and Health thanked
the Member for the report and noted that the best way forward was to refer this
to the County Forum for attention. The
Health Board representative added that it would be difficult to provide the
Action Plan by July as the County Forum would not meet soon. The
agreed timetable regarding the Action Plan would be discussed at the County
Forum In addition, it was confirmed that
Councillor Peter Read, Chair of the Scrutiny Investigation, together with the
Members’ Support and Scrutiny Manager would be invited. In
response to a query regarding the membership of the County Forum, it was
explained that it was limited in numbers in case it got too big and was
currently focusing on the transformation of the service to older people, however,
assurance was given that if there were specific items regarding mental
health/learning disabilities then members and experts would be invited as
required.
(h) For further information, it was noted:
·
By the Corporate Director and Statutory Director
of Social Services that she together with the Cabinet Member for Adults and
Health served on the Mid-Wales Health Board and it would be possible to respond
to some of the recommendations by cooperation with that Board.
·
By the Members’ Support and Scrutiny Manager
that arrangements were on-going to hold a special meeting of this Scrutiny
Committee in July to discuss engagement and consultation with the Health Board.
The Scrutiny Investigation was
thanked for its work and specifically Councillor Peter Read and the Members’
Support and Scrutiny Manager and his team for leading the investigation.
Resolved: (a) To
accept and note the contents of the report.
(b) To
approve:
(i)
The
recommendations outlined in the Scrutiny Investigation Report From Hospital to the
Home together with the comments made in (d) and (e) above.
(ii)
To
submit the final report to the Cabinet Member for Adults and Health and the
Chief Executive of the Betsi Cadwaladr University
Health Board to implement the recommendations by drafting a joint Action Plan
by a time schedule to be agreed by the County Forum.
Supporting documents: