| Welcome to the programme newsletter | Welcome to the latest edition of the Humber Acute Services programme stakeholder newsletter. In it you'll find the latest news and updates about the programme, alongside information about how you can get involved, share your ideas or ask questions.
In the next few issues of our newsletter, we want to highlight some of the developments that are taking place, both in and outside of our hospitals, that contribute to the programme’s vision for the future. Some are national programmes, others are local initiatives, but in all cases, we are aligning our work with these wider changes. This issue focuses on Frailty and Care of the Elderly. | |
| SPOTLIGHT ON - Frailty and Care of the Elderly |
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Integrated Frailty Programme
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The NHS in England is the first health system in the world to systematically identify people, aged 65 and over, who are living with moderate and severe frailty using a population-based stratification approach. This is helping NHS organisations and partners to put in place services and initiatives to better meet the needs of this group of people.
Approximately 1000 older people are admitted to hospital unnecessarily each day across England; this can lead to a decline in health called ‘deconditioning’. Evidence suggests that many patients can spend up to 83% of their time in hospital in bed and for every 10 days spent in hospital, people aged over 80 years can expect to lose 10% of their muscle mass – the equivalent of 10 years of ageing. Deconditioning can be described as an avoidable harm.
Within Humber and North Yorkshire, partners are working together to deliver a range of solutions to support people living with frailty, ensuring they are being cared for in the right place at the right time by the right team. This includes specialist care closer to home. To provide alternatives to in-hospital care, several projects and service concepts have been developed, some are still proceeding through the pilot stage with great success, others are fully operational and transforming how care is provided for elderly and frail people across the Humber.
Key areas of focus being undertaken through the Integrated Frailty programme include:
- Urgent community response – (rapid response teams, providing a 2-hour response)
- Enhanced Health in care homes – (enhanced support and better co-ordinated care, reablement and rehabilitation)
- Anticipatory care – (helping people with complex needs stay healthy and functionally able)
You can read about the 2-hour Urgent Community Response service in Issue 9. It is one of a number of initiatives seeking to provide clinical assessment close to first contact avoiding unnecessary trips to an Emergency Department when people don’t need to be there.
The Jean Bishop Integrated Care Centre is an example of anticipatory care being delivered within the Humber, with the centre providing care to residents in Hull who are living with frailty on a proactive basis to help them to maximise their health and wellbeing.
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| The Jean Bishop Integrated Care Centre (ICC) |
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Hull's frailty model is making a difference
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The Jean Bishop Integrated Care Centre (ICC) in Hull is a purpose-built health and social care centre that opened to patients in May 2018. The centre was commissioned to transform care for older people in Hull by providing specialist holistic care and support to enable residents to keep fit, healthy and living independently in their own homes and avoid unnecessary hospital admissions. The team also in reach into care homes, to deliver the same level of care regardless of place of residence.
The centre was named to recognise the outstanding contribution of the late Jean Bishop, Hull’s ‘Bee Lady’, a champion fundraiser for older people. Jean was an ambassador of Age UK and was awarded a British Empire Medal after individually raising more than £125,000 for Age UK.
The Jean Bishop ICC has been key in the responsive service provided to frail members of our community throughout the Covid-19 pandemic. The centre is the first of its kind in the UK, and provides an innovative, holistic approach to caring for Hull’s elderly and frail residents.
The approach was designed by local community geriatricians and GPs working in partnership with patients and a range of partners. GPs in Hull use the Electronic Frailty Index (eFI) tool to identify patients at risk of severe frailty and invite them to a half-day appointment at the Jean Bishop Integrated Care Centre (ICC) where they receive a number of multi-disciplinary reviews of their care.
The team providing care and services at the centre includes GPs with extended roles, community geriatricians, pharmacists, advanced practitioners, social workers, carer support and therapists who link up with other speciality teams within the community, including the Fire Service operating as the Hull F.I.R.S.T team. The F.I.R.S.T team attended 826 falls between April 2021 and March 2022 and conducted 275 Safe and Well visits.
Patients receive a medication review which helps to reduce the adverse health effects of ‘poly-pharmacy’ (when patients are on five or more medications). In addition to the benefits to patients’ wellbeing, medication reviews have saved approximately £100 per patient per year on unnecessary prescribing. X-ray and pathology are also available for people invited for assessment.
