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Integrated scheme in Somerset cuts DTOCs by 7,500 nights

An NHS programme in Somerset has helped patients avoid 7,500 nights in hospital and freed up at least £2 million for other services.


Somerset’s pioneering ‘Homefirst’ scheme offers patients who are healthy enough, and their families, tailored help to finish therapy at home, with personalised care reducing stays in hospital by up to ten days.


Described by health leaders as ‘a common sense approach’, Homefirst is delivered by specialist teams of staff who have been given additional training in a range of care techniques, so they can do more with patients once they are home, to help them regain independence faster.


The NHS Long Term Plan puts the emphasis on increasingly integrated care across communities with STPS moving to Integrated Care Systems that will see different health services and other agencies working together to provide faster, more convenient and more joined-up care. The Homefirst Scheme is within Somerset STP and is an example of this integrated working.


The Long Term Plan also confirmed an ambition to achieve and maintain an average Delayed Transfer of Care (DTOC) figure of 4,000 or fewer delays over the next two years with a further reduction over the next five years. The latest figures for DTOC (November 2018) report 137,388 total days delayed which is equivalent to 4,580 daily DTOC beds. The number of DTOC beds peaked in October 2016 at 6,455.


In Somerset, instead of waiting to complete assessments, such as walking the ward, in a busy unfamiliar place, people for whom it’s safe to do so can be discharged home at the right time and get support for important tasks, based on their home and enabling a quicker and happier recovery.


The team see patients on the wards at both Somerset’s acute hospitals, involving families about when a patient is ready to go home and liaise with medical and nursing staff to ensure patients are comfortable and happy that they can be discharged safely.


Tim Baverstock, who led the scheme for Somerset County Council, says: “We’ve found that all it can take to avoid a long hospital stay is a frank conversation with the patient and family to learn more about how they can manage at home and their wishes.


“If someone starts to recover they often want to go home and previously paperwork and assessments could have meant waiting weeks. But while the patient waits their mobility and independence reduces and causes frustration – a person over 80 who spends 10 days in hospital loses 10% of muscle mass equivalent to 10 years of ageing. We wanted to bring an end to that.”


In an interview with HSJ, Ian Sturgess, a leading geriatrician and senior medic, warns that a huge number of patients are harmed by spending too long in hospital. He adds that failure of doctors to give patients a planned discharge date is a driver of length of stay. (Full interview is paywalled).


Tim Baverstock adds: “We’ve been working closely with hospital and social care colleagues to transform the culture so decisions are about personalising care, talking to families and setting up the right support as fast and as close to home as we can.”


NHS England published a set of resources at the end of 2018 to provide advice and guidance for all health and care staff to help reduce delayed transfers of care. They include initiatives like End PJ Paralysis, which aims to get patients dressed, out of bed and mobile as much as possible. Download the full guides here.