www.housing.org.uk
Home from hospital
How housing services are
relieving pressure on the NHS
2
Home from hospital
Contents
Introduction 3
The housing offer 5
The scale of the problem 8
How housing providers are helping
Who is affected by delayed transfers of care 12
The housing response
Older people 12
People with mental health problems 15
People experiencing homelessness 16
Other issues related to delayed transfers of care 17
Housing providers delivering cost benefits
Next steps 22
Scaling up the housing offer
Authors:
Ian Copeman, Margaret Edwards and Jeremy Porteus, Housing LIN
Contact:
Housing Learning and Improvement Network (LIN)
020 7820 8077
info@housinglin.org.uk
3
Home from hospital
This report sets out the impact of delayed
transfers of care, the implications for
the NHS and the solutions that are
offered by housing providers, including
the cost benefits these solutions provide
to the NHS.
Introduction
Delayed transfers of care, often referred to as
‘bed-blocking’, occur when a person is assessed as
ready to leave hospital and is still occupying a hospital
bed. According to NHS England
1
, a patient is ready to
depart when:
a) A clinical decision has been made that the patient is
ready for transfer
b) A multi-disciplinary team decision has been made
that the patient is ready for transfer, and
c) The patient is safe to discharge/transfer.
The main groups affected by delayed transfers of care
are older people, people with mental health problems
and people experiencing homelessness. The number
of recorded delayed transfers of care has increased
substantially over the past few years. According to
National Audit Office official data
2
, between 2013 and
2015 there was a 31% increase in bed days taken up
by delayed transfer patients in acute hospitals.
Delayed transfers of care are costly for the NHS.
The National Audit Office
3
(NAO) estimates that the NHS
spends around £820m a year treating older patients who
no longer need to be there. The NAO notes that
“Without
radical action to improve local practice and remove
national barriers, this problem will get worse and add
further strain to the financial sustainability of the NHS.”
Housing providers are ideally placed to relieve pressure
on the NHS, and have developed a joined up plan to extend
and increase the services they offer to help people out
of hospital, into a suitable home with the right support.
1
https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2015/10/mnth-Sitreps-def-dtoc-v1.09.pdf
2
Discharging older patients from hospital’ (2016), National Audit Office
3
ibid
“ Without radical action to
improve local practice and
remove national barriers,
this problem will get worse
and add further strain to
the financial sustainability
of the NHS.”
There are four key components to this sector-wide offer:
1. An increase in the number of housing step down units
or beds nationally which can facilitate efficient discharge
from hospital.
2. More housing staff seconded to discharge teams locally
to coordinate and speed up transfers of care.
3. Care packages to help prevent people from needing
to go into hospital in the first place and to reduce
readmissions.
4. A commitment to facilitating robust evaluation of
this solution.
This offer will ensure that people are getting the care and
support they need, and will free up the NHS to deliver its
services to those who need them most.
National Audit Office
4
Home from hospital
4
Demos ‘Dying for Change’ report (2010)
5
House of Commons library briefing paper 7415, Delayed Transfers of Care in the NHS
At least a fifth of NHS costs are thought to be spent on end
of life care
4
, highlighting the financial impact of preventing
patients being admitted to hospital unnecessarily at the end
of life and ensuring the earlier discharge of terminally ill
patients who can be better supported at home.
Delayed bed days occur when a patient is delayed after they
are medically fit to be transferred/discharged. There were
456,447 delayed days in 2016-17 – this is a huge increase of
45.3% on the previous year which is attributed to “awaiting
care package in own home”
5
.
The 12 case studies featured in this report highlight
examples where housing providers have prevented
unnecessary hospital admissions and avoided or
reduced delayed transfers of care through early and
timely interventions.
From the evidence presented in this report it is clear
that there is a strong case, both in terms of the benefits
for the people assisted and the cost benefits provided to
the NHS, for significantly increasing the scale and scope
of the housing offer.
Total number of delayed days
200,000
210,000
190,000
180,000
170,000
160,000
150,000
140,000
130,000
120,000
110,000
100,000
Total Rolling 12 month average
May 2011 May 2012 May 2013 May 2014 May 2015 May 2016 May 2017
May 2018
Delayed days
5
Home from hospital
It is estimated that over 30% of
households in housing association
accommodation are aged 60 or over
or living with a disability
6
.
