Tag Archives: patients

‘I would worry if my family was taken to hospital at weekends’: NHS boss admits he is concerned about staffing levels

The head of England’s Accident and Emergency departments has said he would ‘worry’ if his loved ones were taken to hospital at the weekends because there aren’t enough consultants.

Keith Willett, NHS England director of acute episodes of care, said that there was a ‘vulnerability’ in hospitals over the weekend.

Writing in an article for the NHS England website, he said: ‘All consultants recognise there is a vulnerability in hospitals over the weekend and I would challenge any consultant not to have a degree of anxiety if one of their own relatives was admitted to hospital at a weekend knowing the amount of current senior involvement there is.’

He said patients were ‘taking up hospital beds’ at the weekends and ‘treading water’ with no treatment or diagnosis.

He drew on his own experience as an orthopaedic trauma surgeon in Oxford 20 years ago as proof that keeping hospitals running at the weekend can actually save the NHS money.
He said routine surgery should be scheduled on Saturday and Sunday. He said consultants could be present to carry out routine operations when they were not dealing with emergencies, the Sunday Times reports.

He said: ‘We also showed in Oxford in 1994 how a seven day service could be highly efficient and cost effective. We reduced admissions and shortened length of stay– and we did it in a hospital that wasn’t really otherwise offering full seven day services.

‘We found that we were able to close down the number of beds – in fact it was reduced by 25 per cent – and that meant we released nursing costs, with that money going into the extra physiotherapy support we needed at weekends.

He added: ‘In terms of cost efficiencies in designing seven-day services, I believe the planned services must be looked at too – particularly for those specialties with lower demand of emergency work which alone wouldn’t justify senior doctor presence.

It comes after NHS England medical director for London Dr Andy Mitchell said hospitals in the city were occasionally ‘unsafe’ because medical staff were spread too thinly.

He warned that hospitals in the capital were ‘at breaking point’ and admitted senior managers are constantly ‘trying to patch up’.

Dr Mitchell, the medical director for NHS England in London said: ‘At times, throughout the week, even throughout the day, services aren’t safe.

‘I feel anxious sometimes about saying it is unsafe, because I, of course, have got a responsibility to change it and improve it, but we are trying to patch up all the time.

‘What we cannot do is carry on with the idea that all hospitals provide a whole range of services.

‘That is completely unsustainable and would become, frankly, unsafe, and is becoming unsafe in many areas.

‘The public doesn’t fully understand, isn’t really sufficiently aware, that many places don’t meet acceptable standards of care.’

Last week a report by the health watchdog Monitor warned that the NHS would be £30 billion in the red every year unless it made crucial changes to the way hospitals and other services run.

Source Mail Online

Don’t be nasty to fat people: NICE tells doctors to show respect to obese patients

Doctors should not blame patients for being fat, according to new NHS guidance.

It urges GPs to be more sensitive when dealing with obese patients, using a ‘respectful’ and non-judgmental tone.

The approach is designed to minimise harm, according to the National Institute for Health and Care Excellence.

With Britain in the grip of an obesity epidemic costing the NHS £5billion a year, NICE calls on doctors, GPs and other health workers, as well as those who run lifestyle weight-loss programmes, to monitor their tone and not add to the stigma of being fat.
Only people with a body mass index (BMI) under 35 – the marker at which people are considered morbidly obese – should have their waist measured. Surgeries, meanwhile, should be adapted to provide out-size equipment for larger patients.

Last year it emerged that several NHS Trusts are refusing to give certain treatments to fat patients unless they lose weight.

The national institute for health and care excellence is urging gps to be more sensitive when dealing with obese patients, using a ¿respectful¿ and non-judgmental tone

Patients have been denied procedures such as hip and knee replacements and IVF, unless they agree to make radical changes to their lifestyle

The NICE guidance also provides instructions for Public Health England, which is responsible for health campaigns.

It says it should ‘be aware of the effort needed to lose weight and avoid further weight gain and the stigma adults who are overweight or obese may feel or experience’.

It adds: ‘Ensure the tone and content of all communications or dialogue is respectful and non-blaming. The terminology used to describe the person’s condition should respect individual preferences.’

