Ian Lightley (Chief Operating Officer, Livewell Southwest) delivered the Livewell Southwest performance report, and discussed:

 

a)    Changes to the management and prioritisation of outstanding cases and demand;

 

b)    A reduction in the ‘longest days waited’ by an individual, since the last meeting;

 

c)    Reviews of outstanding cases to ensure they were still relevant and correctly prioritised;

 

d)    Letters had been circulated to all clients on the waiting list to provide information and signposting. This included average waiting times, reasoning for the waiting list and advice on where to go for interim support. Clients were advised to contact Livewell for re-prioritisation if their situation changed;

 

e)    Improved performance oversight had been achieved, with monthly management updates on actions to reduce waiting times;

 

f)     Recognition of further work required to reduce waiting lists;

 

g)    A reduction in the total number of people waiting for services from 931 in April 2024 to 428 in February 2025;

 

h)    An ambition to shorten the waiting time for those with lower needs, who typically waited longer. Urgent and high priority cases were generally assessed in good time;

 

i)     Ongoing efforts to improve the collection and utilisation of data to support triaging and enhance efficiency;

 

j)     Collaborative work between Livewell Southwest and Plymouth City Council to reduce waiting lists, maintain patient communication, and improve productivity and oversight;

 

k)    A reduction in the number of ‘outstanding reviews’ from earlier in the year;

 

l)     The continued prioritisation of supporting people outside of hospital. There was a target for 75% of people with complex needs to be discharged directly home.

 

In response to questions, the Panel discussed:

 

m)  Dissatisfaction and concern for the waiting list figures, which showed 438 people waiting 21 weeks. It was explained that a large proportion of these figures were people assessed as low need, and that cases were monitored to track risk, and escalated as appropriate;

 

n)    The criteria for eligibility for a care act assessment was relatively low, creating a significant number of applications for assessments, which identified a low clinical need. These cases often only required advice and signposting however, addressing them was often delayed by priority cases;

 

o)    It was recognised that advice and signposting to those of low clinical need could be given earlier, and that this would likely be beneficial to all parties;

 

p)    It was recognised that the report presented to Panel did not demonstrate the level of risk pertaining to each of the cases of the waiting list, and it was therefore difficult to assess the significance of these numbers. Future data would include a representation of risk, and Livewell were working to enhance their prioritisation and triage systems to reflect this;

 

q)    Livewell were developing the ‘waiting well protocol’, proactively contacting people on waiting list to provide advice and signposting;

 

r)    While it was impractical to expect the complete abolishment of waiting lists, it was nationally accepted that a 30 day waiting period was reasonable;

 

s)     There had been a continued growth in demand, and there was an expectation this would continue;

 

t)     Livewell’s staff recruitment and retention was strong, and there were few staff vacancies;

 

u)    There were no delays for carers assessments.

 

The Panel agreed:

 

1.    To request that Livewell Southwest performance data returned to a future meeting to enable continued tracking, and that data included an assessment of risk;

 

2.    To recommend that an introductory briefing and training session was scheduled for Panel members in the new municipal year, and opened to all councillors;

 

3.    To note the reports.

 

 

Sarah Pearce (Livewell Southwest) and Sarah Prideaux (Livewell Southwest) delivered the ‘Alternatives to Admission’ report, and discussed:

 

v)    The Integrated Admission Avoidance Service delivered a 24 hour offer, split into three services:

 

                   i.    Urgent Community Response service;

                  ii.    Integrated Alternative to Admission service;

                 iii.     Out of Hours Nursing service;

 

w)   The Urgent Community Response service provided two categories of responses: an under 2 hour response, and a 24 hour response;

 

x)    The service provided support and additional capacity for UHP (University Hospitals Plymouth) colleagues, delivering  Virtual Wards and IV therapies;

 

y)    The service utilised a range of integrated professionals across UHP and the South West Ambulance Service (SWAST).

 

(A video was played at this point on the Community Urgent Response Service)

 

z)    An overview of caseloads, demand and activity figures demonstrated an increasing number of people successfully helped to remain in the community;

 

aa)  Despite increasing demand, figures for ‘extended length of stay’ remained low;

 

bb)The service in Plymouth already outperformed national targets, with over 80% of patients receiving care within a two hour period;

 

(A video was played at this point of a patient’s experience with the service)

 

In response to questions, the Panel discussed:

 

cc)  Staffing and resource requirements – some areas had received new investment and resource, such as virtual wards, as part of the national shift to provide care in the community. Other measures were expected be self-funding through efficiencies created by implementing the changes;

 

dd)The One Plan – acute and community services were working together to improve efficiency and appropriately direct funding. The Community Frailty Virtual Ward had been established by releasing funding from acute hospital into community;

 

ee)The Community Crisis Response Team were fully equipped to provide care within the community, and had access to transport, lifting equipment, and other specialised assets;

 

ff)    The Community Crisis Response Team was available within the SWAST directory of services, enabling paramedics, GPs and other medical professionals to refer patients into the programme, and call for timely advice / assistance;

 

gg)  Staff were being increasingly trained in multi-disciplinary skills, enabling them to diagnose or refer to the most appropriate service. This included training for social workers to spot sepsis, and training for all staff in the Care Act.

 

The Panel agreed to:

 

1.    Thank and praise staff for the success of the Admission Avoidance initiatives;

 

2.    Note the report.