Health and Social Care agencies join forces

The Guardian (www.guardian.co.uk) published an insightful view into how health and social care agencies in Essex are working together to help older people avoid hospital this winter.

‘When Brian Bailey, 73, had a nasty fall after contracting a urinary tract infection, his family rang 999. But instead of being whisked into hospital, he was assessed and treated at home and a plan was put in place for his rehabilitation without him needing to leave his own front door.

Elsewhere, Bailey would have found himself in A&E and then being monitored on a hospital ward. But he lives in Southend, where the local health and social care agencies are doing things rather differently.

Meeting the care needs of older people is the biggest long-term challenge facing the NHS and local government.

Experts agree that far too many older people end up in hospital unnecessarily. A recent report by spending watchdog, the Audit Commission, found that while there are more than 2,500 emergency admissions a year for every 10,000 people aged 65 or over – a ratio higher than one in four – some parts of England have admissions as high as 3,700 per 10,000. After allowing for local factors, some areas have up to 50% more admissions than would be expected.

South-east Essex, comprising Southend, Castle Point and Rochford, used to have a high rate. In 2008-09, there were 9,624 admissions into acute care of people aged 65 or over at a cost of £22.8m. Forecast spending for this year is £21.5m and admissions are 20% down on 2010.

It’s a remarkable change and, judging by Bailey’s experience, a popular one. “I’ve had the most wonderful help,” he says. “Everyone has been truly marvellous.” His wife, Pam, adds: “The hospital is a great place if they can make you better, but it isn’t the right place for Brian.”

Following that 999 call, an emergency care practitioner (ECP) was first on the scene at the Baileys’ home in Shoeburyness. He diagnosed the infection and summoned the therapy and recovery team, which arrived within 20 minutes. Bailey’s needs were identified and an action plan agreed.

With the help of regular visits from a physiotherapist and other professionals, and using equipment installed by the team, Bailey is working towards weekly rehabilitation targets and his ultimate goal of being able once again to get upstairs to his own bed.

Taking account of all strands of the programme, including fewer admissions to residential care, a total saving of £7.3m was initially forecast for 2011-12 across south-east Essex. That has been revised down to £3.8m, partly because the hospital admissions that have been avoided so far have typically been relatively low-cost. Fewer admissions of more complex cases, such as stroke, have been avoided than had been anticipated.

The programme is now being adjusted to place more emphasis on dealing with cases of greater complexity in the community. A joint commissioning strategy across health and social care is planned for next year, with budgets on each side aligned as a step towards the funds being pooled fully.’

 

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