Problems with patient flow in hospitals might seem inevitable when you consider the pressure on health and social care services, and the many older people living alone with no family nearby to provide support.
However, around the UK, voluntary sector providers are easing the pressure with practical support services designed to keep people safe and well in the community. We spoke to Sue Collins, Head of Independent Living at the British Red Cross about the services they provide and how these can help to manage demand for health services during the winter months.
The British Red Cross offers emotional and practical support through services across the UK, all year round, to enable people to return home or to avoid being admitted to hospital.
Independent living services provide support in a wide range of ways, from transport services to enable people in rural areas to travel to and from hospital for treatment to avoid admission, to mobility aids such as wheelchair loans.
The British Red Cross Support at Home service is specifically designed to support people on a short-term basis (usually 6-8 weeks) when they are discharged from hospital. Volunteers visit people in their homes and support them with activities like shopping and collecting prescriptions. The support and companionship offered can help people to regain their confidence.
All these services focus on helping vulnerable, often older people to gain and maintain their independence.
Commissioned by local authorities, NHS trusts, boards and clinical commissioning groups (CCGs), the specifics vary, but the focus is on preventing a crisis, or helping someone recover after a crisis.
In some hospitals, staff and volunteers from the British Red Cross are part of the discharge team, alongside occupational therapists and social workers. The practical support the service provides can be the missing piece that enables a patient to return home with confidence.
Sue explains, ‘The space we occupy is between home and hospital – that’s really where we can be the glue in the system, and we can fill in gaps. If an older person is stuck in hospital, the kind of services we provide mean we can get them home and keep them at home, where they want to be’.
Reducing social isolation
The British Red Cross services recognise that older and isolated people don’t just need practical support. In addition to providing direct care and companionship, services aim to connect service users with their communities.
This can help to relieve pressure on statutory health services.
‘Your waiting room might be packed with people who are essentially lonely,’ says Sue. ’To help with this, our partnership with the Co-operative Group, launched earlier this year, aims to look at the evidence around loneliness in the UK and develop community-based solutions.’
The British Red Cross already has extensive reach into the community through the other services it runs, such as ambulance services, and first-aid training.
Sue says, ‘We find that’s very useful in terms of reaching out to communities and helping to build community resilience. We’re obviously responding to the floods at the moment, and we’ll get a lot of referrals in that way. The crisis teams will find people who were vulnerable before the floods, who will now be referred into services’.
Assisting with flow
In early 2015, a group of charities were funded by the Cabinet Office to ease the winter pressures facing hospitals by providing practical support to help people get home.
The British Red Cross, alongside Age UK and the Royal Voluntary Service, worked with 29 NHS trusts identified by the Department of Health as being under particular pressure. Staff and volunteers supported older people at home to help prevent the need for them to be admitted to hospital, and worked with people on wards and in emergency departments who did not need to be in hospital for medical care, but needed support to return home.
Between February and May 2015, the project supported over 9,000 people to return home.
Sue says this service is something she is particularly proud of. ‘I think it demonstrates the beauty and the benefit of engaging with the voluntary sector, because we were able to scale up really quickly and respond to that winter surge, that crisis.’
Taking the long view
Recent reports from Monitor and our own research at the Health Foundation have highlighted the need for improved patient flow through hospitals, and the benefit to patients and hospitals of care at home and in the community.
But patients can only be discharged when there is somewhere for them to go. In terms of keeping people safe and well in the community, Sue says, ‘A big part of the problem is that clearly there’s been persistent and consistent underfunding in social care for a number of years.’
And what can be done differently, to manage winter pressures in the long run? For Sue, the answer is effective forward planning.
‘Winter happens at the same time every single year, it’s not breaking news. And yet, every year, it’s a reactive, crisis response. Better planning would be hugely helpful. Not waiting until the crisis is happening, but thinking about what resources are out there that can help us with this, and freeing up some money to support it.
‘Quite a small amount of money can bring big benefits.’