GPs and partners are working with colleagues across the NCA’s four localities in this trailblazing programme of national importance to move older people quicker from hospital to home after urgent and emergency care.
Since early 2023, our teams have been creating and implementing innovative, fast solutions to:
- Keep people over-65 admitted to hospital for emergency treatment active, so they can return home as fit and healthy as possible, as quickly as possible, instead of staying too long and suffering from muscle-loss or developing mental health problems. A Days Kept Away from Home Collaborative (DKAfH) includes many colleagues from 18 wards across the NCA.
- Improve emergency care for people with dementia, both in hospital and supporting them at home.
Frontrunner Video Playlist
Click the play button above and select the icon to the left of the three dots in the top right of the video to view and select more of the Frontrunner programme videos within the playlist.
The new ideas, which have already been put into action, include:
- Launch of specialist dementia unit at Bury’s Fairfield General Hospital.
- Identifying people living with dementia in A&E and treating and supporting them at home, where possible, to avoid a lengthy hospital stay
- Transforming a side room on a ward into a mock flat, with cooking facilities, so people can be checked they could cope at home, potentially speeding-up their discharge.
- Recruitment of a team of an exercise and independence facilitator team consisting of sports science graduates, to deliver light exercise programmes on wards.
Some of the programmes are already making a big difference for people over 65, as well as patients with dementia, with some of the approaches now being rolled out across the four localities as business as usual.
The Department of Health and Care and NHS England have both visited the projects, with a view to incorporate the most successful work into national policy.
The NHS England-funded programme is one of only six of its type in the country, which will develop and test quick, new solutions to discharging people over-65 from hospital.
NHS England chose to fund the pilot programme because of its fresh approach – working across four localities and including an initiative which focuses on people with dementia. Work began in early 2023.
The Discharge Integration Frontrunner Programme is being managed by the Four Localities Partnership, which brings together the NCA’s acute and community services, as well as primary care, voluntary sector, social care providers and commissioners across the four areas.
Two mental health providers are also involved in the Partnership, which are Greater Manchester Mental Health Trust, which provides services in Salford, and Pennine Care NHS Foundation Trust, which provides services for Bury, Rochdale and Oldham.
The programme was due to end in March 2024, but, because of its success, will now run beyond this date to allow further development and testing of the projects, as well as support implementation of some of them across the four localities
We are trialling quick, new solutions to return people home as fast as possible and improve emergency care for dementia patients.
These solutions are called ‘tests of change’ and all four localities have chosen what areas they want to work on.
Bury
A dementia-friendly unit has been created at Fairfield General Hospital, based on a similar approach at the Oasis unit at Rochdale Infirmary.
This was launched in July 2023 and families and carers of people with dementia are rating their experience of it very highly. Also, it is reducing the number of times patients move beds or wards, which can disorientate people with dementia and impact on their mental health.
A business case is now being developed to introduce this model to other localities.
A further test is seeing the development of an alternative crisis pathway in north Bury for people with dementia, to support them in their usual place of residence, working with two agencies and the borough's Rapid Response team.
And work has begun on a new enhanced home offer, which again, will support people with dementia at their usual place of residence. Key partners are working on deploying this test of change.
Oldham
Oldham continues work on its first test of change, which is a new way of supporting people with dementia when they arrive at A&E at the Royal Oldham Hospital.
A pathway is the journey a patient goes on when they arrive at the emergency department, based on agreed next steps, and a new pathway has been created for people with dementia, to try and avoid them being admitted to hospital, if the best option is to treat them at home, or to return them home earlier.
Version three of this test is now underway, working with Age UK Oldham to offer further support for more patients. Oldham Red Cross has also been transporting patients home from A&E in their ambulance.
Rochdale
Weekly multi-disciplinary team meetings were launched to discuss and support people with dementia or delirium who are living at home, or in a care home, to try and avoid them being admitted by delivering care or treatment at home. This test will be finished shortly.
Work is progressing on a community dementia hub, with almost 50 people recently attending a training session. Phase two of this test is in the design stage.
A third test is seeing a registered mental health nurse on the Oasis ward two days a week, to offer specialist support. This has helped to reduce mental referrals from two weeks to one day. Evaluation of this test is complete and will form part of recommendations to wider NCA localities.
