Business Clinic
Innovation in rehabilitation and independent living

The Papworth Trust has launched an innovative, inpatient rehabilitation scheme to bridge the gap between hospital and a person’s home.

Much has been written about the benefits of housing and its integration with health and social care in supporting people to remain independent. It also has the potential to reduce admissions to hospital, assisting with alleviating NHS and social care pressures. Despite all this, housing has been seen as a lesser partner in the drive to integration and new models of care and support.

However, the Papworth Trust’s new scheme aims to address that. It has been developed to promote independent living as an integral part of rehabilitation, or intermediate care, to get people back home and living independently.

The Scheme

MacFarlane Grieve House in Cambridgeshire comprises 28 purpose-built, self-contained flats. It has been designed to bridge the gap between a hospital stay and discharge by replicating a resident’s home. It provides each patient with over four hours of social care and one-and-a-half hours of occupational therapy every day. It supports residents to regain practical skills, confidence and independence while also providing short-term care, 24-hours a day.

Vicky McDermott, Chief Executive of the Papworth Trust explained the aim of the scheme. ‘MacFarlane Grieve House was developed under a pilot initiative with numerous partners across Cambridgeshire. The reason is to deliver better quality care and support for those who are medically stable and no longer need to be in an acute setting. We are supporting people who are leaving hospital having recently suffered life-changing injuries or illness and helping them reintegrate with living independently. When in residence, patients receive intensive therapy, 24-hour care and the opportunity to progress towards a higher level of independence before returning home. The facility is a “home from home” with extended visiting hours and the opportunity to practice independent living techniques in a safe and supportive environment.

‘There are, of course, impressive savings from using the beds in this service, as opposed to in the NHS. We calculate this to be around £800 per bed, per week. The accommodation can support 30 people at any one time. However, as the expected length of stay is approximately three weeks, the Papworth Trust hopes that it will eventually support around 200 people per year. Eight beds have been commissioned initially. Vicky added, ‘The initial pilot, and contract, is with Hinchingbrooke Hospital in Huntingdon and, as such, that is currently our only referral source as this is where the current contract is held. We are looking to fill the rest of the units from many other referral sources. We hope, and expect, that other Cambridgeshire hospitals come on-line very soon to receive these excellent benefits. We believe the scheme will play a crucial role in easing some of the pressure on beds at nearby hospitals.’

Making it happen

The idea was first initiated by the Papworth Trust. Cambridgeshire and Peterborough Clinical Commissioning Group and Cambridgeshire County Council were key partners in its design and implementation. Nursing services are provided by the Cambridgeshire and Peterborough NHS Foundation Trust.

Vicky continued, ‘The CCG holds the Vanguard funding [for the new care models programme, one of the first steps towards delivering the NHS’ Five Year Forward View and supporting improvement and integration of services]. As such we are contracted to them. However, the model has been designed to be easily-replicated and, as such, this is a focus for us. Additionally, this ties in with Simon Steven’s [Chief Executive of NHS England] view that Vanguard funding should be used to innovate and test, with a view to rolling out services that work and have the desired impact. Then, following some evidence-based research due to be published at the end of April 2016, we hope to take the service delivery and all the lessons learned to the wider health community under our social purpose model.’

The scheme is funded under the Urgent and Emergency Care Vanguard which aims to improve the co-ordination of urgent and emergency care services and reduce the pressure on A&E departments through new approaches. It is only funded as a pilot until the end of March 2016, at which point the Papworth Trust will have to bid with the clinical commissioning group for funding to expand the service into the next financial year.

Addressing challenges to the NHS

The Papworth Trust believes that MacFarlane Grieve House is a radical new approach to rehabilitation. They are confident that it will save the NHS money, reduce the likelihood of a patient returning to hospital and also provides a model that can be rolled out nationally.

Vicky concluded, ‘One of the biggest challenges in our current healthcare system is people returning to A&E after they have been discharged from hospital without appropriate rehabilitation. This is expensive for the NHS and detrimental to the health of every individual who is left vulnerable after acute care.

‘We believe that our model for rehabilitation will allow hospitals to discharge patients into our care, happy in the knowledge that they will receive first-class social care and occupational therapy that will enable them to return home and go about day-to-day tasks with improved mobility.

