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Where to care? Exploring system solutions

BCHC is in the forefront of the search for solutions to the challenges the care system faces in Birmingham. Combining innovative and well established approaches, we aim to deliver personalised care closer to home.

Providing people with the care they need in their own home is at the heart of the BCHC mission.

A recent British Red Cross study found that emergency hospital re-admissions have risen by almost 23 per cent in the last five years. The number of people re-admitted within 48 hours now accounts for one in five emergency re-admissions.

Meanwhile, a study commissioned by Birmingham and Solihull Sustainability and Transformation Partnership (STP) found that one in four people admitted to hospital could have been better looked after elsewhere – usually, at home.

It also found that as many as 50 per cent of people in elderly care and longer stay wards who are medically fit to leave are ‘stuck’ because of hold-ups in post-discharge arrangements.

Concepta Tracy - rapid response patient
Concepta Tracy was discharged from Good Hope Hospital to be cared for at home by BCHC's rapid response service.

Advanced nurse practitioners  and discharge liaison nurses work at Good Hope Hospital with doctors, nurses, social workers, therapists and paramedics to prevent unnecessary admissions at the ‘front door’ and facilitate earlier discharges by ensuring patients have the support they need at home.

Concepta Tracy (pictured, above) was discharged from Good Hope into the care of BCHC’s rapid response service after two brief inpatient stays in quick succession this winter to stabilise breathing difficulties.

“I’ve ended up in hospital because, when I have trouble breathing, I panic, and that just makes it worse,” says the 74-year-old, of Falcon Lodge.

“I’m fortunate that I have the support of family around me and the community nurses have been very caring; so they’ve been able to get me out of hospital quite quickly and give me the care I need at home.

“I don’t want to take up a hospital bed that’s needed for others. I recover much better at home.”

With the support of community nurses and family, Concepta has been mostly successful in managing her breathing difficulties.  But the symptoms become worse from time to time – particularly in cold weather, or if she over-exerts herself.

BCHC advanced nurse practitioner Bev Marriott works at Good Hope with doctors, nurses, social workers, therapists and paramedics to prevent unnecessary admissions at the ‘front door’ and facilitate earlier discharges by ensuring patients have the support they need at home.

She said: “Concepta is a very typical example of someone with a long-term condition who gets admitted to hospital when, more often than not, she could receive the care she needs at home.

“That’s what she, and many patients like her, would prefer and that’s why we’re working so hard across the system to improve assessment so that far fewer acute beds are occupied by someone who could be cared for in their own home.”


Paul Yates and case manager Beth Stubbs

Some people need personalised nursing care at home to help them manage the symptoms of more than one long-term condition.

 Birmingham Community Healthcare provides a ‘case management’ service which sees nurses with additional clinical skills and independent prescribing authority work with the patient’s family at home to provide continuing assessment, care and support.

Paul Yates has a heart condition and diabetes. He suffers from leg pain due to poor blood circulation and sometimes has difficulty breathing due to a chronic lung condition.

Three years ago, case manager Bethan Stubbs began regular visits to his home in Four Oaks, where wife Yvonne cares for Paul on a day-to-day basis.

“Before we set up the case management service 16 years ago, patients like Paul with complex needs would have to go into hospital if they were ill - there wasn’t the level of home support they needed.

 “Having the same case manager long-term means we’re looking at the whole person, not just one condition in isolation. The patient and their family build up a partnership to monitor and manage signs and symptoms and take action at an early stage to avoid unnecessary hospital admissions.”

Paul, a former drayman for Ansell’s Brewery, says his family takes reassurance from knowing informed clinical support is only a phone call away when they need it.

“I’m very lucky,” says the 74-year-old grandfather. “Yvonne and I have been married for 55 years and she’s my best friend; and Beth’s become part of the family – we even discovered that she was in the same class at school with our daughter Paula.

“So between the two of them, they keep me going and, touch wood, I haven’t had to go into hospital for long-term health reasons for more than three years now.

“It’s so good to have the same familiar presence; someone you’ve built up a relationship with, who knows your medical history and who’s working with us to achieve the same goal – to keep me at home with my family and out of hospital.”


‘Virtual beds’ pilot

In early 2018, BCHC has been involved in a ‘virtual beds’ pilot scheme in partnership with University Hospitals Birmingham NHS Foundation Trust and Heart of England NHS Foundation Trust as part of continuing efforts to reduce unnecessary acute admissions.

Patients have had the opportunity to discuss next steps with a consultant geriatrician or acute medical consultant on arrival at the acute hospitals’ emergency departments – in particular, if clinically appropriate, whether they would prefer to be cared for at home by BCHC’s rapid response service.

A key benefit being trialled, over and above the established advanced nurse practitioner (ANP)-led rapid response service, was the continuing oversight of the acute hospital consultant geriatrician for the first few days following the patient’s return home.

Rapid response community services manager Heidi Blackham said: “Our rapid response service works closely with all other community services, including general practitioners and social services. “However, ‘virtual beds’ goes one step further by creating an on-going working relationship with hospital consultants.

“This means that, within the first 72 hours of the patient being discharged from hospital, the rapid response nurses and ANPs who are delivering the care have daily discussions with the consultant about the patient, ensuring any change to treatment and or care continues in the home.”

The pilot was funded by NHS Improvement, who will liaise with the provider trusts to analyse the impact on care quality and efficiency.