Salford
Work is underway on a second version of this test of change at the Bevan intermediate care unit, near Salford Royal Hospital, which is seeing discharge to assess beds ringfenced for people with dementia.
A test has also started to ringfence beds at the COPE unit, so dementia patients see the frailty team early in the pathway.
Work is underway to expand both these tests, to make sure they can illustrate a real difference is being made.
The Days Kept Away from Home approach is now being rolled out across Salford with support from the Quality Improvement team.
Success so far
As the tests of change progress we are increasingly receiving both data and anecdotal evidence which suggest they are making a difference.
Oldham pathway test of change:
- 50 people have either avoided being admitted to hospital or returned home faster, creating beds for people who really need them. Dozens supported by services for the first time after being identified as having dementia.
- Only four re-admissions to hospital after 3-6 months, as opposed to 47 in the same time period previous to the Frontrunner programme
- Reduction in pressures on various parts of the health and care system – i.e. visits to GPs and calls to the ambulance service.
- Cost efficiencies to the system estimated to be £15,000 cost avoidance to NHS based on testing option of combining intermediate care and specialist voluntary sector day care, avoiding A&E attendance and hospital admission, against 19 day length of stay, and avoidance of attending A&E and avoiding admission.
- Reduced re-admission rate of 90% 12-27 weeks post intervention (caveat of ongoing data collection). £7,486 per re-admission avoided based on 19 day national average LoS.
- The Department of Health and Social Care and NHS England discussing with a view to possibly spreading the approach nationally.
Days Kept Away from Home:
- 7,000 patients have been discharged quicker
- 84 more patients have gone home from the collaborative wards than otherwise would have
- Length of stay has decreased from 8.84 days to 8.28 days (a 0.56 reduction)
- Senior national director at NHS England said the achievements were “mind-blowing” and discussions are taking place on how the work could influence national health policy.
Ward 21 at Fairfield General Hospital built an assessment flat, so patients could check if they would be able to performan tasks such as making food at home:
- Positive patient feedback
- Average stay on ward reduced
- 8 patients saw their pathways reduced
- 16 x 30 minute carer calls were saved
- Estimated savings were £450 per day saved
- Confidence building in patients
Case study 1
Oldham test of change
- This case study created interventions in a new pathway, challenging at different stages of a patient's journey through hospital whether they could be treated at home, rather than on a ward.
- A woman in her 80s collapsed at home and was taken to A&E at the Royal Oldham Hospital with her husband, who had advanced dementia.
- Frontrunner nurses spoke to the couple in A&E and rather than being admitted to a medical bed for review and tests, they were admitted to Bulter Green intermediate care unit, where they were assessed and discharged home after four days.
- The Frontrunner team worked with Age UK Oldham to support the couple at home. They were provided with meals, dementia support, and referrals were made for a GP appointment and memory clinic.
- Without the intervention of this test of change, the couple could have spent 14 days in hospital, increasing the risk of physical and mental health deterioration.
- The couple were delighted with the support.
Case study 2
Oldham test of change
- A man in his 90s living with dementia fell at home and was taken to the Royal Oldham Hospital.
- The Frontrunner team assessed him in A&E and he said he wanted to go home to be with a relative in their 90s.
- Both the Frontrunner team and Age UK Oldham supported the couple and found they were both living with dementia.
- They were both booked into daycare and have enjoyed the food and socialising.
- The man said: "Thank you so much Frontrunner team for taking me home."
- The person could have spent 14 days in hospital, putting his physical and mental health at risk.
Q: What is the aim of the programme?
A: The programme has two aims:
1) to improve the care for people with dementia when they receive emergency treatment. This is including new test dementia units and redesigning pathways (the agreed steps taken to care for people when they arrive at the emergency department), to try to return them home faster or even treat them at home if possible.
2) to move people over-65 quicker from hospital to home after urgent and emergency care.
It is looking at innovative ways of keeping people active in hospital, so they can return home as fit and healthy as possible, as quickly as possible, instead of staying too long and suffering from muscle-loss or developing mental health problems.
This part is being led by colleagues called the Days Kept Away from Home Collaborative (DKAfH) and aims to see 95% of patients return to their usual place of residence after their stay in hospital by March 2024. It is working with 18 wards across the NCA patch.
Q: How will the programme achieve this?
