In May 2017 two managers working in different parts of public services – Health and Local Government debated the following problem:
“How can the local District Councils in Norfolk help the major acute hospital – the Norfolk & Norwich University Hospitals Foundation Trust (NNUH) – to reduce the number of patients waiting a long time to be discharged due to non-medical housing and lifestyle problems?”
A meeting was held between District Council and NNUH operational staff which aimed to help each organisation understand the needs and capabilities of the other, and to seek ways to help patients with non-clinical problems during their recovery phase in hospital.
The following project was agreed:
• Resource a District Council Officer to work 5 days a week at the NNUH within the acute hospital’s integrated discharge team for a 12 week pilot.
• Implement a set of initial triage questions to help identify patients who might benefit from District Council services and advice. These questions are checked at the point of admission by the ward based Discharge Co-ordinators (DisCos) as a general screening tool.
• Seek formal consent from the patients, where a potential need is identified, for the District Council Officer to attend the ward. When the patient is well enough, a bespoke action plan is discussed and agreed for housing and other lifestyle needs on discharge from the hospital.
The aim of the project was to seek a new way to support patients at the time they are most vulnerable; and subsequently to reduce the time they spend in hospital when they have no clinical need to occupy a hospital bed.
• Introducing and explaining the new service to NNUH clinical staff and encouraging uptake.
• Finding space and physically setting up the work environment for the District Council staff (including separate IT services).
• Overcoming the politics of funding to deliver the pilot. Council staff were released from their duties on a rota basis to cover the new role in the hospital. The pilot was then extended with NHS “Winter pressures” funding.
• Finding a way to evaluate the impact of a completely new service. No benchmarks.
Results of the extended pilot
• 184 patients, 290 interventions plus the provision of general information and advice to patients and acute hospital staff.
• Age range: 31 to 96. Average age: 71 years old
• 725 bed days saved over 29-week extended pilot (average daily saving of 5 bed days). Improved efficiency in the System of around £180,000.
• The projected annual improved efficiency with a 5-day a week service: £325,000
• Average length of stay for the cohort of patients requiring the service reduced by 36% (from an average of 11 days to 7 days from the point of being medically fit)
The service has now been jointly funded for a minimum of 12 months with contributions from Health (the local CCGs), Social Care (Norfolk County Council) and Local Government (the Norfolk District Councils).