GPs and those running weight management programmes for the NHS should ensure patients have a realistic view of what to expect when losing weight, telling them there is no ‘magic bullet’.

Instead, obese patients should be advised of the importance of making gradual, long-term changes to their eating habits and physical activity and how much weight they might realistically expect to lose.

The latest draft guidance is being issued for consultation and will be finalised next May. Tam Fry, of the National Obesity Forum, said patients were often in denial and GPs should be sensitive – to start off with.

He said: ‘One of the big problems we have is that primary care – GPs in particular – have no real training about how to raise weight issues with patients.

‘The abrupt style that many have taken so far have only made matters worse.

‘NICE is correct to say they should be moderate in their tone. But once they’ve got the tone right and the confidence of the patient, they should really think about tough love.

‘It’s essential that patients realise that the consequences of putting on weight are very serious.’

Professor Mike Kelly, director of the centre for public health at NICE, said: ‘Being overweight or obese can have serious consequences for an individual’s health, not only physically with increased risk of high blood pressure and type 2 diabetes, but it can also affect their mental health as a result of stigma and bullying or discrimination.

‘Levels of obesity in England are rising, with a little over a quarter of adults classified as obese and a further 41 per cent of men and 33 per cent of women overweight. This is a huge proportion of our population.

‘This new draft guidance focuses on the provision of effective lifestyle weight management services and makes a number of recommendations to ensure that the providers of programmes, whether from the private, public, or voluntary sector, follow good, evidence-based practice.’

A British Heart Foundation spokesman added: ‘Taking control of your weight can be a daunting task because changing the habits of a lifetime is often a challenge. That’s why it’s a good idea to get support throughout your weight-loss journey.’

Source Mail Online

NHS and care services patients told to fight for their rights

Healthwatch England, which heads up a network of 152 local patient bodies, urged the public to become “savvy consumers” rather than “grateful patients”.

To help, the watchdog set out eight core rights for patients.

It comes after polling indicated half of people who experienced poor care did not report it.

The survey of more than 2,000 people found one in five had experienced poor care – but of those, 54% had not complained.

Healthwatch England was created under the shake-up of the NHS earlier this year.

It is envisaged that the organisation will act as a patients’ champion, carrying out its own investigations and speaking out about issues of concern.

This is its first report to Parliament, and it has used it to highlight the deference shown by patients.

‘Savvy consumers’

Healthwatch England chairwoman Anna Bradley said: “We all need to stop acting like grateful patients and care users and start to see ourselves as savvy consumers, insisting on our right to safe, dignified and high quality care.”

To help achieve that, the organisation has set out its list of rights:

  • the right to essential services
  • the right to access
  • the right to a safe, dignified and quality service
  • the right to information and education
  • the right to choose
  • the right to be listened to
  • the right to be involved
  • the right to live in a healthy environment

Ms Bradley added: “Consumer rights are second nature to us on the High Street, but by thinking this way we can ensure people have a voice at the heart of the health and social care system.”

Care and Support Minister Norman Lamb said he welcomed the initiative.

“Without real and meaningful input from patients, it is impossible for health and care services to improve and move forward in the future,” he added.

Source BBC News

Roger Kline: ‘Student nurses must be able to speak out freely’

Students should be in no doubt that the Nursing and Midwifery Council expects them to raise concerns, says Roger Kline

A few weeks ago a student nurse was publicly praised by a Judge who sentenced three healthcare workers for ill-treating and neglecting older patients at Whipps Cross Hospital (http://tinyurl.com/student-nurse-Whipps-Cross).

She is not alone. Research evidence shows that it is frequently new staff who question and challenge poor or unsafe care that existing staff think is acceptable.

Student nurses and student midwives I speak to often question practices that existing staff have taken for granted and academic institutions all have systems in place to support students who do.

Nevertheless we still have a serious problem. The Francis inquiry into Mid Staffordshire Foundation Trust found there were no records of student nurses raising any concerns about shoddy practice there. I have heard of trusts warning universities whose students raise too many concerns that they might lose valuable training contracts.