‘This will also mean that hospitals can discharge patients quicker, which will free up more beds. A recent review by the CCG highlighted the disparate nature of beds and how the current system is ineffective in meeting the current and future rehabilitation needs of patients.’

Over to the experts…

With a need to align health, housing and social care, will this housing-based rehabilitation model offer an effective solution? Can housing with care offer a suitable alternative to in-home or care home-based rehabilitation or reablement? Will the model be easily replicable across the country? What does the panel think?

A promising alternative

We’re keen to encourage promising alternatives to the situation whereby someone is discharged into a residential setting, only because there is nowhere else suitable for them to go. We have a new resource for NHS England looking at delayed transfers of care. Tackling this problem can only be done through adopting a whole systems approach, involving a wide range of organisations and individuals, including those receiving the care itself.

Although residential settings have an important role to play in supporting certain groups of people they may lack certain opportunities to maximise people’s independence. Services like this one can help people to take a step forward on the road to greater independence.

There are potential economic, health and social benefits to the use of independent living, coupled with social care, to rehabilitate people. The benefits are well-documented: rapid hospital discharge, avoiding unnecessary readmissions, avoiding unnecessary care home admissions and improved outcomes for patients. Integrated services in general as a way of helping people get back home from hospital, well and ready to continue living independently, also carry these potential benefits.

However, achieving this does require a coordinated, integrated approach by all partners to deliver services successfully. Preventative services can illustrate how important the role of housing is in relation to effective health and social care delivery. At the Social Care Institute for Excellence, we have produced a Prevention Library which highlights emerging practice and research in the provision of preventative services in adult social care. It contains plenty of examples of preventative services to show what works in practice.

Ewan King Director of Business Development and Delivery, Social Care Institute for Excellence

A great example building a powerful evidence base

The link between quality of housing and quality of life is clear. Most recently, the House of Lords Select Committee on the Built Environment called for wider provision of specialist housing, noting, ‘The places that we create have a profound effect upon the quality of life, behaviours and experiences of people who live and work in them.’ The potential impact of housing on health, in terms of illness prevention and keeping people independent, is also at the heart of NHS England’s Healthy New Towns Programme.

Housing associations and social care organisations with an interest in housing have been at the forefront of developing partnerships with the NHS to provide solutions to transfers of care and flexible options for people leaving hospital. Papworth Trust’s work here is a great example. We’re seeing it in other regions too.

In the north-east, Keiro has worked with local authorities and Thirteen Housing Group to set up The Gateway Centre, a 40-bed facility offering a range of residential, rehabilitation and support services. In Greater Manchester, Community Integrated Care has worked with Pennine NHS Trust and University Hospital South Manchester to set up intermediate care units to support older people before they return home. However, these initiatives take time to develop, and need to evidence return on investment, in terms of savings for hospitals, income for providers and, crucially, the experience of service users. If we want to see more we need to consider them joint ventures, with the NHS and social care as equal partners for the long-term and demonstrating why it works. The Papworth Trust’s evidence base has the potential to make a powerful contribution.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre and Vice-Chair of Papworth Trust

A ‘Best in Class’ example

No-one would argue that this Papworth Trust scheme in Cambridgeshire is anything but a ‘best in class’ example of supporting vulnerable people to live independent lives in their own homes.

It is reassuring to see that some health organisations are at the vanguard in recognising the return on investment in some housing-based initiatives. Now we need to prove that such schemes can be replicated at scale across other health and social care economies.

This would not only help make significant inroads into the system pressures but also relieve patients’ experiences of the care ‘bridge’ between hospital and once they get home.

What is clear is that we need improved integrated working with the housing and their services. Only if we achieve this will real progress be made into the delayed transfers of care, emergency readmissions and A&E visits that cost the NHS so much and mean so much misery for patients, family and carers.

I believe that it is these issues that partners working locally through health and wellbeing boards, Better Care Fund arrangements and other local transformation programmes should be addressing – while building on the success of the estimable Papworth Trust project. For example, we should also be making better use of technology to enable care services, housing aids and adaptations.

However, the Cambridgeshire project and other initiatives such as ‘step-up’ facilities provide the foundation of excellent reablement services that promote independent living. Let’s build on them and not discharge our responsibility.

Jeremy Porteus Founder and Director, Housing Learning and Improvement Network

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