With hospitals creaking under the strain of seemingly endless demand, it is not surprising that stories tackling the issue often come with shocking statistics. The final line of an article covering a study by Healthwatch England on the problems caused by a ‘revolving door’ approach to hospital discharge delivered exactly that.
It quoted Janet Morrison, chief executive of Independent Age, who said: ‘With two-thirds of readmitted patients returning to hospital within a week, we need to start making changes now.’
Read through the study itself and you’ll find ample statistics that tell you human and financial burden of this revolving door. Emergency readmissions cost the NHS more than £2bn a year and some 6,000 patients remain in hospital longer than clinically necessary.
The picture painted by Healthwatch England’s report is of a hospital discharge system with little consistency or certainty for far too many users. What makes this situation particularly frustrating is that there are effective solutions already out there making a huge difference to people’s lives – we just need to make them the norm.
Foundations, is the national body for more than 200 home improvement agencies (HIAs) and handyperson service providers in England. They deliver home support to vulnerable people to enable them to live independently, manage long-terms conditions and, ultimately, stay out of hospital.
By carrying out adaptations, providing information and advice about issues ranging from debt to dementia and ensuring people live in dry, warm homes, they are on the frontline of preventing hospital admissions.
But a number of them are also working with partners to tackle that revolving door syndrome. In many cases it’s a question of providing practical support that makes it easier for people to return home. For example, in York, a handyperson scheme run by Yorkshire Housing offers a service to fit aids and adaptations to enable hospital discharge within 48 hours.
In Carlisle, Hospital at Home creates a ‘virtual ward’ by providing care in a patient’s home in order to avoid unnecessary admissions to hospital. The service is supported by community services and initiatives like ‘community neighbours’, a volunteer befriending scheme run by an HIA, Homelife Carlisle.
Hospital at Home enables someone to make the choice to remain at home, keeping contact with friends, neighbours and family, while receiving care that would normally be provided in hospital.
However, in Manchester things have moved up several notches and it now has a model that could provide a blueprint for other areas.
Manchester Care and Repair (MC&R) – an HIA and registered charity that works across Greater Manchester and is supported by local authorities, the NHS and many others, has been running a Home from Hospital service since 2012.
It has staff running services from North Manchester General Hospital, Manchester Royal Infirmary and Wythenshawe Hospital and it is also co-located within the integrated discharge teams working closely with NHS and Manchester City Council staff.
MC&R workers provide telephone follow-up calls offering non-medical, low level support to smooth the transition from hospital to home and to help to prevent readmission for the over-60s.
The approach proved so successful that MC&R was asked to put forward a proposal for an enhanced hospital discharge support service. North Manchester Clinical Commissioning Group and Manchester City Council commissioned the service as a one-year pilot in 2014.
After supporting more than 1,450 people in its first year, it has since been extended with exclusive support from the North Manchester Clinical Commissioning Group (CCG) and the service’s success contributed to MC&R winning the Home Improvement Agency Service of the Year Award in June.
It means residents in the city aged over 60 who are being discharged from North Manchester General Hospital have access to a seven-days-a-week personalised discharge service.
The idea was to tackle the very problem identified by Healthwatch England’s report: that too many vulnerable people leave hospital feeling abandoned and isolated. What exacerbates that feeling – and can greatly increase their chances of readmission – is that fact that their home environment isn’t appropriate. Cold, damp and draughty properties with multiple trip hazards are unlikely to foster a speedy recovery.
Patients leaving North Manchester General Hospital receive an assessment to gauge what’s needed to support their recovery and ongoing independence and wellbeing.
As Karen Kennedy, MC&R’s Home from Hospital manager, explains: ‘Any patients identified as possibly benefitting from the service are supported and prepared for their discharge home. We also transport them home and settle them back in. The discharge support service will assist the patient to warm the home, make necessary adjustments, prepare beds and a simple meal, shop for immediate essentials and re-connect with services relatives or friends – in short “that little bit of extra support” that a close relative or friend would seek to provide to someone in recuperation. This is followed up by regular telephone and direct contact as necessary for a period of up to six weeks by staff and volunteers.
‘The overwhelming response to the introduction of this service from both patients and North Manchester General Hospital staff alike has been positive. Most people cannot understand why such a service hasn’t been available until now as it is clear that a little bit of extra support, reassurance and help with practical tasks can make a massive difference to vulnerable patients.’
What makes MC&R’s achievements remarkable is hat they come about during a time of unprecedented austerity for local government – one of the key funders of home improvement and handyperson services. By late 2014 it was facing a potential 58% cut in local authority funding. But the effectiveness of its approach has led to fresh financial support from Manchester’s CCGs and the city council’s housing investment team.
With so many competing priorities, it can be hard for organisations like MC&R to make their voices heard among commissioners. It has therefore lobbied elected members and health commissioners, built strategic relationships and backed up the case for investment by compiling evidence of its impact.
One of the key reasons for its success on the ground brings us back to that Healthwatch England report.
Among the ‘five reasons things go wrong’ with hospital discharges that it highlights, number one is the lack of co-ordination between different services. That is precisely the issue MC&R and its partners tackle head on and it is the kind of approach that needs to be replicated if we are to close the revolving door.
Roy McNally is a development manager at Foundations.
