Tracking the care journey holds the key to a better life

Hospitals are again facing record levels of delays in discharging patients. Figures from NHS England show that during September 2016 there were nearly 200,000 days of delays – a 33% increase from September 2015. Much has been written about the delays attributed to a lack of available care in the community, but if you delve deeper into the figures you find further delays due to waiting for adaptations or other housing issues.

Adding up the delays due to adaptations and housing issues accounts for just 4% of the total, but this still equates to 8,280 days and a cost to the NHS in England of £2.5m. But this average masks some significant variations across the country, with up to 26% of all delay days attributed to adaptations and housing for some local authorities. It’s also worth remembering that unsafe housing can be the reason why people are admitted into hospital in the first place, particularly through cold and trip hazards. These dangers have been estimated to cost the NHS over £600m every year in England.

Compared to the total annual NHS budget £120bn this could still be seen as a drop in the ocean but, as we’ve learnt from our success in the Olympics, there is a lot that can be achieved from the cumulative effect of marginal gains. Particularly when there’s a whole group of people willing and able to help.

Foundations is the national body for Home Improvement Agencies (HIAs) – locally based organisations who work with people to carry out repairs and adaptations to their homes so they can continue to live there: warm, safe and secure. Much of the work carried out by HIAs is funded by Disabled Facilities Grants (DFGs), traditionally paying for home adaptations like ramps, level access showers and stairlifts. By linking DFG activity to social care data, our analysis of this work found that such adaptations can delay entry into residential care by 4 years and significantly reduce the burden on family carers.

For 25 years the DFG was often a stand-alone intervention, working in isolation from health and social care. Then, in 2014 the DFG was incorporated into the Better Care Fund which requires health and social care commissioners to plan services alongside their colleagues in the housing departments. In many areas this is the first time that these conversations have taken place and the potential of housing to support health and care services has been properly considered.

In our recent report – The Disabled Facilities Grant, Before and After the Introduction of the Better Care Fund – we highlight how professionals are increasingly being brought together into multidisciplinary teams and providing a more responsive service for customers. In Warwickshire, a countywide Home Environment Assessment & Response Team (HEART) has been established to deliver the right practitioner at the right time with the right solution. This will enable the customer choice and control to manage their own lives.

For the first time, there’s a clear focus on health and care outcomes for service users, including statutory outcomes and targets, rather than just delivering a service (e.g. providing an adapted bathroom). The government recognised the value of this approach and announced significant funding increases in last year’s autumn statement – up by 127% by the end of the decade compared with 2015-16.

This combination of increased funding and collaborative working means that innovative new approaches are starting to emerge. For example, in Ealing a range of adaptations are being fast-tracked for people admitted to hospital so that their home is ready for them when they’re fit to be discharged.

But, this opportunity to maximise the extra investment in prevention via DFGs – and ensure it continues to be resourced – will only be fully realised if there’s a common link that tracks a person’s journey from beginning to end. That means the sharing and use of the NHS number for all casefiles – something that’s often missing. Otherwise, it will be harder to gauge the full impact of these preventative interventions, embed them and maintain the case for future funding. If the NHS number can be used consistently for these services then it will become possible to evaluate what really works to keep people out of hospital and which approaches help to limit delays in discharging from hospital.

Home Improvement Agencies are willing and able to play their part, the Disabled Facilities Grant budget has been increased and Foundations are available to advise and support commissioner and providers across England to make the most of the opportunities to innovate and collaborate.

This blog was originally published in the Health Service Journal