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Partnership model improves care for older people

How a joint-service rehabilitation unit in Nottingham reduces delays in discharge 

Each year, 1.15 million NHS bed days are lost because of delayed discharges. Most of those beds – 62% according to the National Audit Office (2016) – are occupied by people aged 65 and over.

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Intermediate care units can reduce delays in discharge. Picture: John Houlihan

And for every day of an older patient’s average 11.9 days stay, he or she loses 5% of muscle strength.

In South Nottingham we have launched a short-stay – 14 days or less – rehabilitation unit in The Grand Care Centre for people who are ready to leave hospital and return home, but who first require short-term and intensive multifunctional rehabilitation.

Partnership

The unit is a partnership between the NHS, a care home provider and third sector organisations. It operates seven days a week with admission possible within two hours of referral. To date, all admissions have been from NHS wards or emergency departments.

On admission, people are interviewed so that their goals are immediately shared with staff. Anyone who does not want to remain is discharged home or to a longer-stay facility. Person-centred discharge plans are then prepared within 24 hours.

Care staff under nursing leadership manage the unit with full-time occupational therapists, physiotherapists and high-quality nutritional support. Medical care is provided by patients’ GPs, the on-site advanced nurse practitioner or out-of-hours service.

Bed occupancy

Inappropriate admissions or changes in clinical presentation result in swift transfer to an appropriate NHS facility or care home, thus enabling change in bed occupancy within four hours.

There are no delays in discharge, transfer information is more accurate and patients have escorted home placements with care packages prepared by the on-site social worker. Age UK provides funded workers and volunteers who can pick up medication from pharmacies, and who are collecting client feedback which has been positive.

Lost NHS bed days cost £303.70 a day, or £349 million a year. A bed at The Grand unit costs £165.29 a day. If the model were to be implemented more widely, £190 million could be spent on rehabilitation. This would still leave £159 million for investment in service development.

Dylan Southern is operations director at New Care Projects 

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Reference
National Audit Office (2016) Discharging Older Patients from Hospital. www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital.pdf (Last accessed: 5 August 2016.)

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