10.06.16
Developing an alternative approach to delayed hospital discharge
Source: PSE Jun/Jul 16
Housing associations can lead the way in developing a new and alternative approach to delayed hospital discharge for the NHS and local government, writes Patrick Vernon OBE, health partnership co-ordinator at the National Housing Federation (NHF).
The recent ‘Discharging older patients from hospital’ report from the spending watchdogs at the National Audit Office (NAO) was critical of the current health and social care system’s management of discharging older patients from hospital in not representing value for money.
We all know this is a problem, but the figures are still startling: £820m on unnecessary acute care and 2.7 million patient days wasted waiting for delayed transfers. But it estimated that caring for older people who no longer need to be in hospital in other settings could result in additional annual costs of as little as £180m for other parts of the health and social care system.
The NHS is part of the growing clamour saying something must be done – particularly since the home is such an important part of recovery and can reduce pressure on the financial sustainability of the NHS and local government. The 2014 Memorandum of Understanding – signed by the NHF and other key government, health and housing bodies – is now reflected in the devolution deal in Greater Manchester and provides a real opportunity to mend a broken system.
The idea is simple: enabling older people to return home safely from hospital through efficient transfer of medical and social care allows faster discharge and reduced readmissions, meaning greater independence for the patient and greater efficiency for the hospital.
Curo Step Down
A superb example of this is Curo, a housing association in the south west, which has over 13,000 properties and a successful care and support division. Curo’s Step Down service was commissioned in 2011 by Bath and North East Somerset Council (B&NES) and the local clinical commissioning group (CCG) with funding from the Better Care Fund. The service forms a key element in the council and CCG’s Better Care plans for whole-system integration and facilitates integrated reablement pathways and hospital discharge.
Curo’s Step Down service provides a successful reablement initiative that has enabled emergency discharge from hospital as part of a wider ‘Discharge to Assess’ Pathway, providing a value for money route for discharge and an environment for reablement where assessments can be conducted outside of a primary care setting. The service has recently been recommissioned by B&NES for 2016-17, and continues to deliver a cost-effective solution for discharge and reablement, particularly for older people.
The service offers six self-contained one bedroom flats or bungalows with dedicated support and access to 24-hour care teams, allowing patients to see how they get on with a care and support package in a place just like home. They are provided within, or adjacent to, extra care hubs by Curo who are the main local social housing provider and are, like all NHS care, ‘free at the point of delivery’ and are available seven days a week for periods of time agreed at the point of discharge.
The financial benefits are huge. It is estimated that an excess hospital bed day costs £303 per day or over £2,000 per week. In contrast, Curo’s Step Down facility costs £60 per day. In 2015-16, Curo delivered 1,721 days of Step Down from hospital across its six units, equating to a saving to Royal United Hospitals Bath NHS Foundation Trust of over £520,000 – or £390,000 once costs are taken into account.
In addition, customers get an individually tailored care and support service, which places their needs at the centre of their reablement and gives them opportunities to familiarise themselves with telecare, thus reducing the likelihood of readmission further.
But saving money is just a positive consequence of providing better, more efficient services. And feedback from customers at Curo reflects the value, independence and dignity of care from a housing-led service around hospital discharge.
This work is just a part of a growing evidence base that housing associations can save the NHS money, develop good partnership arrangements and also contribute to recovery and provide dignity to the most vulnerable in society. However, more work is required to provide incentives for the NHS and local government to commission housing associations if we want to provide a 21st century service around hospital discharge where the home is at the centre of clinical practice and service delivery.
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