Cross-border challenges hinder patient discharges into Flintshire

A creative approach to getting patients out of hospital and back home is proving successful in Flintshire – but challenges remain for those treated across the border.

The Countess of Chester Hospital discharges the second-highest number of patients into Flintshire.

According to Chris Phillips, the council’s service manager for older people, while innovation and creativity on the Welsh side of the border are improving patient discharge, cross-border working is proving more difficult.

“We do have good relationships in Wales,” he said. “There are more issues in England. The Countess of Chester Hospital is the second busiest hospital for discharge back into Flintshire, and I think there are some challenges working across two structures in England and Wales.”

His comments came as the authority’s Governance and Audit Committee received a report from Audit Wales on urgent and emergency care and patient flow out of hospitals.

The report made 16 regional recommendations across North Wales’ health boards to improve patient discharge processes and outcomes.

While the impact of Flintshire’s Welsh discharge work was measured in the report, one vital element – the effectiveness of cross-border discharge programmes – was missing.

“Those discharge numbers should at least be mentioned in this report,” said Deputy Leader of the council, Cllr Richard Jones.

Despite this, since the report was compiled earlier in the year, a number of measures have been developed and introduced by Flintshire social services to support patient discharge across Welsh care settings.

Among Audit Wales’ key recommendations was: “The Health Board and local authorities should ensure mechanisms are in place to regularly monitor patients who are discharged home without arranged ongoing social care and to escalate issues to the appropriate service where necessary.”

Mr Phillips told the committee that since the report was compiled, a number of innovative pilot schemes had been launched to improve the process.

“We are, locally, regionally, and nationally, attempting to tackle the issues of increased demand with the existing situation with resources,” he said.

“We have some really responsive arrangements for arranging home care and social care – some of the best in Wales, and I think some very creative work is being done.

“For example, we are running a trial with Wrexham Maelor Hospital that involves a social worker spending time at the emergency department.

“Their role is to identify any possibilities of nipping some issues in the bud – for example, are there patients who, if we saw them sooner in the community, would not have to be admitted at all?

“Our dedicated Discharge Assessment and Recovery Team (DART) is made up of social workers who work with acute and community hospitals to support discharge.

“This includes step-down arrangements with local care homes so that if a patient is ready for discharge and no care package can be found, they can be discharged into a care home where they will be charged the same as if they were receiving domiciliary care.”

By Alec Doyle – Local Democracy Reporter