‘How our post-discharge support is helping cut hospital readmissions for older people’

by David McCullough, CEO of Royal Voluntary Service

Older people represent the single largest spend across primary, secondary, community and social care. Currently more than 4.8 million people in Great Britain are over 75 years old and latest projections show that by 2030, this figure will have increased by over three million – it is likely that as the number of older people increase, so will the demands on providing long-term care.

We know that older people rely more than other age groups on acute care and GP services. Once admitted to hospital, older people stay longer, and when they are discharged, they often return again within weeks. Too often, little thought is given to what happens when a patient leaves hospital and returns home. A shift of appropriate treatment and care from hospital to home is in the interests of both patients and the health service.

Returning home from a stay in hospital can be a very unsettling time, especially for older people, who make up two thirds of all readmissions to hospital. This figure is too high and, we have found, can be addressed by providing simple, cost-effective support to older people when they get home. Royal Voluntary Service is working with Leicestershire County Council to provide a ‘Hospital 2 Home’ service to support those aged 55 and over on a return home from a stay in hospital. The outcomes of the service make for interesting reading.

The Hospital 2 Home service is centred around individuals and the specific care and support they need to progress their rehabilitation. Those who use the service receive a visit by a member of the Royal Voluntary Service team while they are still in hospital, followed by a face-to-face assessment when they return home. From this assessment, an individual support package is put together and agreed with that person, so they are happy that they will receive the help they need to get better at home.

Although this kind of support may not appear particularly revolutionary, its impact is significant; we found that readmission rates among those people who use the service are reduced by 50 per cent.

The best way to examine why readmissions have been so dramatically reduced among those who use the service is to talk to those who have first-hand experience. Everyone we spoke to said that when they first arrived home from hospital they simply no longer had the confidence to go out on their own. We know that when getting out and about is difficult, isolation and loneliness can set in, which can have a serious effect on health and wellbeing; lack of social contact is a known risk factor for poor physical health outcomes.

One of the main functions of the Hospital 2 Home service is to provide those who use it with a friendly face – someone they are sure they can rely on to get the help they need. Many people who use the service say the befriending support they have been given offers them confidence that they will regain the life they had before they went into hospital. This means peace of mind and the right environment for healing.

We can identify two important lessons from the Hospital 2 Home service: firstly, the importance of a person-centred approach. There is no ‘one size fits all’ solution to rehabilitation. Our volunteers take the time to get to know those they help and adapt their approach accordingly. For some people this may mean help walking the dog; for another it may mean the provision of transport to get to medical appointments. If someone uses the service needs help the volunteer can’t offer, they will signpost to someone who can.

Secondly, one of the most important aspects of this service is the dedication and attitude of our volunteers. The significance of having support from someone who is helping you because they want to – not because they are obliged to – and the consequent impact on a person’s sense of wellbeing, should not be underestimated.

Since its conception, the Hospital 2 Home service has expanded; those who use the service are now offered support beyond the initial rehabilitation period, through to helping that person integrate back into the local community by getting out and about to the shops, to see friends, or to have a bite to eat. We know that this kind of service makes a huge difference to the feelings of isolation and loneliness that can set in when we get older; feelings which can have a devastating impact on health and wellbeing. It is vital that more commissioners adopt this preventative approach, which has the potential improve lives and to save the health service a significant amount of money.

As a society it is important that we help older people age well and achieve a better quality of life and we can do this through a focus on preventing as many people as possible needing ongoing support. On paper, this represents huge savings to commissioners, but more importantly, it means that Britain’s older people will be happier, healthier and more independent.