20,000 plus people avoid hospital admission in Birmingham thanks to new health approach
Case study summary
An innovative partnership approach to health and social care in Birmingham helped to prevent more than 20,000 people being unnecessarily admitted to hospital from March 2020-March 2022. The ‘Early Intervention’ approach, now considered ‘business as usual’ across the city, focusses on frail, vulnerable and older people and works to a ‘home first’ ethos. It helped reduce a person’s length of stay in hospital from an average of 12 days to four days, saving 120,000 bed days a year and ensuring that 45% of people are now more likely to go straight home when discharged from hospital instead of being admitted into long-term care, creating a financial benefit valued at £26.7m
A multi organisational health and social care partnership consisting of Birmingham City Council, Birmingham Community Healthcare NHS Foundation Trust, University Hospitals Birmingham, Birmingham & Solihull Mental Health Foundation Trust, Birmingham and Solihull ICB and the former Sandwell & West Birmingham CCG. It was led by an Early Intervention steering group of partner representatives.
Birmingham’s Early Intervention (EI) Lead and Birmingham Community Healthcare NHS Trust Chief Operating Officer Chris Holt outlines the aims: ’Our Early Intervention approach is very different to what has been provided for the 1.3m+ people of Birmingham before. It is driven by a fresh approach to data-led decision-making, front-line staff design, personalised care, testing and iterating programme changes.
‘Our goals are to prevent unnecessary hospital admissions and premature admissions to long-term residential care, reduce delays in discharge from hospital and help people to remain as independent as possible in their own home.’
The solution was to develop a true partnership approach, with more than 1000 staff from six organisations across Birmingham joining forces to deliver EI. The approach first underwent an intensive four-month programme of testing across Birmingham following a review in 2017 by the Care Quality Commission (CQC) and the system partners which highlighted where improvements could be made.
Andrew Marsh Head of Service (Operations and Partnerships) Strategic Lead for Hospitals, Discharge to Assess Pathways and Integrated Hub Adult Social Care at Birmingham City Council added: ‘By working together the team can help to meet the needs of the person standing before us – whether that’s for depression, loneliness, a physical or mental health condition or a practical problem with housing, living or even losing weight.
‘It’s about having a huge bank of skills and knowledge which span the health, social care and voluntary sector and knowing where a person can get the right help at the right time to support them at home. So far, it’s been a real success and patients have been delighted to realise they aren’t going to have a long stay, someone is trying to help them get home as soon as it’s appropriate.’
Andrew McKirgan, Chief Officer, Out of Hospital Services for UHB added: ‘The health and independence of older people is a priority for Birmingham. At a time of intense pressure on our health and social care system it is playing an invaluable role in ensuring that hospital and care home beds are there for those most in need, and those that are medically fit to return home, can do so with the right level of support, or can avoid a trip to hospital in the first place.’
A system review identified a fragmented intermediate care system with poor relationships and variations between providers, inconsistent capacity, an overreliance on hospitals beds and tactical ‘sticking plaster’ responses to pressure only set to get worse without direct action.
This included people in elderly care and on longer stay wards who could have been better looked after elsewhere. They were often delayed leaving hospital and could have achieved a more suitable route out of hospital and better suited to their needs more quickly.
Spanning five localities, covering the whole city, the programme has delivered a transformation in how partners work together to provide a seamless care service for citizens. This means putting the person at the centre and to promote “home first” as the default outcome for citizens who experience, or who are at risk of, the need for acute care.
From March 2020-March 2022 the EI approach helped to reduce a person’s length of stay in hospital from an average of 12 days to four days, saving 120,000 bed days a year and ensuring that 45% of people are now more likely to go straight home when discharged from hospital instead of being admitted into long-term care.
During this timeframe the EI programme created a financial benefit valued at £26.7m for the city’s health and social care system enabling more to be done within the resources available.
EI services are delivered at the acute hospitals of Queen Elizabeth Birmingham, Solihull, Good Hope and Heartlands and in community hospitals, social care services and mental health services across the city.
The new Early Intervention Community Team, launched as part of the new approach, has grown from strength to strength. It manages on average 300 referrals a week and a city-wide case load of 1000 a week. Its care approach means that people who are discharged from the service need on average six hours less care a week than pre-EI. The team has also taken on the responsibility of managing the new Urgent Community Response service which provides a two-hour response or two-day reablement care.
The system is now simpler. Bringing together colleagues from across health and social care from all the organisations to create single multi professional teams means that there is no wrong door for anybody who needs help – the aim being that people only have to tell their story once.
People now see one team which works together and navigates the system for the person. All teams including doctors, nurses, physios, therapists and social care staff, work in collaboration with the different EI services available.
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