Leicester City Clinical Commissioning Group
Many residents within Leicestershire are over 65 years of age, living alone, with limited or no social support locally, rendering them vulnerable and in a greater need of health and social care. Increasing hospital strain and social isolation are issues that particularly impact the county, and have been recognised by Leicester City Clinical Commissioning Group.
The ageing population and rising readmissions
In the UK there are currently over 11 million people over the age of 65, a figure that is projected to rise with increased longevity. A significant challenge for older people is their health: those over the age of 55 make up the largest group of NHS hospital patients, and delays with discharge and readmissions are of particular concern. The growing number of frail and medically complex hospital in-patients, together with continued cuts in funding for social care, have led to readmissions across the UK increasing by 86% over the past 10 years.
Readmissions are a central financial issue for national and local healthcare providers. They are calculated to cost the NHS £2.2 billion each year and are hugely costly to the Leicester City Trust, which is seeing increasing demand for beds within hospitals, as well as reduced numbers of beds available due to local financial constraints.
Readmission is also of significant harm to patients: hospital bed rest accelerates sarcopenia (muscle loss), which adds to frailty within the elderly and inhibits recovery. Just five days on bed rest results in 16% loss in leg strength, in addition to the £12 billion associated costs (calculated from increased hospitalisation, nursing home admissions, and home care expenditure).
Social isolation within the community
Social isolation also plays a major role in the health problems facing older people in Leicester City. Living alone, feelings of loneliness, and a lack of support doubles the likelihood of readmission within three months. Providing opportunities for older people to connect with other people is one of the most effective ways to improve both health outcomes and quality of life.
Leicester City Clinical Commissioning Group commissioned Royal Voluntary Service’s Home from Hospital offer for two reasons: firstly, to reduce the risk of readmission and the frequency and duration of delayed transfers of care amongst older patients, secondly, to improve quality of life and wellbeing for older people.
Home from Hospital takes a positive, person-centred approach to the wellbeing of older people in Leicester City. This focuses on giving people purpose, independence and wellbeing, by helping them to feel valued, connected to others, physically active, and emotionally resilient.
The Home from Hospital service focuses on intensive practical and social support within users’ own homes in the six weeks following their return home from hospital - after illness, surgery or accident. Following discharge from hospital, a Royal Voluntary Service volunteer is matched to a person in need, to help transition their return home.
Based on a structured support plan that's built on the client's individual needs, the volunteer provides practical help where needed. This could include their weekly groceries shop, picking up prescriptions, or taking them to their weekly lunch club, for instance. A cup of tea is always on the schedule as well, with volunteers taking the time to chat to their match to help build connections and social confidence.
By enabling safe discharge from hospital, assisting with recovery and building independence, the service helps to return people home sooner, and keeps them from being readmitted.
The service also:
- Helps users to regain confidence and reduce anxiety about life post discharge
- Provides practical help and support following a discharge from hospital
- Reduces social isolation
- Promotes independent living and choice
- Helps users to maintain day to day activities
- Provides information and signposts users to other organisations.
Value of the service
Based on a proven model of success, the service has brought significant value to the Trust and its beneficiaries:
The national readmissions (28-days) average is 17%. When initially commissioned, the goal was to reduce the rate of readmissions by up to 50% within the Trust. In year one of the Home from Hospital service (from April 2016), the rate of 28-day readmissions had fallen to 2% in 16/17 and 3% in 17/18. In 2018/19, the service is expected to receive 480 referrals and to deliver 67 saved readmissions.
Leicester City CCG cost benefits
In 2017/18 it was estimated that the net savings for the scheme were £20,000. In 2018/19 it is estimated that net savings will be approximately £41,900.
Social care cost benefits
Assuming an expected 17% readmissions of the existing 480 referrals, we can expect that 81 of these patients would have been readmitted - this is an estimated cost of £131,620.
In 2012, Deloitte studies concluded an average saving of £250 per service user to Social Care; therefore, based on commissioned activity of approximately 500 patients, the Home from Hospital scheme could save City Social Care a total of £125,000. This emphasises the potential impact of the service across the combined health and Social Care landscape.
Outcomes to beneficiaries
- Social contacts: 70% of service users felt their social contacts have improved
- Confidence: 52% felt they were more confident
- Health and wellbeing: 50% felt their health has improved
- Happiness: 47% felt happier.