Agenda item

To consider and accept the report

DECISION:

·       To accept the contents of the report.

·       Submit an update on the recommendations in 12 months' time.

Alan Hughes, Fflur Jones, Yvonne Thomas (Audit Wales), Aled Davies and Dewi Wyn Jones ⁠were welcomed to the meeting.

A report by Audit Wales was presented, which referred to an audit issued in February 2024 to identify whether the NHS bodies and Local Authorities had proper arrangements in place to secure the efficient, effective, and economical use of resources in managing the flow of patients out of hospital in the North Wales Region.

It was reported that the discharge of patients from hospitals was a national problem, mainly because the complexity of the demand had increased. Consequently, this created problems such as a reduction in the number of beds available, putting a strain on the service. It was reiterated that a workforce shortage, and deficiencies in the processes for discharge and sharing information added to the challenges. It was noted that there was strong commitment by the Partnerships to try and improve the situation and that the region's response to the recommendations had been positive.

Aled Davies (Head of Adults, Health and Well-being Department) presented the organisation's response to the recommendations for the Committee to consider. He noted that the work and findings of Audit Wales had been welcomed, and that the response was a collective response by organisations across the region, with Cyngor Gwynedd playing a key role in the process of patients' discharge from hospital. He added that the region recognised and identified the improvements that needed to be implemented to ensure support for patients after returning home, and that Gwynedd would make every effort to work with all the partnerships to respond to those challenges. He also noted that many of the issues aligned with the priorities of Cyngor Gwynedd.

Matters arising from the ensuing discussion:

·       Despite the joint-working with Betsi Cadwaladr University Health Board (BCUHB), the situation was not improving; it was a critical situation. Need to see examples of good cooperation.

·       The BCUHB area was too large – the processes were not fit for purpose for all areas within the region.

·       There was a need to hold more discussions between BCUHC, the Local Authorities and Partnerships.

·       The Labour Party had ambitious plans to repair the National Health Service (NHS) – was there scope here to engage with Central Government in London?

·       Patient discharge from hospital was a long-standing problem – we need to focus on what Gwynedd can do to improve the situation.

·       A population breakdown would have been useful as part of the report – setting out the context of the areas within the region.

·       BCUHB was often in special measures – this was not an easy problem to solve.

·       The percentage 'waiting for a new domiciliary care package to begin' was high – it was hoped that the Service was looking at this.

·       A shortage of beds and staff in the hospitals.

⁠In response to a question;

-        regarding how confident organisations were, after the recommendations had been implemented, that the situation will have improved and whether there were adequate resources to undertake the work, it was noted that every effort was being made to respond to the matters raised and that we would have to make the best use of what was already available. It was suggested that possible amendments could improve the process, such as Cyngor Gwynedd's information technology system running in parallel with the hospitals' system so that direct information between wards and residential homes could be facilitated. He noted that it was easy to state that more people were required to deal with this, but the staffing structure was currently full (although there was a problem with recruiting domiciliary and residential carers). It was reiterated that we must focus on changing culture, the way of working, by targeting resources in the right places and perhaps consider not over-providing in some situations; there was a need to ensure that actions, both individually and in partnership, led to improving the situation.

-        Regarding recommendation 1 – 'Improving Training and Guidance' (completion date July 2024), and whether this had been completed within the timeframe – it was noted that the matter was 'in progress' because work on revising the policy was being carried out.

-        Regarding the importance of sharing information and that it was difficult to operate without the latest information, it was accepted that this had been used as an excuse in the past, but sharing information using technology systems that run in parallel could remove layers from the process – it would be a positive contribution and would reduce the risk of losing information (which would usually be recorded on paper).

-        With regard to a comment about shortfalls in the discharge process and the lack of space following discharge, it was noted that there were differences in the care provision in Gwynedd especially between urban and rural care. It was added that the south of the County was worse than the north, with a shortage of nursing beds which sometimes led to the need to make out-of-county arrangements. In the context of residential beds, it was highlighted that this was not such a problem as the service focused on supporting the patient to stay in their home.

The members gave thanks for the report and requested an update in 12 months' time. The committee shared their support with the Service and appreciated the complexity of the situation. It was reported that the recommendations had been discussed in the Management Team and that Audit Wales’s recommendations corresponded with the work programmes of the Adults, Health and Well-being Department; this would ensure that Gwynedd made an effective contribution to the review.

RESOLVED:

To accept the contents of the report.

To submit an update on the recommendations in 12 months' time.