The ICC aims to take a proactive approach (identifying people at risk of frailty using a risk stratification tool) rather than a reactive approach (responding when people go into crisis or require help for a medical condition). By working with elderly and frail residents to ensure they have the support they need to stay well, rather than waiting until they have an issue that needs to be addressed, the ICC has contributed to significant reductions in ED attendances, emergency admissions and re-admissions for Hull’s frail population.
- Compared with the 12 months prior to review at the ICC, those who have been seen at the ICC have had (on average) a 13% reduction of Emergency Department attendances and a 24% reduction of unplanned hospital admissions.
- Those who had attended ED more than 5 times in the preceding year had the greatest benefit with a 34% reduction in ED attends and 100% reduction in admissions
- Alongside this, 75% of care home residents have received a Comprehensive Geriatric Assessment (up to March 2022)
With a focus on quality improvement and data, the ICC team have now expanded to include those who are moderately frail plus other conditions. The team are also working together with partners across the Humber to learn from and expand the approach across other parts of the region. This includes a virtual model of delivery which is now in place within East Riding (Holderness area) with plans to expand further.
The innovative ways of working now also include other secondary care teams, including Parkinson’s and diabetes, working with the ICC team to deliver further specialist support within the community.
The Health and Social Care Secretary recently visited the Jean Bishop Integrated Care Centre and saw how closer integration between health and care services is helping deliver a better service for elderly patients. Click here to read more about this.
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Can you help?
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We have been listening to feedback and ideas from people across the Humber over the past 18 months and these have really helped to influence our emerging ideas.
As we develop these ideas for how services could look in the future, we will be continuing to reach out to particular groups within our community, to help us better understand how they may be impacted by any potential changes to acute hospital services. Throughout our work we are seeking to listen to all communities and individuals and reduce health inequalities in the Humber area.
The groups we would particularly like to engage with include:
- People living with serious and enduring mental illness
- People living with poor mental health, including parents and carers.
- Adults and children with learning disabilities or difficulties, including parents and carers.
- People from black, Asian or minority ethnic backgrounds
- People who identify as LGBTQ+
- People affected by homelessness.
How can you help?
- Do you work with or support any of these groups, or know someone who does?
- Do you know of any pre-existing groups we could attend?
- Would you like to be involved and represent the voices of the people you work with?
If you answer 'yes' to any of the above, then please click here to register your interest in hosting or supporting a focus group or other engagement activity over the coming months.
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Hospital at Home for the Elderly
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Question:
It's great to see Hospital at Home (HaH) being trialled for children and young adults. May I ask if there's any plans for HaH for elderly patients? I worked for an NHS Trust before that had HaH for elderly patients. Normally the frailty consultant assesses them in A&E and if suitable, they are discharged with HaH support. Even admitted patients could be accepted for HaH if they met the criteria. I think patients at risk of delirium or even patients with mild delirium probably would benefit more from being treated at home and there might be a quicker resolution to their delirium.
Answer:
In the Humber, there are plans to deliver Virtual Wards, including both Hospital at Home (mostly face to face) and Remote Monitoring (mostly non-face to face) models. These models will build on the COVID Virtual Ward models that we implemented in 2021 in response to the pandemic and have seen many patients successfully treated at home who would otherwise have been in hospital.
Following recent confirmation of some available funding, the clinical and operational teams plan to expand these models to include other conditions, such as frailty.
The Frailty Virtual Ward in particular will include supporting people with the needs you have described. Delirium is an acute episode of confusion that can happen in people who become medically unwell, which gets better when the cause is treated. The Hospital at Home teams would look for the underlying cause (like infection, dehydration, medication side effects) whilst also treating acute episodes of confusion.
Based on experience in other areas where Virtual Ward/Hospital at Home models are in place, it is anticipated that there will be a group of patients who could have good, or even better outcomes from being cared for in their own environment as you have suggested.
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We launched our revamped Humber Acute Services programme newsletter in July 2021. Each newsletter includes a range of information about the programme and you can access previous editions by clicking the links below:
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