Agenda Item No 5
The Vale of Glamorgan Council
Healthy Living and Social Care Scrutiny Committee: 16th January, 2017
Report of the Director of Social Services
Wales Audit Office - Review of Delayed Transfers of Care
Purpose of the Report
The purpose of the report is to present to Members the findings of the Wales Audit Office review in respect of Delayed Transfers of Care (DToC) in the Cardiff and Vale Health and Social Care Community.
THAT Members note the Wales Audit Office report attached as Appendix A.
Reason for the Recommendation
To keep the Scrutiny Committee informed and to ensure that Members of the Committee are fully aware of the findings and conclusions of this review.
A delayed transfer of care is when a hospital in-patient is ready to move to the next stage of care but is unable to do so, for one or more reasons. The arrangements for transfer to the next stage of care can either be within the NHS or outside.
For local authorities, DToCs are especially associated with complex cases where patients need a care package or move to a different care setting such as a care home. These patients are more likely to be older, vulnerable people with a number of medical conditions.
The Cardiff and the Vale region has one of the highest numbers of DToCs in Wales. Unlike other health board areas, Cardiff & the Vale of Glamorgan has no community hospitals to provide step-down intermediate care. In addition, the University Hospital Wales is a tertiary, specialist hospital and so demand from outside the region is greater. These two factors mean there is added pressure on acute hospital beds and extra demand on community services.
Timely transfer and discharge arrangements are important as delays lead to poor patient experience and increased operational pressures on the whole unscheduled care system. The Regional Partnership has set ambitious targets for reducing the number of DTOCS (25% per year for the last two years) and for the number of Bed Days Lost (a 25% reduction on the June 2015 position).
Relevant Issues and Options
During the period March and June 2016, the Wales Audit Office (WAO) carried out a review of DToCs in Cardiff and the Vale of Glamorgan. The review sought to answer the following question: Are partners making a sustainable improvement in delayed transfers of care?
The WAO review concluded that:
"Partners are working well together to manage DToC, whilst realising their plans for a whole system model".
In reaching this conclusion, the WAO found that independence of older people was being prioritised through joint working and the implementation of an integrated service model. However, continuity of joint funding was a risk.
Furthermore, the WAO review outlined that performance was steadily improving, although the level of delayed transfers of care remained the second highest in Wales. The WAO also found that there was a maturing, dynamic partnership in place with strong governance, performance monitoring and evaluation arrangements.
The WAO made two recommendations. The first was for the findings of the Delivery Units discharge planning audit to be addressed, either by developing a separate action plan or by incorporating actions into existing service improvement actions plan. The second recommendation was to explore ways that mainstream services were funded through the Intermediate Care Fund to ensure that services remain resilient.
A copy of the Wales Audit Office report on Delayed Transfers of Care is attached at Appendix A.
For Members information, attached at Appendix B, is the latest census of DToC taken on the 21st December 2016.
Resource Implications (Financial and Employment)
13. None as a direct consequence of this report.
Sustainability and Climate Change Implications
14. None directly from this report
Legal Implications (to Include Human Rights Implications)
15. None as a direct consequence of this report.
Crime and Disorder Implications
16. None as a direct consequence of this report.
Equal Opportunities Implications (to include Welsh Language issues)
17. None as a direct consequence of this report.
18. The service helps the Council to fulfil the following Corporate Plan outcomes:
An Active and Healthy Vale - Residents of the Vale of Glamorgan lead healthy lives and vulnerable people are protected and supported; and
An Inclusive and Safe Vale - Citizens of the Vale of Glamorgan have a good quality of life and feel part of the local community.
Policy Framework and Budget
19. The proposals in this report are in accordance with the policy framework and budget.
Consultation (including Ward Member Consultation)
20. No further consultation is proposed.
Mr Gareth Davies, Democratic and Scrutiny Services Officer
Head of Adult Services/Locality Manager
Director of Social Services
Philip Evans, Director of Social Services