Rt Hon Paul Burstow shares how getting the transfer of care right can support improved patient outcomes and experience
Getting the transfer of care right between services can improve both patient outcomes and experience – as well as ensuring the health system runs efficiently. That is why the focus of the “Right Place, Right Time” Commission is on sharing what works, and crucially, understanding why it works. In fact, I have been encouraged and inspired by the excellent local partnership working I have observed around the country. Both national policy and the media spotlight often focus on reducing delayed transfers of care from acute hospitals[i] and while this is critical, we have deliberately broadened the Commission’s scope to explore the impact of transfers of care across the acute, mental health, community and ambulance sectors and on the interface with primary and social care as well as housing.
What do we know?
Lord Crisp’s interim report into acute adult psychiatric inpatient care recently found that the difficulties in meeting demand for adult inpatient mental health services largely stems from delays with discharging service users and offering community based alternatives to hospital admission[ii]. In addition, more than a quarter of patients in general hospitals have a mental illness as well as a physical illness[iii] with implications for the support they need. Pressures are growing across the system, as people, including adolescents have to travel for specialist mental health care, and detention rates are rising as doctors fear their patients will only get a bed if they have been sectioned[iv]. There is more we must do to address these issues.
The Commission will release a report later this year but there is so much good activity ongoing at local levels, I wanted to share these emerging themes:
A partnership approach
Despite the growing operational pressures, creating time for local collaboration remains essential. National policy makers must also play their part in ensuring that targets, pricing and other incentives do not unintentionally create a barrier to integration.
Those localities which are doing most to improve transfers of care recognise that it is a “system issue” in which commissioners, providers, local government and the voluntary sector all have a vital role to play. For example, in one coordinated care partnership, care homes, trusts and GPs provide care and treatment at home and offer short-term residential care to reduce avoidable hospital stays. Mental health, the voluntary and community sectors and housing, are an integral part of this model[v].
Involving patients and service users
Healthwatch England recently found that 46 per cent of people in England did not think they were fully involved in decisions about their discharge from hospital. Service users reported variation in how assessments for NHS Continuing Care are undertaken and lack of co-ordination with their GP. Lack of support following discharge can lead to readmission[vi] with negative consequences for the individual, and the associated cost to the system. Patients, services users and carers must be at the heart of developing personalised approaches to care which work for them as individuals.
For instance, in one London borough, upon discharge from a mental health service, people are allocated a navigator to support them individually for a period of 12-18 months. A pilot showed a reduction in crises where regular contact with the navigator was maintained, as well as shorter crisis episodes and reduced stays in secondary care[vii].
Support closer to home
A growing number of organisations are also developing projects in partnership with social care, housing or the voluntary sector. This projects deliver community care packages, that include interim support solutions, where a person is ready to be discharged, but a care package is not yet in place. Many providers also have discharge coordinators or care navigators acting as the point of contact for the patient and their family. NICE is expected to recommend the creation of this role in all hospitals.[viii]
For example, patients in one area of the West Midlands who may be suffering from mental health problems can access assessment, support and advice from any of the acute hospitals, 24 hours a day, 7 days a week. The rapid assessment, interface and discharge (RAID) model was first piloted at a city hospital, and has since been replicated around the country to help people receive care in the right setting, and where appropriate, closer to home[ix].
The Commission provides a helpful insight in to tried and tested service coordination methods, as well as new and emerging initiatives across the country. I am grateful to those who have contributed to our work so far and look forward to sharing our findings.
The “Right Place, Right Time” Commission is led by Rt. Hon Paul Burstow and supported by NHS Providers, the membership organisation for NHS foundation trusts and trusts. To contribute or seek further information, visit the website:
[i] QMR 16, King’s Fund, July 2015 (ibid)
[iii] Psychiatric support teams improve patient care and save hospitals millions, The Guardian, June 2014. http://www.theguardian.com/society/2014/jun/03/psychiatric-support-teams-in-acute-hospitals
[viii] NICE, transition from acute to community and social care settings for adults with social care needs, draft guideline. August 2015. http://www.nice.org.uk/guidance/indevelopment/GID-SCWAVE0712/consultation/transition-between-inpatient-hospital-settings-and-community-or-care-home-settings-for-adults-with-social-care-needs-draft-guideline-consultation
[ix] As above