A: Colleagues across the NCA have been involved in identifying where there are problems in returning people home, or keeping them active on wards, and creating new tests of change, where we can quickly trial ideas to see if they work and, ultimately, could be rolled out long-term here, or even nationally, if NHS England is impressed with the results.
All four NCA localities are now working on their ideas, called tests of change, and it is hoped they will make a difference and make the programme a success.
For example, new ideas being tested include the recruitment of five exercise facilitators and a team leader to deliver light exercise programmes on hospital wards, regular multi-disciplinary meetings in Rochdale to discuss how to support people with dementia or delirium at home to try and avoid hospitalisation, and part of a ward being turned into a dementia unit at Fairfield General Hospital in Bury.
Q: Why has the programme been launched?
A: NHS England asked trusts across the country to bid for funding for programmes which would look at quick solutions to returning people home faster after emergency treatment. The bid for this programme was successful, together with five others in the country, with NHS England especially interested in the dementia side of the work, which is not being covered elsewhere.
Here at the NCA, as is the case across the country, we are focused on speeding-up discharges when it is safe to do so and improve people’s chances of making the best possible recovery.
Also, in Greater Manchester, the number of people with dementia is forecast to increase by around 4,000 to more than 14,000 by 2030, so we need to reassess how we treat and support patients and their carers or families.
Q: Is this an NCA programme?
A: No, it is funded by NHS England and is being managed by the Four Localities Partnership, a new body which brings together the NCA’s acute and community services, as well as primary care, voluntary sector, mental health, and the four local authorities’ social care providers and commissioners.
This, in itself, is an innovative approach and has not been trialled before.
Q: Is it the same thing at Hospital at Home?
A: Although parts of the Frontrunner programme have similar aims to Hospital at Home, such as supporting and treating people at home where possible, it is also very separate. It is a short-term initiative to test quick solutions for specific groups of people.
Q: Have any of the tests been successful so far?
A: Although evidence is still being gathered to assess the success of the tests, we can see from the data so far that there have been several positive outcomes from the work.
For example, the Days Kept Away from Home wards achieved the following:
- 7,000 patients discharged quicker
- 84 more patients gone home from the collaborative wards than otherwise would have
- Length of stay decreased from 8.84 days to 8.28 days (a 0.56 reduction)
The Oldham pathway test of change achieved the following:
- Around 50 people avoided hospital and were supported at home
- Only four re-admissions to hospital after 3-6 months, as opposed to 47 in the same time period previous to the Frontrunner programme
- Reduction in pressures on various parts of the health and care system – i.e., visits to GPs and calls to the ambulance service
- Cost efficiencies to the system estimated to be £15,000 cost avoidance to NHS based on testing option of combining intermediate care and specialist voluntary sector day care, avoiding A&E attendance and hospital admission, against 19 day length of stay, and avoidance of attending A&E and avoiding admission.
- Reduced re-admission rate of 90% 12-27 weeks post intervention (caveat of ongoing data collection). £7,486 per re-admission avoided based on 19 day national average LoS.
Work is continuing to evaluate all the tests.
Q: When did the programme start and when will it end?
A: The work began in January 2023 and is continuing into 2024 to allow further testing and evidence gathering.
Q: Who can I contact for more information?
A: Please contact the programme team. Details are listed in the ‘Contact us’ section.
News
Delivering for our dementia patients - story and photographs highlighting the creation of a dementia unit at Fairfield General Hospital.
Stakeholder bulletins
How we talk about dementia
A guide has been published which gives health, social care and communications professionals guidance on how to talk about dementia.
The manual also uses feedback from people with dementia, their families and carers to collate advice on what type of images to use.
Summary of dementia work
Read a summary of the work completed in the dementia workstream, including the outcomes and impact.
An event is being held this month to discuss the work of the Frontrunner programme with wider Greater Manchester health and social care stakeholders.
The session is being held on the morning of Wednesday, July 10, at the Village Hotel, in Bury, and many of the teams involved in the different tests of change and the Days Kept Away from Home Collaborative will be there to discuss their work.
Please email the Frontrunner programme team if you are interested in more details and attending.
If you would like further information on the Discharge Frontrunner Programme, please contact the programme team:
Lindsey Darley, programme director
Robert Gray, project manager
India Wood, project support officer
Mark Donaghy, communications lead
Days Kept Away from Home Collaborative programme team
Daniel Rowbotham, associate director of improvement
Jack Fallows, quality improvement site lead