There is a glaring legal gap too. None of the ministerial speeches about the need for student nurses to have the right values and speak out mention that student nurses and midwives are not yet covered by the Public Interest Disclosure Act if they do raise concerns and are then victimised.

Despite this, students should be in no doubt that the Nursing and Midwifery Council expects them to raise concerns. The NMC guidance Raising Concerns: Guidance for Nurses and Midwives reminds students that the NMC code applies to them and that:

“You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk (paragraph 32).

You must inform someone in authority if you experience problems that prevent you working within this code or other nationally agreed standards (paragraph 33).

You must report your concerns in writing if problems in the environment of care are putting people at risk (paragraph 34).

The NMC guide explains that “speaking up on behalf of people in your care and clients is an everyday part of your role. Just as raising genuine concerns represents good practice, ‘doing nothing’ and failing to report concerns is unacceptable”.

All universities follow NMC advice that if you do have a concern you should:

“8.1 Inform your mentor, tutor or lecturer immediately if you believe that you, a colleague or anyone else may be putting someone at risk of harm.

8.2 Seek help immediately from an appropriately qualified professional if someone for whom you are providing care has suffered harm for any reason.

8.3 Seek help from your mentor, tutor or lecturer if people indicate that they are unhappy about their care or treatment.”

The NMC guidance explains

“You do not need to have all the facts to prove your concern but you must have a reasonable belief that wrongdoing is either happening now, took place in the past, or is likely to happen in the future.”

That’s the theory. However, the 2013 Nursing Times student nurses survey found that only 7% of student nurses felt there were no barriers to raising a concern on placement, while 24% of those who did raise a concern felt it had negative consequences for them.

After the shock of Mid Staffordshire some employers are much clearer about needing to encourage student nurses to speak out and to protect them, but that is far from universal. Students are understandably fearful of sacrificing their careers at such an early stage.

Despite that many do speak out. The Speak Out Safely campaign wants a safe environment for all student nurses to be a priority, setting a standard for the rest of their careers. It is the job of all of us – universities, NHS trusts, trade unions and the NMC – to make sure student nurses can indeed safely raise concerns. That’s why Patients First is supporting the Nursing Times campaign.

Source Nursing Times

Cameron promises more flexible GP hours

David Cameron says he wants to offer more patients the chance to visit a GP in the evening or at weekends.

Under a scheme to be piloted in nine areas of England, surgeries will be able to bid for funding to open from 8am to 8pm seven days a week.

The prime minister said the £50m project would mean doctors “fit in with work and family life”.

Mr Cameron has also denied his plan for a budget surplus in the next Parliament will lead to further spending cuts.

The prime minister said the 2008 banking crisis had brought the UK economy “to the brink” and it would be irresponsible not to put money aside for a “rainy day” when the economy improved.

In other developments on the penultimate day of the Conservative Party’s annual conference in Manchester:

  • Mr Cameron said he would welcome MBoris Johnson back to Parliament while the Mayor of London has urged the Tories to go “flat out” for victory in 2015.
  • The proposed marriage tax break is “very much a first step” to recognising the institution in the tax system, Mr Cameron said
  • The prime minister said he “understood” Ed Miliband’s reaction to an article in the Daily Mail about his father and newspapers and politicians should show “judgement” about press limits
  • Work and Pensions Secretary Iain Duncan Smith outlined plans to force the jobless to attend 9-5 classes at job centres
  • Culture Secretary Maria Miller says a new £10m fund will be set up to mark UK historic events, such as forthcoming anniversaries of the Magna Carta and the Battle of Waterloo

Manchester is already piloting an extended-hours scheme for GPs, with family doctors grouping together to offer extra care, in what is being billed as an attempt to prevent “unnecessary” visits to hospital A&E wards.

‘Skype appointments’

The wider scheme will see practices applying for a share of a £50m “Challenge Fund”, with surgeries becoming “pioneers” in each of nine regions, starting in 2014/15.

The Labour government encouraged practices to open later in the evening and on weekends – offering them extra money if they did so.

Most GPs gave it a go. But the problem was that in many places there was just not the demand and so the funding was reduced and hours cut.

