Michael Laing; director of Integrated Community Services at County Durham Care Partnership gives an update on care in the county.

“Success is best when it is shared” has been attributed to Howard Schultz business leader and author. It was certainly the message the County Durham Care Partnership were trying to communicate to colleagues from the Number 10 Delivery Unit when they visited us recently to look at hospital discharge.

Our guests from Number 10 asked us two questions. First “what is the “secret sauce” that makes hospital discharge work in County Durham?” Secondly, “what else could Government do to help?”

The ingredients in the “secret sauce” include positive relationships between individuals and partners, integrated posts, shared responsibilities, using the expertise and capacity of all partners and strong and effective commissioning.

The visit was hosted by our partners from Carehome Selection. Around the table were staff from adult social care, our NHS Trust, community services and commissioning. County Durham is slightly unusual in that we have a lot of integrated and joint posts.

This pays dividends in hospital discharge as it helps us take a view across health and social care. Some examples: I work as a director in the Council and executive director in the Trust as well as system lead for hospital discharge. Our Commissioning Team is fully integrated and is led by a person who is a director in the Integrated Care Board and the Council.

These joint posts mean that responsibility for hospital discharge rests with senior staff working across partners. We don’t get into debates about organisational boundaries because the two most senior posts working on hospital discharge span organisations.  

Add to this our working relationship with Carehome Selection (CHS). They have been critically important in working with our residential and nursing care home providers to find beds for people leaving hospital.

They are trusted by the providers, work with them every day. CHS have a detailed knowledge of both bed capacity and staffing.

What does this mean in our day-to-day operations? In short, we take a joint approach to patients who are ready to be discharged. We never, ever get into “passing the patient” between partners. Every day we scrutinise the Discharge Ready List. This then forms the basis of our discussions at our daily 12 noon multi-agency team meeting. 

The partners who take an active part in this meeting include the Trust’s Discharge Management Team, CHS, the Adult Social Care Hospital Social Workers, the Housing Team, staff from the mental health trust and our Continuing Health Care nurses. These meetings bring together a range of skills and expertise with a strong focus on patients and getting shared solutions.

Our work on hospital discharge relies on and is underpinned by our commissioning. Over many years working with our providers we have incrementally shaped the adult social care market to meet need. This means that over winter we had bed capacity in adult social care and domiciliary care.

At Durham County Council, we have invested in adult social care, not only in beds but also in the skills of the workforce.

We have a Care Academy which supports new entrants to adult social care and develops the skills of more experienced staff. Independent sector provider staff have access to the Trust’s training resources. A special mention should go to community services nurses who train our care home staff and share their expertise generously. 

“What else could Government do to help?” The significant additional Government funding to support hospital discharge was of course, welcome. 

Some of that came with requirements which didn’t reflect local circumstances in County Durham where we had invested in care home capacity and the workforce. 

The Ministerial Letter on Winter Planning in Adult Social Care which came out at the same time as the funding set out the range of activity that we need to get right to have successful hospital discharges. 

The more detailed Policy Note for the funding was more restrictive and we would welcome more local flexibility to meet local needs.

We also need to look at charging for hospital discharges to care home beds. It is a major concern for patients and families and sometimes delays discharges. Charging was suspended for the 6 weeks after discharge during the Covid pandemic. 

For councils, we have to apply the charging regulations equitably and avoid unfairness.

The feedback from the Number 10 Delivery Unit was positive. It was encouraging that Number 10 staff wanted to listen, question and share their experiences. However we can’t be complacent. We expect next winter to be challenging.

The way we will get through it by remembering Warren Buffet’s comment “Partnership… is an emotional alliance… between people who are committed to each other’s success.”