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Let's all get home safely: a commentary on NICE and SCIE guidelines (NG27) transition between inpatient hospital settings and community or care home settings
- Authors:
- WINFIELD Anna, BURNS Eileen
- Journal article citation:
- Age and Ageing, 45(6), 2016, pp.757-760.
- Publisher:
- Oxford University Press
Safe and appropriate transition between inpatient settings and the community is one of the major challenges facing the modern NHS. The National Institute for Health and Care Excellence in conjunction with the Social Care Institute for Excellence published guidance on this challenging area in December 2015. This commentary provides context, summary and discussion of the key areas covered. The guidance particularly emphasises the importance of a person-centred approach in which patients are individuals and equal partners in the multidisciplinary team who should be treated with dignity and respect. Additionally, communication and information sharing is crucial both on admission and when taking a proactive approach to discharge, including the role of the discharge coordinator in liaising with community teams and arranging follow-up post-discharge. Self-care and the significance of carers are also highlighted as valuable in facilitating safe discharge and reducing readmissions. It is clear that in older people with complex needs, safe appropriate transition between hospital and community settings has a positive impact on patients and their carers. Given the financial and capacity pressures facing the NHS, strategies to reduce readmissions and prevent delays in discharge are increasingly important. These guidelines are therefore both timely and advocated to improve care for older people. (Publisher abstract)
Understanding and improving older people's experiences of service transitions: implications for social work
- Authors:
- TANNER Denise, GLASBY Jon, McIVER Shirley
- Journal article citation:
- British Journal of Social Work, 45(7), 2015, pp.2056-2071.
- Publisher:
- Oxford University Press
This paper examines the concept of transition and its centrality to later life experiences. It considers how an enhanced and more user-centred understanding of transitions can be harnessed to improve older people's experiences of moving into and between health and social care services. It focuses, in particular, on the neglected dimension of subjective experiences of transition and considers how social workers can engage with older people's emotional responses at times of change to improve their experience of transition processes and outcomes. (Publisher abstract)
Testing the bed-blocking hypothesis: does higher supply of nursing and care homes reduce delayed hospital discharges?
- Authors:
- GAUGHAN James, GRAVELLE Hugh, SICILIANI Luigi
- Publisher:
- University of York. Centre for Health Economics
- Publication year:
- 2014
- Pagination:
- 25
- Place of publication:
- York
Hospital bed blocking occurs when hospital patients are ready to be discharged to a nursing home but no place is available, so that hospital care acts as a more costly substitute for long-term care. This study investigates the extent to which higher supply of nursing home beds or lower prices can reduce hospital bed blocking. The study used new local authority level administrative data from England on hospital delayed discharges in 2010-13. The results suggest that delayed discharges do respond to the availability of care-home beds but the effect is modest: an increase in care-homes bed by 10% (250 additional beds per local authority) would reduce delayed discharges by about 4%-7%. The study also found strong evidence of spillover effects across local authorities: higher availability of care-homes or fewer patients aged over 65 in nearby local authorities are associated with fewer delayed discharges. (Edited publisher abstract)
The (multi-) billion dollar question: embedding prevention and rehabilitation in English health and social care
- Authors:
- ALLEN Kerry, GLASBY Jon
- Journal article citation:
- Journal of Integrated Care, 18(4), August 2010, pp.26-35.
- Publisher:
- Emerald
As policy makers seek to develop a more preventative and rehabilitative approach to older people's services, new policies and integrated initiatives have made a positive contribution. This paper provides a critical review of English health and social care, exploring attempts to embed a more preventative and rehabilitative approach through multi-disciplinary and cross-organisational initiatives. Data for this article were collected between February and September 2009, as part of the European Commission Framework 7 Interlinks project. An English National Expert Panel (NEP) was created and took part in a consultation on the identification and discussion of key national strategy, policies and initiatives in prevention and rehabilitation and related literatures. A national report on English rehabilitation and prevention was then validated by each NEP member. The report considers: developments in English rehabilitation and prevention; hospital discharge; intermediate care; reablement; and the pilot project initiatives Health Action Zones, Partnerships for Older People Projects, and LinkAge Plus. The article concludes that, in spite of a stated commitment to prevention, there is a lack of clarify about what it means or how to do it in practice. It ends with a list of several outstanding questions for older people’s services in England.
