Doing radio on our Plan for A+E.

I hate early mornings. So reluctantly I was up to do an interview at 7am with BBC Radio 5 Live. But a good slot to talk about our plans to help relieve pressure on A+E departments this winter. I'm seeing Jeremy Hunt this afternoon to talk about it.

And then off to Millbank to do all the local radio stations. Stuck in a small room - with my headphones on - I was busy for a couple of hours chatting away to radio York, Essex. Lincs etc etc. Good to know all the hundreds of regional ACEVO members would be hearing me as they drive about their business!

So what is it we are proposing?  In October I was asked by No. 10 what we could do to help reduce pressures on A+E this winter. We know that much of the increased demand in a cold snap is from more elderly people. And we know that many elderly people end up in hospital beds unnecessarily. This winter’s crisis is likely to be especially bad, as seen by the PM’s decision to get personally involved. It’s clear that charities could be an important way to cope with demand and improve the quality of care in A+E.

So I met with the heads of our 3 largest national charities dealing with these issues; RVS, the Red Cross and Age UK. In a week we had produced and sent off a plan to No. 10 and DH.

It’s worth reproducing that here. This is the short paper I sent and we will discuss later today with Jeremy Hunt. I'm hopeful we will get traction. It’s sensible and affordable, and in fact it will save money longer term.

Here it is.

Proposed crisis programme from charities to support A&E services this winter.

Issue

Every winter, tens of thousands of older people die or become seriously ill due to the cold placing huge strain on A&E. Age UK has calculated that the annual cost to the NHS in England of cold homes is approximately £1.36 billion - not including the large associated costs of social care.

Plan

ACEVO has identified three of its members that have the scale and experience to be able to implement a crisis support service to work with hospitals and GPs to identify and support targeted frail elderly, reduce A&E attendance, reduce admissions and secure early discharge.  Working with AGE UK, Royal Voluntary Service (RVS) and the British Red Cross, these crisis services could be provided this winter to the target 53 hospitals if decisions are made quickly. 

1. Reducing the amount of time that people spend at A&E 

• As part of a triage team who try and re-route people away from A&E with treatment being supported at home or via primary care.   
• Providing an ambulance support model whereby when an older person calls an ambulance, Age UK attends too with the effect of supporting people who don’t need to go to A&E.  Age UK has experience of offering this service. 
• Provision of A&E assisted discharge services for vulnerable people where there is no clinical need for them to remain in hospital but there is concern that there is no support at home.  The Red Cross currently has support at home schemes in 162 locations in the UK.  Age UK operates a similar service. 
• ‘Home from Hospital’.  A package of care provided by Age UK for older people recently discharged from hospital which prevents re-attendance and readmission to A&E.  Support involves linking person to support services and acting as GP liaison. 
• Supporting early discharge of patients from hospital .Patients who are poorly but stable (commonly frail elderly people with LTCs) remain under the formal care of the hospital consultant but cared for at home. At home they receive extra nurse-led support for several days and help such as washing and dressing. (RVS has experience delivering this  support; readmission rates since its introduction at the Royal Free have fallen from about 20% to 3.5%.)
  
  

2. Providing support on A&E and elderly wards

• Managing the volunteers in the hospital as a total group and expanding their role to work on-ward alongside the medical, nursing and staff teams to improve patient outcomes.  Help with people’s hydration and feeding as well as providing company and interactions to improve recovery time.

AGE UK, RVS and BRC all providing services in this area.  

3. Providing support to GPs with most vulnerable patients

• Working with local doctors and CCGs to catch those older people who are habitual attenders at A&E, consumers of blue-light services – generally because of loneliness and isolation.
• A home health check – 100 local Age UKs delivering a check to 5,000 of the most vulnerable older people’s homes (identified by GPs). To ensure they are safe and ready for winter (e.g. no trips/falls hazards, energy efficiency measures in place).  
• 1m leaflets via local Age UK and GP surgeries on “Stay well Choose well” supported by Age UK telephone line.  

Crisis package: Management of  relationships, plan and coordinate the work to be undertaken by each of the charities and to provide a formal evaluation of this crisis intervention for future planning.   ACEVO is in a prime position to coordinate these activities and would be keen to do so.