Background
The Coventry and Warwickshire Integrated Care System (ICS) covers a population of approximately 1 million. Warwickshire has an older population profile compared to the English average, with a significant portion of older people living in rural areas within the patch.
The problem being solved
Significant operational pressure across the health and care system has encouraged many health and care leaders to consider how they can ensure they can get the right care, in the right place, at the right time. In Warwickshire, the level of demand in summer 2022 meant that on any day, there could be 200 individuals being discharged from hospital or requiring care in the community waiting for a package of care. Health and care leaders in Warwickshire acknowledged that this was unsustainable and began exploring potential solutions, including but not limited to the development of a Community Recovery Service.
Warwickshire's Community Recovery Service
Health and social care partners across Warwickshire have been working together to improve timely access to therapeutic intermediate care services on discharge from hospital. The team are developing a Community Recovery Service which, from April 2023, will allow more people to access rehabilitation and recovery services after a hospital stay, with the aim of reducing length of stay in acute hospitals and maximising the home first approach. The package of intermediate care will be provided and paid for by the NHS (via the Better Care Fund) for up to six weeks, with individuals being encouraged to maximise the use of this time to reduce the need for further care.
How it will be delivered
As part of this programme, all patients who no longer fit the criteria to reside in hospital and are assessed as pathway 1, will be assessed and triaged by the therapy team to decide if they need ongoing therapeutic intervention alongside their domiciliary care. The aim is for the intermediate care package to be available 24-hours after a referral from the hospital team is made. Care will be delivered at a person's home by the Community Recovery Service which is made up of domiciliary care workers and allied health professionals from South Warwickshire University NHS Foundation Trust. Residents only receiving domiciliary care as part of the service are still able to re-access therapy services at any time during the six-week intermediate care period.
The trust and local authority have been working closely with domiciliary care providers to think differently about how they commission care, allowing greater flexibility for home care providers to recruit and retain staff and think about how they can be deployed differently. NHS trusts have also been doing some work internally to bolster resources around therapeutic professionals through the use of home care equipment which can be used by individuals, resulting in increased capacity for staff to provide more care elsewhere.
The wider programme
Other workstreams of the frontrunner programme will give Warwickshire the opportunity to explore their connections with the voluntary and community sector and organisations; these includes organisations such as Helpforce but also volunteers, groups, organisations, enterprises and charities, to work collaboratively testing new approaches to meeting people's needs in the community. Building on a partnership already operating within South Warwickshire Place Partnership, the programme will also explore what part technology and partnerships such as the Tribe Project can play.
Key enablers
Health and care leaders in Warwickshire cite strong relationships as one of the key enablers to developing this programme of work. Reflecting this, the chief commissioning officer for health and care in the area is a joint post across Warwickshire County Council and South Warwickshire NHS Foundation Trust. This provides a unique perspective and supports the post holder to make decisions with a view of the whole system.
South Warwickshire University NHS Foundation Trust and George Eliot Hospital NHS Trust are part of a Foundation Group, alongside Wye Valley NHS Trust. The groups' commitment to integrating health and care and supporting people to get the support they need in the right place, has been demonstrated in their recent shared strategy. The strategy outlines five big moves, one of which is 'supporting domiciliary care'.
The use of digital is another key enabler to freeing up staff across the sector. NHS trusts in Warwickshire are keen to support staff to become technology enabled and have worked with industry to trial new digital solutions to support remote monitoring, allowing staff to monitor people at home rather than needing to visit in person.
Health and care leaders in Warwickshire also cite the importance of partner organisations recognising the limits of their expertise and leaning into learning from other organisations. To support this, ICSs are well placed to facilitate this joined up working around patient flow given their broader view and focus on population health across a system. This perspective should be maximised and embraced.
As a practical enabler, NHS trusts and local authority leaders have also been reviewing the commissioning of home care and looking at what support domiciliary care providers need to deliver and staff a care package within 24-hours. This has involved changing contracting arrangements so that home care hours are purchased as a block ahead of time, providing stability for domiciliary care providers when planning for recruitment and retention of staff.
The trusts and local authority are paying domiciliary care providers delivering care as part of the hospital discharge community recovery service via a block which gives providers financial security and enables them to plan staffing accordingly. Domiciliary care staff that are commissioned as part of this programme are also being empowered to work proactively to deliver services beyond personal care, with the core aim of supporting people to be independent.
The community team at South Warwickshire University NHS Foundation Trust are working to share learning with domiciliary care staff to help upskill staff and support career progression. All of this promotes recruitment and retention in the sector, boosts staff morale and demonstrates the value of home care staff.
Key barriers
Operational and financial pressures facing the NHS and wider system partners can make it challenging for organisations to meaningfully progress similar initiatives. The national focus on delayed discharges from hospital settings can be unhelpful. There must be greater emphasis on prevention, admission avoidance, and home first to truly tackle some of the persistent issues relating to delayed discharges.
Benefits for staff, patients and system flow
In Warwickshire, improved access to therapeutic services post-discharge is expected to support a reduction in delayed discharges. Recent data shows that the average number of people waiting for a package of care has been reduced significantly from around 200 in summer 2022.
As this programme of work develops, health and care leaders in Warwickshire are looking to gather further evidence to demonstrate its benefits, much of which will be done through integrated care board data collection.