Community care is coming home

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The new care model to be rolled out in Arbroath and which has enjoyed success elsewhere has been re-energising services according to the NHS.

The Enhanced South Angus Community Support Programme, which has been running successfully elsewhere, is due to be rolled out in Arbroath at the beginning of March to provide improved care.

The pilot was run through four GP practices - Carnoustie, Monifieth, Broughty Ferry and Grove - and set out to test whether it was possible to prevent unnecessary admissions through enhanced assessment and support at home and to promote timely discharge from hospital. It supported not only those requiring a short term higher level of intervention to remain at home but also facilitate the discharge of medically and clinically stable patients from hospital.

Dr Dougie Lowdon, Clinical Lead Consultant Medicine for the Elderly at NHS Tayside, is enthusiastic about the programme’s success to date and the potential for the future.

He explained: “The feeling has traditionally been if you are old and frail you need to go hospital, but lots of older people who are frail don’t need to be treated in hospital.

“The multidisciplinary team that deals with medical assessments has historically been based in hospitals. We are trying to recreate that model in the community rather than a hospital, it’s because we now have the capacity.

“The Enhanced Community Support (ECS) was a trial programme with Scottish Government funding and what it allowed us to do was employ more therapists, more nurses more GP time, more pharmacists’ time to look after all these frail people in the Monifieth, Carnoustie and Broughty Ferry communities at home.”

According to Dr Lowdon the statistics speak for themselves, with emergency admissions reduced by 13% at the ECS practices, compared with a rise of 10% at other GP practices. Occupied bed days were down by 23%, compared to around 3% at non-ECS centres and the average length of stay during the trial was down 12%, around 1.5 days, again compared to non-ECS areas which was 6%

Dr Lowdon said: “If you take older people out of a routine and put them in hospital a lot of patients find it difficult to get back to normal and we find it difficult to discharge them. What tends to happen next is they go off to care homes and the number of people doing that has been halved. Reducing admissions, reducing bed days, because of that hospitals are getting quieter and Arbroath Infirmary and Little Cairnie have more empty beds as a consequence.”

Feedback through staff surveys and patient video diaries has been positive and health professionals in Arbroath appear keen to get onboard. Dr Lowdon explained: “The feedback from all has been the crucial thing. We’ve had health professionals telling us this was the kind of job they envisaged when they took up their careers. From the patients we’ve heard that this was what they had always envisaged when people spoke to them about being cared for at home.

“The feeling we were getting from the health professionals in Arbroath was it was not fair that Carnoustie, Monifieth and Broughty Ferry were getting it and they weren’t. I haven’t heard many negative criticism from health professionals. It’s a good sign that they have been biting our hand off for this.

“There was also a very positive public health survey by NHS Tayside and because of that the programme will run indefinitely and it will start in Arbroath on 9th March.”

Angus South MSP Graeme Dey met this week with Dr Lowdon and also Senior Charge Nurse Sheila Pudney. Mr Dey commented: “What struck me most about my discussions with Dougie, Sheila and other staff at the Infirmary was their enthusiasm for and absolute belief in this approach.

“This isn’t being rolled out on a whim. The model has been proved to work in Carnoustie and Monifieth where there’s been a 50% reduction in the number of patients that leave hospital for a care home. The fact is that the longer frail patients stay in a traditional hospital setting the less likely they are to return successfully to their home environment.”