To receive the above presentation by Hillary Hall.

Hilary Hall, Head of Commissioning - Adult, Children and Health gave a brief presentation and Members noted the following key points:

Ø  National context – Admissions and delayed transfers of care

o   A&E attendances in 2016 had been 5% higher than in 2015

o   The number of emergency admissions rose by 4.5%. the rate was currently 10% higher than raw population increase

o   In 2016, each month’s total admissions had been higher than the same month in each previous year

Ø  Build up of pressure in the national ‘system’

o   21% of patients spent more than four hours in major A&E departments in December 2016, compared with 13% in December 2015 and 6% in December 2011

o   Long waits for emergency admission were 58% higher in 2016 than in 2015, and five times higher than 2011

o   However, the Borough was not performing as badly nationally

Ø  Emphasises the need for integrated approach to managing front and back door in acute rusts reflected in BCF targets

o   Delayed transfers of care had increased substantially over the past three years

o   There were 23% more delayed transfers of care in 2016 than in 2016

o   Compared with 2015, delays where NHS was at least partially responsible rose by 17% whereas social care delays rose by 37%

o   There were lots of ongoing actions to try and keep on top of the figures and the situation was being reviewed weekly.

Ø  Local actions to address Delayed Transfers of Care (DTC)

o   Integrated weekly meetings with Wexham, Royal Borough Hospital team, Short Term Support and Rehabilitation Team and Carewatch to review individual cases and agree packages of support

o   Support from GP practices to identify and support frail patients using new electronic frailty index

o   Pilot in Old Windsor with support of parish council to identify those who live alone or are vulnerable – and offer them proactive support and advice

o   Focus on choice – proactive support for carers via SIGNAL and Dementia Advisors to enable residents to continue to live at home where possible

o   Review of third sector support from Red Cross to ensure that Royal Borough residents had access to the home from hospital service, e.g. milk in the fridge, settling in, prescriptions etc.

o   Proactive engagement with wider East Berkshire programme, including:

§  Monitoring patient flow – daily telephone calls with Wexham and partners to identify patients ‘fit for discharge’ and use of Alamac data set

§  Pilot of Discharge to Assess model in new Windsor Care Home for East Berkshire residents

§  Review/mapping of service pathways between Optalis and Berkshire Healthcare Foundation Trust to meet resident needs – June 2017

Ø  Non-elective admissions – average stay post non-elective admission was decreasing as lots of work was ongoing with partners.

Ø  Proportion of adults (65+) who were home 91 days after discharge from hospital –

o   The data showed the proportion of people who were at home 91 days after discharge from hospital from April 2015 onwards. That excluded those residents who had passed away, the target for the year was 87.5% and performance was currently at 87.09%

o   Significant increase in referrals direct from acute rather than community discharges – those were often more frail residents that needed more support and recovery time

o   Increase in falls related referrals and service users with long term/complex conditions

o   Slight increase in older age groups 85-94

o   More remaining in need of continuing support for longer at home due to having more complex needs and longer recovery times.