That is a vital priority for us, as a partnership. We have approached the issue on a whole-system basis, so we have an unscheduled care and delayed discharge improvement board, which covers the North Lanarkshire and South Lanarkshire partnerships and the acute sector. It is the planning vehicle for all unscheduled care and delayed discharge work in the partnership.
A range of work has been undertaken. The headline figures are that, over the past year, there has been a 12 per cent reduction in the number of delayed discharge bed days and an 18 per cent reduction in the number of code 9 bed days, so there has been a move on that.
On the specifics of what we have done, the North Lanarkshire and South Lanarkshire partnerships both have a home support strategy and new models of home support, which focus on much more reablement, including rapid response reablement, rather than run-of-the-mill packages. The impact of that being rolled out is the start of a significant reduction for both partnerships in the number of home-support delays of more than three bed days. The ultimate positive is that rapid response reablement has a much better impact on individual patients in the long run, because we maximise their independence at that point. We hope that that will reduce the overall demand for home support in the longer term.
Daily conference calls take place in the partnership to co-ordinate complex and significant cases. Within the two health and social care partnerships, conference calls do the same across health and social care to ensure that we have sight of every complex case in the hospitals and know exactly how best to move cases forward.
We have done a piece of work on the national protocol on code 9 patients, which has had a significant impact. Twelve months ago, we would have been sitting with figures in the mid-teens for the number of delays of more than 100 bed days for individuals who were going through the guardianship process. The national protocol says that the process should take about 13 weeks, which is 91 bed days. Since doing our bit of work on that, which included identifying a number of escalation points for when things get blocked, we now—as of last week—have only four delays of more than 100 bed days in the three acute sites in Lanarkshire. That is a big improvement.
We are also taking forward a tested change for guardianship applications, and the NHS now spot purchases care-home beds so that individuals are put into an environment that is much more homely to live in during the process, and in which they are supported by appropriate medical and mental health officer cover.
In acute wards, there has been work on estimated dates of discharge. We are trying our best to do that collaboratively, so that social work is involved in the discussions much earlier.
Reviews of intermediate care provision have also been undertaken in both the north and the south. It is a critical issue, and we have started to get real traction from looking at off-site beds and step-down capacity. We are trying our best to have more of a rehab and reablement focus in those sites, because that will not only allow throughput to a much more positive destination and back into the community, but will provide the step-down capacity that we require to support people who come out of acute care.
Another recent development is the roll-out of integrated teams. In North Lanarkshire, we have integrated our rehab teams, which required our taking some physio hours from the acute sites and the community assessment and rehab service—which was acute based, too—and disaggregating that into the localities, as well as turning domiciliary, physiotherapy, occupational therapy and social work occupational therapy into integrated teams. South Lanarkshire has taken a similar approach in its integrated community support teams.
That has allowed us to create a rapid response vehicle. Over the past three weeks in North Lanarkshire, we have supported 20 early discharges to people’s homes. In other words, we took people out of the previous process, in which people were required to wait on site for OT physio assessment, and supported them at home instead with a rapid wraparound service and rapid access to equipment on the day. That allows assessments to be undertaken in the community.
The big benefit of that approach can be seen not just in the number of delayed-discharge bed days, but in the destinations of individuals. If we can get people home much earlier, they deteriorate much less than they would if they were sitting in the hospital, and the assessment is likely to be more accurate in maximising the opportunity for them to remain in their own homes instead of ending up in institutional care.