£2million Cabinet Office initiative, seems like a good investment

By May 6, 2014Uncategorized

When the NHS was founded you could expect to live into your early 60s. Today you will get, on average, 20 years more life. The modern day diseases and health challenges that come with longevity and ‘over consumption’, such a cancers, diabetes and obesity were difficult to conceive in an environment of post-war rationing, when retirement was for the fortunate few. 

In those days the aim was to get people into mass vaccination programmes and filling up hospitals with sick patients seemed like a perfectly sensible idea. But as more and more people live with long term conditions this health model looks like folly.  Enter a joint Cabinet Office and NHS initiative aimed at evaluating projects to keep people out of hospital, based on social action.  

The target audience for this funding is older people and the approaches fall into two categories. First, supporting the discharge process from hospital and, second, identifying ‘frequent flyers’ who end up in A and E unnecessarily, and finding approaches to reduce such admissions.

The motive, of course, is to help control costs but the potential benefits to patients are also self evident. At The Campaign Company we have been wrestling with a model based on social action that focuses on the second category: frequent flyers. In fact, I’ve just come back from a very positive discussion with a health team in South East London on how we might make it work. 

We think a model needs the following elements:

  • Well defined risk stratification.
  • Good data to support this risk stratification, so we really know which patients have been making lots of unwarranted hospital visits. This data will also be vital for the evaluation process, which should look particularly at the real cost of admissions and the reduction in the number of admissions during the pilot phase.
  • The support of a few well organised GP practices to localise the model. We know they are busy but this will help them be less busy.
  • An easy and proactive process to gain the patient’s consent.

 

Once you have this in place the hard work can start.  For us this would mean identifying and training a volunteer co-ordinator, who would be based in the patch.  Their first task would be to interview the patient and find out some fundamentals about their lifestyle, social networks and aspirations.

Then the plan would kick into action. Each patient would get a tailored package of support. 

This might include simple behavioural things. For example, a patient who repeatedly ends up in hospital with a urinary tract infection because they get dehydrated might get some nice new plastic beakers and a note on the fridge. Patients at risk of falls might get slippers. 

A diabetic who fails to take their insulin might get a regular reminder, perhaps a text. Then there’s building up the volunteer base, perhaps asking a neighbour to take someone to bingo or for their regular swim, or just to pick up a prescription.  If there are formal volunteers ready to support, even better. This links in to ‘social prescribing’, which many GP practices are considering, and as well as evaluating the hard numbers on admissions and costs it seems logical to include the social return on investment.  

If you are thinking of putting together a bid you have six weeks to do it. The deadline is Friday 13th June. 

Nick Pecorelli is an Associate Director at The Campaign Company.