Agenda item

The Chair introduced the item and welcomed Taneisha Scanlon, Assistant Director Place – Central London from the North West London Integrated Care Board, Charlotte Williams, Kensington and Chelsea Manager at Healthwatch, the Lead Member for Adult Social Care and Public Health and the Director of Health Partnerships to the meeting.

The Lead Member presented the report, noting that hospital discharge in the borough was aided by Council staff being based in Chelsea and Westminster hospital. Officers added that the Council worked in partnership with the North West London Integrated Care Board (NWL ICB) and NHS Trusts to deliver the discharge service, and the services met regularly to identify risks and plan accordingly. As a result RBKC was one of the highest performing boroughs in London for hospital discharge. The Council’s number one priority was to ensure residents were discharged to a safe destination to enable them to continue recovery. Ms Scanlon summarised the four discharge pathways identified in the report.

At the invitation of the Chair, Ms Williams summarised the findings of a Healthwatch focused project on Patients’ and carers’ experiences of step-down care access and provision in Westminster and Kensington & Chelsea. The data was collected through semi-structured interviews with 15 participants, including patients, carers, and a community professional. Healthwatch recognised the limitations of the small sample size and cautioned that whilst the local research was valuable information and provided good insight to patient experience, the findings should not be considered representative of the full range of perspectives across the local population who had gone through the hospital discharge pathway. 

The report found that while the quality of step-down care services was generally positive, issues with poor communication, inconsistent care, and challenges during the discharge process caused significant difficulties for patients and carers. Carers frequently took on advocacy roles to navigate the system, with many reporting mental strain and inadequate support. The report made several recommendations including better communication between services, more involvement of patients and carers in decision-making, tailored support for carers, and improved consistency in care delivery.

The Chair invited comments or questions from the Committee. The Committee:

1.      Asked about the main challenges affecting the discharge process. Officers advised the most significant challenge was securing care placements for patients with complex needs at short notice, with a lack of beds or specialist care available to ensure appropriate care of long-term or ongoing needs. Delays could also be caused by patient or familial resistance to long-term residential care placements.

2.      Discussed obtaining feedback from frontline workers to improve service provision. Officers confirmed that feedback was sought from frontline workers and was generally positive. Increasing capacity was key to improving performance and the Council met regularly with its partners to plan, coordinate and reduce pressures on frontline workers where possible.

3.      Sought assurance that residents were discharged locally where care was necessary in a residential and reablement facility. Officers confirmed the Council worked with providers to ensure local capacity, including block-booking beds to enable patients to be discharged to a bed-based setting promptly. The Council was also looking to invest in supported living accommodation in the long-term to increase local capacity. Discharge teams also worked with patients or carers to facilitate placements out-of-borough where that was requested or required.

4.      Were assured, in response to a concern, that a system was in place to urgently respond where delays in delivery of specialist equipment were causing blockages in the discharge process.

5.      Challenged the significant increase in discharge delay days in Kensington and Chelsea in December 2024, especially given the comparative decrease across North West London in the same period, and asked what other Local Authorities were doing differently. Officers advised that it was too early to fully understand the cause of the peak, with further data calibration and analysis work to be undertaken. The Committee requested the ICB report back when it had clarity on the cause of the peak and learnings.

Action: NWL ICB

6.      Requested data on average delay day by discharge pathway. Ms Scanlon advised the average discharge delay by days for Pathway 1 was 7-8 days across North West London and 3-4 days in RBKC. For Pathway 2, the North West London average was 15-20 days compared to 10-12 days in Kensington and Chelsea. Local discharge rates were within target ranges.

7.      Noted an increase in the number of people being discharged through Pathway 1 and asked if resource was being deployed to match the demand. Officers advised that grant funding via the Better Care Fund was used to manage care needs in Pathway 1.

8.      Discussed the process for identifying the appropriate discharge pathway.

9.      Asked how recommendations made in the Healthwatch report were being responded to by the Council and ICB. Officers advised a series of meetings had been held between the Council, ICB and NHS Trusts to take learnings and coordinate action in response. The Council had recruited a dedicated Housing Officer to support the discharge process, and was embedding resident feedback in discharge processes and using data to enhance its understanding of residents’ hospital journeys. Ms Scanlon added that the Healthwatch report was informing planning work for 2025-26.

10.   Discussed the possibility of patients being discharged prematurely in order to free capacity and avoid delays. Ms Scanlon assured the Committee that patients were only discharged from a hospital setting when there was no medical need for continuation of hospital-based care.

11.   Asked if measures were in place to improve communication with patients and carers. Officers were confident that the assessment process ensured patients and carers concerns were listened to, in addition to robust arrangements for lack of mental capacity or language barriers.

12.   Received assurance that discharge teams worked across London to ensure effective discharge where residents were in hospital out-of-borough.

13.   Discussed the discharge data presented in the report. Members commented that there was no context of patient numbers or clear understanding of how many delay days per month were occurring. The Committee requested additional data, including unnecessary bed days; number of patients who experienced a delayed discharge; number of failed discharges and readmissions.

Action: NWL ICB