As we shift our services to being delivered around people and place, some of the traditional models of who does what are increasingly being blurred.
- Project: District Direct
- Objectives: To identify and overcome barriers to discharge via a dedicated district council resource within the integrated hospital discharge hub. The aim is to support residents to return home in a timely manner from hospital to an environment that meets their needs with the necessary support in place.
- Timescale: Pilot ran September 2017-March 2018, with a year’s funding secured until March 2019
- Cost to authority: In-house resources used during pilot, and extended via winter pressure money. Extra year’s funding secured via adult social care, CCGs and district council contributions
- Number of staff working on project: 1 full-time employees during pilot, with 2.5 full-time employees ongoing
- Outcomes: Between Sept 17 – March 18 * The pilot supported 184 patients, has undertaken 290 interventions and provided wider information and advice to patients and Norfolk and Norwich University Hospitals staff. Patients have ranged from 31 to 96, with an average age of 71 years. * Based on Norfolk and Norwich University Hospitals performance management information this saved 725 bed days over a 29-week pilot (average daily saving of 5 bed days) creating a saving of £181,250 (based on £250 cost per bed day) * Over the course of a year for a 5-day could lead to a saving of £325,000 (5-day service) or £456,250 (7-day service) * The average length of stay across the service has reduced by 36% (11 days to 7 days days)
- Officer contact details: firstname.lastname@example.org
Focusing on the outcome and efficient delivery is leading us to try new things, and with experiments showing positive results we must get better at sharing good practice.
We all understand the importance of supporting people to stay in their own homes for as long as possible. However, it became obvious to us that patients leaving hospital were not receiving the support they needed at the right time, an observation backed by evidence from the Clinical Commissioning Group (CCG).
In response, we agreed to work directly with the integrated hospital discharge team to investigate reducing the number of stranded patients in hospital care, reducing the number of excess bed days and preventing re-admissions.
While only 5% of people aged over 65 admitted to hospital stay for more than 21 days, that 5% accounts for more than 40% of all bed days. There is also pressure on hospitals as emergency re-admissions for people over 65 within 28 days is around 15% – and numbers are rising.
It’s vital that we get people home as soon as possible, as a patient over 65 can lose 14% of their hip and muscle strength and 12% of their lung capacity, while suffering a decline in mobility and fitness, after just 10 days of being in hospital. For an older, frail patient the impact on their life expectancy and independence is life changing.
The District Direct initiative was initially resourced by five district councils as a 12-week pilot, using officers from a range of backgrounds and expertise from across the county.
Officers experienced in dealing with homelessness, housing adaptations and benefits were seconded into the hospital integrated discharge team. They were co-located within the hospital hub and, following our ‘Help Hub’ ethos of collaborative working, given access to all relevant hospital systems.
Working together, the District Direct officers and the hospital discharge coordinators identify patients at the point of admission who have the potential to bed block. This is done by asking a series of triage questions.
If the answers to the questions identify an issue, the patient is asked for their permission to be referred to the District Direct officer. The officer will visit the patient and make a detailed assessment of their needs.
Then the officer will liaise with the patient’s home authority to put an action plan in place, making sure that help is provided to enable the patient to return home and live independently as soon as possible.
Being co-located with the integrated discharge hub, with District Direct officers attending frequent discharge meetings, has meant that the wider discharge team has support at hand from the resources in our Help Hub to deal with non-medical issues that are preventing patients returning home.
Savings from the pilot benefit the hospital, adult social care and the CCG. The success of the pilot was quickly recognised and it was agreed that hospital would fund an extension of the pilot to maintain momentum. NHS England have also identified the pilot as an example of best practice.
With results like these, it was extraordinary that at the end of the pilot our partners could not find the funding to keep the initiative going.
After much supplying of evidence, board meetings and calling in favours – and, I must admit, a little tantrum – we are now up and running again. District Direct makes a real difference, not just to people’s lives, but also to how we make more effective use of scarce public resources.
Sandra Dinneen, chief executive, South Norfolk DC