FIFE COUNCIL
Adult Services Committee
19 December 2003
Agenda Item No.
DELAYED DISCHARGE ACTION PLAN
1.0
Introduction
1.1
The Delayed Discharge Action Plan announced by the Minister for Health and
Community Care in March 2002 was supported by a recurring investment of
£1.32 million for Fife. This was joint money with allocation to be agreed by the
Partners, Fife NHS and Fife Council.
A further £333k investment for Fife was confirmed by the Executive on 1 st April
2003 and following approval of our Joint Action Plan (available in the Members
Lounge) an additional £313k has been confirmed. These allocations build on an
initial investment in 2000 of £3.6 million.
1.2
This report provides information on the process developed by the partnership
between Fife Council and Fife NHS to allocate the additional funding. It outlines
the criteria used to prioritise proposals submitted to strengthen and redesign
services, the initiatives that have already been funded and proposals for further
developments.
1.3
The report also provides information about the demographic trends in relation to
delayed discharges and the way in which joint working has resulted in the
development of a range of services to support frail older people remaining in the
community.
2.0
Background
2.1
Following the experience of winter 1999/2000 Fife Health Board in collaboration
with Fife Council and the two Health Trusts in Fife established a small project
team which planned and implemented the distribution of Winter Planning money
from the Scottish Executive.
2.2
This team became the Fife Project Team and subsequently the Capacity
Planning Team and although the membership has changed over the last 3 years
it has retained a good representation of all key stakeholders.
2.3
The Fife Project Team was given the responsibility for developing an Action Plan
to allocate the investment of £1.32 million in 2002 and deliver long term
sustainable reduction in both waiting times and delayed discharges which
enabled us to achieve a reduction in delayed discharges in Fife to 99 by April
2003. Details of the initiatives funded are in Appendix 1.
2.4
The Project Team developed a whole system approach to tackling delayed
discharges in Fife and although initially focussing on early supported discharge
through the establishment of Integrated Response Teams, further recurring
investment has enabled Fife to invest across the health and social care
continuum and in particular to concentrate on the avoidance of unnecessary
admission to hospital. Using a whole system approach the partnership has
tackled a number of key issues in the short, medium and longer term.
2.5
The main reason for delayed discharges in Fife has consistently been ‘non
availability of Care Home places’. Additional investment in Nursing Home
placements and development of a Single Care Home model in Alan McLure and
Ladywalk has and will continue to impact positively on the number of patients
awaiting discharge in the short term. In the medium to longer term the key
issues in Fife are to invest in services which will support crisis intervention and
prevent avoidable admissions to hospital and long term care. This will be
achieved through the development of intensive rehabilitation services to people
in their own homes, managing emergency admissions effectively and supporting
early discharge wherever possible.
2.6
A meeting with providers was organised by Fife Council Social Work
Service in partnership with Fife NHS in February 2002. This gave an
opportunity to discuss with Care Home providers the type of Care Home Models
we would like to see developed in Fife. Further discussion has taken place with
providers to look at preferred models.
2.7
Discharge Planning from the moment service users are admitted to hospital is
essential and Discharge Co-ordinators, Hospital Based Social Workers, Bed
Managers and the Integrated Response Teams play a key role in ensuring
effective multi disciplinary assessment and arrangement for discharge to
appropriate settings including returning home. Details of these services is in
Appendix 2.
2.8
This development has strengthened our ability to provide a speedy response to
requests for assessment of people in hospital which has resulted in a reduction
in the waiting times for assessment. The census figures show delays in
discharge attributed to ‘non completion of assessment’ fell from 21% in April
2003 to 18% in July 2003. Details of the July 2003 census is in Appendix 3.
3.0
Developments in 2003/04
3.1
A further £333k investment for Fife was confirmed by the Executive on 1st April,
2003 and following approval of our Joint Action Plan and a commitment to
reduce delayed discharges by a further 10% to 90, an additional £313k has
been confirmed. Fife Council Social Work Service has added to the figure a sum
of £250k from Sutherland investment this year for improving Rapid Response
Systems. An amount for inflation of approximately £50k on the 2002/03
initiatives in relation to staff costs has also been set against this years funding.
3.2
Each Local Management Unit was asked to undertake a mapping exercise to
identify services to Older People in their area and assess areas of unmet need.
The criteria for proposals being submitted was that they would provide a
reduction in the number of delayed discharges. This formed the basis of
proposals for services to be supported within the Delayed Discharge Action Plan.
The joint Delayed Discharge Action Plan is attached in Appendix 4.
4.0
Process and Procedures
4.1
Discharge policies have been in place in Acute Hospitals in Fife for many years
however there is no Joint Discharge Protocol agreed between Fife Council and
Fife NHS. An outline proposal is being produced to bring together the relevant
policies and procedures, which are required to achieve this and will include joint
policy on Choice.
4.2
The issue of service users exercising choice of care home and thereby in some
cases, occupying a hospital bed unnecessarily is a key factor in the number of
delayed discharges in Fife and the July 2003 figures show that 55% of delayed
discharges in Fife were due to people awaiting placement with 17% of this being
due to people exercising choice.
4.3
A leaflet for service users and their families has been produced to advise people
what they should do following the decision that their needs can only be met in
long term care and the problems associated with remaining in hospital longer
than necessary (available in the Members Lounge – blue leaflet entitled “Social
Work Service in Fife – Moving on from Hospital”).
5.0
Conclusions
5.1
This report outlines the strategy being adopted by the partnership in Fife
between Fife Council and Fife NHS to address the issues related to Delayed
Discharge.
5.2
There are several factors, which influence the fluctuating numbers of delayed
discharges in Fife and other Scottish Local Authorities. For example capacity
within the Care Home system, lack of services in some areas to support frail
older people in their own homes and services ability to respond quickly to
discharge people as soon as possible following admission.
5.3
The developments in services supported by funding for Delayed Discharge are
aimed at tackling the issues at all levels and, most importantly, to build on
existing good models of practice.
5.4
One of the main criteria for new initiatives has been evidence that services are
‘integrated’ and that there are clear links that strengthen the community
infrastructure to support older people to live safely in their own homes, taking
account of quality of life issues.
5.5
The development of Local Management Units in Fife provides the forum for joint
management between Social Work and Health Service of a range of services
and will further support the integration of key services to support vulnerable
people in the community.
6.0
Recommendations
6.1
The Committee is asked to note the content of the report and to comment on
performance information it would wish to see in future reports.
Stephen Moore
Head of Social Work Service
Social Work Service
(Patricia McCaw / 701 7820)
Fife Council
Fife House
North Street
Glenrothes
Fife
KY7 5LT
21 November 2003