Faced with an ageing population and cuts to public spending, early action can provide an alternative way forward for local authorities and the NHS

Yesterday, the National Audit Office (NAO) published a report calling for radical action to tackle delays in discharging older patients from hospital and stop the costs adding further strain to the financial sustainability of both the NHS and local government. The spending watchdog estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million. Delayed discharge also has a huge personal cost as people that are delayed more than 72 hours are far more likely to fall ill again, lose independence or mobility and be admitted to residential care.

The evidence clearly indicates that the care system needs to be transformed. We believe that adopting early action is a common-sense approach for the NHS and local authorities who face the worrying combination of an ageing population and cuts to public spending.

When considering the problem of delayed discharges, an early action approach encourages us to ask the question ‘where could we intervene earlier?’

The ideal solution to reducing delays in discharge is to reduce the need for admissions altogether by focusing on primary or secondary prevention. Primary prevention enabling older people to lead thriving lives could focus on adapting our society to be more ‘age-friendly’ through a myriad of relatively small, innovative interventions, for example by installing grab rails in homes to prevent falls or providing more public benches. There is also a considerable amount of evidence that interventions throughout a generation’s lifespan, not just in the early and later years, will help reduce pressure on health and social services from an ageing population.

Secondary prevention to reduce hospital admission would target individuals with more clearly identified needs. A good example of a simple intervention that does just this is the Call & Check Service based in Jersey. Postmen ‘call and check’ on older people, reminding them of medical appointments / prescriptions and connecting them with other support services. It prevents social isolation and enables them to live independently for as long as possible. This simple concept demonstrates that communicating and linking people with existing services is an effective way of using resources to act earlier. It also shows the strength of combining normally disparate sectors by using an existing service to increase the efficiency and quality of health and social care. [1]

Emergency hospital admission rates are correlated with chronic illnesses, so secondary interventions should also focus on enabling people with chronic illnesses to manage their own care. The US Veterans Health Administration ‘Health Buddy’ uses innovative yet simple technology to produce dramatic outcomes – an evaluative study showed savings of $3,506 on average per patient, hospital admissions reduced by 66% and bed days reduced by 71%.[2]

Of course, even with the best of care some older people will need to be admitted to hospital, so early action is also about considering how services can be improved to ensure that older people can be discharged quickly and safely as soon as they no longer need acute care. The NAO report highlights that financial incentives for the NHS to reduce delayed discharges are not matched with incentives for local authorities to speed up receiving older people back into the community. One possible solution is to integrate health and social care, by pooling budgets in order to reduce departmental silos and encourage information sharing. The cost benefits accrued through improved efficiency could then also be shared.

The Government has shown some appetite for integration through the establishment of the ‘Better Care Fund’, designed to support local areas to plan and implement unified health and social care services. However, in a survey of local authority care directors, almost half (43%) said they believe the Better Care Fund has had little or no impact on care budgets and service quality. This is perhaps a somewhat negative outlook given the BCF is still in its infancy, but it does demonstrate that there is still a lot of work to do on integration. Different funding streams remain a major barrier and more must be done to bring them together.

Furthermore, integration alone is not enough. It is essential that services are designed with the involvement of both those who deliver the service and those who receive it to ensure buy-in to the new approach. ‘Co-production’ leads to a person-centred approach which focuses on the older person’s needs, rather than organisational targets. Hospital to Home, featured below, is one initiative which has adopted a co-production approach to redesigning integrated health and social care services in Scotland. The project is still ongoing, but practitioners from the working group report that the project has “greatly improved communication” with one respondent estimating that they have “reduced care home admissions from our hospital by about 50%”. Equally as important, interviews with older people and their carers evidenced positive relationships with staff but also helped to identify gaps in their care that still remained.

There is recognition amongst councils of the importance and benefits of investing in prevention – and the spirit of prevention is now embedded in the Care Act. However, overall funding pressures resulted in local authorities’ planned spend on preventative measures dropping from £937 million in 2014/15 to £880 million in 2015/16 – a 6 per cent reduction in real terms. If the government is serious about prevention, it needs to translate words into action – backed up with hard cash.

How can integrated services be designed whilst improving older people’s care experience?

Hospital to Home is an initiative aimed at improving the care experience of older people being discharged from hospital in the Tayside region of Scotland. Delivered by Iriss, the project worked with local health and social care practitioners, older people and their carers. This group shared their own experiences with each other and co-designed issues to be addressed. This resulted in three broad recommendations which have been adapted and embedded locally with partners from the case study areas of South Angus and Dundee over the past year.

Hospital to Home’s starting point is improving the experience of the person receiving care, yet its effect is increasing the efficiency of hospital discharge and improving community based care, with an aim to minimise hospital admissions in the first place. It demonstrates the process of redesigning services for early action, highlighting an approach that removes departmental silos by focusing on the desired outcomes of the person. Strengthening communication between practitioners, patients and their families and coordination between acute and community services is key in tailoring health and social care around patients’ needs and improving care and efficiency in hospital discharge.

We will be publishing a more detailed case study of Hospital to Home on our website soon. In the meantime, you can find out more about the project here.

 

[1] You can read more about Call & Check in our ‘Rough Guide to Early Action’

[2] Coye, M. (2009) Transformation in chronic disease management through technology: improving productivity and quality in the shift from acute to home based settings. San Francisco (CA), Health Technology Center

Original source – linksUK

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