Bedford Adult Services step in to help people leaving hospital get home safely

Bedford Hospital entrance

Bedford Borough Council’s Adult Services is working more closely with partners on hospital discharges and to support people to get them home safely, a meeting heard.

Kate Walker, director of adult services, told the Adult Services Overview and Scrutiny Committee on Tuesday (14 December) that there is “significant pressure” on every area in the acute trusts, and this is having a knock-on effect on hospital discharges.

But, she added that in some respects “this isn’t different to any winter”.

“I think I’d be saying this every winter to you,” she said.

Ms Walker was updating the committee on the Home First/discharge to assess programme.

The LGA website says that this provides short-term care and re-ablement in people’s homes or using ‘step-down’ beds to bridge the gap between hospital and home.

Adding that the programme aims to ensure that people do not need to wait unnecessarily for assessments in hospital, to reduce delayed discharges and to improve patient flow.

Ms Walker said: “There will be pressures as people are required to be discharged sooner and be assessed in the community.

“But our ultimate aim is where it is safe to do so, is to do so in a way that people can go home, if it’s in their interest to go home.

“Or if they are required, because of a clinical reason, to have a resource from a bed base for a period of time, such as a designated setting if people have a positive COVID result,” she added.

The committee was told that Adult Services is working more closely with partners on discharges and to support people as far as possible to get them home safely.

“The winter planning is really coming from all perspectives to try and reduce the pressure and release the beds in the hospital,” Ms Walker said.

“But we really have to balance that so we prevent readmissions as far as possible and that we have knowledge of those with health and social care needs as soon as they enter the hospital so that planning can take place.

“We are seeing people with complexity who may require more care initially when they come home to what they may require in the medium term.

“So we’re monitoring and reviewing people all the time so that we can manage the market and respond to their needs,” she added.

Cllr Dean Crofts (LibDems, Kingsbrook Ward) said that hospital discharges was quite close to his heart because of a bad experience in Cambridgeshire.

“What’s the communication like between the ward managers, the hospitals and our discharge team,” he asked.

“Are we being allowed on the wards when there’s a discharge so we can assess the patient,” he added. He also asked whether communication was mostly via emails.

Ms Walker replied: “The discharge arrangements are very, very tight, it’s not all by email.

“The community health service within the hospital and the ward rounds are very closely connected to adult social care, we are able to be in there,” she said.

Ms Walker explained that under Home First the initial assessment is carried out by the hospital and the discharge navigation service. The assessment of people once they move to the next setting is where adult social care requirements step in, and this isn’t by email.

“The feedback I’m getting is that our system is working closer together than ever has since COVID and it’s continued, even though the demand has increased,” she said.

Ms Walker explained that a lot of work has gone into getting the pathways right for discharges.

“Because there are simple discharges, there are complex discharges and some don’t come anywhere near the local authority because they are health-related discharges,” she said.

“But where there is social care involvement the confidence that I receive from our teams is that it’s extremely pressured, but their communication is good,” she added.

Councillor Crofts said it was good to hear that the communication channels are good at the moment between your team and the hospital team and that it was “really important” that those communication channels are kept open.

“So the patient is not in a position where they have to go back into the hospital,” he said.

by John Guinn
Local Democracy Reporter

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