Agenda item

Bethan Hopkins and Leanne Watkins introduced the report and presented their key findings of the audit.  Jenny Jenkins delivered a presentation and together, they answered the members’ questions:

 

Key Questions from Members:

 

·       Councillor Bond expressed frustration that the information she reviewed was outdated and that the updated information presented during the meeting was not shared beforehand, limiting her ability to scrutinise effectively. She requested that updated information be shared upfront in future meetings to allow for proper scrutiny.

 

Jenny acknowledged the importance of sharing updated information and agreed to circulate the data. She emphasised that the main theme was the improvement in the length of stay despite the constant number of delays. Action: Jenny Jenkins.

 

·       Councillor Bond asked how the risk appetite has changed and whether there are still issues with resources despite the improvements made.

 

Bethan explained that risk aversion was a common theme in acute settings, with clinicians often trying to get patients to a higher standard before discharge. Leanne added that communication and education are key to reducing risk aversion.

 

Jenny confirmed that there are ongoing issues with resources and capacity, impacting performance, and that prioritization and allocation of cases are used to manage these challenges.

 

·       Councillor Edwards asked if any data is kept on discharged patients in the weeks after leaving hospital and if this impacts their need to return for medical treatment.

 

Leanne explained that data on readmissions is kept by secondary care, and if a patient returns, they review what went wrong and how to fix it.

 

·       Councillor Edwards enquired whether the discharge period starts again if a patient moves to another hospital within the Aneurin Bevan structure.

 

Jenny clarified that the length of stay does not start again when a patient moves; it is continuous regardless of hospital moves.

 

·       Councillor Edwards asked about the unplanned absence rates in exhibit 5 and why no data has been available since June 2023.

 

Jenny mentioned that they are working to minimize unplanned absences with HR support and regular reports to managers. Bethan added that the lack of data since June 2023 is due to Welsh government not publishing it.

 

·       Councillor Edwards questioned why Monmouthshire's figure for social care assessments was so high and if best practices from Caerphilly were shared.

 

Jenny noted that Monmouthshire has done a lot of work to reduce social care assessment figures and has worked with Caerphilly to embed best practices, particularly in developing their reablement service.

 

·       Councillor Riley acknowledged the limitations of the data validation approach and expressed concern about people escaping the data.

 

Jenny acknowledged the challenges of the data validation approach and the need to manage it effectively.

 

·       Councillor Riley asked how the need for family agreement sits or conflicts with people deemed to have capacity, noting the absence of best interest assessments can be daunting for those with lasting power of attorney (LPA).

 

Jenny explained that family dynamics and individual circumstances require management, and families often need time to get their heads around decisions. Leanne supported this by noting the challenges faced on the ward.

 

·       Councillor Riley questioned whether self-funding leads to smoother transitions for patients.

 

Jenny clarified that self-funding does not necessarily facilitate quicker transfers, as it involves finding appropriate placements and negotiating with care homes.

 

·       Councillor Riley enquired if care workers are now working their full contracted hours, as there were concerns about this not recovering since COVID.

 

Jenny confirmed that care workers in work are working their full contracted hours.

 

·       Councillor Butler asked for clarification on acronyms. She expressed concern about the need for multiple computer systems and asked if there is any work being done to standardize them, and if Monmouthshire has a role in this.

 

Leanne explained the challenges of using multiple computer systems and mentioned that it has been flagged as a concern. Jenny added that previous attempts to integrate systems faced technical and legal issues, and Monmouthshire is working regionally to develop standardization with a new system called Mosaic. Bethan Hopkins commented on the challenges of integrating IT systems for health and social care, noting that this is a national issue, not just specific to the region. She emphasised the need for a sophisticated, integrated IT system that allows health and social care to share information seamlessly. Bethan acknowledged the practical challenges faced by staff, such as using multiple screens and logins, and highlighted the importance of recognising these barriers in the report.

 

·       Councillor Butler asked for clarification on the significance of the cost of domiciliary care being capped at £100.

 

Jenny Jenkins explained that the maximum charge for domiciliary care is £100 per week following the completion of a financial assessment. This simplifies the financial assessment process for domiciliary care, as it does not require consideration of capital assets, unlike the more complex financial assessments needed for residential placements.

 

·       Councillor Howarth questioned why it took nine months for the audit report to be scrutinised.

 

Bethan explained that the delay in scrutinising the report was due to the extensive coordination required for a regional report, which had to go through the Regional Partnership Board structures.

 

• Councillor Howarth enquired about the health boards' operations from Friday to Monday and how this impacts discharges.

 

Bethan noted that the issue of weekend discharges is a national challenge, with operational patterns affecting the discharge process.

 

• Councillor Howarth asked about the effectiveness of the £15 million grant from the Welsh Government intended to improve discharge operations.

 

• Bethan and Jenny clarified that the £15 million grant was intended to address operational challenges, but specific details were not provided.

 

• Councillor Howarth expressed a desire to review the 2024-2025 data in detail rather than being presented with it during the meeting.

 

• Jenny acknowledged the desire to review the 2024-2025 data in detail and noted that the average number of delays remains constant, but the length of stay has improved. Bethan clarified that the review undertaken was part of the Welsh Government's six goals program, specifically focusing on goals five and six, which pertain to discharge planning and urgent care flow. She noted that prevention and early intervention, covered under goals one and two, were not included in this particular review. Bethan mentioned that these areas would be addressed in separate pieces of work.

 

• Councillor Howarth asked if Aneurin Bevan University Health Board (ABUHB) handles discharges when there are complications with care plans and funding.

 

Jenny and Leanne discussed the handling of complex care discharges, noting that continuing healthcare assessments are being managed within primary care to improve the process.

 

• In highlighted the increasing budget demands for health and social care due to the aging population in Monmouthshire, Councillor Howarth questioned the impact of critical care units and patient transfers on the connectivity and coordination of care.

 

Jenny highlighted the strategic focus on early intervention and prevention to address the increasing demands due to the aging population.

Leanne addressed the impact of critical care units and patient transfers, acknowledging the challenges and the need for better coordination.

 

• Councillor Powell asked if providing better pay and facilities for local carers would help in recruiting more community carers.

 

Jenny acknowledged that while better pay might encourage more people to join the workforce, Monmouthshire is already paying some of the highest rates for domiciliary care. She also emphasised the importance of providing good training and offering long-term contracts to domiciliary care agencies to ensure workforce stability and investment.

 

Chair’s Summary:

 

The Chair thanked Bethan from Audit Wales for her time in attending to present and answer questions and thanked officers for their hard work in supporting staff to provide the best quality of care for our residents.