A long-term approach to social care
- Author:
- GOSLING Paul
- Journal article citation:
- Local Government Chronicle, 12.3.09, 2009, pp.22-23.
- Publisher:
- Emap Business
The costs of social care have risen substantially in recent years. This article looks at strategies that can both improve quality of life and cut costs. The use of 'reablement' or 'enablement' in reducing hospital readmission and the use of extra-care accommodation in Coventry are two of the approaches discussed.
Tackling delayed transfers of care across the whole system: overview report based on work in the Cardiff and Vale of Glamorgan, Gwent and Carmarthenshire health and social care communities
- Author:
- WALES AUDIT OFFICE
- Publisher:
- Wales Audit Office
- Publication year:
- 2007
- Pagination:
- 110p.
- Place of publication:
- Cardiff
Tackling Delayed Transfers of Care Across the Whole System, makes a number of recommendations, including a clear local vision of service models to promote the independence of vulnerable older people and the strengthening of processes so that provision is centred on people's needs for care. The report also says that commissioning is under-developed and needs to ensure that health and social care communities have the appropriate capacity in a wide range of services that promote independence. The Committee found that the number of people experiencing a delayed transfer of care, has fallen over time but is not a good measure on its own of the extent of the problem because it does not reflect the length of the delays they suffer. A better measure is the number of hospital bed days occupied by people experiencing a delay, and that number in Wales as a whole actually rose by 2 per cent between 2005-06 and 2006-07 from 262,595 to 268,491. The report recommends that the Assembly Government should align its guidance, budgets, priorities, performance measures and incentives more closely with its vision of the whole system, in particular by improving the current measurement systems which are inaccurate and understate the impact of delayed transfers of care.
Changing places: report on the work of the Health and Social Care Change Agent Team 2002/03
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2003
- Pagination:
- 36p.
- Place of publication:
- London
This is the first annual report on the work of the Health and Social Care Change Agent Team (CAT). ‘Delayed discharges’ are people, quite often frail and vulnerable older people whose future care is uncertain. An acute hospital is not a good place to be whilst waiting for care arrangements to be made. Hospitals make people more dependent and there is an increased risk of acquiring an infection. While older, vulnerable people are away from home, their care networks may break down and the longer the time spent away from home, the more difficult it is to set these up again. Sometimes, had the right services been in place in the community, the person need not have gone into hospital in the first place. If people are waiting in hospital beds, other people’s admissions for planned surgery such as a hip replacement may be delayed. About 60% of all people in acute hospitals are over 65 years, so many of the people waiting to come into hospital are likely to be older people. The more medically fit people waiting in hospital beds, the fewer beds are available for emergency admissions, leading to longer waits on trolleys in the Accident & Emergency department (A&E) or the Medical Assessment Unit (MAU).
An electronic referral system supporting integrated hospital discharge
- Authors:
- WILBERFORCE Mark, et al
- Journal article citation:
- Journal of Integrated Care, 25(2), 2017, pp.99-109.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England. Design/methodology/approach: Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process. Findings: Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals. Research limitations/implications: The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed. Originality/value: There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries. (Publisher abstract)
Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study
- Authors:
- BAILLIE Lesley, et al
- Journal article citation:
- International Journal of Integrated Care, 14(1), 2014, Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. Theory and methods: The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. Findings: Three themes are presented: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. Discussion and conclusions: A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other's roles and build relationships and trust. (Publisher abstract)
On the pulse: housing routes to better health outcomes for older people
- Author:
- LENG Gill
- Publisher:
- National Housing Federation
- Publication year:
- 2012
- Pagination:
- 28
- Place of publication:
- London
This report features analysis of current health and care priorities, focusing on quality of care, innovation, productivity and prevention. It explores how housing associations can work with health and social care commissioners to enable older people to manage changes in their health; help people live as independently as possible; and reduce the need for more costly care. The report includes six case studies describing some innovative solutions which Federation members have developed. These reflect the diverse ways in which housing providers are responding to both the needs of older people at critical points in their lives and NHS priorities. The services featured in the report deliver one or more of the following health and care outcomes: they help older people to recover their independence after illness, stroke, injury or trauma; get people home from hospital quickly, while preventing hospital admissions and readmissions; delay the need for more intensive care and support; reduce the likelihood of emergency admissions help to stabilise and manage chronic conditions such as dementia; enable people to remain in their homes to the end of their lives; and maximise the benefits of technology, such as telecare. (Edited publisher abstract)