Specialist help for patients

A specialist health and social care team is working around the clock to support the patient discharge from hospital process in Northumberland.

This issue was brought to the fore during the winter – with unprecedented demand on A&E departments and hospital beds across the country.

Northumbria Healthcare NHS Foundation Trust’s Hospital2Home (H2H) team is made up of multi-skilled health professionals, including community nurses, social workers, occupational therapists and physiotherapists, care managers, discharge nurses, support planners and care co-ordinators.

Recent figures show the team supports an average of 350 people a month across Northumberland and North Tyneside.

“We are one of the trailblazers for joined up care nationally and H2H is a good example of this,” said Jane Weatherstone, GP and clinical director for Northumbria Healthcare NHS Foundation Trust.

“It helps to get people through the system faster and more safely. The value of this joined up approach was demonstrated in the winter during peak demand when the team worked at maxmium capacity to get the right professional to the right patient and proactively get the patient home.

“The results have been impressive, with increased patient satisfaction, more people maintaining their independence in the community than the national average and fewer people requiring longer term support.”

The team works in every hospital speciality.

Other initiatives in Northumberland include the Short Term Support Service, Immediate Response Team and the Joint Equipment and Loans Service.

Dr Weatherstone added: “There are real opportunities in having an integrated organisation which includes hospital, community health and social care services.

“Our philosophy is to join up social care with primary, community and secondary healthcare to provide a seamless service for patients.

“The services are responsive to each patient’s individual needs and are strengthening patients’ capabilities at home, which in turn are avoiding unecessary hospital admissions and supporting the earliest discharge from hospital as soon as hospital care is no longer needed.”

The trust is in the unique position to be one of few in England to deliver adult social care in partnership with a local authority (Northumberland County Council) and it has been chosen to lead work with partners to deliver an integrated primary and acute care system for the county.