Teams from the NHS, social care and voluntary sector are working together to come up with innovative ways to improve care for people and reduce pressures on health and care services.
One example of a small scheme but with big potential has been developed by Lancashire County Council, NHS England and University Hospitals of Morecambe Bay NHS Trust, and has so far helped 40 patients and saved more than 100 nights in hospital.
The Hospital Discharge Home Recovery Scheme helps people across Lancashire return home from hospital in a safe and timely way and is working so well it is now being extended, with other regions looking at it with interest.
It works by giving family and friends practical and financial support to enable informal care to be provided for up to six weeks, with input from the local carers service. It can include a grant through which one-off items or services can be purchased to help people recuperate safely home.
Over an initial six-month period it has helped 26 people to return home more quickly and has saved a total of 67 hospital bed nights.
The scheme is incrementally being extended across Lancashire and is aimed at people who need some support to recover or recuperate, but who otherwise would have been delayed in hospital until a package of care could be arranged.
A further 14 people have been supported through the scheme, 9 to return home more quickly saving a further 41 hospital bed nights, and 5 to remain in their home safely. The scheme has also just been extended to include discharges from Acute Mental Health wards.
As well as helping people return home to continue their recovery, the scheme also benefits the flow of patients in hospital and limits the need for formal care at a time when both areas are under increasing pressures due to the pandemic.
Although the numbers are small so far, local partners believe the potential of the scheme is significant, not just for the release of bed nights in the hospitals, but importantly in better and more personalised outcomes for people.
Sharon Doyle, the discharge lead at the Royal Lancaster Infirmary, said: “The Morecambe Bay pilot came along at an opportune time as this was a difficult period for both the community and acute services as a result of the pandemic.
“It gave us the ability to offer support to people who need it the most, without having to apply through various pathways which was often time consuming.
“The team were seeing high levels of people requiring support for simple things, such as an equipment to store medications such as insulin or installing WiFi to support remote tele-health monitoring. They had no means to obtain these themselves and no family to support.
“The scheme reduces the hospital stay and makes it possible for people to remain in their own homes. However, the biggest thing was it gave people a feeling of worth that someone cared enough to do this for them.
“The scheme has made a massive difference. We’re able to do the right thing, at the right time and facilitate home as the discharge destination – Home First always”.
Kirsty Williamson, a social worker for Lancashire County Council, said: “I was able to utilise the discretionary fund to help one of my service users who had recently been discharged stay at home.
“Without this funding, I feel my service user would have ultimately returned to hospital.”
Lancashire County Council is working closely with three other local authorities to extend the scheme across the Lancashire & South Cumbria Integrated Care System.