A third sector voluntary scheme helps service users return home from hospital sooner and resume their daily activities - and it even helps to avoid admissions in the first place, says Emma Dent.

An evaluation of the British Red Cross’s Care in the Home schemes is the only voluntary sector case study to be included in the National Institute for Health and Clinical Excellence’s evidence base or the quality, innovation, productivity and prevention programme.

The charity has been running the schemes for over 20 years and is commissioned to provide them by nearly 30 primary care trusts, acute trusts, local authorities and, most recently, a commissioning consortium.

Care in the home under the schemes has been shown to prevent ambulance call outs and resulting two day hospital admissions in 75 per cent of cases, and reduce length of stay.

The schemes are available in four broad categories: emergency admissions avoidance, accident and emergency assisted discharge, supported discharge and an intermediate care programme.

Emergency admissions avoidance works with service users who are often people with a long term condition and need support to be able to stay in their own home. A rapid response home visit provides companionship and reassurance, help with accessing or navigating other care services, and light housework.

Volunteers on the A&E discharge programme transport a person home from hospital, settle them in, make a risk assessment, tell neighbours and relatives of the service user’s return, check on pets and help prepare a meal. A further home visit is made the next day.

On the supported discharge programme, patients’ self-confidence is built up by helping them to manage themselves. Volunteers make home visits and telephone calls to provide conversation, companionship and practical help.

Prompt discharge

Red Cross staff provide care on the intermediate care programme, which aims to enable patients with complex care needs to be discharged promptly. The service is provided from 8am-8pm seven days a week and can include emotional support to help the service user gain confidence, help with housework and shopping and administering medication.

There is an example of intermediate care in Torfaen, south Wales. The service, established in April 2006, provides tailored care to people who live alone. Originally designed to help after discharge from hospital it now works to prevent admissions and receives around 400 referrals a year.

“We work with the service user to ask what they would like us to achieve for them,” says British Red Cross head of health and social care Liz Urben. “Sometimes they are socially isolated or need a bit more support than family members are able to provide.

“This could mean helping with shopping, getting prescriptions reviewed, applying for benefits or looking at nutrition. Commissioners appreciate our flexibility to be able to respond to these requests and service users appreciate being able to keep their independence.”

Staff work closely with district nurses and interventions are time limited to up to around six weeks. In 80 per cent of cases, medication reviews and support are part of the care provided.

A crisis intervention service in Nottingham is commissioned by the Nottingham North and East practice based commissioning consortium and has been running since the summer of 2009.

It aims to respond within an hour to referrals of service users who might otherwise be admitted to hospital, with staff visiting up to four times a day for up to four weeks.

“One recent client was an elderly gentleman with multiple health needs who lived alone and didn’t like ‘official’ visitors. We were able to visit as our service is not from the statutory sector and visited daily, looking at issues such as what this gentleman was eating and what activities made him get out of breath,” says Ms Urben.

 

Top tips

  • Identify gaps in existing services
  • Have clear agreement on outcomes, such as what you are trying to achieve for service users
  • The voluntary sector can have flexibility the statutory sector may struggle to offer
  • Having staff and volunteers who do not work for the NHS or social care can be an aid when a prospective service user is suspicious of the statutory sector
  • When developing a programme always tailor it to individuals

Potential savings

Emergency admission avoidance - Based on 360 referrals a year

Commissioner savings£286,200
Red Cross programme£53,000
Net commissioner savings£233,200

 

Accident and emergency assisted discharge - based on 360 referrals a year

Commissioner savings£369,000
Red Cross programme£38,000
Net commissioner savings£331,200

 

Supported discharge - based on evidence from ward staff on estimated saved bed days

Commissioner savings£185,000
Red Cross programme£63,000
Net commissioner savings£122,000

 

Intermediate care - based on 500 referrals a year

Commissioner savings£600,000
Red Cross programme£190,000
Net commissioner savings£410,000

 

Nottingham: Service users analysis

Equal opportunity monitoring: age and gender of service users July 2009 - June 2010

AgeNumber of users
Female316 (total)
18-498
50-6415
65-6910
70-7964
80-89157
90-9961
100-plus1


AgeNumber of users
Male165 (total)
18-495
50-647
65-699
70-7935
80-8993
90-9915
100-plus1

 

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