6
In our Lifetime, National Housing Federation (2010)
7
The Quick Guide: Health and Housing, produced by NHS England’s Better Use of Care at Home working group, is a reflection of both the latest in policy development
around delayed discharge and the difference that housing can make, as well as providing a range of examples
8
As part of the drive for more integrated approaches, the Health and Housing Memorandum of Understanding to support joint action on improving health through the
home (MoU) was agreed between government departments, agencies such as ADASS, NHS England, Public Health England, and the Homes and Communities Agency,
and other housing and health sector organisations in 2014, including the NHF and the Housing LIN. https://www.gov.uk/government/publications/joint-action-on-
improving-health-through-the-home-memorandum-of-understanding
9
The case studies have been identified from NHF members; NHS organisations including CCGs and NHS Trusts; local authorities; the Housing LIN
The housing offer
There is now a growing evidence base
7
and clear policy
drive
8
that demonstrates how housing associations and
health commissioners can and are working together
to avoid or reduce unnecessary hospital admissions,
lengths of stay in hospital, delayed transfers of care and
readmission rates.
A wide range of examples of services
9
supplied by housing
providers are highlighted in this report. These show the cost
benefits provided to the NHS, and the positive outcomes for
the people who are assisted. It is not just tenants who can
benefit from these services – the housing offer also applies
to the general public.
These examples demonstrate how housing providers
across England are successful in preventing unnecessary
hospital admissions and avoiding or reducing delayed
transfers of care through early and timely interventions.
They demonstrate a diversity of housing and health services
including:
• providing a temporary home, i.e. ‘step down’, for people
coming out of hospital who cannot return to their own
home immediately
• enabling timely and appropriate transfers out of hospital
and back to patients’ existing homes
• providing a new home for people whose existing home or
lack of housing mean that they have nowhere suitable to
be discharged to, and
• keeping people well at home who would otherwise be at
risk of being admitted or readmitted to hospital.
“ If one were to scale up this
work it would be massive
across the UK. Savings of this
magnitude would go a long
way towards funding 7-day
secondary care”.
Dr Mark Holland,
President of the Society for Acute Medicine
6
Home from hospital
Curo – Step down scheme
The Curo Step Down scheme in Bath, North East
Somerset provides accommodation for vulnerable
adults who are ready to be discharged from hospital
but cannot return home.
The service offers six self-contained flats or bungalows
with dedicated support and access to 24-hour care
teams, allowing people to see how they manage
with a care and support package in a place like their
home. Step down units are provided by Curo, within
or adjacent to extra care hubs. The service is provided
on a ‘free at the point of delivery’ basis and is available
seven days a week for periods of time agreed at the
point of discharge.
Curo’s step down service can offer transport from
hospital, avoiding delays in access to non-emergency
ambulance services. The emphasis is on relearning
skills to improve future independence, supporting
people to move into appropriate or adapted homes
and reducing the risk of re-admission.
Outcomes
•
The service commenced at the beginning of 2014.
In 2016/17, 84.6% of clients were discharged to
somewhere other than residential care.
• Every year, between 20-30 people are discharged
from hospital and enabled to live independently as
a result of six step down units.
• In 2016/17 the service saved 1,854 excess bed days.
• The six step down units provided a cost benefit
of £561,762 for the NHS in 2016/17 by enabling
discharge of patients.
Case study
The six step down units
provided a cost benefit
of £561,762 for the NHS
in 2016/17.
7
Home from hospital
Mansfield District Council
Mansfield District Council’s Advocacy, Sustainment,
Supporting Independence and Safeguarding Team
(ASSIST) service has received a National Institute for
Health and Care Excellence (NICE) Shared Learning
Award. The organisation has recently been awarded a
National Institute for Health and Care Excellence (NICE)
Shared Learning Award for its ASSIST early discharge
scheme. This service aims to expedite discharges from
the Kings Mill Hospital in Mansfield, from residential
care and to reduce or prevent avoidable admissions to
hospital or residential care.
ASSIST provides a 360-degree service to improve the
transition of patients from hospital to home. Housing
staff work on the wards at King’s Mill Hospital to provide
a triage service for people who are medically well
enough to go home but need extra help to do so. The
team also works on the emergency admissions wards to
identify those with social needs to free up medical staff
time. Interventions range from simple adaptations to
complex rehousing cases.
This project is regarded as one of the top four projects in
the country for supporting the NICE NG27 1.5 guidance
10
on reducing delayed transfers of care and improving
discharge rates.
Outcomes
An independent evaluation by Nottingham Trent
University of the ASSIST scheme concluded that:
• There was clear evidence that the scheme benefits
the efficiency of hospital discharge and reduces the
burden on hospital and social services staff.
