When moving between hospitals, home and care homes, it can be harmful to
those receiving care if the process is poorly managed. Quite simply, time is
muscle. In as little as 12 hours, an older person admitted to hospital can lose
the ability and confidence to stand unaided. Once lost, that muscle and
confidence is hard to recover.
Following a 2015 review by NHS Providers into transfers of care,
which I chaired, it was concluded that “there is no simple solution to delays
in transfers of care: no one individual to blame nor a magic bullet that will
solve everything”.
Getting these moves – these transfers of care – right can make a huge
difference. When it comes to moving someone between a hospital and home,
especially a care home, their needs should be paramount. That might sound
daunting but often it’s the small details that make a difference.
One solution is intermediate care and there is good evidence that it could play a bigger part in helping people regain
their strength. After it was identified that delayed transfers of care
were causing older people to stay in a hospital bed longer than necessary, a
“stabilise and make safe” scheme in Trafford, Greater Manchester, has seen 70% of people achieving full independence and a
£7.78 return on investment for every £1 spent.
Andrea Sutcliffe, chief inspector for social care at the Care Quality Commission,
says that small, practical solutions can be important. She suggests
matching people with members of staff who share a common interest,
giving the example of attending a pub quiz together. This can make life more
interesting for everyone, rather than merely concentrating on individual tasks.
But small things can be complex to get right; registered managers of
care homes and homecare services play a key role and can be the difference
between a good or poor transfer.
So much has been written on transfers of care that it is sometimes hard
to see the wood for the trees. This is why the Social Care Institute
for Excellence (Scie) and the National Institute for Health and Care
Excellence (Nice) have produced a quick guide for registered managers, based on detailed
Nice guidelines.
The guide offers a practical overview of what registered managers and
their teams need to do before, during and after a hospital stay. When someone
has to go to hospital, managers and their teams can make sure the hospital has
their care plans, details of any preferred routines or communication and
accessibility needs, and any medication the patient is taking.
The key question they should be asking themselves is: how do we help
this person get back to where they want to be?
One good answer to that question is NHS Sutton’s Red Bag Scheme;
a simple innovation that makes sure someone takes and brings back everything
they need when admitted to hospital, from their medication to details of
current care. Developed by Sutton Homes of Care Vanguard in Surrey, the
scheme allows ambulance and hospital staff to determine the treatment a
resident needs more effectively. When patients are ready to go home, a copy of
their discharge summary is placed in the red bag so that care home staff have
access to this important and updated information when their residents return.
Moving to and from hospitals and the community is one of a series of quick guides to meet the needs of busy frontline
health and social care professionals, while others address such issues as
recognising and preventing delirium, and planning for children and young people
transitioning to adult services.
It’s easy to assume that hospital transfers are solely about avoiding
unnecessary admissions. This is an important component, but it’s crucial to
remember the whole journey – from a community setting, to hospital, and back
again. Registered managers and their teams have an important role to play and
if time is muscle, much can be done in an efficient manner to make sure
people’s experiences and outcomes are improved.
SOURCE: The Guardian, Paul Burstow
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