There are still plenty of surgeries that offer out-of-hours appointments, particularly in large urban areas.

But the truth is that the people who are most likely to make use of the service – those of working age – are the least likely to need a GP.

Whereas, the elderly and children who are the most frequent users tend not to have a problem attending appointments during regular hours.

Mr Cameron is also promising more “flexible access”, including email, Skype and telephone consultations for patients who prefer this to face-to-face contact.

He told the BBC: “Many hard working people find it difficult to take time off to get that GP appointment, so having these pilot schemes… is, I think, a very positive step forward.

“It also links to the problems we have seen in our accident and emergency departments because the number of people going to A&E departments is up by four million since the changes to the GP contract that Labour put in in 2004.

“What we need to do is enable the right people with the right ailments, as it were, to either go to a GP or to accident and emergency.”

’24/7 society’

Health Secretary Jeremy Hunt said: “We live in a 24/7 society, and we need GPs to find new ways of working so they can offer appointments at times that suit hard-working people.”

Jeremy Hunt: “We need to rediscover the ideal of family doctors”

The Royal College of GPs said doctors were keen to do more, but were already struggling with their workload.

“We now need the government to go much further and give general practice its fair share of the NHS budget so that GPs can deliver more care and better access to services for their patients in the community,” it said.

But Labour said an extended opening scheme introduced by the last government had been scrapped.

“Under the Tories, hundreds of GP surgeries are shutting their doors earlier,” said its health spokesman Andy Burnham.

“Patients are also finding it harder to get appointments, and turning to A&E instead, after he removed Labour’s guarantee of an appointment within 48 hours.”

In his speech to conference, Mr Hunt also pledged to legislate to give the Care Quality Commission statutory independence from government.

This would end “political meddling” and ensure the interests of patients were always put first, he said.

‘No splurge’

The Conservatives say they would continue the coalition’s policy of fiscal restraint throughout the next parliament – if they form the next government – with the aim of achieving a budget surplus.

Mr Cameron said this would require tough decisions for the next six or seven years but did not “necessarily mean” there would have to be more cuts on top of those announced up to 2016.

“What it definitely means once those years are over you cannot sort of plan another spending splurge. We are going to have to be responsible in our country for very many, many years into the future.”

The government was right to focus on containing spending, he added.

“I don’t think you tax your way to a strong recovery and we need to recognise that hard working people need more money in their pockets to spend as they choose.”

The prime minister also insisted that the government would find the money to freeze fuel duty until 2015, describing help for motorists as a “real priority”.

Source BBC News

Competition in NHS is harming efforts to improve patient care, says outgoing chief Sir David Nicholson

Private-sector style competition in the NHS is harming efforts to improve patient care, the health service’s top official has admitted, in a damning verdict on a key pillar of the government’s health reforms.

Sir David Nicholson, the outgoing chief executive of NHS England, said that hospitals were being held back from making changes that made “perfect sense from the point of view of patients” because they did not meet new rules on competition between healthcare providers.

Speaking at an event hosted by the Health Service Journal last week, Sir David spoke candidly about the rules, which have already stood in the way of mergers and service changes that NHS managers and clinicians said were urgently needed.

His comments were made under “Chatham House rules”, but he later gave special permission for them to reported.

“All of [the politicians who drew up the Health and Social Care Act] wanted competition as a tool to improve quality for patients,” he said. “That’s what they intended to happen, and we haven’t got that…”

“I’ve been somewhere [where] a trust has used competition law to protect themselves from having to stop doing cancer surgery, even though they don’t meet any of the guidelines [for the service],” he continued.

“Trusts have said to me they have organised, they have been through a consultation, they were centralising a particular service and have been stopped by competition law. And I’ve heard a federated group of general practices have been stopped from coming together because of the threat of competition law.

“All of these [proposed changes] make perfect sense from the point of view of quality for patients, yet that is what has happened.”

He said that the law may have to change and that the health secretary, Jeremy Hunt, would have to act “quite quickly” to enable “the big changes needed” – an apparent reference to plans to reform NHS services in reaction to major budget restrictions.

