APPENDIX 2
Memorandum submitted by Rhondda NHS Trust
ADDITIONAL FUNDING
FOR NHS WALES
IN RESPECT
OF MEDICAL
EMERGENCIES
The Rhondda Trust obviously welcomes any additional resources
made available to the NHS in Wales particularly in view of the
increase in demand on Healthcare during the winter period. This
was very much in evidence last year and prior to that and there
is little doubt that a similar pattern of demand can be expected
in the coming winter period.
As a Community Trust primarily dealing with people in their
own homes, community premises and providing rehabilitation care
in Community Hospitals, the impact of emergency medical admissions
is not felt at the admission stage but is very much a pressure
to be managed in terms of transfer of patients from the District
General Hospital to the Community Hospitals we provide and onwards
to a safe discharge back into the community. The effective management
of patients within primary and community care both prior to admission
into Hospital and following treatment is extremely important and
requires a high level of inter agency working to provide an holistic
care package to what is very often a complex need. The Rhondda
Trust is fortunate in that it enjoys a very good relationship
with both our District General Hospital partners, Primary Care
and the Local Authority Social Services Department and this partnership
enables us to consider innovative means of caring for people within
their own homes, thereby avoiding admission or re-admission into
a District General Hospital Service.
Attached to this correspondence are a number of proposals
that the Trust has submitted to Bro Taf Health Authority which
it considers may help in relieving the pressure on the Health
Service during the winter periods and provide for appropriate
care in suitable environments within the community. (See Annex
1.) You will note that the proposals rely heavily on inter-agency
work and are jointly submitted between ourselves and the Rhondda/Cynon/Taff
Local Authority Social Services Department. Whilst we very much
welcome the additional resources being made available to us for
this difficult period there are a number of concerns that the
Trust has in relation to this additional funding and the practicability
of establishing a short sharp response to what is a seasonal and
somewhat short term problem.
1. The additional funding being made available is non-recurrent
and cannot therefore be regarded as an additional resource available
to the Health Service over a long period. The ability to make
meaningful use of non-recurrent funding is restricted by a very
short timescale and perhaps a longer term view of the management
of these potential crises would be more appropriate.
2. Much of the resources required to manage increased
medical emergencies and the resulting moving to community care
is reliant upon the recruitment of additional medical, nursing
and social care staff. In the current climate, it is extremely
difficult to recruit these staff groups on a short term basis
and at very short notice. This is particularly so when the nature
of demand requires staff with significant skills and levels of
expertise to deal with these complex issues. Whilst the Trust
is hopeful and pursues a vigorous recruitment campaign to attract
these staff groups it is a very difficult problem when there are
seasonal variations for short term increases in nursing staff.
The Rhondda Trust would wish to see an evaluation of the
measures undertaken to manage the increase in emergency admissions
this current year and the effectiveness of the increased funding
on a non-recurring basis. Consideration could then be given to
what measures may be instigated on a recurring basis to manage
surges in activity and avoidance of crises during the winter period.
E H Lewis
Chief Executive
27 November 1997
Annex 1
RHONDDA NHS TRUST/RCT SOCIAL SERVICES AND COMMUNITY CARE
PARTNERS
PROPOSALS FOR
FUNDING FROM
£9.5 MILLION (EMERGENCY
ADMISSIONS)
1. The following proposals are submitted as a joint bid
between Rhondda NHS Trust, the Community Care Division of Rhondda
Cynon Taff Social Services and their Community Care Partners.
They are intended to address the issue of winter pressure on the
health and social care system from three perspectives; avoiding
unnecessary admissions, increasing in patient provision and facilitating
early discharge.
The proposals are in the following format:
Proposal One Health Service input to the maintenance
of patients in the community.
Proposal Two Health Service input into expediting
Discharge.
Proposal Three Social Services input to areas of
Admissions and Discharges.
Proposal Four Increasing In Patient Provision.
2. PROPOSAL ONE
There are patients known to Community Nursing and to Social
Care Teams who are admitted to Hospital when extra community nurse
input could have maintained them at home.
Examples of such patients are:
Mrs E, who has multiple sclerosis and is cared for by her
elderly mother and the District Nursing Team. She is heavily dependent
and requires four District Nurse visits per day. She was recently
admitted to Hospital because pressures on the District Nursing
Team meant that their intensive support could not be maintained.
Mr P. has cirrhosis of the liver. He too was admitted because
the District Nursing Service should not sustain their intensive
support without respite.
These are patients who do not require the medical assessment/investigations
which would necessitate admission. They require additional care
hours in their own home.
We wish to create a "virtual team" of Community
Nurses who could input extra hours to existing Practice Based
Teams to support such patients over the winter period. This "virtual
team" would take the form of additional hours held centrally
by the Community Directorate and allocated to the appropriate
Practice Based Teams as and when the need arose. By allocating
the hours as necessary through the existing Practice Based Team
network these problems will not arise.
