Case study summary
Durham have set up an emergency crisis bed to give people with a learning disability, autism or both somewhere to go when they need extra support. This means that they don’t have to go into hospital.
The ‘crash pad’ is a self-contained flat with a lounge, kitchen and bathroom which is an annexe to a residential care home. This means that staff are on site and can easily help the person living there if needed.
Funded by an NHS England Transforming Care grant, the bed is designed for when a person’s existing placement breaks down and can take referrals at very short notice. It’s on the ground floor and accessible so that anyone can use it.
“It provides a bridge between living in the community and admission to hospital. Typically a person might have had a dip in their mental health which leads to challenging behaviour,” says Fred Grand, Commissioning Policy and Planning Officer at Durham Council.
They receive intensive support from the Community Behavioural Team at Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), the provider, Swanton Care, and Learning Disability nurses who remain in daily contact to help keep plans on track. Early priorities are to stabilise the person and plan their discharge.
The unit was set up in February 2017 as a six month pilot. In that time, three people spent time in the unit that would otherwise have been admitted to hospital.
Fred says: “Everyone has either gone back to their previous placement or moved on to somewhere different that was more suitable than what they had before.”
Expanding the service
Designed to help deliver Transforming Care – the national programme to make sure that people live in homes, not hospitals – the pilot has been so successful that Durham (the council, two CCGs and TEWV hospital trust) are considering commissioning a second bed with another provider. They are investigating whether the model can be used in other places across the Cumbria and North East.
“If we have more beds like these, we will be able to keep more people out of hospital. Community placements can be far more effective. They are less isolating for the service user, and in less clinical environments they are more likely to respond quickly and be supported back into the community,” says Fred.
“In addition, care based in the community is very likely to be cheaper than a hospital ward.”
Engaging the market
One of the keys to success was finding the right provider. Because it was a pilot, Durham wanted to use one of their existing providers to deliver a ‘service within a service’.
“We needed to think creatively within what we already had in the local provider market,” says Fred. “It was a process of dialogue, where we looked at various options and whittled them down.
“It had to be somewhere that was used to working with people with challenging behaviour; that could provide a standalone unit that wouldn’t impinge on the other residents. We found the right provider and the new service is an add-on to their existing contract.”
The Crisis and Outreach team from TEWV worked with the manager and team leaders to make sure they had the right training to respond in a crisis.
Getting people back to the community more quickly
The TCP and provider are evaluating the service and hoping to extend it beyond the pilot on a ‘spot purchase’ basis.
Initial admissions are for 28 days, although so far the admissions have gone beyond this. The team are looking at whether they can move people on more quickly so that the average stay in the bed reduces.
“My advice to others is to make sure everyone across health and the local authority works jointly. It’s also vital to work with providers to make sure they’ve got the appropriate level of staff and right support.
“People shouldn’t be in hospital if they don’t need to be, and the crisis bed helps us to achieve that.”
Matthew was living in a residential care home. One Friday afternoon he reached a point of crisis and assaulted a member of staff. It was possible that criminal charges would be pressed, and he needed a place of safety over the weekend.
Matthew spent a month in the crash pad, where he was given intensive support from the multi-disciplinary team. After a month he was ready to move on. He was fully involved in the decision about where he would live and his now living in a much more suitable placement in his own flat. He is doing well, and is no longer considered to be ‘at risk’ on the joint Local Authority and CCG Dynamic Risk Register.
Fred Grand, firstname.lastname@example.org