Agenda item

To submit a report by Audit Wales.

The Chair welcomed Ms Fflur Jones and Mr Alan Hughes from Audit Wales to the meeting.

The report of the Wales Audit was presented for consideration by the Committee.

The Head of Adults’ Services reported that Audit Wales conducted research on Flow Out of Hospital – North Wales Region and the relationship between the Health Board and Social Services which resulted in several recommendations as to how to facilitate the improvement journey for patients to enable the service to be more effective and to consider the experience of the individuals.

Ms Fflur Jones, Audit Wales reported that the report summarises as to how the North Wales Region addresses the risk resulting from delays of patients being discharged from hospital and the implications for the patient in terms of their recovery, rehabilitation and independence and addressing their needs within the care services.  She further said that the partner organisations understand and shows a commitment to improving patient flow out of hospital.   Improving patients flow from hospital is a key feature of plans across the partners, which align to the Welsh Government’s six goals for urgent and emergency care.  Partners also need to maximise the use of the Regional Integration Fund (RIF), to improve the services provided.  She noted that consistent training needs to be undertaken by Health Care staff.   Audit Wales has outlined 16 recommendations within the report and a positive response has been received.

In considering the report, the Committee discussed the following main matters:-

·     In terms of delayed hospital discharges, how does the North Wales Region compare with other Regions on a National level.  Ms Fflur Jones responded that page 11 of the reports highlights the number of delayed discharges per 100,000 of population between April 2023 and February 2024 which compares with the average delays across Wales.  Appendices attached to the report also highlights comparisons across the region. 

·     Reference was made that 10 out of the 16 recommendations by Audit Wales requires joint working between the Local Health Board and the Local Authority.  Questions were raised as to how Audit Wales will monitor the effectiveness of this collaborative working.  Ms Fflur Jones said that it will be the responsibility of the Health Board and Local Authority to monitor and document the effectiveness of the collaborative working in response to the recommendations of Audit Wales.  She noted that organisations use different systems to track and monitor against the recommendations put forward by Audit Wales.  Assurances is required by Audit Wales that required monitoring and progress is undertaken.

·     Reference to the Welsh Governments Health Minister recently announcing a challenge to Health Boards and Local Authorities to improve hospital discharge and community care.  It was noted that the Audit Wales report refers to the lack of information shared between the Health Board and the Local Authorities.  Questions were raised as to whether there are improvements regarding sharing information between the Health Board and the Local Authorities.  The Director of Social Services responded that an improved arrangements needs to be put in place in sharing information between both organisations. However, there is sensitivity between patients’ information and the permission of the patient is also required.  The Chair referred that the reports highlights that awaiting clinical assessments is the highest cause of delays in the West of the region compared to the Wales average.  He questioned as to how joint assessment by the Health Board and the Local Authority can improve the discharge for hospitals.  The Head of Adults’ Services responded that whilst most people will be admitted to hospital and discharged will be after a few days with limited assistance required or no assistance required.  However, there is a small proportion of patients with complex needs that will require additional care needs which may result in delay in discharge from hospital.  He noted that it is accepted that this process needs to be improved, and Social Services staff are now visiting Ysbyty Gwynedd to facilitate the discharge process whilst ensuring that people are safe within their own home following discharge.  The Chief Executive of Betsi Cadwaladr University Health Board said that Western Region is fortunate in the willingness by the Local Authorities to work closely with the Health Board in addressing the needs of the patients.

·     Questions were raised as to the monitoring processes that exists within Audit Wales to ensure the recommendations set are being met.  Ms Fflur Jones responded that Audit Wales is only able to make recommendations to the statutory bodies and it is expected that these recommendations will be implemented through the Local Authority’s track and reporting systems.  The Regional Partnership Boards (RPBs) will also be reviewing and responding the recommendations set out by Audit Wales. Further questions were raised as to how Audit Wales will be reporting on the improvements in addressing the recommendations within the report.  Mr Alan Hughes, Audit Wales said that the Council receives internal reports from the regulators and progress reports thereafter will be considered by the Governance and Audit Committee.  He noted that internal process within the Authority to update Members on the progress achieved should be reported to all Elected Members.  The Chief Executive said that this Committee could ask Audit Wales to report back to this Committee on the findings of improvements of the joint working between the Health Board and this Authority within 18 months.   

