In most cases patients look forward to being discharged from hospital, but for some old and vulnerable people, who lack the support network provided by close family and friends, it can be a daunting prospect.
Normally they have to wait until the local authority makes arrangements for suitable community-based care. This often delays discharge even though patients are medically fit to leave hospital, and puts further strain on NHS bed availability, as well as adult social services.
The financial cost to the health service of such hold-ups has been put at £600,000 a day. There is also an emotional price to be paid by patients, many of whom are anxious to return to the familiar surroundings of their own home.
A chance meeting in 2012 between Trixie Bennett, chief executive ofAdults Supporting Adults (ASA), which helps vulnerable people live in the community, and Chris Slavin, head of the Lincolnshire partnership foundation NHS trust (LPFT), led to a ground-breaking initiative.
“The trust was admitting patients to wards after what should have been a routine visit to accident and emergency simply because appropriatesocial care couldn’t be arranged in time to allow same day discharge,” Bennett explains. “This was already putting pressure on bed availability and the imminent onset of winter would, in all probability, make matters worse. Together, we tried to find practical solutions.”
A three-month pilot followed, entirely funded by the trust, which paired patients being discharged with two trained and supervised employees. The aim was to bring a number of agencies together to create a seamless and speedy “hospital to home” pathway.
Known as the prevention and avoidance community team (Pact) the service offers wide-ranging support to patients during and after hospital discharge. It is based on a close collaboration between the NHS and the third sector. In addition to ASA, which takes the lead co-ordinating role, Lace Housing Association arranges transport from the hospital to the patient’s home and Age UK Lincoln provides further or additional community-based social support such as domestic help and personal care. The scheme is entirely funded by LPFT but it is working in conjunction with United Lincolnshire hospitals NHS trust to provide the service.
Pact staff ensure clients can gain access to their home, and that they have enough food and groceries to tide them over. They make sure patients understand when and how to take medication, and are trained to identify any additional care needs. These are reported to the scheme coordinator so the appropriate community-based support can be arranged.
Team members also check for any obvious hazards that could lead to a fall – one of the most common causes of hospital admission among old people.
It is a seven-day-a-week service, running from 10am to 8pm, and is free to users. “Once a patient is medically fit we aim to get them home within two hours,” Bennett says. “Patients no longer sit in a hospital corridor waiting for transport, or are sent home alone in a taxi.”
The trial project, which started in January, is now a permanent service and has been extended to include Lincoln county hospital. There are plans to roll it out to hospitals in Boston and Grantham by this autumn.
To date, Pact has helped more than 300 patients make the transition from hospital to home, at an estimated saving to the NHS of £350 per person per night. The initiative is currently being evaluated by the University of Lincoln, and ASA says initial indications suggest that not only does it free up beds and save money, it also reduces readmission rates.
The scheme has certainly found favour with its clients. Irene Birkett, 83, recently returned home from hospital with Pact support: “I was so pleased and extremely grateful that they were there to help me – they were like angels.”
Bennett says the consortium has plans to broaden the initiative: “When the ambulance service is called out to see an elderly or vulnerable patient they are trained to deal with medical problems, but not the social care needs that may have triggered the initial call. If we can work with the NHS to prevent patients going to accident and emergency in the first place, by addressing these underlying issues at an early stage, then money will be saved and vulnerable people can retain their dignity and independence in the community rather than remain in hospital unnecessarily. That’s surely in everyone’s interest.”
