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Hospital discharge scheme saving more than £1.3m per year

An innovative early hospital discharge scheme run by Mansfield District Council has the potential to save in excess of £1.3m per year, according to an evaluation carried out by Nottingham Business School.

Hospital patient
The scheme ensures vulnerable patients receive support when discharged from hospital

An innovative early hospital discharge scheme run by Mansfield District Council has the potential to save in excess of £1.3m per year, according to an evaluation carried out by Nottingham Business School, Nottingham Trent University.

Recent estimates indicate 59% of people over the age of 65 in Mansfield have a limiting long-term illness[1], the highest level in the County and far higher than the regional and national average.

The ASSIST (Advocacy, Sustainment, Supporting Independence, Safeguarding Team) pilot project was established to support the early discharge and immediate residential care of patients from the Kings Mill Hospital in Mansfield.

A financial evaluation of the ASSIST project, from September 2014 until May 2105, was carried out by Peter Murphy and Dr Don Harradine from Nottingham Business School. They assessed the actual and potential savings to date, whether the scheme should continue, and whether it is portable to other locations.

In Mansfield there is a perfect storm of circumstances which has enabled this pilot to work so well.

Peter Murphy, Nottingham Business School

The work of ASSIST begins when patients, often the most vulnerable members of the community, first arrive at the hospital. The team, whose members have specialist knowledge on areas such as drug addiction and care of the elderly and frail, identifies those it can help and has the support ready for them upon discharge – reducing the number of discharges which are delayed due to unsuitable housing.

ASSIST can help in three ways depending on the needs of the patient; people leaving hospital are assisted to find suitable accommodation; where appropriate, the patient's own property is made fit for their return; and discharged patients are provided with a range of supporting services, such as advice on money and welfare and help transferring belongings from the old to the new home.

The evaluation report shows that even with conservative estimates of the cost per night stay in hospital, the savings are approximately five times the cost of the investment necessary to run the scheme. There was also clear evidence that the scheme makes hospital discharge faster, more efficient and reduces the burden on hospital and social services staff, with improved outcomes for individual patients. Readmission to hospitals and admissions into residential care are also prevented.

However, the outcomes of ASSIST cannot be achieved by the same model in other areas of the country, as Peter Murphy, principal lecturer in Public Service Management at Nottingham Business School, explains: "The next step, is to identify other locations in the UK where similar projects could be introduced and potentially save the NHS and local authorities millions of pounds. We also need to evaluate a full year of operation to see if there are seasonal fluctuations and we also need to assess the full returns on investment from the scheme, social as well as financial.

"In Mansfield there is a perfect storm of circumstances which has enabled this pilot to work so well, such as a large number and variety of housing stock, a directly controlled Direct Labour Organisation to maintain and adapt dwellings, and a team which boasts specialist knowledge and experience of working with vulnerable groups. This means that we need to assess other locations – most likely to be in the Midlands, the North, Scotland and Wales - for which of the critical success features are present and, if any are missing, whether they can be developed or not."

Hayley Barsby, head of Housing at Mansfield District Council, said: "By working together we are able to ensure that scarce resources are utilised in the most appropriate way, minimising the number of people that stay in hospital that are medically fit, freeing up beds for those that really need them. By recognising this and delivering a citizen focussed response we have been able to create and deliver a service that benefits so many vulnerable people.

"The comprehensive independent appraisal that Nottingham Business School have done in evaluating the scheme has enabled the clarity of the true financial impact to be quantified and has also captured the finer details of the critical success factors and the whole life benefits for those affected."

Councillor Muriel Weisz, chair of Nottinghamshire County Council's Adult Social Care and Health Committee, said: "The County Council works with ASSIST to provide any personal care required by patients  on discharge as part of this scheme whilst a permanent home is found by Mansfield District Council.

"In many cases this scheme reduces the need for us to place discharged older patients in a residential care home on a short-term basis, which doesn't offer the same home environment that supports recovery and greater independence, and is a more expensive option."

Chief officer for NHS Mansfield and Ashfield Clinical Commissioning Group, Dr Amanda Sullivan, said: "We are committed to supporting the most vulnerable people in our society by making sure they get personalised care at the time they need it the most. Not only does this scheme help us achieve that, it is also helping to relieve much needed pressure on hospital beds."

ASSIST has been commissioned by the NHS Clinical Commissioning Groups, with additional financial support from Mansfield District Council, and is an integral part of the Better Care Plan for Mid Nottinghamshire. It receives client referrals from health, housing and social care partners in central Nottinghamshire as well as occasional ad-hoc referrals.

The service operates as an inter-agency collaboration between the NHS Commissioning Group, Nottingham County Council Adult Social Care, Mansfield District Council, Sherwood Forest Hospital Trust, Kingsmill Hospital, Mansfield Community Hospital and Macmillan Nurses.

The scheme has now been shortlisted for the Association for Public Service Excellence (APSE) Annual Service Awards 2015 in the Best Health and Wellbeing Initiative category.

[1]NHS Atlas in Variation in Healthcare – reducing unwarranted variation to increase value and improve quality / Public Health England.

Hospital discharge scheme saving more than £1.3m per year

Published on 25 August 2015
  • Category: Business; Press office; Research; Nottingham Business School

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