DELAYED DISCHARGE

COMPLEX NEEDS SHORT LIFE WORKING GROUP

27 JANUARY 2010

  1. Present

Chris Bruce / Scottish Government / Chair
Alex McMahon / NHS Lothian
Elaine Parry / Information Services Division
Gillian Crosby / City of Edinburgh Council/ ADSW Learning Disability Sub-Group
Isla Bisset / Scottish Government
Jane Davidson / Joint Improvement Team (JIT)
Keith Bowden / NHS Forth Valley & NHS Quality Improvement Scotland
Lance Sloan / NHS Fife
Michael McCue / JIT
Neil Simpson / NHS Greater Glasgow & Clyde/ Royal College of Psychiatrists
Richard Fowles / Social Work Inspection Agency
Anne Harkness / NHS Greater Glasgow & Clyde
Sally Lakeman / Community Care Providers Scotland
  1. Apologies

Sandy DunstanNHS Grampian / NHS Directors of Planning

George KapplerMental Welfare Commission – Chris advised that George had sent a message suggesting that the Mental Welfare Commission may not be able to nominate any representative to future meetings, The group felt strongly that their membership is potentially very helpful – Chris to ask again.

  1. Minutes of meeting of 27th January and 16th March

Feedback provided from Michael, Chris and Isla of the workshops held at the Delayed Discharge Learning and Sharing event. Most groups were not in favour of a target for complex cases, but felt that something was needed to bring focus to this agenda. A feeling that pressure exerted locally to hide behind code 9s.

The minutes of the meeting held on 27 January 2010 were agreed.

  1. Matters arising

Is there a need for a target? Consensus of views from members localities:

  • General consensus was that this was not the time for a target, and given current financial pressures it could be difficult to achieve. May also cause harmful decisions.
  • However, it was generally agreed that a higher level of scrutiny and performance management was required. Possibly through SOAs rather than HEAT target.
  • Suggested that cases should not appear more than twice on quarterly census, where this happens more scrutiny and possible assistance needed to move patient on.

Code 9s – New Narrative

Jane explained the changes to the code 9 narrative form. These included:

  • A continuous history detailing the progress of each patient from census to census.
  • Only need to record the first 5 numbers of the CHI number, which will enable tracking of cases but keep them anonymous.
  • Form should be completed by those that ‘own’ the patients, ensuring better narratives.
  • AWI cases should be recorded when delayed over 6 months.

Code 9 paper (Annex A)

  • Chris explained our intention to contact/meet with Boards to discuss the reasons behind the code 9s to try and gain a better understanding of the issues.
  • Also suggested that meetings be held with key consultants (e.g. Learning Disability, long term conditions) to gain an insight to the types of delays. Group agreed this was a positive step.
  • Also suggested that it would also be useful to look at the Continuing Healthcare Survey.
  • Members of the group will be provided dates of scheduled meetings and invited to attend, where available.
  1. Presentations: Planning Future Capacity – Edinburgh Partnership (Annex B)

Presentations from Alex McMahon and Gillian Crosby on the work carried out by NHS Lothian and City of Edinburgh partnership looking at the cost of complex cases and planning capacity. A wide range of points were made – some of which we may be able to progress through the recommendations of this group. Others are fundamental and may require broader engagement – can we set these out?

  1. Co-morbidity workshops

Michael explained that they were in the early planning stages of the workshops. These were planned to be held within the three managed care networks in mid September.

  1. Future work
  • Meeting on 29th September will focus on the category B patients in the Continuing Healthcare census and the annual learning disability inpatient survey. Also to consider a first draft of a final report.
  • November 24th meeting will conclude final report and recommendations.