Innovation Exchange

Integrated Care for Older People - Intermediate Care

Introduction

Key activities

Benefits and impacts

Learning

The health and social care system was struggling to accommodate increases in demand for older people’s services with resources under significant pressure, patients delayed in hospital and support rationed.

 

To address this issue, Social Work Services in partnership with NHSGCC (CHP and Acute) developed a model of intermediate care, including 72 hour discharge and step down care from hospital with the aim of:

 

  • promoting independence
  • enabling individuals to live at home as long as possible
  • reducing long-term care admissions

 

There have been significant performance improvements with reductions in delayed discharges, bed days lost and numbers of long term care home placements.

Theme: Health and Social Care

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Commencing in September 2014, the projects objectives were:

 

  • develop, test and implement an older people’s pathway that promotes independence with the aim of returning more people to their own home
  • reduce the number of people being placed in permanent care.
  • reduce the number of bed days lost by preventing unnecessary admission to hospital
  • facilitate timely hospital discharge.

 

The project’s objectives were developed in response to the high numbers of delayed discharges from hospital and unsustainable numbers of people being placed in long term care.

 

Throughout 2014-15 multiagency stakeholder events were hosted in order to develop the vision for the project, along with focus groups with care providers and consultation with service users and carers.

 

The project is multi-agency in both its planning and delivery. Over 20 staff from NHS, SWS and Cordia are represented in the wider project group with frontline staff from each service involved in the delivery of the project. Providers from the independent sector have been closely involved. Service users and their carers have been consulted and surveyed at various stages in the development of the project.

The success of implementing the 72 hour discharge target project is now being replicated across the city. The project also serves as a model for other local authorities and NHS Boards.

Analysis has shown that;

 

  • people have been identified appropriately for intermediate care,
  • identified earlier and discharged from hospital earlier
  • avoiding any unnecessary delays for the individuals
  • ensuring they receive every opportunity to enhance their rehabilitation journey and
  • increased numbers returning to their own home and
  • increased numbers moving on to residential care rather than nursing home care.

 

Performance data highlights that as at as at 5 January 2015, 63 people over 65 years (excluding Mental Health/Learning Disability/Adults With Incapacity), were delayed in acute hospital care with an average delay of 23 days.  By 4 Jan 2016, 17 patients were delayed in hospital for an average of 13 days. This represents a 73% reduction in the number of patients delayed.

 

In December 2014 the total acute bed days lost in Glasgow City was 2897, by December 2015 this has reduced to 1566, a 46% reduction in the number of bed days lost.

 

Areas of service weakness were highlighted through comparison of sector analysis across the three areas. Following detailed discussions action plans were put in place to address these. This analysis led to improved sharing of information, the reduction of a high number of performance reports into one comprehensive report and improved quality of information on individual service users via the use of an agreed risk assessment tool.

 

Better targeting of Social Work resources was also achieved by linking social workers to hospitals, with tighter management and named rehabilitation workers.

 

Evidence of cultural change and improved joint working practices is reflected in regular multi-disciplinary team meetings and positive staff feedback in evaluation forms from stakeholder events. A practitioners group has been established to ensure robust engagement with GPs and hospital consultants and is working well.

 

Recognising the impact of this work, the Scottish Government has often used Glasgow as an example of outstanding practice.  The most recent demonstration of this was in December 2015 when the Health Secretary Shona Robinson noting that “the figures in Glasgow are impressive. Over the last 12 months, there have been significant and sustained reductions in the number of people delayed in hospital because they are waiting for the appropriate care and support in the community.  Hospital bed days lost have halved, far fewer elderly patients in Glasgow are waiting in hospital and we’ve seen a big shift towards discharging people within three days.”

http://news.scotland.gov.uk/News/Dramatic-drop-in-delayed-discharge-2019.aspx

 

Introducing 72 hour discharge is an innovative approach compared to national targets. We implemented it first from 1 December 2014 in North East Sector, followed by North West and South from 1 February. This was well ahead of the Scottish Government target of 14 days from 1 April 2015.

 

A Scottish Care Accolade Award was awarded to one of the care providers for its innovative working as part in the intermediate care project.

An initial barrier identified in the project was the different cultures and professional language between GCC and NHS staff. This was resolved by adopting a whole system reform approach with staff jointly focusing on the individual patient rather than a service led approach.

 

Short-term bridging resources were required. Additional funding was used to support the expansion of “Step Down” intermediate beds and rehabilitation support along with funding of additional short term care home placements on the basis that this is more cost effective in the long term than having high numbers of delayed hospital discharges and long term care home placements. As a consequence, the numbers of delayed hospital discharges were reduced, along with waiting lists.

 

Previous models of intermediate care projects in 2012 and 2013, Assessment at Home and Step Up projects, served as pilots for the IC project. The evaluation of these projects directly fed into the development of the Intermediate Care project.

 

Feedback was obtained from service users and carers. Social Work Carers’ Teams surveyed a selection of service users and their carers (this feedback also sought areas for development for the project). Overall, over 80% of those surveyed would recommend Intermediate Care. Patients were also given information leaflets with comments section for return. Staff also provided qualitative data on the service.

 

Staff stakeholder events took place throughout 2015 with another planned for February/March 2016. Service user and carer engagement is being planned through local Public Partnership Forums as part of our ongoing work to continuously improve the services.

Contact details:

To find out more about this case study, please contact:

 

Afton Hill

Policy Support Officer, Strategic Policy and Planning

Glasgow City Council

0141 287 0411

Case study added to site: June 2016

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