IMPOWER was commissioned by Somerset County Council to carry out an operational review of hospital discharge pathways, with a view to understanding avoidable demand across the health, social care & community system. This has led to the development of an alternative delivery model covering all of intermediate care in the county – a renewed end-to-end reablement service encompassing bed based and home pathways. The sustainability of the model was predicated on building the capability of frontline, multidisciplinary discharge teams.
Following the design phase, the work transitioned to acute and community hospital settings to help build ownership of the model amongst ward staff, embed the principles and support decision making in the ward setting.
IMPOWER helped the council, CCG, hospital leaders, and clinical and professional leads to review existing policy, leading to the development of a new strategy to transform the intermediate care offer, building on pre-existing strengths.
Our team worked across the system to:
The emerging data about system behaviours in response to Covid is promising. Although in April 2020 a large number of interim beds were used to clear the hospitals in preparation for a surge, May showed a greater use of home pathways than prior to Covid.
In May 2020, around 50% of supported discharges were onto the D2A home pathway compared to 39% onto Pathway 1 between April and December 2019. The capacity on the home pathways (D2A and Rapid Response) has risen considerably as evidenced by the caseload, from a caseload of around 120 on 22 May to around 180 on 22 June, with only minor changes to length of stay.
Since the introduction of the intermediate care model in May 2020 there has been an 81% reduction in Long Term Care placements directly from hospital.
The ward work delivered several key impacts: