|Evidence-gathering for the second phase of this review (discharge to an individuals own home) continued at this Committee meeting, with contributions from representatives of Five Lamps and Tees, Esk and Wear Valleys NHS Foundations Trust (TEWV).|
The Committee received a presentation from the Director of Corporate Services at Five Lamps that, in addition to providing a general overview of the organisation, addressed several important areas, namely:
Communication around discharge with statutory partners.
For those Five Lamps have provided care for, are people aware of the avenues of support when discharged to their homes? Are an individuals family / other carers aware and informed?
Any specific issues relating to hospital discharge that Five Lamps have experienced regarding those they have provided care for?
Impact of COVID-19 on discharge from hospital back to an individuals own home (not a care home) and impact on Five Lamps in relation to this issue.
The presentation focused mainly on the commissioned service that Five Lamps delivers but ended with an outline of the Lottery-funded Home from Hospital initiative which provides low-level hospital discharge support. A separate Home from Hospital - Impact Report (July 2019 - December 2020) had also been circulated to the Committee prior to this meeting.
The main issues highlighted / discussed in relation to Five Lamps commissioned home care service were as follows:
The Rapid / Hospital Discharge commissioned service provides support for 14 days (160 hours per week), though some individuals have been supported for longer. Referrals should be via email and follow-up call (latter does not always happen), and those received from hospital are often with limited information. Five Lamps have previously provided feedback to hospitals regarding a small number of unsafe discharges.
Those individuals who are referred to Five Lamps are not always informed that Five Lamps are not their permanent provider and have flexibility on call times. Next of kin are involved at the point of discharge.
Social Workers should make contact with Five Lamps seven days after receipt of referral - this sometimes does not happen, and Five Lamps need to chase.
Weekly meetings with Stockton-on-Tees Borough Council (SBC) and the other Rapid / Hospital Discharge provider has improved communications and led to smoother discharges - Five Lamps are now informed if discharge will be delayed (historically, there have been incidents of a carer being sent to a persons home when they are still in hospital) and sometimes get follow-up contact by a person sending a referral to check everything is in order which is helpful.
There has been a much greater focus on care homes than home care / extra care providers during the COVID-19 pandemic. Keeping staff safe is an important priority, but Care Assistants only received regular testing from December 2020. Currently have to chase up COVID-19 test results on discharge; if no result, the individual is treated as COVID-19-positive.
Receiving a lot of positive support from SBC in relation to the pandemic, but now the additional 5% funding for personal protective equipment (PPE) has stopped, the free Government supplies are not enough. In addition, the current Service Level Agreement (SLA) for the commissioned service has expired and there is uncertainty around the future of the project, despite it receiving good customer feedback.
The Committee asked how Five Lamps were coping with effects of the pandemic. As a result of staff being furloughed, the organisation had to change its delivery model and had tried to secure funding to cover this period. Its care service had experienced the greatest impact, with a number of staff either absent from work or self-isolating - this in turn affects income which impacts upon the overall business.
Concern was expressed in relation to the need to chase Social Workers following a referral, and Members asked if there was anything the Committee could do to address this. The Councils Director of Adults and Health (also present at the meeting) was unaware of this issue and felt that the weekly meetings involving both SBC and Five Lamps gave an opportunity to raise any concerns. For now, this would be followed-up internally with relevant staff.
Regarding the 160 hours per week commissioned support, the Committee queried how many staff involved in an individuals care that equated to, as people tend to prefer the same carer coming to help them. Five Lamps stated that whilst they do try to provide consistency in those giving care to an individual, this has been a significant challenge due to staff sickness and self-isolation. It was acknowledged that continuity is vital for clients, and staff familiar to an individual can pick-up on any emerging issues much quicker.
The Committee questioned what was being done about the inadequate PPE supplies from the Government. Five Lamps confirmed that they do have adequate levels of PPE at present, but that cost is a challenge (need to have enough over and above the norm). As mentioned previously, the Council have provided significant help around PPE, but costs are increasing.
Five Lamps Home from Hospital project was outlined:
Started in October 2017 and was initially funded via Catalysts Health Initiatives Fund. Successful project, performing above contract targets.
Whilst Catalyst funding expired in March 2019, Lottery funding was secured for a further three years, with the service re-commencing in July 2019.
Provides low-level hospital discharge support (transport home, shopping, collecting prescriptions, attending appointments, liaising with other services, signposting and referral) for people aged 50+ for up to 14 days post-discharge from the University Hospital of North Tees.
Some issues noted - have seen customers readmitted, occasions where Five Lamps had to organise medication due to miscommunication on discharge, and referrals not always with full information (e.g. customers need more support and / or are COVID-19-positive).
Pandemic Support Project highlighted - Lottery-funded for six months (from August 2020) delivering services to the most vulnerable across the Borough and supporting individuals who are shielding or self-isolating with daily telephone calls to help reduce social isolation and help with food shopping, picking-up medication, and sorting any immediate problems out that will reduce their level of anxiety. Store cupboard essentials and cleaning packages also available for each customer to reduce the stress of trying to find home products and reduce the risk of infection.
Addressing the data within the Home from Hospital - Impact Report (July 2019 - December 2020), Members noted the slight reduction in the rate of referrals to the service over the last six months (July 2020 - December 2020) compared with the previous year (July 2019 - June 2020), but queried if the needs of those being referred were now greater. Five Lamps confirmed that referral rates are starting to increase and that some individuals do indeed require a higher level of support. As demonstrated by the self-referral rate, leaflets about the service are given to hospitals and it appears that people are receiving this prior to discharge as well as contacting Five Lamps soon after they leave hospital.