We do not want to create a "crisis team" as this
would result in problems of integration and continuity of care
with the existing Practice Based Teams. It would also create practical
difficulties with a Team covering a large geographical area.
Resource Implications
Staff Costs
Equivalent of:
| 2 WTE E Grade Nurses (7 days) | £19,074
|
| 2 WTE D Grade Nurses | £16,694 For a 6 month period
|
| 2 WTE B Grade Nurses | £12,767
|
| |
| (To be used as hours) | |
| |
| Supplies/Travel | £4,000
|
| Additional Equipment | £15,000
|
| TOTAL | £67,535 |
2. PROPOSAL TWO
Work has been carried out over the past year which has given
this Trust detailed information on the reasons behind delayed
discharge.
The reasons fall into three categories:
- Delays where the lead responsibility lies with Health.
- Delays where the lead responsibility lies with Social
Services.
- Delays which involve issues of patient choice.
Experience in other parts of the Country has shown that Primary
Care Liaison Nurses have a significant impact on reducing Hospital
length of stays-particularly in the Community Hospital setting.
They are able to "chase" individual cases, liaising
directly with Consultants, Social Services and Primary Care Teams.
This is not the role of the existing Discharge Liaison Nurse who
has responsibility for bed management and monitoring and who only
becomes involved at an individual patient level when cases are
particularly complex.
We propose that there are two short term appointments, one
in the Rhondda area and one in Taff Ely, for Primary Care Liaison
Nurses to facilitate discharge on an individual patient basis.
Evaluation of this input would be crucial as it might, if
successful, be a role which would be useful in the long term.
Resource Implications
| 2 WTE G Grade Nurses (5 days) for 6 month period
| £22,268 |
| Travel | £2,000 |
| TOTAL | £24,268 |
4. PROPOSAL THREE
In order to complement Rhondda NHS Trust proposals the Community
Care Division of RCT and its Community Care Partners, Age Concern
and Repair Cymru would propose the following:
- The appointment of a number of "virtual Home Care
Workers hours" to be held as casual hours, to be used for
very short term involvement to either avoid Hospital admission
or assist speedy discharge, prior to full assessment of review
taking place.
- The temporary appointment of a Home Care Organiser in
each of the two Principal Offices which serve Rhondda and Taff
Ely. Their role would be to:
i. Manage casual Home Care Worker hours outlined above.
ii. Liaise with Primary Care Liaison Nurses to ensure that
discharges are appropriate, timely and local Authority and Voluntary
Sector Services are in place.
iii. Where necessary carrying out urgent assessments (outside
of current agreed timescales for discharge assessments) or very
urgent community provision prior to a fuller assessment from our
normal assessment and care management staff.
- Additional funding for Age Concern Hospital Discharge
scheme to employ two part time temporary Support Workers.
- Additional funds for Taff Ely Care and Repair and Rhondda
Staying Put Scheme, Safety at Home Initiatives. This will ensure
that small works up to a value of £500 can be carried out
to either prevent admission or assist discharge.
Resource Implications
| 2 Home Care Organisers for 6 months | £22,220
|
| Travel | £2,000 |
| 300 hours per week Home Care Worker for 6 months
| £46,800 |
| Travel | £4,000 |
| Equipment Costs Moving and Handling etc |
£10,000 |
| Age Concern Hospital Discharge 2 part time workers
| £9,000 |
| Safety at Home Initiatives | £8,000
|
| TOTAL | £102,120 |
Monies for Age Concern can be paid either direct from Bro
Taf as an addition to their agency agreement with Age Concern
or through RCT as an addition to their Service Level Agreement.
Monies for Care and Repair and Staying Put can be paid through
RCT as an addition to their Service Level Agreement.
PROPOSAL FOUR
The Trust is currently working to agreed contract levels
which have been agreed with Bro Taf Health Authority in relation
to medical activity.
To date the Health Authority have indicated that no additional
funding will be made available for increased activity above this
level.
At Dewi Sant Hospital we have the ability to increase activity
through the use of an additional 19 beds which would facilitate
an increase of 128 (deaths and discharges) over a six month period.
This has been calculated using average length of stay data.
We consider that this is a more cost effective and clinically
acceptable approach to managing increased medical activity than
wholly relying upon the acquisition of Nursing Home beds.
Resource Implications
| 9.03 WTE E Grade Nurses for 6 months | £103,285
|
| Non Staff Costs | £10,000
|
| TOTAL | £113,28 |
CONCLUSION
The Partners in this proposal believe that one of the keys
to managing winter pressures is to take a co-ordinated, multi-agency
approach. It is for this reason that these proposals are presented
as a unified bid. The total investment required is:
| Proposal One | £67,535 |
| Proposal Two | £24,268 |
| Proposal Three | £102,120
|
| Proposal Four | £113,285
|
| TOTAL | £307,208 |
| 