·     Questions were raised as to how the Authority intends to work in collaboration with the Health Board for the benefit of the people who are having to be admitted to hospital.  The Head of Adults’ Services responded that staff within the Social Services Department meet with staff from the Health Board at least three time per week when patients are ready to be discharge from the hospital.  He assured that collaboration is undertaken with the Health Board especially when some patients with complex needs require additional support and people within the communities need to be prioritised who may need intervention.  Further questions were raised as to the further steps which can be taken to improve the service following Audit Wales’s report.  The Head of Adults’ Services said that Wales Audit report was published at the beginning of  this year and a work programme has been created to address the issues raised in the report; a different models of work is undertaken to facilitate the discharge and needs of patients from hospital.

·     Reference was made that WLGA have recently highlighted to Welsh Government as significant gap for funding within Social Care.  Questions were raised as to how it is possible to ensure more funding can be available to combat the challenges faced within the Social Care Sector.  The Chief Executive said that Welsh Government is fully aware of the pressures and demands of social care, but funding has limited to make a difference.  He said that it is hoped that greater recognition on the pressures on social care will attract more funding at the beginning of the next financial year by Welsh Government.  The Chair said that WLGA has written recently on behalf of all the Local Authorities to Welsh Government expressing the concerns of funding for social care as it is not sustainable and more financial assistance is required. 

·     Reference was made to para 103 within the report regarding that the Health Board has established the Urgent and Emergency Care Board.  The Board oversees the planning and delivery of the six goals programme, aiming to ensure collaborative planning and ownership among system-wide stakeholder.  The Chair read out from the report ‘despite several requests to the Health Board, we were unable o observe the Board nor receive any relating documentation and as such, we were not able to review its effectiveness’.  The Chair questioned whether there was any update as regards to this matter.  Ms Fflur Jones responded that no response had been received by the Urgent and Emergency Care Board but through more recent work with the Health Board that there are different arrangements in place.  The Chief Executive of the Health Board said that internal mechanisms have been undertaken as there is pressure for  Urgent and Emergency Care. 

·     Reference was made to Recommendation 10 – Addressing key gaps in capacity within the report.  Questions raised whether Audit Wales has examples of good working practice in other Health Boards.  The Director of Social Services responded that work has been undertaken as regards to the ways of working practices and staff from the Councils’ Teulu Môn Team works from Ysbyty Gwynedd who undertake work in assessing the needs of the patients.  He noted that it has become obvious that some patients do not require the assistance of a Social Worker and may be discharged to the care of their families.  He considered that early interventions and discussions with the patients and families is paramount to enable early discharge from the hospital environment.  Ms Fflur Jones said that a ‘good practice’ team is within Audit Wales which is able to share good practices. Further questions were raised that whilst there is a focus of improvements within data of patients been released from hospitals, questioned where raised as to whether some patients are release too early to improve the data.  The Head of Adults responded that it is accepted that patients should not been released too early from hospital and having to be re-admitted.  He further said that a Care Team has been established in Holyhead to offer care to people within their homes and to afford support when they have been discharged from  hospital. 

·     Reference was made to the WCCIS system that enabled Local Authorities and Health Board to be able to access data in respect of patients care. Questions were raised as the WCCS system will be phased out, whether another system will be available.  The Director of Social Services responded that it came evident that as there are different digital systems within the Health Board which did not serve its purpose of the WCCIS system.  He noted that it is anticipated that a new portal system will be available but there are challenges as to whom will be financially paying for a new system.  

The Chair thanked Ms Fflur Jones and Mr Alan Hughes for attending the meeting.

It was RESOLVED to accept the recommendations contained with Audit Wales’s report in relation to the National Health Service and Adult Social Care.

ACTION : As noted above.