Leicester City Clinical Commissioning Group

Leicestershire City CCG

The problem

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 ten years.

Readmissions are a central financial issue for national and local healthcare providers – calculated to cost the NHS £2.2 billion each year, and being hugely costly to the Leicester City Trust who are 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.

The solution

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, an Royal Voluntary Service volunteer is matched to an older person in need, to help transition his or her return home. Based on a structured support plan, grounded 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 older people from hospital sooner, and keeps them out of hospital.

  • 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

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