• Between July 2015 and April 2016, of 1129
admissions, 5078 excess bed days were
saved across Mansfield, Ashfield and Newark.
• On average, for each admission, 4.5 bed days were
saved with an average saving of £936 per admission.
• Total savings in terms of the reduction of acute bed
days was £1,371,060.
10
https://www.nice.org.uk/guidance/ng27/chapter/recommendations
Case study
Total savings in terms of the reduction
of acute bed days was £1,371,060.
8
Home from hospital
Over the period 2013-2015, the number
of delayed bed days rose by 31%.
In 2014/15 there were 1.6 million total
delayed bed days in England, which
averages at approximately 4,500
delayed transfers of care per day.
The scale of the problem
How housing providers are helping
Monthly delayed transfers of care figures March 2015-March 2017
December ‘16
January ‘17
February ‘17
March ‘17
200,000
150,000
100,000
50,000
0
March ‘15
April ‘15
May ‘15
June ‘15
July ‘15
August ‘15
September ‘15
October ‘15
November ‘15
December ‘15
January ‘16
February ‘16
March ‘16
April ‘16
May ‘16
June ‘16
July ‘16
August ‘16
September ‘16
October ‘16
November ‘16
NHS Social Care Both Total
Source: https://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/2016-17-data/
11
ibid
In addition, the National Audit Office estimates
11
that the
number of older patients in hospital who are no longer
benefitting from acute care is approximately 2.7 times
higher than the figure for reported delayed transfers of
care. This discrepancy is due to delays in people being
assessed by clinicians, delays during treatment and
inconsistencies in counting delayed transfers of care.
The table below shows that the overall monthly level of
delayed transfers of care has been increasing over the
period March 2015-March 2017.
9
Home from hospital
There are a range of reasons why a delayed transfer of
care may occur, including when someone is:
• waiting for the completion of an assessment
• awaiting nursing home placement or availability
• awaiting residential home placement or availability
• waiting for a suitable care package to be put in place
in their own home
• waiting for further non-acute NHS care
• awaiting community equipment or adaptations to be
put in place.
Some of these reasons will be attributable to the NHS and
others will be attributable to local authority social care.
In 2015/16, 1.1 million delayed days were attributable to the
NHS, an average of more than 3,000 per day.
In 2015/16, 1.1 million delayed
days were attributable to the
NHS, an average of more than
3,000 per day.
12
Delayed transfers of care in the NHS, House of Commons briefing paper (December 2015).
In 2014/15 there were
1.6 million total delayed
bed days in England.
Delayed days occur when a patient has been delayed
one day after they were medically fit to be transferred/
discharged. Although the majority of delayed days are
attributable to the NHS, delays attributable to local
authority social care – for example, people waiting for
a suitable home care package to be put in place or for a
residential care home place to be found – have risen by
44% over the past two years
12
.
NHS England’s delayed transfers of care figures for
2015-16 show a marked rise in delays due to ‘awaiting a
care package in own home’, up 62.1% in comparison with
the previous year. There have also been increases of over
10% for ‘awaiting completion of assessment’, ‘awaiting
nursing home placement or availability’, and ‘awaiting
residential home placement or availability’.
Housing association ‘step down’ services that utilise
older people’s housing schemes to enable a person to
be discharged, such as in extra care housing, provide a
solution to this problem.
10
Home from hospital
Wigan Council
Wigan Council operates a housing hospital discharge
service. The purpose of the service is to:
• reduce delayed transfers of care across all wards
and be part of a safe discharge planning process, and
• reduce unnecessary attendances and readmissions
through Accident & Emergency (A&E) departments.
The service provides a specialist housing advisor to
assist people with housing issues on admission to
hospital rather than react when a housing problem
is identified at the point of discharge from hospital.
The hospital housing advisor:
• has access to temporary accommodation in a crisis
• acts as first point of contact when issues arise
where housing is a critical factor, and
• identifies housing solutions that meet the
patient’s needs.
Outcomes
•
The service has delivered savings of £644,300 over
a two-year period (2014/15 and 2015/16) based on
800 excess bed days saved. In 2016/17 the service
saved £337,150 and 920 bed days.
• The person-centred approach delivered by the service
means that the outcomes reflect the needs of specific
clients, but with a consistent focus on reducing
delayed transfers of care and reducing unnecessary
attendances and readmissions through A&E.
