Issue - meetings

Cllr. Dilwyn Morgan to present the report.

To accept the report and ask for a progress report in 18 months.

The report was presented by the Cabinet Member for Adults and Well-being, Councillor Dilwyn Morgan, the Head of Adults Department, and the Head of Adults Health and Well-being, Mari Wynne Jones.

It was reported that the project encompassed the important work of the multi-agency network in supporting residents to return home from hospital. The current arrangements of the Community Resources Teams in supporting adults after they are discharged from hospital were outlined. It was explained that the Teams supported adults with physical needs, ill-health, age-related conditions and dementia. Details were shared of the care pathways available to patients in the context of the principles of the Social Services and Well-being Act. It was emphasised that individuals' personal resources and strengths were at the centre of care and support needs assessments and plans, to ensure that individuals received bespoke care. 

It was confirmed that the principles were based on the Social Services and Well-being (Wales) Act 2014. It was noted that the legal framework was used to identify a person's personal outcomes and to assess their care and support needs. The importance of encouraging people to return home from hospital for their own good was emphasised, noting that it was a matter of concern that "an extra 10 days in hospital equated to 10 years of muscle ageing in people over the age of 80". It was emphasised that the project aimed to ensure the best possible care by supporting people to stay at home in their communities, to promote individual independence and alleviate the pressures on social care and community services that were already hard pressed.

It was elaborated that the project was being implemented in response to a report published by Senedd Cymru, investigating the role of local authorities in supporting people to leave hospital in a timely manner. It was explained that there was a lot of work undertaken between the Council and the Health Board to try and improve the journey for individuals upon leaving hospital. It was noted that the Association of Social Directors had produced a paper framing the national context in Wales and the importance of collaboration between the different agencies. It was highlighted that NHS Wales used specific codes to determine the pathway of individuals who are discharged from hospital, based on the principles of Discharge to Recover then Assess (D2RA). Details were given of the four streams.

The Project Manager detailed that this was a Pilot Scheme that would run for a period and the developments would hopefully be rolled out across the county. An overview was given of the project's objectives in the context of the Llechen Lân (A Clean Slate) report and the Ffordd Gwynedd way of working. It was explained that there would be a greater demand for care and support with an increasing older population. It was confirmed that the work resulting from the project would ensure that there was an appropriate resource to address the increasing long-term challenges.

During the discussion, the report was welcomed, and  ...  view the full minutes text for item 6