New hospital at home plan needs NHS staff to go ‘above and beyond’

The government has announced a new ‘hospital at home’ plan that gives more tailored support in the community in an attempt to curb unnecessary trips to hospital and improve ambulance response times.

The urgent and emergency care plan aims to reform and improve community services such as falls and frailty teams.

Urgent community response teams will also be scaled up to increase the number of referrals and patients seen by a range of health and social care professionals within two hours, with services running 12 hours a day. This is to ensure people can get the care they need at home, without the need for a hospital admission.

Same day emergency care units, staffed by consultants and nurses, will also be open in every hospital with a major A&E, helping to transform patients’ experiences and allowing thousands of people each week to avoid an overnight hospital stay.

Care for older people should be centrepiece

The British Geriatrics Society (BGS) has welcomed the plan and said that care for older people with frailty should be the centre of the recovery plan.

It said that for many older people requiring urgent care, hospital admission is not the best option and may cause more harm than good. Therefore, it is essential that these units enable older people with frailty to receive same-day assessment by specialist multidisciplinary teams so that they can have timely care without needing to go into hospital.

BGS President, Professor Adam Gordon, added: “The proposal to increase capacity in virtual wards is a centrepiece of the plan. Among the various virtual ward models being developed by the NHS, it is Hospital at Home for older people with frailty which is most likely to make a difference. Research has shown that this type of care can enable some people to receive hospital-level care where they live, with equivalent health and wellbeing outcomes as would be expected if they went into hospital. While this is not an option for everybody, we know that many older people who receive care this way value being able to stay at home.”

He said that the biggest challenge will be ensuring that appropriately trained staff are in place to provide these services. Because if the workforce crisis is not addressed, the ambitious proposals will not succeed.

A fifth of hospital admissions are avoidable

Health and Social Care Secretary Steve Barclay said: “The health and care service is facing significant pressures and, while there is no quick fix, we can take immediate action to reduce long waits for urgent and emergency care.

“Up to 20% of hospital admissions are avoidable with the right care in place. By expanding the care provided in the community, the most vulnerable, frail and elderly patients can be better supported to continue living independently or recover at home.

“This includes rolling out more services to help with falls and frailty, as well as supporting up to 50,000 patients a month to recover in the comfort of their own homes. Not only will patients benefit from better experiences and outcomes, it will ease pressure on our busy emergency departments.”

Falls and frailty services have already been shown to improve patients’ experiences, and reduce pressure on urgent and emergency departments. For example, South Warwickshire University NHS Foundation Trust has rolled out an integrated frailty service linking up emergency services and hospitals.

Frontline capacity will be boosted by 800 new ambulances, including 100 specialist mental health vehicles, and 5,000 more sustainable hospital beds backed by a £1 billion dedicated fund.

The two-year delivery plan for recovery comes amid record demand for NHS services, with the latest data showing more A&E attendances than ever before, growing numbers of the most serious ambulance call outs, and millions of NHS 111 calls a month over winter.

NHS staff still need to go ‘above and beyond’

NHS Providers said it is right the NHS takes stock of the steps needed to recover performance. This includes expanding key initiatives that are already leading to improvements, such as ‘virtual wards’ and same day emergency care units.

It did caution, however, that this will not only depend on NHS staff continuing to go above and beyond, but also on concerted action to reduce the numbers of people needing to come into contact with emergency and urgent care services in the first place.

Matthew Taylor, chief executive, added: “The NHS has been at the mercy of a sluggish and short-term approach from the government in its response to the crisis facing emergency services this winter. Extra pots of money have been welcome but they have come too late to have maximum impact when it comes to easing winter pressures. In future years, health leaders are clear this funding needs to come much earlier to give health and care services enough time to recruit extra capacity.

“Also, if the government continues its standstill with the trade unions on pay this could lead to further disruptive strikes and frontline staff walking away when the NHS needs them more than ever. The NHS needs the right numbers and mix of staff in place if it is to truly recover the performance of emergency care and other services long term.”

The two-year plan aims to stabilise services to meet the NHS’s two major recovery ambitions, to help achieve A&E four-hour performance of 76% by March 2024 and improve category two ambulance response times to an average of 30 minutes over the next year, with further improvement in the following year.