Case study
The service has delivered savings of
£644,300 over a two-year period based
on 800 excess bed days saved.
11
Home from hospital
Nottingham City Homes
Nottingham City Homes (NCH) provides a Hospital
to Home (H2H)/Housing Health Coordinators (HHC)
scheme which:
• supports people’s transition from a reablement
bed to self-care/supported living at home
• facilitates earlier discharge from hospital
where inappropriate housing is the delaying
factor in discharge
• provides early intervention in supporting people
affected by poor or inappropriate housing
• improves the uptake of empty social housing
properties for older persons in the city, and
• improves the health and wellbeing of people who are
negatively affected by poor or inappropriate housing.
The service is funded by Nottingham City Clinical
Commissioning Group (CCG).
Outcomes
An evaluation by Nottingham CCG was carried out to
assess the outcomes and financial cost benefits of the
HHC project. The project was launched as a 12-month
pilot in November 2015, which was further extended
until March 2017:
• The evaluation for the full period demonstrated that
the service had generated savings of over £931,203
(£807,307 net) as compared to the alternative
scenario in the absence of the HHC project.
• The evaluation estimated the net financial return
on investment to be £6.40 for every £1 spent on the
project, as a result of savings generated for local
public-sector agencies (NHS, NCH and Nottingham
City Council).
• For those people who had used the service, health
outcomes and the ability to manage health at home
have improved.
• Almost all (97%) H2H customers now report that they
feel as safe as they would like to be, compared to only
18% who stated this in relation to when they were in
their old home.
• Levels of social contact have improved. When living
in their previous home, over half of respondents
(58%) reported that they had little or not enough
social contact with others. Since moving, 85% now
have adequate or as much social contact as they
would like.
• 91% feel more confident managing their health at
home now, compared to 12 months ago.
• The service enabled citizens to live independently for
longer, with less reliance on intensive care packages.
• Carers’ quality of life has improved (nine were
surveyed). This shows that overall satisfaction
with their quality of life has increased from 3.1
out of 10 whilst their friend/relative was living in
their previous accommodation, to 7.9 out of 10 now.
This is a significant improvement in the quality of
life of those caring for H2H customers.
Case study
The service generated
savings of over £930,000.
12
Home from hospital
Who is affected by delayed
transfers of care
The housing response
Older people
There are more than 10.3 million older people over the age
of 65 in the UK. This represents an 80% increase since the
1950s
13
. The population will continue to grow older, with the
65+ population expected to reach 16.9 million by 2035
14
.
Patients aged 65+ in 2014/15 accounted for 62% of total
bed days, and those with longer stays (of seven days or
more) accounted for 52%
15
. Many had existing and complex
medical conditions requiring particular consideration and
care in planning discharge and aftercare.
Reducing how long older people stay in hospital can
have benefits for both patients and hospitals, and for
demand for social care in the community. Evidence shows
that longer hospital stays for older patients can lead
to worse health outcomes and an increase in their care
needs on discharge
16
.
The efficient use of hospital beds relies on there being a
‘home’ for people to be transferred to, in which any needs
for recovery, ongoing support or plans for end of life, can
be met. To enable a timely and effective hospital discharge
means coordinating relevant people and services in the
community. Housing providers are well placed to assist
with this process due to their experience as landlords and
managers of housing, and increasingly as providers of a
range of care and support services.
13
House of Commons Briefing, Rutherford, T. (2012) ‘Population ageing: Statistics’ www.parliament.uk/briefing-papers/sn03228.pdf
14
Kings Fund ‘Life expectancy’ figures http://www.kingsfund.org.uk/time-tothink-differently/trends/demography/life-expectancy
15
Health and Social Care Information Centre, Hospital episode statistics, 2014-15
16
https://www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital-Summary.pdf
The population will continue
to grow older, with the 65+
population expected to reach
16.9 million by 2035.
13
Home from hospital
One Housing Group
One Housing Group’s scheme at Roseberry Mansions
in King’s Cross, London, provides support for older
people. The ten step down beds are provided within
an extra care housing scheme that has 50 units in
total. The service provides time-limited reablement
in purpose-built apartments where people can
relearn skills and get support from a team of
occupational therapists, physiotherapists, social
workers and support workers.
The purpose of the service is to:
• improve the quality of people’s lives by enabling
and reskilling them to be able to return home
or to other appropriate accommodation in a
sustainable way
• facilitate earlier hospital discharge and avoid
unnecessary or repetitive hospital admissions
• prevent or delay the need for long-term residential
or nursing care placements, and
• deliver significant NHS and adult social care savings.
