Agenda item

To consider a report by the Chairman of the Scrutiny Investigation, Councillor Peter Read, on the above.

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.