How investing in social work helped cut delayed discharges

Social workers have played a leading role in a project to reduce the number of medically fit patients occupying beds at Whiston Hospital in St Helens, delivering substantial savings. The addition of five social workers to a hospital discharge team helped more than double the number of monthly social care assessments carried out on patients, freeing up an average of 35 beds a week – the equivalent of an entire ward.

The enhanced integrated discharge and community care project was launched in November 2011 with the aim of reducing the number of medically fit patients occupying acute beds at Whiston Hospital from 40 to 10 in three months. It more than achieved its aims, reducing the total to five. As a result key elements of the project – including the additional social workers – have received funding until March 2013.

Led by St Helens Council, the project involved St Helens and Knowsley Teaching Hospitals NHS Trust, which runs the hospital, NHS commissioners and community services, two other councils, Halton and Knowsley, and St Helens Home Improvement Agency.

Integrated discharge team

It built on the creation of an integrated discharge team at Whiston last year, which brought together hospital social care staff from the three councils with nursing staff. Prior to that, if a discharge came in for a St Helens resident, only a St Helens social care worker could provide an assessment or care package, creating significant delays and inefficiencies.

The integrated team also established allocated social care workers for each ward, enabling them to get to know nursing staff and patients, and start identifying their needs before discharge.

However, while these staff carried out generic assessments on patients with less complex needs, more complex cases had to be referred to community teams for assessment, lengthening the discharge process. This changed with the launch of the enhanced integrated discharge and community care project last November, as the additional five social workers were able to pick up these more complex assessments within the hospital.

Massive increase in assessments

This resulted in an increase of 140%, from 59 to 143, in the number of social care assessments carried out at the hospital, between December 2011 and February 2012. An evaluation of the project said the additional practitioners “not only significantly impacted on the number of social care assessments completed but have ensured that assessments are being picked up earlier and carried out in a much more timely manner”.

All partners agreed that the additional qualified social workers have been fundamental to the success of the project and recommended that they remain in post. As a result of this, funding for the posts has been agreed until the end of March 2013.

Capacity was also boosted by the addition of 29 “step-down” beds at nearby St Helens Hospital for patients discharged from Whiston who were medically fit but could not be immediately discharged into the community. Seventeen transitional beds were also purchased from local care homes for patients to ease the discharge process.

Home improvements vital

Another key plank of the project was the involvement of St Helens Home Improvement Agency, which provided two team members to carry out required home improvements within two days of an assessment (see case study). This involved installing grab rails, ramps or telecare, or repairing heating systems, as necessary.

Though the project has delivered significant savings by reducing delayed discharges, it has also improved outcomes by ensuring people were discharged, quickly and safely, to the most appropriate setting.

“The nature and profile of our service users tends to be frail older people whose health needs can fluctuate quite quickly,” says integrated discharge team manager Francesca Smith. “It is therefore important for individuals to be discharged home or to an appropriate care setting after an acute episode.”