COMMUNITY CARE HOME CARE


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ne of the many tough lessons that can be learned from the Mid-Staffs debacle is that hospitals are overstretched and desperately in need of help. Services that can relieve some of that strain, can improve the care experience and outcomes for patients, while saving the


NHS much-needed funds. Indeed, the Hackett Report concluded that the NHS could save £1.7bn a year through greater use of home healthcare. It would seem that healthcare providers of all types have reached consensus with the private sector equally willing to support the notion. Bupa has labelled home healthcare a ‘win-win’, saying it helps the NHS save money and patients prefer it as they’re able to get on with their lives. The report said that commissioning agencies have a vital role to play in the strategic development of homecare medicine and the management of authorised providers to deliver effective homecare medicine services to patients. It states that they can enhance their role by working with acute providers to deliver a strategy and annual plan for homecare, involvement in collaborative procurement and develop incentives between the authorised provider and themselves to maximise value for money. It also provided strategic advice for commissioners around home healthcare, advising commissioners to consider how homecare fits with their chronic disease or stable disease models and other strategic implementation. Adding that the ‘whole life cycle’ cost of introducing a homecare service should be considered, not only the savings from VAT but the impact on direct hospital incomes and restructuring, which could have substantial savings to the health economy.


Hackett recommends that commissioners develop a three-year strategy around non-tariff and tariff therapies, and says they should ensure that as part of national or regional procurement there are clear up-front agreements on the share of financial savings with providers. He also says commissioners need to participate in the procurement of homecare provision with the authorised organisation. This is all very well in a report, but implementing it in the real world can be a rather different matter. So, more than a year after the report was published, what have CCGs been doing to promote home healthcare in their areas? Corby CCG is one group that decided to tackle the issue last


an intermediate care team, local community facilities and beds to look after them. It showed a substantial reduction in both A&E attendances and subsequent admissions.” The service now runs eight to eight, seven days a week and links to the out-of-hours service at weekends. “Usually if GPs go and visit patients in the middle of the day, by the time the ambulance picks them up, it’s two or three o’clock and then by the time they’re in hospital it’s four or five,” says Dr Wilczynski, “so the ability to turn them around in casualty and discharge them back to a community service is lost because those services have ceased to function or accept new referrals after about 5 or 6[pm]. It’s about keeping people at home, when it’s safe to do so with additional community support.”


Another CCG working hard to keep patients in the comfort of their own homes with community care is South Reading. An audit of emergency admissions to local hospitals in Berkshire showed that as many as a quarter could be avoided. To find ways for more patients to be treated at home, South Reading CCG linked up with other CCGs in Berkshire, along with councils, ambulance services, hospitals and community trusts to find out what could be done. As a result, a new programme is focusing on providing care in the community for older patients as an alternative to hospital. A new rapid response and re-enablement service helps GPs and community matrons to easily find support from physiotherapists, occupational therapists and social care professionals for patients who might otherwise have gone into hospital. Each of Berkshire’s CCGs (Newbury, South Reading, North


r“Patients are seeing the eal benefit of additional


support, enabling them to stay in their own homes”


West Reading and Wokingham) have appointed community geriatricians to advise GPs and community teams how best to manage patients who have a number of different illnesses and conditions. All of this has been made possible by continuous communication with all of the county’s GPs, streamlined processes and better information for hospital clinicians through a smartphone app that helps them access community services such as the night-sitting service that provides emergency night-time support for adults in their own homes. “We put in a lot of hard work at the outset to bring together health and social


year, during a problematic winter period. Dr Peter Wilczynski, clinical lead, explains: “We were faced by problems with casualty breaching its four- and 12-hour targets, and ambulances stacking up outside hospitals, because people were being taken that didn’t need to be there.” The group set up a dedicated home visiting service staffed by local GPs, operating between one o’clock in the afternoon and half past six, Monday to Friday. It’s particularly the housebound frail and elderly people that need a home visit. Dr Wilczynski recalls: “If you waited until the end of your surgery to see these people, by 6.30-7[pm] when you actually get there, you would have very few options open to you, other than to admit. If you can see them at one or two o’clock, you’ve got time to organise social care,


services and we have been seeing big financial savings in year two that have enabled us to invest in other services,” says Dr Elizabeth Johnston, clinical lead, South Reading CCG. “This has really paid off for patients who are seeing the real benefit of additional support which is enabling them to stay in their own homes and recover from illness.” As well as saving money, the approach seems to be popular


with patients. “In my opinion I have recovered much quicker through being in my very familiar surroundings, knowing the position of everything and how far I have to walk before I can sit down,” says David Haylock, a hip replacement patient who has benefited from the scheme. With a range of inspiring methods on display from the CCGs that have attempted it so far, there are plenty of ideas to seize upon, it’s just a matter of taking the plunge.


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