Anthony Middleton, Chief Operating Officer Wirral University Teaching Hospital (WUTH) introduced his report that provided Members of the Adult Care and Health Overview and Scrutiny Committee with a progress briefing on the 30-bedded Transfer to Assess (T2A) facility, Grove Discharge Unit (GDU), that came into operation at the end of November 2018. 

The Chief Operating Officer’s  (WUTH) report informed that the 30-bedded Transfer to Assess (T2A) facility, Grove Discharge Unit (GDU), came into operation at the end of November 2018, operating under the direction of Tamaris-Four Seasons Healthcare to fulfil the purpose of providing a sub-acute model of care. The contract was a 2-year tenure with the mutually agreed option of a 2-year extension. The 30-bedded Nurse-led Unit on the Clatterbridge site was flexible and responsive to the needs of individuals who were medically optimised and no longer required care in an acute setting. The unit also helped to manage the on-going urgent care pressures by freeing up capacity on the Arrowe Park site.

Members were apprised that the unit provided a much more flexible approach than was standard with, for example, a Unit Manager being onsite 24hrs a day. The Adult Care and Health Overview and Scrutiny Committee also noted that occupancy level for the unit was virtually 100% at all times.

The Chief Operating Officer informed that high levels of satisfaction were being received from patients and since the establishment of the unit key performance indicators were being met. He added that although effective, the service was not cheap, but reviews were underway to explore different models across varied wards.

There followed an in-depth question and answer session where Members sought clarification on a number of matters relating to the contract, support provided in respect of Social Care (and by whom), inspections, staff surveys and patient outcomes.

The Chief Operating Officer responded accordingly and stated that the contractual arrangement with Tamaris-Four Seasons Healthcare and NHS England had not raised any immediate concerns, staffing levels had been maintained and there was no hold on procurement at present. He informed Members that the existing two-year contract was scheduled for renewal in November 2020.

In response to questions on who provided support for Social Care matters Mr Middleton advised that this responsibility fell to the Council’s Social Workers who were now co-located with NHS staff. He further informed the Committee that staff feedback across a variety of service areas had flagged a number of matters requiring action at the month-end reporting period, but since production of the report and at the time of the Overview and Scrutiny meeting there were no outstanding actions.

A Member asked for further details re patient outcomes i.e. transfer into residential nursing care and actual percentages, whether more than one team dealt with admissions and if the same criteria was used. Mr Middleton replied, stating that most patients were expected to go from hospital to home, and were not treated as ‘total’ discharges. He added that roughly 50% of patients were cared for at home with a ‘package of care’. The Integrated Discharge Team (IDT)  worked together on variable elements of transfer of care decisions, and the decisions on whether patient was accepted or not by an individual care home was ultimately made by the nursing/care home providers, each of whom was contractually bound to the most effective model for individuals.

Further questions followed in relation to due diligence, monitoring of performance and the role of the Overview and Scrutiny Committee in these matters. The Committee was advised that the arrangements for care, occupancy and satisfaction levels were assessed against the contract.

The Director of (Adult) Care and Health, Graham Hodkinson took note of Member’s comments and stated that it illustrated a need for proper overview of system. He expressed his concern about pressures placed on of Social Worker workforce and referred to the need for continued efforts by the Committee to monitor performance of nursing/care homes located in Wirral and rated as ‘inadequate’.

Councillor Gilchrist thanked the Chief Operating Officer WUTH for providing a detailed understanding of the operation of the model.

Resolved - That

1)  The Adult Care & Health Overview and Scrutiny Committee seeks reassurance on the quality of the recent inspections;

2)  Internal inspections reports be made available for assessment by Members and Officers; and

3)  A further report be presented to the January meeting of this Committee to address Members’ concerns in respect of ownership, operation and any potential impact regarding future business contracts that impact on vulnerable people in care.