Healthcare delivery
offered for a period of up to six weeks. It is also possible that reablement will last for longer if full independence can be achieved with further support.5
Challenge 4 – Building credibility and scale GPs and ambulance personnel need to believe in the project before they make referrals, and do not immediately send patients to hospital. Likewise, hospital clinicians should know about the scheme and its outcomes for patient when they are making discharge arrangements. This indicates that data and evidence are important to the new schemes to establish the right level of credibility with referrers and that there are incentives for expansion to build on the trust, so that the volume of referrals increases. Monitor reports4
that in order for all this to
occur, it is vital that there is a general local awareness and that staff are actively promoting referrals. They must have 24 hour opening hours, so that referrals can occur when patients need the service. It is equally important that the schemes have broad admission criteria – an example from the Abingdon Community Hospital shows that it is more effective to frame the admission criteria as taking all patients apart from ‘x’, ’rather than ‘taking patients with ‘y‘. It states that if the admission criteria are too fixed or specific, then ambulances and GPs will use A&E, rather than the alternative. One of the key suggestions is to build an element of staff rotation from the acute sector, so as to build skills and first-hand knowledge of the schemes. This cross fertilisation has much
merit and may help in the overall recruitment of skilled staff.
A further suggestion, which enables the
developments to be as flexible as possible, is to allow them to take patients from across Clinical Commissioning Group borders (CCG), so that they are as flexible as possible, enabling them to be as successful as possible. The borders of the CCG should not be a barrier to the schemes.
Challenge 5 – Collecting data to evaluate effectiveness and setting payment incentives Schemes or pilots are often set up to run for a short period, with no particular suggestion to collect detailed data or to negotiate anything more than short-term funding. Payment incentives are essential, according to Monitor, to ensure that the developments rapidly reach efficient scale and operate as efficiently and effectively as they can for maximum impact across the health economy. It is a fact that there is very little data on community-based schemes, and this makes it difficult to evaluate the financial gain comparing it to before the pilots were set up. The data specifically needs to record the type of patients treated and the effect of the treatments provided, as well as gains and losses across the whole health economy, both clinical and financial.
Conclusion Rebalancing the whole of health infrastructure to move care closer to home is a long-term project which will have potentially many beneficiaries, as well as delivering possible
cost savings across the board. However, the latter must not be the driver of plans to set up local schemes. Having lost so many community facilities in local community-based hospitals over the last twenty years, there is a dearth of appropriate places for these plans to be based. It will require a great deal of detailed planning by the ICBs and to be driven skilfully by clinical leads to be effective. Clinically, it is the right direction of travel, and this author hopes for its overall success.
References 1. Baird B, Fenney D, Jefferies D, Brooks A, 2024 King’s Fund, Making care closer to home a reality. Accessed at
https://www.kingsfund.
org.uk/insight-and-analysis/reports/making- care-closer-home-reality
2. D’Arzi A, 2024 Independent investigation of the NHS in England. Accessed at: https://www.
gov.uk/government/publications/independent- investigation-of-the-nhs-in-england
3. NHS mandate 2025,
https://www.gov.uk/ government/publications/road-to-recovery- the-governments-2025-mandate-to-nhs- england/road-to-recovery-the-governments- 2025-mandate-to-nhs-england
4. Monitor – not dated. Moving care closer to home: implementation considerations. Accessed at:
https://assets.publishing.service.
gov.uk/media/5a8006dee5274a2e8ab4dbfb/ Moving_healthcare_closer_to_home_ implementation.pdf
5. Reablement. Accessed at https://www.
highspeedtraining.co.uk/hub/what-is- reablement/
No it must read ‘Winner Healthcare Infection Socie Innovation Dragons Den 2024-2025’
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www.clinicalservicesjournal.com 17
WINNER HealthCare
Infection Society INNOVATION
DRAGONS DEN 2024 - 2025
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