Outcomes
An evaluation based on a 10 month period in 2014/15
showed:
• 57% of referrals came from acute hospitals and
43% from the community. People stayed on average
for 41 days, just under the six-week limit.
• Savings were made of between £400 and £700 per
person per week in excess bed days. Across ten
apartments this equated to between £200,000
and £364,000 of savings per year to the NHS.
• The service has resulted in a 30% reduction in the
size of care package people need when they return
home, compared to those not receiving the service;
these are cost benefits to the local authority.
• 95% of people who moved on from the step down
service avoided moving to residential care.
• 20% of people were previously unknown to
Adult Social Care; without a multi-disciplinary
team assessment and a place to discharge to,
these people would have been at greater risk
of delayed transfer.
Case study
Savings were made of between £400
and £700 per person per week in excess
bed days.
14
Home from hospital
The role and importance of housing in supporting
people living with dementia to remain living in the
community is widely recognised. However, the Alzheimer’s
Society’s report,
Home Truths
17
, notes that there are
significant difficulties linking housing, health and social
17
Home Truths: Housing services and support for people with dementia, Alzheimer’s Society (2012)
18
Dementia-friendly Housing Charter, Alzheimer’s Society (2017)
Alliance Living
Alliance Living’s Home from Hospital service in North
Somerset has a daily presence in Weston General
Hospital and identifies patients who will need practical
support to return home and remain safely at home,
including people living with dementia.
The aim of the service is to support the safe discharge
of patients from hospital through timely housing-
related interventions. Discharge to a person’s home
environment supports independent living and helps
to prevent future readmittance. The service supports
any vulnerable person who would struggle to be
discharged from hospital safely. Alliance Living has
two dedicated full-time members of staff working in
Weston hospital permanently.
Outcomes
•
In 2016 the service supported 890 people.
• 297 excess bed days were saved – however, this is
likely to be an underestimate due to under-recording
during 2016. This equates to approximately £148,500
of savings in terms of excess bed days avoided.
• Over half the patients were contacted on the day
of referral and 88.5% within 24 hours. This helped
to reduce hospital staff time spent chasing referrals,
responding to patient and family enquires and
dealing with anxiety about delays and uncertainty.
Case study
In 2016 the service
supported 890 people.
care services and support, including the link
between people with dementia having the right housing
options in place to support timely hospital discharge.
This is reinforced in the recently published dementia-
friendly charter
18
.
15
Home from hospital
Healthwatch England undertook a substantial study
19
across England in 2015 in relation to people’s experience
of hospital discharge. The study was informed by the
experiences of more than 300 people with a range of
mental health conditions.
That study heard from people who had been kept in a
mental health setting longer than necessary due to
delays arranging their aftercare, housing and support.
There was evidence that these delays were detrimental
19
Safely home: What happens when people leave hospital and care settings? (July 2015). Healthwatch England.
20
Healthwatch England analysis of My NHS Mental Health Hospitals in England data at October 2014: http://www.nhs.uk/Service-Search/performance/
Results?ResultsViewId=1014
Havant Housing Association
Havant Housing Association provides step down beds
and low-level support for people in psychiatric inpatient
beds whose discharges are delayed. It provides these
safe and inexpensive step down beds in the community
setting alongside a low-level community support service.
It is offered to people whose discharge from the
psychiatric acute ward in South East Hampshire
is delayed because either there has been no
accommodation to be discharged to or there has been a
delayed transfer back to the patient’s own authority.
A ‘meet and greet’ service is provided at the local
psychiatric hospital to assist in creating a safe
transition from hospital to the step down unit.
Outcomes
•
Eight patients accessed the step down between July
2016 and January 2017.
• Total occupancy over that period was 179 days.
• Over this period the service generated cost benefits
of £98,987 compared to the cost of people remaining
in an acute psychiatric bed.
Case study
Between July 2016 and January 2017,
the service generated cost benefits
of £98,987.
to people’s psychological wellbeing, for example an
unexpected delay in discharge could reduce confidence in
managing outside of hospital. An estimated one in 20 bed
days are used by people experiencing a delayed discharge
in a mental health setting
20
.
For someone in recovery from mental illness, a safe and
secure home with a supportive environment provides the
basis for them to recover, receive support and help, and
ultimately return to work or education.
