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Hospital to home: people’s needs must be central to transfers of care

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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.

https://www.theguardian.com/social-care-network/2017/sep/25/hospital-to-home-transfers-of-care-nhs-health-social

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