Agenda item

The Committee considered a report detailing the opportunities in Carmarthenshire to develop and implement a health and care system for older people based on ‘what matters’ to this population and would be fit for purpose both now and into the future.

The Committee welcomed Rhian Matthews (Hywel Dda UHB / Carmarthenshire County Council – Integrated System Director) to the meeting.  The Integrated System Director provided the Committee with details of the current state of the health and social care system and the challenges.  It was noted that there was an imbalance in terms of demand and capacity relating to managing the needs of the older people population.  The frail and elderly population in West Wales was growing in the region of 3% a year and would continue to grow for at least 10 years.  The current position would get substantially worse without change and transformation.

It was acknowledged that hospital stays for the severely frail predisposed them to harm and poor outcomes including infection, an increased risk of falls as well as muscle loss and deterioration in previous levels of independence. This in turn increased the need for care and support on discharge increasing the demand on the finite availability of social care.  Additionally, poor discharge rates compromise the Emergency Departments’ ability to receive patients arriving by ambulance resulting in ambulance handover delays.

The Committee noted that there was a Section 33 Agreement between Carmarthenshire County Council and Hywel Dda University Health Board which supported an integrated management structure across community health and social care for older adults and the development of integrated care pathways (Home First) which had demonstrated in the last twelve months to have reduced care and support requirement for a targeted element of frail and elderly population by up to 85%.

The Integrated System Director clarified that the ‘Home First’ was an approach (not a service) taken by multi-disciplinary teams of professionals which embedded best practice for managing the frail.  It consisted of rapid access to care and treatment for acute health needs within a 1 – 2 hour period providing a safe alternative to hospital.  It also provided urgent access to primary care and reablement provision within a 8 – 72 hour period to support people to receive treatment and to recover from injury or illness.

It was noted that Delta Wellbeing provided a digital infrastructure and monitoring of patients being managed at home through the Delta Connect pathway.

The Committee also noted the benefits and governance arrangements as detailed in the plan.

A number of questions were raised, the main matters were as follows:

• In response to concerns expressed that some patients may request a level of support that may put them in danger, the Integrated Services Director stated that the assessment would always be based on what matters to the individual but that different treatments, the potential risks and alternative options were always considered.
• In response to a question regarding the Ty Pili Pala model, it was stated that the outcomes were better than those who stayed in community hospitals and that the Ty Pili Pala model should be rolled out to community hospitals.
• It was stated that one of the biggest challenges at the current time was changing the mindset and culture of staff from a reactive to preventative approach.
• It was acknowledged that additional work was required regarding the promotion of the Delta Connect service.  It was stated that take up was better when referrals were made by health professionals. 
• Concern was expressed regarding the loss of care packages when individuals were admitted to hospital for more than two weeks.  The Integrated Services Director explained in some cases individuals were losing care packaged unnecessarily and that mitigations were being put in place including referrals to the Home Care First team within 36 hours.  It was also noted that often when individuals were in hospital for a period of time packages of care may change due to issues such as muscle loss. 
• Officers were asked if resources (staff) were available to implement the packages of care required.  In response,  the Integrated Services Director stated that workforce availability across the health and social care system was a problem for the whole of the UK but that this different approach would contribute to a more effective and efficient use of resources.  Additionally, more attractive roles and reward packaged had been developed and several successful recruitment rounds had resulted in 20 additional staff being employed recently. 

UNANIMOUSLY RESOLVED to recommend to Cabinet the approval of the proposal and high level plan.