Thursday, 19 January 2017


Beds unblocked

How one care home is using its facilities to help the NHS reduce costs from bed-blocking. Robert Cusack reports

For use in Inside Housing, 12 February 2016

The problem - and cost - of older people who cannot be released from hospital because they do not have suitable housing to return to is a well documented one.

“We had some empty beds which were useful to nobody.”

Adrian Handley, community partnership manager, Anchor Housing

The issue is so well known that the controversial term ‘bed-blocking’ has become a mainstream phrase. Mainstream, widespread solutions have proved trickier to come by, however.

The government and healthcare professionals could do worse that look at the Kerria Court care home in Birmingham as they cast around for answers. Without it, many residents would otherwise be in hospital, and its existence has helped the local clinical commissioning group (CCG) save thousands of pounds.


Cost reduction

When Adrian Handley, community partnership manager at 22,500-home Anchor Housing, read in the media that the Sandwell and West Birmingham CCG was facing a problem with ‘delayed transfers of care’ (the NHS’ preferred term for bed-blocking), he saw a way to help - and an opportunity for Anchor. So he picked up the phone and asked if he could show the managers at his local CCG around some of the beds at Kerria Court..

“We had some empty beds which were useful to nobody, so I thought it would be really nice for the CCG to come and see how we look after people,” he explains. “Once the CCG managers saw the home, it was much easier for them to visualise what solutions the home could create for them, at a much lower price than they were already paying.“

“It is ultimately a waste of money for the taxpayer.”

Hilary Blackwell, healthcare partner, Capsticks

The rationale for the NHS was obvious. According to Age UK, 2.43m hospital bed days were lost between June 2010 and March 2015 to older patients who could not be discharged due to a lack of beds in social care units for them to go to.

Bed-blocking leads to further deterioration of health, and delays in release from hospital. According to an NHS report, patients who cannot be discharged to care homes spend four times longer in hospital than that initially estimated by consultant geriatricians.

By December 2013, Anchor was ready to start a pilot scheme which would provide six beds across four care homes in Birmingham, funded by the CCG. A bed at a care home such as Kerria Court cost the local CCG £550 a week, excluding extra costs for medical attention and therapy, compared to £1,610 a week for a rehabilitative bed at Birmingham City Hospital.

For use in Inside Housing, 12 February 2016

Source: Anchor Housing

Kerria Court care home in Birmingham

After the pilot demonstrated an initial reduction in costs, it was then expanded to run another 10 months, finishing in November 2014.

One of the wings of the home was refurbished and turned into a ‘reablement unit’ at “tiny” cost to Anchor, although the association was not able to put a pound figure on it. Existing residents were simply moved to other rooms in the care home.

“As good and effective as these projects are, if the money’s not there, it’s not there and that’s it.”

Adrian Handley, community partnership manager, Anchor Housing

“It was really easy to create this bespoke unit at a very low price,” says Alison Bentley, manager of the Kerria Court care home. “We fitted a new keypad to the door of the wing, the bedrooms were refurbished at minimal cost and made comfortable with some new beds and TVs.”

The scheme was so successful that Anchor then continued the programme, and housed more than 52 patients in 10 beds between January and November 2015. Anchor estimates that the scheme saved the CCG more than £300,000 over this period, and it is now looking to expand the project to care homes in other parts of the country, including Coventry and Nottingham.

Kerria Court has 47 beds in total, most of which are occupied long-term by older people with dementia. But now 13 of the beds are used to help NHS patients to rehabilitate, with 10 funded by the CCG and three more by Birmingham City Council. Patients in these ‘emergency assessment beds’ are referred by the interim referrals team at City Hospital, at a rate of around three or four admissions a month. They typically stay between two weeks to a month.

So will Anchor expand this project even further? The main restriction is funding. Mr Handley explains: “Sometimes the council or the CCG funding just isn’t there. As good and effective as these projects are, if the money’s not there, it’s not there and that’s it.”

Multiple benefits

Hilary Blackwell, healthcare partner at law firm Capsticks, points out there are perverse incentives not to support such schemes. “It’s the CCGs and NHS England who are paying for the hospital beds and it’s the local authorities who are providing funding for people in care homes,” says Ms Blackwell.

“If the CCG are spending lots of money in keeping people in hospital beds, that doesn’t bother the local authorities, so they don’t worry about it, but it is ultimately a waste of money for the taxpayer.”

The Nuffield Trust, a healthcare thinktank, estimates that spending on social care will fall by 2.2% each year for the next five years, leading to a funding gap for social care in 2020 of between £2.8bn and £3.5bn.

For use in Inside Housing, 12 February 2016

Source: Anchor Housing

Living space in the care home

There are signs that CCGs and local authorities may outsource rehabilitative care to lessen the strain on hospital bed provision and, according to Susie Rogers, partner in the real estate team at Capsticks, this is likely to lead to regular funding.

“It’s been really positive as care managers to see such a large number of people get better.”

Christina Cook, care manager, Kerria Court

Steve Nicholls, service redesign project manager for Birmingham’s cross-city CCG, says that Kerria House is the only care home it’s using like this. Still, the CCG would consider working with other housing providers, depending on the future direction of traffic.

Ultimately, the Kerria Court scheme could work in other areas of the country, but success was helped along through healthy communication between the CCG, the council and the housing provider.

“It’s benefited us, the CCG and the council working so closely together,” says Mr Handley, who is proud of the effect his project has had on the community. “There is a really good connection here and the authorities talk amongst each other a lot - you don’t get that in every area.”

Of those residents that do make it to Kerria Court, many get better much more quickly than previously expected.

Christina Cook, care manager at Kerria Court, says: “It’s been really positive as care managers to see such a large number of people get better. We build up a relationship with these tenants over a really short space of time, so to see them get healthy again is amazing.”

Transfers from Birmingham City Hospital to Kerria Court are administered by CHS Healthcare, a care home referral service with a total of eight care homes in Birmingham. In the financial year 2014-15, it claims to have managed the discharge from hospital of more than 600 patients in Birmingham in total.

“Our service reduces unnecessarily long hospital stays while patients wait for assessments,” says Pip Coley, a health care co-ordinator at CHS.

“It is also far better for the individual, because we are giving them physiotherapy and more time to recover. In doing so, we are giving them the best chance of being able to return to their own home.”

Finally, for Anchor, there has been another unexpected benefit. Some of those patients who first encountered the home when they came to recover after hospital stays liked the home so much, they’ve come back to live there as regular residents.

“In terms of business plan development, providing short-term care does actually give us future referrals,” says Mr Handley.

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