Agenda item
DOMICILARY CARE STRATEGY UPDATE
Minutes:
The Committee considered a report they had requested surrounding the current pressure on domiciliary care and the impact that this was having on hospital discharges. The report was to provide assurance that patients were being safely supported to leave hospital and outlined the pressures and how Carmarthenshire County Council was responding to those pressures.
Amongst the questions/observations raised on the report were the following:-
· In response to a question regarding how the Authority was increasing the flexibility of contracts and how this would impact the consistency of care provision, the Director of Community Services advised that there was an impact on the continuity of care and also on the ability to deliver at the best time for when people needed and wanted the care. The Committee was advised that the report set out what the Authority was doing to mitigate supply issues and assured the Committee that the Authority ensured that the care delivered did not impact on safety. It was highlighted that there was an overall situation over the flexibility of care and that difficult conversations had to take place with families and individuals around what practical options of care were available. In some cases, compromises would have to be made over the ideal package of care but this would still be preferable than remaining in hospital. It was noted that there were currently around 50 individuals in temporary residential care, the majority of whom should be supported at home. The situation was described as dynamic and that significant improvements had been made over the last few weeks, but the situation remained difficult. It was highlighted that the Authority was attempting to offer more flexible contracts than the traditional rigid rotas to assist with the recruitment and retention of staff.
· Concern was raised that the flexible contracts would result in lack of continuity of care with individuals ending up with a different number of carers. It was advised that while several people may be providing care every effort was undertaken to ensure that this was kept to the same group of people. It was acknowledged that this continuity was of benefit to both the individual receiving care and to the carer.
· Clarification was sought regarding the use of microenterprises. The Committee was advised that the scheme was already in use in Pembrokeshire and that it was very early days for Carmarthenshire. The scheme was very much in its infancy and aimed to assist the areas where it was traditionally difficult to obtain domiciliary care. It was stated that the Authority was in the process of recruiting a member of staff to lead on the initiative and drive it forward.
· It was asked if the Authority had been pressurised into prioritising hospital discharges over those already waiting for care packages. The Committee was advised that there was constant pressure balancing hospital discharges and community waiting lists and that there was some inevitability that those in the community would be waiting longer due to the prioritisation of hospital discharges. Despite limited capacity, people who were living at home and waiting for the start of domiciliary care were managed, with those deemed in a red category given immediate priority.
· In response to a question regarding what practical help was offered to family members who stepped up to provide care and how the quality of the care they provided was monitored, it was stated that family members would receive appropriate training and a manual handling assessment.
· Reference was made to the development of the Care Academi and if budgetary constraints would impact the set up. It was advised that a care academy launched by the authority was targeting sixth formers with the prospect of attaining a degree level qualification. It was stated that there was a set of quite high-quality individuals with the required resilience, confidence, and knowledge to go on a journey to hopefully professional training. It was acknowledged that getting the academy going was proving to take time and that budgetary constraints were not impacting the academy.
· It was asked if the Authority was looking to increase the number of step-down beds within the County. It was advised that the Health Board had commissioned an additional 15 beds on a short term basis and that the Authority had 14 beds in Llys Y Bryn care home (Ty Pili Pala). Community hospitals were also being used with 28 beds in Amman Valley and 14 beds in Llandovery hospital. It was acknowledged that additional capacity was required in the community and as a model it worked well with the achievement of better outcomes for individuals. It was agreed that a geographical spread was required however spread was limited to where care homes had capacity.
· The Committee requested regular updates regarding domiciliary care and progress with the Health Board. It was agreed that updates would be included systematically within the performance and data monitoring reports.
UNANIMOUSLY RESOLVED that the report be received.
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