As a leading provider of community health and care services, we took part in the national initiative #ActNowHomeFirst by NHS Improvement. Our ‘Homeward’ project led by colleagues at St. Martins Hospital in Bath implemented a hybrid community model to free up hospital beds, easing the burden on our NHS.
As well as the associated costs to the hospital (and care system), the issue of delayed discharges, commonly known as bed blocking, has been a severe problem for hospitals who badly need to free beds, especially during the busy winter months. This has been dramatically illustrated during the COVID-19 pandemic when lack of available hospital beds had led to significant delays for ambulances handing over patients to the hospital.
Acute hospitals need to be able to discharge patients once they no longer need acute care and community hospitals need to discharge patients to make way for others who need a community hospital bed.
However, while medically fit, many patients need support to be discharged safely and to avoid the risk of readmission. While some patients can go straight home with a package of care, others need a period of reablement in a community hospital before returning home. Finding a way for people to be able to return home more quickly, but also to be fit and well enough to remain there safely, must be a key priority.
To find solutions to some of these problems, we took part in the #ActNowHomeFirst Collaborative, led by NHS England and Improvement.
The NHS long-term plan focuses on discharging patients safely and quickly to free up beds in acute and community hospitals. Providers from all health service areas, including us, had been encouraged to find ways to make this happen.
A national shortage of reablement, therapy, social care staff and appropriate care home places has slowed down patient flow through the system. It has also led to high agency costs.
Therefore, the challenge was to shift the focus to more intensive rehabilitation that promotes independence and confidence and to find ways of getting patients mobile and confident enough to manage at home once they were well enough to be discharged.
Wards providing rehabilitation and reablement are not new, but the ‘Homeward’ project ran by our team at St Martin’s Hospital in Bath, was developed to offer a unique approach by creating a hybrid community hospital model that increases the flow of patients and prepares patients for safe discharge.
The project looked to develop a service which could:
The six-bed therapy-led ward approach called ‘Homeward’, was trialled by our team at St Martin’s Hospital.
The project was led by a senior Occupational Therapist. Core to the project’s success was the development of Reablement Therapy Workers (RTWs), trained in a range of therapeutic and clinical skills, who can better support patients with a more holistic care plan, supporting both medical and therapeutic care needs. The new RTWs were better able to promote patients’ independence in the wards while ensuring patient safety.
Along with therapy staff, RTWs were allotted together with nursing staff to the e-roster to support integrated workforce planning, supporting a whole ward approach.
The ward was fitted with a ‘Tasks of Daily Living Area’ which comprised a kitchenette, a bathroom, a sofa and TV area so the patients could practice (and be assessed) in daily living activities such as cooking meals, using appliances, getting up off the sofa and standing from a wheelchair. The enhanced therapy approach allowed patients to practice daily living tasks as part of their daily ward routine.
The key to the success of the project was the Rehab Therapy Worker (RTW) role which offered:
For those patients discharged home with reablement, the patient required fewer community teams visits (15 less a week). Capacity could then be focused on the more complex patients across the patch.
An excellent example of the therapy-led ward’s effectiveness is a lady admitted to the ward with a high dependency score. The lady in question needed two people to help her to her wheeled frame, needed help washing and support during the night to use a commode. She was unable to mobilise and required her medication to be administered by nursing staff.
After spending time on Homeward, her dependency score reduced dramatically. Upon discharge, she was able to mobilise, make her food and snacks and take them to a table using a wheeled frame. Then with the help of a profiling bed, use a commode herself – all tasks both she and community teams were happy she could manage herself in her own home.
Responding to what local people had said they wanted from their health and care services, Bath and North East Somerset Council (BaNES)and NHS Bath and North East Somerset Integrated Care Board (ICB) needed a partner to run a new, joined-up community health and care service.
Initially commissioned by the Clinical Commissioning Group (CCG) in 2017, our job was to join-up services so that they worked better together, resulting in local people having more control over their health and care. The NHS and Council wanted a partner to help deliver an efficient service, which could use technology and new ways of working to reduce the increasing costs of community services over the length of the contract.
Read more about our BaNES Community Health and Care contract
