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A joint initiative between Lancashire County Council, NHS England, and University Hospitals of Morecambe Bay has helped saved local health and social care services thousands of pounds by paying informal carers to facilitate quicker hospital discharges and purchasing one-off items or services.

In January 2021, the council, local hospitals, and NHS England recognised that there was an opportunity to develop a new offer that would enable some people to go home from hospital in a safe and timelier way.

They believed that this initiative would benefit hospital flow and limit the need for formal care at a time where health and social care services were under increasing pressures due to the pandemic.

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Through the organisations collaborating, the Hospital Discharge Home Recovery Scheme is aimed at people who need some support to recover or recuperate and which could be met through informal care, either entirely or alongside reduced formal support.

There are two elements to the scheme. One is to enable family and friends to provide informal care where there are challenges in them doing so for up to six weeks to support someone to return home quickly to recover and recuperate via a grant of up to £1,200. The second is the purchase of one-off items or services.

The scope of the scheme sets out that any proposal must be aligned to the Hospital Discharge and Community Support: Policy and Operating Model; it must be person centred and must not duplicate available existing supports or services. This scheme also incorporates the principles of personal health budgets (PHBs).

Sue Lott, Head of Community North and County Acute & Prisons, Adult Social Care, Lancashire County Council, said: “To date we have supported 26 people to return home more quickly, of which 15 people were during the initial phase the pilot, spending a total of £4,419 but saving a total number of 67 hospital bed nights (an average of four per person). Using the assumption of £800 per night’s stay in hospital, the financial ‘saving’ is £53,600.

“Although the numbers are small so far, the potential of the scheme is significant, not just for the release of bed nights in the hospitals, but importantly in better and more personalised outcomes for people.”

The support for informal carers is delivered through the Lancashire Carers Service. They offer a rapid referral process, contact the informal carer, understand and apply the solution they need, and support them for up to six weeks through weekly check ins. The service then also offers continued support beyond the six weeks where appropriate.

For instance, a daughter of a lady being discharged from hospital was supported to care for her mum for 11 days until a formal package of care was put in place. The scheme enabled the daughter to provide this care by covering the costs of the unpaid leave she took from work and her travel expenses to stay with her mum. The lady was able to return home sooner and did not have to enter a short-term residential home placement. Plus, during those 11 days at home, her recovery was such that the formal package of care could be reduced at implementation.

To complement the support for carers, the scheme also has the option to purchase one-off items or services that a person needs to enable them to return home sooner. These cannot be care related or be covered via an alternative funding route or existing service, unless the existing service would cause a delay in a timely discharge.

For example, a local district council handyman service was unable to move furniture from upstairs to downstairs in a person’s home for 10 days. The Hospital Discharge Home Recovery Scheme paid for an alternative provision, and the person was able to be discharged next day. This reduced the need for an extended stay in hospital or having to transfer to a residential placement until the furniture could be moved.

Kate Buffery Head of Personalised Care, NHS England-Improvement North West, added: “The discharge pilot in Lancashire has demonstrated how using personal health budgets to empower people, their families, and carers to access flexible and creative solutions can improve outcomes and experience. Work is underway to scale up this approach locally and increase spread across regions. Well done to all involved!”

The initial pilot phase of the scheme ran for three months linked to two hospitals to understand what could be achieved. It was relaunched in September 2021 in the same area because of the mounting pressures in the hospitals.

From December 2021, it is now expanding across Lancashire, commencing with the purchase of one-off items first and will be closely followed by the carers’ element.

Lancashire County Council is working closely with three other local authorities to extend the scheme across the Lancashire & South Cumbria Integrated Care System (ICS).

Sharon Doyle, Discharge Lead Royal Lancaster Infirmary, commented: “The Morecambe Bay Pilot came along at an opportune time for the discharge team across the acute and community footprint, it was a difficult time within both the community and acute sector, and the pilot gave us a contingency plan, a different angle to do things that we couldn’t do previously. In all honesty it gave us the ability to offer support to people who needed it the most, without having to apply through various pathways which was often time consuming.

“The team were seeing high levels of people requiring support for simple things, a microwave, equipment to store medications such as insulin, supporting patients who needed support with a safe for medications but had no means to obtain these themselves and no family to support.

“It reduced the hospital stay, but also enabled people to stay at home, but the biggest thing was it gave people a feeling of worth that someone cared enough to do this for them.

“The carers service also provided support to families that couldn’t get to loved ones due to other commitments, and to be able to say that we can help made a massive difference. This enabled the team to do the right thing, at the right time and facilitate home as the discharge destination – Home First always.”

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