“I know the secretary of state would be prepared to take legislation back [to Parliament] if that’s what needs to happen,” he said.

The Department of Health said that proposed NHS mergers had been considered by the Office of Fair Trading (OFT) on only two occasions and that Mr Hunt was “absolutely clear that patient safety must always trump any competition concerns”.

“The Health Secretary has recently met with the OFT to seek assurances that the current system is working well for patients.  As a result, the OFT have committed to set out further guidance on the merger review process shortly,” the spokesperson said.

Sir David’s  criticisms were revealed as the Labour party pledged to make a “a clear break” with its former support for greater competition within the health service.

Speaking at the party’s conference, the shadow health secretary Andy Burnham launched a fierce attack on the Coalition’s record on the NHS, saying that competition lawyers had been allowed to “call the shots”, hospitals had been encouraged to charge patients for more services and private companies had been favoured over NHS providers.

“For too long, market forces have been allowed to advance into the NHS,” he said. “Well no more. We will make a clear break with that… I am not neutral about who provides NHS services, I will never see the NHS as an empty blue and white brand to be used by any qualified provider.”

A Labour source said that Mr Burnham wanted to restore the principle that NHS organisations would be the “preferred provider” of health care – a clear break from the last Labour government’s health policy.

“We let the market in too far,” the source said. “Andy recognised that as health secretary in the dying days of the last government… We’re going back to the idea that the NHS is its own preferred supplier.”

Mr Burnham outlined Labour’s plans to “complete [NHS founder Aneurin] Bevan’s vision” by integrating the health service with the social care sector – a plan which the Government has also made a priority in the face of growing crisis in elderly care provision.

Under a Labour government, elderly people and the disabled would have “one named contact” who would coordinate their care needs, Mr Burnham said.

Home carers would also be able to go with patients into hospital.

End of life care would be free, and terminally ill people would have greater rights to spend their last days at home, he added, in a pledge that was welcomed by Macmillan and Help the Hospices.

The health secretary Jeremy Hunt said that Labour were “playing catch-up on joining up services” and criticised Mr Burnham’s speech for failing to mention the Mid Staffordshire hospital scandal, which unfolded under the last Labour government. 

The Government announced a £3.8bn fund to begin the work of merging health and social care in July.
Source The Independent       

Hip fracture care ‘improving’

Care is improving for hip fracture patients, a national report has revealed.

Just 3.5% of patients are reported to develop pressure ulcers and 86% of patients receive surgery within 48 hours.

Before leaving hospital 94% of patients receive a falls assessment, according to a report released by the British Orthopaedic Association, the British Geriatrics Society and the Royal College of Physicians.

However, the length of time that a patient spends in hospital recovering from a hip operation varies widely across the UK.

The National Hip Fracture Database (NHFD) national report 2013 shows that on average patients were hospitalized for 33 days in Northern Ireland, 35 days in Wales and 22 days in England.

Dr Kevin Stewart, clinical director of the Clinical Effectiveness and Evaluation Unit at the RCP said the results are “very encouraging”.

He said: “Since hip fracture mainly affects frail older patients, it is especially important that we get it right in this vulnerable population.

“These results have been achieved despite the recent well-publicised pressure on emergency departments.”

Martyn Porter, president of the British Orthopaedic Association said: “We have seen improvements year-on-year because surgeons, doctors, nurses and therapists have all worked together, as a team, to enhance care of these patients.

“Rather than focus on a single target, the NHFD has tried to improve the whole pathway from hospital admission to ward care and surgery and then to rehabilitation and a quicker return home.”

Source Nursing in Practice

NHS patients ‘should not face constant moves’

The era of NHS patients being shunted around hospitals needs to end, an expert group says.

The Future Hospital Commission – set up by the Royal College of Physicians – said a radical revamp in structures was needed to bring care to the patient.

This was particularly true for frail people with complex needs, who often faced multiple moves once admitted to hospital, the report said.

It also recommended closer working with teams in the community.

The commission said this could involve doctors and nurses running clinics in the community and even visiting people in their own homes – as is already happening in a few places.

