Hospital at Home Consultation

The Trust has been asking for views on whether it should retain the hospital at home approach to service delivery for older people with mental health problems who don’t have dementia and continue ward based provision for those who need it at Newhaven, or if it should revert to ward based care at Athelon and New Haven. 

This survey has now closed

If you have any questions please do not hesitiate to get in touch by emailing: whcnhs.communityengagement@nhs.net 

About the service

The Hospital at Home Service is a service for older people with mental health problems who don’t have dementia that enables patients requiring treatment and support for an acute mental health problem to be cared for within their own homes.The service offers time limited interventions and support and it works closely with a range of other Trust services. 

Operating times for the service are between the hours of 8:00am - 8:30pm, with an aim to respond to referrals within 24 hours.

The service provides mental health care for people aged over 65 years with severe and enduring mental ill health or disorder which includes conditions such as psychosis, bipolar affective disorder, severe depression and personality disorder.  The service also works with patients who have a mental illness that is secondary to other physical, organic or neurological conditions.  Service staff work collaboratively with patients and carers and aim to empower and enable patients and their carers to take an active role in their treatment.

The Hospital at Home service aims to reduce or prevent admissions to inpatient services and facilitate early discharge from a ward.  It also provides out of hours or crisis support and seeks to reduce the need for out of area placements.  These aims reflect national and local priorities around mental health care.  The service was originally established in response to the Covid-19 pandemic, when efforts were made to keep older people out of hospital as much as possible, so that they were kept safe and could be cared for and treated in familiar environments.  This resulted in the temporary closure of Athelon ward in Worcester, and the ward budget was used to pilot the hospital at home service. 

The Hospital at Home Service is an additional resource insofar as ward based care continues to be provided for patients who need this at the New Haven site in Bromsgrove.   This ward supports older people with mental health problems and those who have dementia separately, but on the same site.  Currently some building work is taking place to eliminate dormitories on Trust mental health wards and provide all patients with a private room, and Athelon ward is being utilised to support this work on a temporary basis.  However, whilst this work is happening beds for older adults who need ward based mental health care are available at New Haven and will be available at Harvington Ward in the Wyre Forest, should further need arise and until all building work is complete.    

The Herefordshire and Worcestershire Health and Care NHS Trust now wants to hear your view on whether it should retain the hospital at home approach to service delivery for older adults with functional mental illness and continue ward based provision for those who need it at Newhaven, or if it should revert to ward based care at Athelon and New Haven.  To help you respond to this, the Trust has undertaken an extensive evaluation of the service since inception and the findings of this are below.   

Evaluation overview

During the pilot phase there has been much work done to evaluate the new approach to see how well it works for patients, carers and staff.  This work has comprised an early Equality Impact Assessment to understand the impact of the new approach on certain communities and vulnerable groups.  It has also included feedback from patients and carers that has been gathered through different engagement approaches, and which includes both quantitative and qualitative information.  Work has also been done to capture information about the number of people who have needed to be sent to an out of area placement to be cared for, together with information about lengths of stay.  We have also reviewed all complaints, compliments and Patient Advice and Liaison Service enquiries about the service, and have undertaken a staff survey to understand how staff who refer into the service, feel about this new approach.

All of this evaluation information has been summarised and is included below. 

Equality Impact Assessment (EIA)

The EIA for this service change was presented to the Equality Advisory Group (EAG) in October 2020.  The EAG comprises a membership of people who identify with one or more of the nine protected characteristics or who are from another group or community identified as vulnerable in some way. 

At presentation, the service felt that overall the impact of the change in approach to providing a hospital at home would be positive for most groups, with no negative impacts identified.  Primarily, the positive impacts emerged from the view that there are benefits to being cared for in a familiar home environment by staff that have the skills and experience of working with this age group. It was also recognised that a change in the care environment can be traumatic for many and even more so for the elderly and those with a disability, particularly if the home has been adapted for need whether that be for a physical or mental health issue. So too there can sometimes be delays in finding a bed for some patients, whereas care at home can commence quickly.

The EAG members acknowledged the view of the service but did question the support that would be given to carers, recognising care at home for an elderly person could add an additional burden for this group.  It was the view of the EAG members that carer impact information needed to be collated during the pilot to better understand this – this has been actioned and is included below.  The EAG members also noted that if someone was living alone and away from their carer and didn’t have any on-going support in the home environment, this would need to be taken into consideration in terms of the suitability of a hospital at home approach for such patients. 