The Committee expressed concern about the medication issues raised and questioned if there was a dedicated contact within the hospital that Five Lamps go to regarding this. Members were informed that there is no single contact and that staff have to chase-up individual wards.
The relationship between Five Lamps and hospitals was explored. It was explained that there are no significant communication issues and that the Home from Hospital staff had built up a good rapport with hospital personnel. Similarly, there were no particular concerns in relation to specific wards, though it was acknowledged that any problems arising from a referral to the service may be a result of which staff member makes the referral and what pressure they are under at the time.
Tees, Esk and Wear Valleys NHS Foundations Trust (TEWV)
The TEWV Locality Manager for Mental Health Services for Older People (MHSOP) across Teesside presented a report to the Committee addressing a number of the reviews key lines of enquiry from a mental health provider perspective. Key highlights included:
Current discharge policy
Discharge data (August to December 2020)
Patient and family / carer involvement in the discharge process
Information given prior to discharge
Identification of carers who require treatment, and support for those they care for during this time
Assistance with transport and medication
Feedback on discharge experience
The Committee was informed that all patients, whether already known to the service or new, will be allocated a Care Co-ordinator (who leads on discharge planning) on admission to hospital. The Care Co-ordinator will inform the service users GP on admission and ensure other agencies, family and carers are updated and invited to all reviews. Discharge planning and aftercare arrangements should begin with the Care Co-ordinator and relevant others as soon as possible following admission.
In relation to feedback received from patients regarding their discharge, Members queried what this had raised and how TEWV go about responding to it. In addition to the family and friends questionnaire which is used to inform thinking and improve the approach to discharge, medics are asked for feedback and a group of carers and previous service-users also help shape how services operate. Learning from past events in Adult Mental Health was highlighted - in light of the ongoing COVID-19 situation, the Trust is currently offering daily contact with carers (if desired).
Members heard that the Trust asks for the family and friends questionnaire to be completed on both an individuals admission to and discharge from hospital. Completion rates were low (despite it being an anonymous questionnaire), but assurance was given that any issues raised are followed-up. The Trust also encourages people to relay any concerns via the Patient Advice and Liaison Service (PALS).
The Committee drew attention to those individuals who are without family and friends, and asked how they are supported through the discharge process. In response, the TEWV advocacy service was noted, as well as the chaplaincy service and the excellent support provided by a number of volunteers.
Members were informed that the intended contribution from ERS Medical (a private transport provider contracted by North Tees and Hartlepool NHS Foundation Trust) had been deferred until the next Committee meeting in February 2021.
The scope for this review had originally identified the North East Ambulance Service (NEAS) as a key contributor, but following recent correspondence with them, it was found that NEAS are involved in a very small number of discharges from local hospitals (just 12 from the University Hospital of North Tees in November 2020, with not all of those being discharged to a residence within the Borough). As such, very recent contact had been made with ERS Medical who are involved in a greater number of discharges back to an individuals own home, and more time was required to provide an appropriate response to the Committee.
|Following an introduction by the new Independent Chair of the Teeswide Safeguarding Adults Board (TSAB), the Committee was presented with the latest TSAB Annual Report for 2019-2020 (full report and Strategic Business Plan for 2020-2021 was provided in advance) by the SBC Director of Adults and Health. The following key elements were highlighted:|
There had been a 34% reduction in the number of Section 42 Enquiries in relation to incidents between residents in care settings, likely to be as a direct result of the work undertaken in 2018-2019 to provide a clearer framework and guidance for dealing with these types of incidents.
Increase in the use of social media to help raise the profile of adult safeguarding (Members were encouraged to check out the TSAB website).
Similar themes arising from Safeguarding Adults Reviews (SARs) and a lot of work is undertaken to understand the key factors emerging from such cases.
The Boards top three priorities (included within the Strategic Plan for 2020-2021) were emphasised.
The Committee expressed its thanks for another clear and informative report, and was pleased that issues raised by Members during consideration of the last Annual Report (2018-2019) in December 2019 had been acted upon. One of these concerns - echoing previous views that the online training on offer was not of the required standard - was again probed, and it was subsequently proposed that an overview of the current TSAB training provision was provided to the Committee after the meeting to demonstrate how the Board had addressed this feedback. The relatively low number of attendees for the new Self-Neglect for Practitioners course was also noted.
Another query raised last year was the sense that Adults and Childrens Social Care could sometimes be at odds with each other when involved in the same case, and the Committee asked what had been done to investigate any such incidents. Members were informed that cases are discussed on an individual basis but acknowledged that further work could be done in what are day-to-day operational issues. It was crucial to think family, not just adult or child.
Regarding the interplay between Adults and Childrens Social Care, the TSAB Independent Chair confirmed that this was a theme the Board would be keen to pick-up on, and highlighted a forthcoming TSAB event in March 2021 to establish the Boards priorities for 2021-2022. It was also vital that other partnerships (i.e. Health and Wellbeing / Adults / Childrens Boards, Community Safety Partnerships, etc.) work as closely as possible to ensure a shared understanding of priorities. The Team Around the Individual concept was a good starting point, but issues can emerge around required resourcing.
Members drew attention to the Deprivation of Liberty Safeguards (DoLS) applications within the reports appendix and questioned why Stockton-on-Tees was a clear outlier when compared with the other Tees Valley areas. Assurance was given that there was a lot of good practice taking place in this area locally, and further details were offered if required.
The Committee recorded its thanks to the previous TSAB Independent Chair, Ann Baxter, for all her efforts over a number of years and wished the new Chair well in his new role.