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Councils must lead on integration of health and social care

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Last month a report by the King’s Fund suggested that PCTs and local authorities could help to free up 7,000 emergency hospital beds if they worked more closely together, better integrating housing, health and social care services for older people.

The research shows that areas with the lowest rates of emergency bed use are those that design and co-ordinate well blended services which are focused on the needs of older people.

This echoes messages from the recent care and support White Paper which emphasised the importance of joined up preventative services. The Department of Health called on hospitals, councils, housing providers and home improvement agencies to work more closely to save vital resources.

For the past six months, I’ve been involved in a project that has aimed to boost integration of this kind. The initial results show just how powerful combined health and social care work can be.

In 2011 staff in the local health and social care economy identified an increasingly urgent need to reduce the number of days that medically fit patients were unnecessarily occupying acute beds at Whiston Hospital, part of St Helens and Knowsley Teaching Hospitals NHS Trust.

These patients often stayed in hospital because their property needed adaptations, their preferred care home couldn’t accommodate them or they were waiting for domiciliary care to be arranged.

During the winter of 2010-11 there were, on average, 40 stable patients occupying acute beds. This figure needed to be cut to 10 by winter 2011-12 - the equivalent of freeing up a 30-bed ward.

A multi-agency approach was needed and my department – St Helens Council Adult Social Care and Health project-managed the process. The local acute trust, the newly-formed St Helens Clinical Commissioning Group, the local NHS community healthcare provider and the neighbouring Knowsley and Halton local authorities were all closely involved.

Our aim wasn’t just to manage anticipated winter pressures in the health and social care system. Instead we wanted to develop a longer term model of integrated health and social care services, breaking down some of the barriers which often hinder good performance and positive outcomes for service users and carers.

To achieve this, the Integrated Discharge Team was bolstered by experienced social workers, occupational therapists and home improvement agency staff. In addition the number of intermediate care beds was increased in the community and transitional beds were procured. 

St Helens Home Improvement Agency (HIA) played an important role in the project, providing a team of two people to carry out essential property improvements within just two days of a patient being assessed.

The HIA team responded to patient needs quickly and effectively - installing grab rails, ramps, telecare and repairing heating systems. The HIA also educated the hospital discharge team on the importance of the home environment in facilitating safe and timely hospital discharges and a ‘Hospital to Home’ pack was produced to boost awareness.   

The results have been significant. Between December 2011 and March 2012 the number of medically fit people occupying acute beds reduced from 40 to an average of five per week - surpassing project targets by 100%.

There has been a 17 per cent drop in delayed discharges and a five-day reduction in the average length of time between hospital staff alerting the discharge team that a person may need community care - and actual discharge. The volume of assessments undertaken by the enhanced discharge team has also increased by 140% – from 59 in December 2011 to 143 in February 2012.

As the King’s Fund report suggests, close working and better communication between community, primary and acute service providers is central to finding alternatives to emergency hospital admissions. Our project is proof that an integrated approach can speed up discharge and reduce the length of hospital stays.

Importantly, though, joined up health and social care services can prevent hospital admissions in the first place and reduce the likelihood of re-admissions. With the population aging rapidly, councils must invest further in preventative models in order to create substantial savings in the longer term.

Mike Wyatt, director of adult social care and health at St Helens MBC

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