The themes of the conference were set as focusing on Delayed Transfers of Care (DTOC), or more humanly put- people stuck in hospital that don't want to be there. There was praise for good management of this across the system but that huge variation also existed, fundamentally more needs to be done to get the right care, in the right place at the right time.
The National Audit Office presented a whistle-stop tour of their recent report on discharging older patients from hospital. Of interest highlighting that there was no correlation between the change of DTOC and the change in adult care spending. The theme of variation was recognised by the variation in practice impacted the variation of admission (admission prevention strategies) and risk appetite (those at the "front door" need to know the options of what can be offered locally). DTOC is only part of the picture and suggested the considerations
- Understand the scale of the problem/opportunity
- Understand the costs/benefits of change
- Incentives to make changes/increase activity
"Change can be done but it wont be quick"- Ashley McDougall
Grainee Siggins then discussed the role of local authorities in improving transfers of care, emphasizing the need for joint working between health and social care commissioners, enhanced out of hospital health and care services ensuring that these are integrated around the individual. The need to plan jointly at a system wide level was raised. The changes needed to manage transfers of care in a system were set out in 8 points
The 8 system changes required
Dr Olliver Gaillemen then discussed the importance of the NICE quality standard focused on discharge planning and that "We are obsessed by complexity and we forget the small things, like talking to someone"
The first breakout session "Discharge To Assess" was attended. With words of caution, wisdom and motivation to think home first came from Tower Hamlets, Barts Health and NHS improvement
In this presentation there was a call to stop pajama paralysis and get people out quick. The thought that it is solely the responsibility of an occupational therapist or physiotherapist to mobilise a patient was challenged- "it is everyone's responsibility". The dangers of not adapting a successful model to your local system was discussed, one simply cant "lift and shift"; meetings, building trust, being visible, being credible and using the most appropriate staff in the system for the work, were raised as points needing to be addressed while embarking on a home first program.
lunch was held in the orangery for networking and learning opportunities
The second session on intermediate care had speakers from NHS benchmarking highlighting the audit of intermediate care would be free of costs to commissioners and providers for 2017, as well as giving access to the previous years audit. Funding for intermediate care was brought up and the data suggested a need for funding to be doubled back in 2012, no funding however was increased in 2013 or 2014 with a decrease in 2015 occurring. Amy Newman and Katie Kew from the early intervention team delivered their presentation about the work they do, including offering a "one stop shop" for their patients, offering feedback related to a patients outcomes to the referrers of their service and reflecting on working in a service that demonstrates a positive can do attitude.
Before the closing panel discussion Liz Sargeant presented her thoughts on discharge to assess, renamed "home first" as the wording of early supported discharge and discharge to assess has a risk of frightening those who access the service. On the idea of using the terminology baseline "get me back to how I was before I came in" was given as a more worthy and person focused phrase. In order to make a success in setting up home first the advice given was that:
- It will take time
- It will take courage-be brave
- There will be a paradox, even apparent chaos
- Populations and frontline staff need to design and own the changes, with support, not top down
- Create social movements
The closing panel discussed how the Sustainability Transformation Plans can help with elderly discharge: "STP's are plans not people", "Need to focus on prevention not symptoms", "Bring together leaders, build possibility and offer unconditional teamwork", "Stop talking about the institutes, Plan about what the person wants"
The panel on STP plans....