Hospital at Home Service - STP Equality Impact Assessment Form.DOCX [docx] 443KB October 2021

Hospital at Home service - Equality Impact Assessment[docx] 443KB August 2021

Patient and Carer Feedback - quantitative

All patients and carers who use Trust services are invited to give us feedback on their experience of the services they access.  A summary of the feedback we have received relating to the Home from Hospital Service is below:

• 80.77% of respondents said they were very satisfied with the time it took from referral to first appointment. 19.23% said they were neither satisfied nor dissatisfied. 0% said they were very dissatisfied.
• 88.46% said they had been given enough information and advice about their condition and what services are available.  11.54% said they didn’t know/could not remember
• 96.15% said they had been given contact details/a telephone number from the team that they could call. 3.85% said they had not
• 72% said they had been given a copy of their care plan.  8% said they had not.  20% said their care plan was not yet developed.
• 80% said they felt fully involved in the decisions about their care and treatment. 4% said they felt partially involved.  4% said they were not involved but did not want to be. 12% said they did not know or could not remember
• 65.38% said the support they receive helps them do the things that matter to them; 26.92% said it sometimes helps them and 7.69% said they did not know or could not remember
• 84.61% reported that the service had made a positive difference to their well-being.  7.69% said the service had made a difference in some ways.  3.85% said the service had not made a positive difference and 3.85% did not respond to this question
• 100% of respondents said they had been treated with dignity, compassion and respect
• 84.62% rated their experience of the service as very good; 7.69% rated it good; 3.85% rated it neither good nor poor; 3.85% said they did not know

Patients and Carer Feedback – qualitative

As well as rating various aspects of the service, some patients and carers have also given us their comments and views about the service.  The general themes from all of these comments are below:

• Hospital and ward based care were both considered good services
• A benefit of ward based care is that for some patients and carers it takes stress away, particularly when the patient is most unwell
• The benefit of home based care is that it is familiar.  In addition, home based care means patients, families and carers can be together which for some is less stressful than being apart.  Being at home is felt to aid recovery, plus there is a sense of individualised care
• Consistency of staff was experienced as greater on the ward, whereas for the home based service, staff changes were more common.  Staff consistency was deemed important as changes can be confusing
• Daily visits and having a number to call if needed, is helpful for home based care
• Home based care may require some families to consider who else can support the carer, in addition to the service staff

Out of Area Placements

No older adults requiring mental health treatment have had to be sourced a bed on a ward outside of Worcestershire since the Hospital at Home Team started in October 2020 and during its time of operation.

Lengths of Stay

The average patient length of stay for the nine months of the Hospital at Home service, compared to the same nine months the previous year, showed a decrease of 12.5 days from 59.3 to 46.8 days.

Since the Hospital at Home service commenced its work to prevent and reduce ward admissions there has been, on average, a reduction of one admission per month on the mental health ward.

Complaints, Compliments and PALS enquiries

During the period of evaluation, no complaints were received about the service and a number of compliments and gifts were registered.

Staff Survey

Staff from other services, who refer into the Hospital at Home service, have been invited to give their views on some key areas via a survey. 

Key findings of this survey are as follows:

The service overall

Scoring the service overall on a scale of 1-10, with 1 being very poor and 10 being very good:

• 6 members of staff scored the service between 1 and 5
• 10 members of staff scored the service between 6 and 10

Comments:

• The Hospital at Home service provides a good level of support to patients.
• Good communication between referring service and Hospital at Home service has facilitated continuity of patient and carer support
• Different staff on duty in the Hospital at Home service and variations in capacity to accept referrals has caused some challenges.
• Clarity is needed around the remit of the service and the referral criteria.

Access

Scoring ease of access to the service on a scale of 1-10, with 1 being very difficult and 10 being very easy:

• 5 members of staff scored the service between 1 and 5
• 11 members of staff scored the service between 6 and 10

Comments:

• Access to the service has been aided by helpful phone calls, good communication and a responsive team
• Access challenges are linked to variations in the capacity of the team to accept referrals.
• Clear referral requirements and criteria required

Benefits to patients

Scoring the service in terms of the benefits it brings to patients on a scale of 1-10, with 1 being no benefit and 10 being great benefit:

• 7 members of staff scored the service between 1 and 5
• 6 members of staff scored the service between 6 and 10

Comments:

• The service offers intensive support and helps prevent admission to hospital and facilitate early discharge.
• The service offers short term reassurance
• The service provides specialist care
• The service offers support around medication
• The service helps patients engage with services and transition from wards to the community
• The service offers a home environment that is less traumatic for patients and carers, and which aids recovery.

Confidence in the service to meet patient needs

Scoring the service in terms of the confidence staff had in it to meet the needs of referred patients on a scale of 1-10, with 1 not confident and 10 very confident:

• 7 members of staff scored the service between 1 and 5
• 18 members of staff scored the service between 6 and 10

Comments:

• It is difficult to judge the service as it has not been running for long enough.
• The service supports patient needs
• Team capacity to accept referrals can be challenged.

Other staff comments

• The service should be extended and offered to patients with Dementia
• The service has received good feedback from patients and families
• Clarity is needed for referrers around referral criteria and processes
• Clarity is needed for referrers around service remit
• Support for closer working between the team and referrers