Hospital at home team’s innovative approach to care praised by health chief

Written by Euan Duguid.
Published at 12:50 on 29 January 2015.
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AN innovative partnership project geared to keeping older people out of hospital has been hailed as a model of best practice by a national health chief.
 
Professor Jason Leitch, National Clinical Director of The Quality Unit at The Scottish Government – tasked with improving the national delivery of health and social care – said he was ‘encouraged and inspired’ after a recent visit to The Age Specialist Service Emergency Team (ASSET).
 
ASSET allows older people in some areas of North Lanarkshire to remain at home rather than being taken to hospital and treats a range of complaints and conditions.
 
The team is made up of NHS Lanarkshire consultants, nurses, rehabilitation staff, occupational therapists, physiotherapists and a trained psychiatric nurse. 
 
ASSET also work with North Lanarkshire Council Social Work Department to enable patients to receive immediate and additional community support if needed.
 
Across Scotland, and Lanarkshire, the next year will bring changes in the way health and social care services are delivered. A new Act requires health boards and local authorities to integrate their adult health and social care services.
 
Professor Leitch said the innovative work in Lanarkshire bodes well for the future.
 
“I’m both encouraged and inspired by what I’ve seen today,” he said.
 
“Research shows most older people would prefer to remain in their own homes, with support, if they are unable to look after themselves. We want them to be able to do that. We want the right care in the right place at the right time.
 
“Sometimes that will be an admission to hospital but increasingly it will be care provided appropriately at home.”
 
Professor Leitch continued: “Some partnerships and boards have got similar programmes where they treat relatively sick people in their homes, rather than in institutions, including Fife and Lothian. 
 
“Yet, this sort of care isn’t as widely spread as we’d like and we’re going to endeavour to change that. Lanarkshire is clearly the most mature example of it working well.”
 
ASSET is a key pilot initiative within numerous Reshaping Care for Older People (RCOP) projects in North Lanarkshire. RCOP aims to make independent living a reality to growing numbers of older people by providing more support and care in the community, at home or in homely settings.
 
The team is currently operational in the North Lanarkshire localities of Airdrie, Coatbridge and Cumbernauld/Kilsyth, which is in the catchment area of Monklands Hospital.
 
Data, based on rigorous evaluation, shows that between 1 April 2013 and 31 March 2014, ASSET were responsible for 913 hospital admission avoidances in these areas. Based on this evidence, 25 fewer beds were used over the course of the year.
 
Heather Knox, Director of Acute Services for NHS Lanarkshire, said: “The approach successfully adopted by the ASSET team is key to improving outcomes for older people by avoiding, where possible, hospital admission. 
 
“It is one of a number of joint initiatives aimed at supporting more older people at home. Work like this demonstrates that we are fully focussed on making a real difference to the lives of people throughout area.”
 
ASSET: A positive impact
 
  • ASSET treat a range of complaints and conditions including infections, pneumonia, delirium or falls.
  • When a patient is referred to ASSET, the team aim to visit them within one hour to see if they can be cared for at home.
  • A nurse will examine the patient as well as carrying out tests such as a cardiograph and blood tests so, when the consultant arrives 30 minutes later, they can study the test results and further examine the patient.
  • As part of the overall partnership approach, in the areas of North Lanarkshire where ASSET has been operational, there has been a positive impact on the rate of increasing hospital admissions.
  • From Feb 2012 – July 2014 over-75 admissions to Monklands Hospital from localities covered by ASSET rose by only 1.3%. In the same period, in areas across the rest of Lanarkshire not covered by ASSET, there was an 11.7% rise in over-75 hospital admission.
  • Between February 2012 – July 2014, figures show 2303 patients were supported at home by ASSET.
 
FALLS TEAM PRAISED
 
During the visit Professor Leitch also said he was also “thoroughly impressed” by local work that’s part of a national programme geared to managing falls and fractures in care homes.

As part of Up and About in Care Homes, NHS Lanarkshire staff have been working with local authority and independent sector partners to reduce the potential of falls which can have serious implications for older people.

As well as improving systems and processes, one way of addressing falls is to increase and encourage appropriate physical activity which can increase core stability, well-being and confidence. Activities run in Lanarkshire to date have included swimming-fitness classes and physical activity programmes
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