Dear Ms Mutch,

Re: Regulation 28 Report to Prevent Future Deaths – Thomas Barton 27th January 2023

Thank you for your Regulation 28 Report dated 21/07/2023 concerning the sad death of Thomas Barton on 27/01/2023. On behalf of NHS Greater Manchester Integrated Care (NHS GM), I would like to begin by offering our sincere condolences to Mr. Barton’s family for their loss.

Thank you for highlighting your concerns during Mr. Barton’s Inquest which concluded on 27th of June
2023. I apologise that you have had to bring these matters of concern to our attention. We recognise it is very important to ensure we make the necessary improvements to the quality and safety of future services.

Following the inquest, you raised concerns in your Regulation 28 Report to NHS GM that there is a risk a future death will occur unless action is taken. The main areas of concern are linked to the demand and availability of social care, so we have connected with Trafford Local Authority.

I hope the response below demonstrates to you and Mr. Barton’s family that NHS GM has taken the concerns you have raised seriously and will learn from this as a whole system.

The inquest heard that the delayed discharge of Mr Barton from hospital was due to the challenges of putting an appropriate social care package in place. The evidence before the inquest was that delayed discharges such as Mr Barton’s put the lives of frail elderly patients at risk as it is far more likely that they will become deconditioned and develop and infection if they spend unnecessary time in hospital. The evidence was that delayed discharges such as Mr Barton’s were not uncommon due to the demand on social care and the availability of suitable care. The evidence was that speedier discharges would occur if there was improved availability of social care and that this would improve outcomes for elderly patients and reduce the risk of preventable deaths occurring.

Response from Trafford locality: In Trafford, we plan all the year round to ensure capacity in the market. Historically, the Council has struggled with both residential and homecare capacity around winter, in particular January and February, Easter and the summer holidays. Every bank holiday brings with it increased numbers of discharges too. This means that the Council does not just look at winter but at capacity all the year round.

The Council has redesigned the homecare offer with local providers on a locality model to ensure there is enough capacity in the harder to staff areas. The Council has also looked at different ways of supporting homecare as a whole, and in one area where public transport is a barrier to delivering care, we have funded a minibus from additional grant monies to maximise the capacity and ability to deliver care hours.

4th Floor, Piccadilly Place, Manchester M1 3BN Tel: 0161 6257791 www.gmintegratedcare.org.uk

During winter 2022/23, the Council had sufficient homecare capacity because of the measures already in place and the high vacancy level in care home beds. However, not all of these vacancies met the needs of patients being discharged and the Council had to source specialist placements elsewhere. The pace and number of people being discharged requires funding which is in excess of the identified budget and any winter funding has been used to enhance capacity to support hospitals through rapid responses to requests for discharge.

In addition, the Council has identified several barriers to timely discharge from hospital, such as housing, minor repairs and 1:1 capacity. The Council has used additional winter funding both to manage these gaps and to enhance the support required to source placements in a timely manner and manage the flow from hospital into Discharge to Assess beds and then back home with appropriate support.

In 2022/23 Trafford Council delivered over 960,000 hours of homecare to 1,930 people with a long-term homecare plan. The Council additionally delivered short term homecare plans to 1,005 people, in the form of ‘Stabilise and Make Safe’ plans or additional support for current people with a care plan to support their discharge from hospital. Trafford has 27 framework providers that are split into two tiers, Tier one has 21 providers and Tier two has 6 providers. Tier one providers are lead providers that work across the 4 neighbourhoods, North, Central, West & South Trafford in a locality model. Tier two has 6 providers that are used to address system pressures and to maintain capacity and flow.

The Council has the following identified capacity gaps:

1. Specialist dementia nursing and residential care The Council currently spot purchase these beds, usually outside of Trafford. Although these number are small the weekly costs are high. Numbers average 1 or 2 people a week totalling 60 last year.

2. Extra care

Extra care is an affordable housing option from not for profit social landlords offering self-contained homes for older people aged 55 or over. It includes flexible and responsive services to enable them to maintain their independence and stay where they live if their care needs change.

National modelling estimates the number of extra care units required in Trafford as being 96. Developers prefer to build care homes rather than extra care as the returns are more profitable. The Council is not able to develop the scale of extra-care provision required but is committed to work with partners to maximise relevant developments.

3. Therapy The Council’s Discharge to Assess and reablement provision is constrained by having no therapeutic input. This is an area which is under constant discussion with our acute trusts and the community health providers.

As indicated above, there is a reasonable supply of homecare currently.

The Council has an over provision of residential care within the borough. There is sufficient supported living – but the Council is moving away from 6/8 bedded models to more personalised housing models

4th Floor, Piccadilly Place, Manchester M1 3BN Tel: 0161 6257791 www.gmintegratedcare.org.uk where people are supported to buy their own properties, live in ordinary properties with outreach support or share with friends in smaller properties.

Response from NHS GM: Whilst we appreciate that during the period of time that Mr Barton was in hospital there was increased demand on care at home, we are confident that there is sufficient capacity to support timely discharges from hospital for people to return to their homes. Supported by NHS GM funding, localities have commissioned home from hospital support from voluntary/community organisations in addition to the independent care providers that provide substantive services.

