In March this year we were very proud to win an LGC award for our Intermediate Tier Service (ITS), which is helping to reduce the amount of time people spend in hospital.
- Objective: Working effectively with our health and social care partners to deliver our innovative Intermediate Tier, Home in a Day and Discharge to Recovery services
- Timescale: September 2015 - present
- Cost to authority: £200,000
- Number of staff working on project: One integrated support planner, plus existing care staff
- Outcomes: More person-centred care in the right place at the right time; reduction in delays in the system; improvement in the time taken for discharges; helping to ensure people can leave hospital quicker, with access to good quality health and social care in an environment of their choice
- Officer contact details: Andy Jones
We formed the ITS with Heywood, Middleton and Rochdale CCGs. We pooled our budgets in 2015 to create a combined pot of £7.2m and set about creating an integrated service to reduce delayed transfers of care.
Rochdale’s innovative and pioneering policies are delivering improved health outcomes for thousands of people across the borough.
There are many examples of improvement. For example, between January 2016 and April 2017 we halved the number of delayed days in hospital from more than 500 a month to fewer than 200. Throughout June of this year we had just five delayed transfers of care during the month, lower than any other authority across Greater Manchester. In the same month we also had just over eight delayed days per 10,000 adults in the borough, which was one of the best performances in the country. Our care home admission figures are improving and user satisfaction amongst carers, revealed in a recent survey, are also very high.
We are delighted with these achievements, but we recognise this is the start of the journey. Our determination to succeed is continuous, as we drive our vision forward to help make radical changes to our care system.
These success stories have not happened by accident. We have been working to integrate our urgent care services on the ground for three years and the ITS is a key part of this.
The ITS has a strong focus on avoiding admissions and discharging people from hospital at an optimum time. It is highly effective.
The key components are:
- High-quality, medically supervised community beds. The medical supervision is essential; people are ill when they are referred and without proper medical cover the service could not safely operate as an alternative to hospital
- A comprehensively staffed home support team that can be put into place within two hours, with nursing, therapy and care
- Extended support to regain independence skills which is at the heart of the ethos of the service and can also be put in place within two hours
- Effective discharge planning, making sure the mainstream services can accommodate needs of people coming through, to maximise productivity and best use of the ITS
- Support for informal and family carers
All of this works well for us. We intend to expand this service in the coming months, as part of our local transformation plan to reduce reliance on hospital care and improve independence outcomes.
However, the ITS is only part of the jigsaw. To achieve our system efficiency we have simplified various processes in the past year, particularly easy pathways into assessment and easy pathways out of hospital, including our successful ‘home in a day’ and ‘discharge to recovery’ schemes. In essence, these schemes allow people to return to the community or to a 24-hour setting, with the appropriate support to recover, and with the necessary social care assessments to ensure longer term plans meet people’s needs
Our low levels of delayed transfer of care (DTOCs) are a result of speedy assessment processes. We implemented the ‘discharge to assess’ process, in which the default route out of hospital is to return people to their homes for further assessment there. Our out of hospital supply arrangements are also critical; there is no point in having super-slick assessment processes if the domiciliary care providers, who are essential to enabling people to leave hospital at the best time, are full. We have worked with domiciliary care providers to ensure temporary care can be put in place quickly which allows time to make permanent arrangements for care and support if needed.
The other issue is attention to detail when it comes to the proper recording of DTOCs. I imagine many of you reading this will recognise that the Department of Health DTOC guidance is not always consistently interpreted; we work very hard to make sure only people who really are delayed are recorded as such. It’s frustrating but still necessary.
When we talk about capacity, it is not just hospital capacity that matters. Let’s talk about whole system capacity. As a director of adult social care I know the capacity issues in our local hospital. Equally my NHS colleagues know the capacity issues in social care. We don’t indulge in a blame game but instead take shared responsibility for the whole system; that’s what integration and effective partnership working really means. Shared budgets, that can put the investment in the right place, are a natural development from this. From April 18 2018, the new local care organisation (LCO) will deliver health and social care from a shared budget.
A priority for us in Rochdale is to grow and strengthen our local social care providers. We are working with providers on different models of home care and care home delivery. All health and social care providers in the borough will be working in partnership, through the LCO, to improve the quality of health provision. This will be supported through transformation funding. If we reduce unplanned hospital admissions by, for example, 20% over five years, people will need more care at home. The established social care providers in our borough, with support to develop their scope and workforce, are ideally placed to step up to this. It will enable providers to broaden their remit, extend their business, and increase pay and development opportunities for staff. This has a number of wider benefits for the local health system, helping us to understand even more the different needs our patients, ensuring the best possible service across the borough. Social care is the solution not the problem.
Finally, if we are to reform our health and care system we should resist the pressure to put all our energies into managing DTOCS. That simply isn’t the real problem. Instead we must provide high-quality alternatives to hospital care; we need to put our energies into how to support people to be safe and well at home.
We welcome any contact from colleagues who would like to know more about our innovative and pioneering policies. Our key messages to other authorities are: look at your level of intensive support at home; ensure the support is suitable for people with significant levels of health needs; ensure family carers are supported; and develop high-quality intermediate tier units, as well as providing one-to-one care at home.
These ideas are not about institutional care, but short-term comprehensive health and care provision that helps more people, cost effectively, to live safely and well at home.
We have come a long way over the last two years but this is a start point, not an end one. In a town famous for its pioneering spirt, we are leading the way and delivering a Rochdale health and social care system to be proud of.
Sheila Downey, director of adult services, Rochdale MBC