Agenda item

The Sub-committee Members are recommended to:

-       Note the progress with the implementation of the Integrated Discharge Frontrunner programme.

-       Note that the data on performance and outcomes is under development and can be brought back to the Committee in due course.

The Sub-Committee reviewed a report set out on pages 81 to 92 of the agenda, which provided an update on the rollout of the Integrated Discharge Frontrunner Programme. The report was presented by Annette McPartland, Corporate Director of Adult Social Care and Health.

-          Councillor Yvette Hopley – Cabinet Member for Health and Adult Social Care

-          Councillor Margaret Bird – Deputy Cabinet Member for Health and Adult Social Care

-          Annette McPartland – Corporate Director of Adult Social Care & Health

-          Simon Robson - Director of Adult Social Care Operations

-          Richard Eyre – Head of Improvement

-          Liz Wells - Managing Director of Acute Services

-          Hilary Williams – Managing Director for Community Services and Integration

-          Rachel Flagg – Integrated Delivery Manager

The first question raised by the Sub-Committee addressed how the programme had evolved since its inception. The officers explained that it began with extensive diagnostic work that assessed both health and adult social care data. This diagnostic process revealed that delayed discharges were caused by a variety of bottlenecks within the system. The work also examined what was being done in the wards, particularly with regard to multidisciplinary efforts. Following this, attention shifted to discharge teams, transforming them into one integrated, multidisciplinary team. In addition to that a significant progress was made with the Transfer of Care Hub.

The next question focused on ensuring patients do not remain in a hospital longer than necessary due to unsuitable home environments. NHS officers explained that a daily multidisciplinary team meeting reviewed each patient’s discharge journey, allowing early identification of home needs. This provided sufficient time to make any necessary home adjustments, which became part of discharge planning. If needed, environmental assessments were conducted to further evaluate home conditions. When asked about delays caused by such adjustments, the officers stated they were unaware of any significant backlogs. However, potential delays could occur if very specialised equipment was required, but regular case reviews and early discharge planning helped minimise this risk.

The Sub-Committee followed up with a question regarding collaboration with third parties to prevent delays during transitions. The officers noted that most discharges were supported by families, and effective communication between families and the multidisciplinary team was crucial. Additionally, the 'Home First' workstream was launched, focusing on home discharges and patients regaining independence.

The Sub-Committee then asked how residents, including friends, family, and carers, were involved in discharge planning. NHS officers said they aimed to include these groups, although they acknowledged that this was an area needing improvement. Feedback from these groups was routinely collected, contributing to continuous communication improvements. When asked if there were designated staff for managing relationships with patient families, the officers explained that this responsibility fell primarily to the integrated discharge team, particularly the discharge navigators and facilitators.

Further enquiries were made about the objectives and outcomes of the Frontrunner Programme and the progress being made. NHS officers emphasised that the main goal was to reduce hospital stays. For example, in March, the average stay was 11 days—lower than the 16-day average in other South West London hospitals. By July, this had improved to 9.6 days in Croydon. The Sub-Committee then asked about the publication of performance reports, to which officers responded that they would discuss the matter with the Business Improvement team. It was mentioned that weekly reporting to NHS England was already in place for some aspects of the programme.

The Sub-Committee inquired about feedback from third-sector organisations, the officers noted that while there was no specific feedback at this stage, and assured that they were open to receiving it. Another question concerned the impact of extreme weather, such as heatwaves, on discharges. The officers explained that while not relevant to all discharges, environmental assessments for more complex cases would consider this. In winter, particular care was taken to avoid discharging patients after dark. For those receiving care packages, care providers were issued heat health alerts with guidance on managing extreme weather risks.

The Sub-Committee also enquired about the timely transition of acute mental health services and any potential vacancies in this area. The officers clarified that while the Frontrunner Programme focused on Croydon University Hospital, funding for CAMHS and SLAM was not included. Nevertheless, solutions developed through the programme could be extended to other providers.

When asked about the colocation of teams and the impact of triage delays. The officers reassured the Sub-Committee that all relevant parties within the integrated discharge team were already working together, following a recent restructure and consultation. No reductions in staff had occurred, and recruitment efforts were ongoing.

The final question asked by the Sub-Committee addressed a wrap-up or performance update report. The officers explained that while the diagnostic and consultation processes had been completed, work with the wards to implement necessary changes was still ongoing. A report was expected to be produced within the next six months.

Actions

Following its discussion on the Integrated Discharge Frontrunner Programme the Sub-Committee agreed the following action to follow up outside of the meeting:

1. The Sub-Committee requested more information on discharge delays for patients who no longer meet the criteria to remain in the hospital, including delays related to home adjustments, the provision of necessary equipment, and placement arrangements.

Conclusions

Following its discussion of this item, the Sub-Committee reached the following conclusions on the information provided:

1. The Sub-Committee recognised that this was a crucial area of focus, highlighting the significance of the work being undertaken. The importance of continuing efforts in this direction was strongly emphasised.
2. The Sub-Committee acknowledged the hard work involved and expressed appreciation for the dedication shown by all parties. It was anticipated that this commitment would lead to measurable improvements within the next six months.