The success of the community assessment, rehabilitation and treatment scheme (CARATS) in Rotherham has shown how plans aimed at reducing unnecessary admissions and increasing early discharge can help in the long term, as well as relieving pressure at critical times.
Winter pressures money was used to set up CARATS in late 1997, but it has run continuously since then. It has four key components:
A fast-response service to provide short-term social and healthcare support (usually up to 72 hours) in people's homes.
A nine-bed residential rehabilitation unit in a social services-run home.This aims to get patients back to their own homes, if possible, but some patients end up transferring to long-term care or hospital.
A day rehabilitation unit, jointly funded by social services and health services.
Nurse-led beds purchased from local nursing homes. These are used for a maximum of two weeks and can be accessed by the fast-response team.
Pauline Riley, primary care clinical manager at Rotherham Priority Health trust, has managed the CARATS project since the start. She says co-operative working is key to the scheme, enabling, for example, the fast-response team to call in social care or emergency equipment loans to prevent admissions to hospital.
The process can start as soon as someone is admitted to hospital. Medical staff can identify them as a likely unnecessary admission and call in the fast-response team, which will carry out an assessment of the care needed within a couple of hours. Patients can also be referred before they have been admitted - by GPs, district nurses and other therapists - and can be assessed quickly in their own homes.
Generally, patients suitable for CARATS care will need nursing and therapist support - and quite possibly social care - but won't need acute medical treatment.
So does it work? Evaluations of the scheme found that the fast-response service 'saved'an average of 4.2 to 7.1 days stay per patient in its first 15 months - equivalent to between four and seven beds freed for other patients to use.
The evaluation found that residential rehabilitation was also very cost-effective, saving money for both the NHS and social services, and that the cost of using nursing home places compared favourably with inpatient costs.
Despite the success of CARATS, it has had to overcome some reluctance to refer to it. A few GPs were initially worried it would add to their workload, and some hospital-based staff are reluctant to refer. The York evaluation suggested the fact that patients were means-tested for the rehabilitation unit might be behind this reluctance.
'It is a change and people often feel very threatened by change. We have been able to reassure existing staff that we are not there to take over - we are there to complement them, 'says Mrs Riley.