‘Bold and refreshing’

It also called for an end to the concept of hospitals discharging patients.

Sir Mike Rawlins: “Hospital shouldn’t stop at the walls of the building”

Instead, it argued that many of those seen in hospitals in the 21st Century needed ongoing care that did not end when they left hospital.

So the report recommended that planning for post-hospital care should happen as soon as someone is admitted.

Key to that will be a new hub that should be created in every hospital, called a clinical co-ordination centre, which would act as a central control room, helping to ensure information about patients is shared and their care planned properly.

Once in hospital, patients should not move beds unless their care demanded it, the report said.

That contrasts with the multiple moves many patients with complex conditions often find themselves facing as they are passed from specialism to specialism.

It said this would require a greater emphasis on general wards with specialists visiting patients rather than the other way round.

Case study

The longest Suzie Hughes, who has the auto-immune condition Lupus, has spent in hospital is 21 days.

During her stay, she was moved five times for non-clinical reasons.

“I would find myself being wheeled down the corridor with my flowers and chocolates. Nurses would be with me and I kept thinking, ‘What a waste of their time.’

“And each time I arrived on a new ward I had to explain my condition again. The information does not get passed on and it results in delays.”

The authors – drawn from across the NHS and social-care spectrum – also called for an end to the two-tier weekday and weekend service in many facilities.

They even said it would be preferable to work at 80% capacity across the seven days if extra resources were not available in the short-term.

Commission chairman Sir Michael Rawlins said it was about providing the care patients “deserved”.

Alzheimer’s Society chief executive Jeremy Hughes said too often hospitals were stressful places with patients being moved “from pillar to post”.

“We need nothing less than a revolution… in order to ensure our NHS is fit for the future,” he added.

Health Secretary Jeremy Hunt said the report was “bold and refreshing”.

“I agree completely that we must make services more patient-centred both inside and outside hospital.”

Shadow health secretary Andy Burnham said: “We must turn this system around and help support people where they want to be – at home with their family around them.”

Source BBC News

Millions of A&E patients ‘should just see their GP’ to avoid crippling emergency services

Millions of patients going for treatment in A&E should see their GP, a paramedic or chemist instead, says a senior NHS official.

Professor Keith Willett, who is leading a review of accident and emergency services, said up to 30 per cent of those who use casualty units would be better treated elsewhere.

But he admitted that 6.5million patients who needlessly queue at A&E are frustrated by long waits for a GP appointment or lack of access to out-of-hours care.
Choices: Patients should see their GP as oppose to clogging up A&E according to a senior NHS official

Choices: Patients should see their GP as oppose to clogging up A&E according to a senior NHS official

In an interview to be broadcast on Sky News today, Professor Willett says the NHS review will ‘start to address the demand’ by improving primary care, which he says clearly ‘did not make itself available’ to some patients.

England’s A&E departments were in crisis last winter. Waiting times were the worst for nine years, with more than 300,000 patients waiting four hours or more.
Professor Willett’s review, published this autumn, will state that all A&E units must always have a consultant available, and other senior doctors on duty, including elderly care specialists.


Foreign doctors working in Britain will face language tests if concerns are raised about their fitness to practise.

It follows a string of scandals in which overseas doctors have been blamed for poor care.

Currently only those from  outside the European Union are given strict language tests, but from next year the doctors’ regulator, the General Medical Council, will test all applicants.

In addition, those who are already working can be tested if they are going through disciplinary proceedings.

Health minister Dr Dan Poulter said: ‘Overseas doctors make a hugely valuable contribution to the NHS but it is clear that tougher checks are needed.’

Paramedics will be sent to treat more patients at home or by the roadside so they do not need hospital care, and patients will be told to ring the 111 helpline to see what care is appropriate.

‘We have to manage the situation and take away from emergency teams those patients who could be managed by other parts of the system,’ he said.

‘We know that 15 to 30 per cent of people who turn up to be treated at A&E could have been treated in general practice. We can look at the way primary care is available to people, by changing the way we deliver services.’

He asked the public to ‘understand the issues’ and consider calling for advice or contacting a GP or pharmacist.