People with mental health problems
16
Home from hospital
The Healthwatch study identified that co-ordination
between hospitals and housing services was a significant
issue affecting homeless people’s recovery after discharge.
When it is agreed that someone should be provided with
accommodation, it may only be temporary accommodation
or a hostel, which may not be appropriate for somebody
who has just been discharged from hospital.
Bournemouth Churches Housing Association
Bournemouth Churches Housing Association (BCHA)
has staff based at three hospitals in Plymouth to
support people who are homeless to be discharged
from hospital to suitable housing in a timely way.
Initially funded by the Department of Health, the
hospital discharge service, as part of a wider Housing
Information Signposting and Support service (HISS)
provides advocacy and support to individuals who
have come into hospital and are homeless or at risk of
becoming homeless (patients with no fixed abode).
The overall objective of the service is to ensure that
people are supported into appropriate accommodation
and that they are engaged or re-engaged with
appropriate health and community services. This group
of patients typically have longer lengths of stay and
more frequent readmissions than other groups.
Outcomes
BCHA ran a comparative study of a sample of 61
patients who accessed the service in 2015 at Derriford
Hospital. The main measures were the number of
hospital admissions and the subsequent bed days 12
months prior to, and 12 months after the intervention
from the service.
• These 61 people were frequent users of the health
service; in the 12 months prior to being supported
by the hospital discharge service, together they
were admitted 122 times and took up 595 bed days.
In the 12 months after the intervention the same
group were admitted 109 times and took up 457 bed
days, a reduction of 23%.
• This equates to a reduction in bed days of 138, with
an estimated cost of £400 per day
21
an annual saving
estimate of £55,200 to the NHS.
• Due to the progress the service is making and the
evidence above, it has recently been awarded an
additional £35k a year to provide further support to
those leaving hospital homeless.
• In the three years the service has been running, it has
made significant progress in bringing various agencies
together, providing appropriate accommodation and
supporting people quicker with earlier referrals, all
contributing to reducing admissions and bed stays and
improving access to support.
• Across 2016, the service supported another 72
people in hospital. Based on the sample data of 2015,
the service could save the NHS around £65,150 in
2017 (average of £905 of savings per individual).
Case study
The service could save the
NHS around £65,150 in 2017.
People experiencing homelessness
Good coordination between health and housing services
to ensure that homeless people have suitable
accommodation to move into after a hospital stay can
help to significantly improve their recovery and prevent
or reduce readmissions to hospital.
21
data.gov.uk, 2015
17
Home from hospital
Other issues related to delayed
transfers of care
Housing providers delivering cost benefits
22
Department of Health. Reference Costs 2015-16 (Dec 2016)
There are other problems associated with
delayed transfers, such as a higher need for
reablement after transfer, and increased
risk of hospital-acquired infection.
This chapter sets out some of the areas affected and how
housing providers have demonstrated that they can help
reduce pressure on services and deliver cost savings.
Excess bed days
In 2015/16 the total cost of non-elective inpatient care
in England was £16.7bn
22
. Non-elective care represents
provision for people coming in to hospital in an unplanned
way i.e. mainly via emergency departments. Where a
patient stays longer in hospital than would be expected for
their condition, this is described as an ‘excess bed day’.
In 2015/16 each excess bed day in an acute hospital bed
occupied by someone admitted for non-elective care was
costed at £306.
Housing providers are able to help facilitate timely hospital
discharge, which reduces expenditure on excess bed days.
In 2015/16 the total cost of
non-elective inpatient care
in England was £16.7bn.
18
Home from hospital
Staffordshire Housing Group
Staffordshire Housing Group provides a
Hospital Discharge Support Service.
The objectives of the service are:
• to support prompt, safe discharge from hospital,
reducing the number of delayed discharges, and
• to support people to live independently at home,
reducing the number of readmissions resulting
from lack of support after discharge from hospital.
To achieve this, the service provides:
• bedside assessments within two hours of referral,
providing prompt and accurate assessment of each
patient’s needs before they go home
• a ‘meet-and-greet’ service, for patients requiring
immediate support at home after discharge, and
• A home visit for all patients within 48 hours of
discharge, ensuring patients are seen quickly after
leaving hospital.
Outcomes
•
An evaluation of the service showed that 92%
of people using it were not readmitted to hospital
within 30 days.
• The evaluation estimated that where 25% of
patients are prevented from experiencing a delayed
discharge, £320,000 p.a. of cost benefit in terms of
saved excess bed days is achieved. Where the service
prevents 10% of patients being readmitted into
hospital, cost benefits of £130,000 p.a. are achieved.