NHS GM have recently undertaken capacity and demand modelling of home care and care home markets. Localities are using the detailed modelling and analysis to inform development and shaping of their market, to ensure that it continues to meet the needs of current and future Greater Manchester residents.

Actions taken or being taken to share learning across Greater Manchester:

1. Learning to be presented/shared with the Greater Manchester System Quality Group on the 21st of September 2023. This meeting is attended by commissioners, including commissioners of specialist services, localities, regulators, Healthwatch and NICE. Through sharing in this forum, we expect members to review and ensure learning is incorporated into their commissioned services.

2. Shared learning from this and similar cases at Greater Manchester and borough level will be cascaded to professionals through relevant governance and learning forums to ensure that learning is incorporated into their services.

In conclusion, key learning points and recommendations will be monitored to ensure they are embedded within practice. NHS GM is committed to improving outcomes for the population of Greater Manchester.

I hope this response demonstrates to you and Mr. Barton’s family that NHS GM has taken the concerns you have raised seriously and is committed to working together as a system including our service users, carers and families to improve the care provided.

Thank you for bringing these important patient safety issues to my attention and please do not hesitate to contact me should you need any further information.

Dear Ms Alison Mutch, Thank you for your Regulation 28 report to prevent future deaths of 21 July 2023 about the death of Thomas Barton. I am replying as Minister with responsibility for Adult Social Care and hospital discharge. Firstly, I would like to say how saddened I was to read of the circumstances of Thomas Barton’s death, and I offer my sincere condolences to his family and loved ones. The circumstances your report describes are concerning and I am grateful to you for bringing these matters to my attention. Please accept my sincere apologies for the significant delay in responding to this matter. The report raises concerns over the delayed discharge of Mr Barton from hospital which was due to the challenges of putting an appropriate social care package in place. Delayed discharge is a risk for frail elderly patients. In preparing this response, Departmental officials made enquiries with NHS England and the Care Quality Commission. The Integrated Care Board (ICB) advised that Trafford Council have redesigned the homecare offer with local providers on a locality model to ensure there is capacity in areas that experience difficulties in recruiting staff. The Council has identified barriers to timely hospital discharges and capacity gaps in care provision. In addition, Greater Manchester (GM) ICB have undertaken a capacity and demand modelling of home care. I understand the ICB will be sharing learning across the system and stakeholders as well as monitoring of key learning points and recommendations. It is our priority to ensure that all patients receive safe and timely discharges from hospital. The Hospital Discharge and Community Support Guidance published by the Department of Health and Social Care, sets out how the discharge process should operate in practice, and how NHS bodies and Local Authorities should work together to plan and implement hospital discharge, recovery and reablement in the community. NHS bodies and local authorities have a statutory duty to cooperate in exercising their A4 1

respective functions, including as they relate to hospital discharge. In addition, where a relevant trust is responsible for an adult hospital patient and considers that the patient is likely to require care and support following discharge from hospital, the relevant trust, must, as soon as is feasible after it begins making any plans relating to discharge, take any steps that it considers appropriate to involve the patient and the carer of the patient. We put in place £500million for the 2022/2023 Adult Social Care Discharge Fund and this enabled more people to be discharged from hospital in a timely manner. We have since increased the Fund to £600million for the 23/24 and to £1billion for 24/25. This funding has so far been used to deliver additional care packages and beds, provide equipment to support people in returning home, and boost the social care workforce. Local authorities and NHS integrated care boards have the flexibility to spend their allocations in ways they deem most appropriate for their local area. Funding must be spent on measures which seek to free up the maximum number of hospital beds and reduce bed days lost, for example short-term packages of care, community-based reablement capacity, or building the workforce capacity needed to continue to support care users. We have published an evaluation of the 2022/23 discharge fund which has explored how local areas spent their funding. We found evidence that funding was associated with a positive impact on delayed discharge with local areas reporting a reduction in delayed discharges, and improved flow through the system. In January 2023, NHS England published the Urgent and Emergency Care Recovery Plan. This year, and in line with the commitments in this plan, we continue to work with the NHS and local authorities to roll out care transfer hubs in every part of the country to manage discharges for patients with more complex needs. These hubs bring together professionals from the NHS and local authority to manage discharges for people with more complex needs, who need extra support when being discharged. At the time of Mr Barton’s admission to hospital in November 2022, the health and social care systems were experiencing increased pressures due to a rise in hospital admissions related to COVID-19 and seasonal flu. In the seven days to 30th November 2022, the time of Mr Barton’s admission, the average number of patients with delayed discharges (no longer meeting the criteria to reside but remaining in hospital) reported by the Greater Manchester Integrated Care Board was 910. This had decreased to 703 for the average of the seven days to 30 November 2023 and was 665 for the average of the seven days to 31 March 2024. We recognise there is still more to do, and it is a government priority to continue to drive forward a decrease these numbers. I hope this demonstrates we are taking active steps to reduce delayed discharges and to avoid the adverse impacts they can cause to patients, as highlighted in this case. Thank you again for bringing these concerns to my attention. Yours, A5 HELEN WHATELY