Chief Executive’s Message – Friday 30 June

June 30, 2023

By Daren Fradgley, Deputy Chief Executive – Richard Beeken is away.

Many of you will have heard the term ‘No Criteria to Reside’ or maybe you are more familiar with the old term of ‘Medically fit for Discharge’ – but do you understand what it means and particularly how it affects patient flow throughout the hospital.

I wanted to spend some time in my Friday message this week raising awareness of this matter and what we can all do to help support timely and appropriate discharge.

Across the Trust we currently have approximately 56 patients who we class as having ‘no criteria to reside’ – this means that we have treated their original reason for being admitted and they have no clinical reason to be in a hospital bed.

There are many reasons why people may be staying longer with us such as waiting for equipment to continue their recovery at home, perhaps they need a package of care to support them to stay at home or in some cases they will be waiting for a placement within a nursing or residential care home. We classify these as discharge pathways:

Pathway 0: Simple discharge, no formal input from health or social care needed once home
Pathway 1: Support to recover at home; able to return home with support from health and/or social care
Pathway 2: Rehabilitation or short-term care in a 24-hour bed-based setting
Pathway 3: Require ongoing 24-hour nursing care, often in a bedded setting. Long-term care is likely to be required for these individuals.
Pathway 4 All end-of-Life pathways (either home or 24 hr care)

Having people within our care that are classed as no criteria to reside has an impact on our patient safety and flow, which means when people arrive at our emergency departments and the decision is made to admit them, we have (currently) 56 less beds to admit them into, which means they often face longer waiting times within the department – an issue I am sure you have seen lots about in the media.

This isn’t just a Sandwell and West Birmingham problem and responsibility – and it’s not one that is in our gift to solve either – it is a widespread issue across the NHS and social care, but what we can do locally is try to improve the experience of local residents.

We are aware that we need to be more pro-active in discharge planning and our integrated discharge hub and the recent introduction of the admission checklist on Unity are some good examples of how we are looking to improve this. The admission checklist asks clinical staff to identify any social care or complex discharge needs a person may have right at the beginning of their stay. This enables the discharge hub to start planning their safe discharge right away and doesn’t mean we are rushing to put things into place once they are declared as medically well. Although this is a relatively new process, we are already seeing positive impacts on our length of stay.

So, my ask is that you continue to be complete with the admission checklist and identify and escalate any complex needs to the discharge hub as soon as you possibly can. The team require a clear description of a person’s needs and you should describe not prescribe. For example, don’t tell a person that they are going to be discharged to a care home, because when the team start planning that discharge, they may discover that the person doesn’t meet the criteria. We have lots of community resource to make home a safe and valid option for many patients, rather than them going into a care setting. The more detail the team have and the earlier they have it, the more prepared we can be to enable a person to have a safe and effective discharge from hospital.

We also work as an integrated team with partners, including Sandwell and Birmingham Local Authorities and third sector organisations such as The British Red Cross, Sapphire, and Home from Hospital to help support the discharge of patients and the development of our ‘place’ partnerships will continue to support this too.

The discharge hub is open seven days a week, from 8am – 8pm and can be contacted on extension 3147.

Onto other matters. As you may be aware, our current E-Rostering system contract ends on 31 July 2023. NHS provider organisations need to be increasingly versatile as they manage challenges such as changing demography, new technologies and changing patient needs and expectations.

E-rostering enables organisations to respond dynamically to these challenges. As an organisation we have invested in the market leader of electronic rostering systems that gives us the tools to provide safe and effective staffing for our population, patients, and our people. We must ensure that all services using the trusts current electronic rostering system transition across to Allocate with some urgency.

If you have any concerns/ questions, please contact shila.patel@nhs.net.

Finally, you may have seen in the media this morning that the NHS has published the first ever NHS Long Term Workforce Plan. The plan looks at how the NHS will work to put staffing on a sustainable footing and improve patient care, focuses on retaining existing talent and making the best use of new technology alongside the biggest recruitment drive in health service history to address the gap.

You can watch a short video from NHS CEO, Amanda Pritchard explaining the plan by clicking here.

I was pleased to see that this plan aligns so well with our own People Plan, which we launched earlier this year. It will make the NHS and particularly SWB an exciting place to work.

Have a good weekend.