• Patient satisfaction levels are high: 98%
of patients say they would recommend the
service to other people.
Case study
98% of patients say they would
recommend the service to other people.
19
Home from hospital
In 2015/16 the total cost of A&E services in England was
£2.7bn
22
. Each A&E attendance costs £138 on average.
Housing providers can provide immediate responses to
Accident and Emergency attendances
23
ibid
Oldham Council
Oldham Council provides reablement flats within extra
care housing schemes.
It provides a short-term community reablement and
assessment space to support improvement back to
independent living for people who are ready to be
discharged from hospital, either through residential
care, intermediate care or for those who are unable to
return to their previous home.
The service provides
•
A wrap around well-being service providing a
morning check, leisure activities, a 24 hour presence
and emergency response on site, in addition to a
reablement package of care.
• Court manager support and night concierge support.
• A reablement package from Oldham Care and
Support Services, which initially provides four
visits a day to support daily living skills and tasks,
as well as building a person’s resilience and
independence.
• The opportunity for people to be supported
to rehabilitate and learn and regain skills. This
allows for a more realistic, formal assessment
of skills and abilities, and as a result provides
more relevant and successful next steps for the
people using the service.
Outcomes
•
In 2015/16, Oldham Council benefited from reduced
costs in social care of £77,000 because people who
had used the service did not require residential care,
or had a reduced need for home care.
For example, two people moved into the reablement
flats from hospital. One of these people had three
A&E admissions immediately before she moved to
the reablement flats. She left the scheme equipped
with more skills and was more stable – preventing
the likelihood of admissions to A&E. This brought
positive cost benefits: the service meant hospital
discharge time was shorter, and it prevented and
reduced her reliance on community, intermediate
care and hospital services.
Case study
The council accrued savings
of £77,000 in 2015/16.
people with emergencies and have staff who know the
individual well. People diverted away from hospital reduce
the costs and pressures on A&E services.
20
Home from hospital
In 2015/16 the total cost of community nursing services
was £2.8bn
23
. Each contact (for example a home visit) costs
£45 on average.
Radian Group
Radian Group provides ‘Radian Adapt’ for tenants
who are older or have disabilities across its operating
area (southern England) to enable people to remain
independent in their own homes.
The aim is to deliver a comprehensive, effective and
timely adaptations service to Radian residents to assist
them to live independently and safely at home including
avoiding delayed transfers of care and promoting older
people’s wellbeing. To do this Radian has employed its
own in-house occupational therapists.
The Radian service is provided to tenants in its own
housing and offers occupational therapy assessments
for rehousing or local authority grant applications for
major works. Radian uses its own trades teams or
contractors to undertake minor adaptations up to the
value of £1,500. Requests for simple items like grab
rails, half steps and additional bannister rails are
managed through customer services teams raising jobs
which are completed within one week with the aim of
preventing falls.
Outcomes
•
Financed 1135 minor adaptations up to a value
of £1,500.
• Processed 187 Disabled Facility Grant funded jobs
(approximate total value £1m) in 19 different local
authority areas.
• Radian’s occupational therapists were involved in
404 adaptations cases.
• 93% of those residents surveyed were reported as
being satisfied with their aids and adaptations.
• Provided adaptations to enable successful timely
discharge from hospital.
Case study
Community nursing
24
ibid
93% of residents surveyed were
satisfied with their aids and adaptations.
Where housing providers offer preventive services – e.g.
adaptations that promote health and wellbeing; physical
activities to improve circulation and control body weight,
plus a healthy diet – these can reduce the incidence of
chronic problems that require regular community nurse
visits over several weeks, such as leg ulcers.
21
Home from hospital
In 2015-16, the total cost of ambulance services in England
was £1.7bn
24
. Of this cost, £1.2bn was for cases where the
service ‘sees, treats and conveys’ i.e. takes the person
to hospital. For each person who was given immediate
treatment and then taken to Accident and Emergency, the
average cost was £236.
Gentoo Group
Gentoo Group in Sunderland provides a service to
enable older people to remain independent in their
own homes.
This service is offered to older people living
in any type of housing and aims to prevent people
from entering institutional care, losing tenancies
or homes and to support those older people who
are at most risk of admission to hospital.
Outcomes
•
During 2015-16, 2,013 older people were supported
by the service and continued to live well at home.