But Dr Chaand Nagpaul, chairman of the British Medical Association’s GPs committee, said family surgeries are ‘bursting at the seams’, and the 111 number is not fit for purpose.

‘There is no doubt there are patients who attend A&E who would be better treated in a community setting, but NHS 111 has been fuelling the problem by inappropriately advising patients to go to hospital,’ he said.

‘That needs to be improved so people get quality advice from clinicians, not untrained people using a computer program.’
The Government has given the NHS an extra £500million over two years to find short-term solutions to the likely rise in demand for emergency care in the winter.

Source The Mail Online

From hospital to home: freeing up beds in the NHS

An initiative to support old and vulnerable patients during and after hospital discharge is also reducing readmission rates.
In most cases patients look forward to being discharged from hospital, but for some old and vulnerable people, who lack the support network provided by close family and friends, it can be a daunting prospect.

Normally they have to wait until the local authority makes arrangements for suitable community-based care. This often delays discharge even though patients are medically fit to leave hospital, and puts further strain on NHS bed availability, as well as adult social services.

The financial cost to the health service of such hold-ups has been put at £600,000 a day. There is also an emotional price to be paid by patients, many of whom are anxious to return to the familiar surroundings of their own home.

A chance meeting in 2012 between Trixie Bennett, chief executive of Adults Supporting Adults (ASA), which helps vulnerable people live in the community, and Chris Slavin, head of the Lincolnshire partnership foundation NHS trust (LPFT), led to a ground-breaking initiative.

“The trust was admitting patients to wards after what should have been a routine visit to accident and emergency simply because appropriate social care couldn’t be arranged in time to allow same day discharge,” Bennett explains. “This was already putting pressure on bed availability and the imminent onset of winter would, in all probability, make matters worse. Together, we tried to find practical solutions.”

A three-month pilot followed, entirely funded by the trust, which paired patients being discharged with two trained and supervised employees. The aim was to bring a number of agencies together to create a seamless and speedy “hospital to home” pathway.

Known as the prevention and avoidance community team (Pact) the service offers wide-ranging support to patients during and after hospital discharge. It is based on a close collaboration between the NHS and the third sector. In addition to ASA, which takes the lead co-ordinating role, Lace Housing Association arranges transport from the hospital to the patient’s home and Age UK Lincoln provides further or additional community-based social support such as domestic help and personal care. The scheme is entirely funded by LPFT but it is working in conjunction with United Lincolnshire hospitals NHS trust to provide the service.

Pact staff ensure clients can gain access to their home, and that they have enough food and groceries to tide them over. They make sure patients understand when and how to take medication, and are trained to identify any additional care needs. These are reported to the scheme coordinator so the appropriate community-based support can be arranged.

Team members also check for any obvious hazards that could lead to a fall – one of the most common causes of hospital admission among old people.

It is a seven-day-a-week service, running from 10am to 8pm, and is free to users. “Once a patient is medically fit we aim to get them home within two hours,” Bennett says. “Patients no longer sit in a hospital corridor waiting for transport, or are sent home alone in a taxi.”

The trial project, which started in January, is now a permanent service and has been extended to include Lincoln county hospital. There are plans to roll it out to hospitals in Boston and Grantham by this autumn.

To date, Pact has helped more than 300 patients make the transition from hospital to home, at an estimated saving to the NHS of £350 per person per night. The initiative is currently being evaluated by the University of Lincoln, and ASA says initial indications suggest that not only does it free up beds and save money, it also reduces readmission rates.

The scheme has certainly found favour with its clients. Irene Birkett, 83, recently returned home from hospital with Pact support: “I was so pleased and extremely grateful that they were there to help me – they were like angels.”

Bennett says the consortium has plans to broaden the initiative: “When the ambulance service is called out to see an elderly or vulnerable patient they are trained to deal with medical problems, but not the social care needs that may have triggered the initial call. If we can work with the NHS to prevent patients going to accident and emergency in the first place, by addressing these underlying issues at an early stage, then money will be saved and vulnerable people can retain their dignity and independence in the community rather than remain in hospital unnecessarily. That’s surely in everyone’s interest.”

Source The Guardian