Bed blocking in hospitals has tripled in the past five years and with winter around the corner pressures on our hospitals are set to grow.
In east and north Hertfordshire a new role has been introduced to help speed elderly care home residents from hospital, back to their care home once they are well enough to be discharged.
It is one of a package of initiatives in the Vanguard Care Homes programme - a partnership between Hertfordshire County Council, East and North Hertfordshire Clinical Commissioning Group and Hertfordshire Care Providers Association – working together across health and social care to help keep frail, elderly people at home rather than in hospital
Heather Mc Andrew is a nurse, employed by NHS Vanguard partner HCPA, at the Lister Hospital, Stevenage, to carry out assessments of elderly patients to see whether they are well enough to return to their care homes.
Heather took up her role at the Lister Hospital, Stevenage in August and already figures show a reduction of one/two days in hospital for elderly care home residents. Currently it is a five day service but plans are in hand to extend it to six days and widen the hospital base too.
Heather liaises with the patient, hospital discharge team and care home staff as well as carrying out a comprehensive patient assessment.
Sharon Davies, Chief Executive of the HCPA, a care home membership organisation said: “We hear all too often about delayed discharges and we are delighted to have been given the funding to enable us to place an Impartial Nurse Assessor at the hospital representing private care homes.
“The job involves a huge degree of trust because traditionally care homes have done their own assessments by sending a member of staff to visit the patient in hospital. Heather’s role relieves pressure on care home staff who often have to travel long distances to the Lister in order for residents to be discharged. Sometimes discharges are delayed because the home is facing other pressures on staff time.”
Twenty one care homes have so far used the new service and to date Heather has completed 91 assessments.
Julie Hutchins, Registered Manager at Honister care home, Hatfield, said first impressions of the new Impartial Assessor service were good.
“I thought the process and communication were very good and our resident’s discharge went well.
“I certainly think this process will benefit us at Honister, because most of my staff live locally and do not drive, so cannot pick this task up if I am not around. Lister Hospital is a 30 mile round trip from here, so there is sometimes a time issue on busy days. We look forward to working with Heather again in future.”
Heather added: “Working for the Hertfordshire Care providers Association means that care homes feel that I am on their side and won’t send patients to them who they don’t have the skills or capacity to support look after. Ultimately, I know that I’m helping patients to get the best, most appropriate care in the setting that offers them the best quality of life.”
Q How does the Trusted Assessor (TA) role work with self-funders being discharged from hospital into care homes?
A The TA role works in the same way for both self funders and those who are funded through social care. The referral routes are can be different as more self funder referrals come from the Integrated Discharge Team and directly form care homes.
Q How did you engage GPs working with the care homes?
A Engaging with GPs is not part of the IA role.
Q How is staff training delivered and how would this be sustained long term if there are high staff turnovers in care homes?
A The IA does not deliver training, wider workforce issues are being focused on by the Vanguards.
Q If the placement is not suitable, what support would care homes receive from other to find an alternative suitable placement?
A In line with CQC guidance, care homes will accept the IA assessment of the placement. If the placement for a resident was unsuitable the usual process (outlined in CQC guidance) would be followed. The IA will conduct follow up calls 48-72 hours from discharge to understand any issues that may arise and take on any feedback.
Since August, there have been 5 instances of re-admittance following an assessment by an IA recorded.
- How do you facilitate assessments at the weekend and after 17:00 and are care homes still required to complete assessments out of hours?
The current IA service runs from 08:00 to 16:00 Monday to Friday, the service will be extended to cover six days from June.
There is ongoing work with the Integrated Discharge Team and the Hertfordshire Care Providers Association to establish the work that can be done to encourage care homes to conduct assessments out of hours this is also part of the wider work of the Impartial Assessor service.
Q How does this role work with End of Life patients who be in urgent need of a nursing home placement?
A The service works to facilitate everyone into a placement as quickly as possible. If a care home is identified and willing to take on a end of life patient, assessments can be expedited following advice from the IDT Team Leader. The IA service is not responsible for finding homes for individuals, the IDT provides a Home Finder service which is utilised for this although the two roles do work closely.
Q Is there a criteria that care homes use to accept or decline a resident post assessment?
A No, the assessment is uniform across all homes although there is no common criteria for all homes.
Q How does the TA/IA keep up to date with what is going on in the care homes e.g. staff turnover may lead to a loss of a certain skill in a particular home?
A The IA is employed via Hertfordshire Care Providers Association, so they are aware of lots of issues within the homes and feed this through the IA. However, the IA doesn’t really need to be aware of staff turnover. The assessment must be agreed by the care home.
Q Would you be happy to share their job description/operational guidance?
A Yes, the job description can be found here: http://www.hcpa.info/work_for_hcpa
In terms of guidance, we have an animation that shows the process in an easy manner: https://www.youtube.com/watch?v=rD1aj_Ic6ns
Q Have you found that having a specific post as IA has led to bottlenecks, waiting for that person to have time to assess?
A NHS England uses a model where everyone is a “Trusted Assessor” as part of their role. We have found that by having this as a specific role we have been able to build the trust with care homes and for them to accept the referrals.
Q I understand that there is a requirement for care homes to assess new patients before accepting them but this does not seem to be necessary in some areas – how has this been done?
A All assessments are shared and agreed by the care home before the resident is moved back to the care home. This complies with the national CQC guidance.
Q How did you reach agreement with all your homes for the IA role?
A The provider forum, HCPA, who deliver this service and manage the IA. Extensive engagement with care homes has been done through engagement events and communications describing the benefits. The IA also met key care homes such as those with the highest discharge figures and large companies to discuss the role.
Currently this is only being delivered by East and North Herts CCG (90 homes) and as the post is impartial this has helped adoption as the role is not seen as part of the system and have been able to challenge processes in the hospital.