• For the financial year 2015-16 a social return on
investment (SROI) assessment identified potential
social value worth £1,422,039, and SROI has been
calculated at a ratio of £3.41 of cost benefit for every
£1 invested.
Case study
Ambulance services
Housing providers with staff who can respond swiftly
to emergencies and provide increased levels of support
where needed can reduce the numbers of cases where
ambulances are called out and where ambulance crews
decide they need to take somebody to hospital.
25
ibid
A social return on investment (SROI)
assessment identified potential social
value worth £1,422,039.
22
Home from hospital
The case studies featured in this report
clearly demonstrate the significant
impact that housing services can have,
both in making a real difference to
people’s lives by helping them to stay
well for longer and in reducing pressure
on acute services to help achieve
substantial savings for the NHS.
Next steps
Scaling up the housing offer
Evidence from these existing schemes shows that they
successfully reduce delays in discharging people from hospital
and help to prevent unnecessary hospital admissions.
There is a strong case for increasing the scale and scope
of the housing offer, and within the sector there are high
levels of support for doing this. This would have significant
cost benefits for the NHS. The savings achieved as a result
of the individual schemes featured in this report represent
a tiny fraction of the total cost savings that could be
achieved if provision of these services was extended across
the country.
Housing providers are ideally placed to do this, and have
developed a joined up plan to extend and increase the
services they offer to help people out of hospital, into a
suitable home with the right support.
There are four key components to this sector-wide offer:
1. An increase in the number of housing step down units
or beds nationally which can facilitate efficient discharge
from hospital.
2. More housing staff seconded to discharge teams locally
to coordinate and speed up transfers of care.
3. Care packages to help prevent people from needing
to go into hospital in the first place and to reduce
readmissions.
4. A commitment to facilitating robust evaluation of
this solution.
This offer will ensure that people are getting the care and
support they need, and will free up the NHS to deliver its
services to those who need them most.
Given that the population of older people is set to rise
steadily over the coming years, the potential savings
that housing providers could make in the future will
increase significantly.
One Housing Group’s scheme for older
people saves £400 to £700 per person
per week. Based on an average of around
6,000 excess bed days per month across
England, this equates to savings to the
NHS of between £10m and £18m a month.
23
Home from hospital
Projected population by age, United Kingdom, mid-2014 to mid-2039
millions
Ages 2014 2019 2024 2029 2034 2039 % increase in age
group 2014–2039
0-14 11.4 12.0 12.3 12.3 12.3 12.4 9%
15-29 12.6 12.4 12.3 12.6 13.2 13.5 7%
30-44 12.7 12.9 13.6 13.7 13.3 13.2 4%
45-59 13.0 13.4 12.9 12.6 12.7 13.4 3%
60-74 9.7 10.4 11.1 12.0 12.4 12.0 24%
75 and over 5.2 5.8 7.0 7.8 8.7 9.9 90%
75-84 3.7 4.1 4.9 5.4 5.6 6.3 70%
85 and over 1.5 1.7 2.0 2.4 3.2 3.6 140%
All ages 64.6 66.9 69.0 71.0 72.7 74.3 15%
Children 12.2 12.7 13.1 13.1 13.2 13.2 8%
Working age 40.0 42.0 43.0 44.2 44.3 44.6 12%
Pensionable age 12.4 12.2 13.0 13.6 15.2 16.5 33%
Old Age Dependency Ratio
(people of pensionable age per
thousand people of working age) 310.4 290.4 301.3 308.1 344.1 369.6
Source: Office for National Statistics
Notes:
1. Children are defined as those aged under 16.
2. Working age and pensionable age populations based on state pension age (SPA) for given year.
3. Between 2012 and 2018, SPA will change from 65 years for men and 61 years for women, to 65 years for both sexes.
4. Then between 2019 and 2020, SPA will change from 65 years to 66 years for both men and women.
5. Between 2026 and 2027 SPA will increase to 67 years and between 2044 and 2046 to 68 years for both sexes.
This is based on SPA under the 2014 Pensions Act.
The National Housing Federation is the voice of
affordable housing in England. We believe that everyone
should have the home they need at a price they can
afford. That’s why we represent the work of housing
associations and campaign for better housing.
Our members provide two and a half million homes for
more than five million people. And each year they invest
in a diverse range of neighbourhood projects that help
create strong, vibrant communities.
National Housing Federation
Lion Court
25 Procter Street
London WC1V 6NY
Tel: 020 7067 1010
Email: [email protected]g.uk
Website: www.housing.org.uk
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