Throwing off the lanyards. Liverpool Intermediate care

Featured article - 28 July 2017
By Dyane Aspinall, Director Adult Social Care and Health (interim), Liverpool City Council

Sometimes the number of emails I receive can get me down but increasingly the following represents the type of thing popping into my inbox.

Staff at Venmore are fantastic and I can’t thank them enough for the way they cared from my mum. She has made a full recovery after her rehabilitation and is able to walk independently, go shopping and has even been able to go dancing again.

Relative of Reablement Hub user

Dancing again! Wow- the result of our wonderful new joined up working. I want more of this sort of thing, but we are transitioning from an old model to the new and waiting for change can be frustrating. It’s hard to get the intermediate care balance right between 'admission avoidance' and 'hospital discharge', particularly during surges in demand when we sometimes don’t have enough quality beds in the community.

• SCIE Higlights report on intermediate care

Home First

But based on the pragmatic idea that “everyone has a bed at home” - and anyway, most people tell us they want to be at home as soon as possible after hospital episode - our discharge-to-assess ‘Home First’ service model was developed. Workshops conducted with our Hospital and Community Trust suggested that we could do something different and so in Sept 2016, senior leaders across the partnership agreed to pool resources in a different way. Our multi-disciplinary health and social care teams, alongside GP’s in the neighbourhoods, threw off the lanyards and agreed Home First - a new way of working.

Success criteria

The seemingly endless challenges of transport, IT access, e-mail firewalls and trusted assessments were overcome and now we ensure 14 people per week are moved out of hospital within 48 hours of being ‘ready for discharge’. The figure was previously one of up to two weeks. Home First has benefitted 442 people and in over 50% of cases people do not need long term homecare. Those that do have a much reduced package. This all points to an improved continuity of care and a good service user experience and outcome.

They gave (my husband) time for him to be able to let him do what he could do for himself; there has also been an improvement in what he can do.

Typical feedback

Decompensating in hospital

This all sounds amazing. However, the pooled resources have limited capacity and for every person benefiting from Home First, there is another who will have to spend another week or two in hospital ‘decompensating’ whilst the usual assessment notification, assessment, care brokerage and final discharge system still face plenty of challenges.

Funding an expansion of the service has proved difficult amongst partners with hard pressed budgets but I am hopeful the increasing positive evidence will speak for itself; and that the 'gain share' across the system will be recognised. This in turn will hopefully see jointly developed mechanisms that will allow funds to flow from one part of the system to another.