2. 2
We have completed our fifth year for the Leaving Hospital Support Service, and referrals to
the service remain high. The team have shown passion and commitment in ensuring that
patients, carers, families and ward staff receive excellent customer service and that patients
have a safe and timely discharge from Royal Bournemouth Hospital.
We continue to have a reduced amount of patients referred to social services from when we
took on the service.
We believe a reason for maintaining the increase in referrals to the service is the constant
training the team do with ward staff, the good working relationships with all professionals in
the hospital and our promotion of the service externally to bring awareness of the service to
people before they come into hospital.
The table below demonstrates some of the work undertaken by category and has seen yet
another increase in carers support.
Year Referrals
Received
Referred to
Social Services
LHSS Core
Work
Percentage
Referred to
Social Services
2009-2010 4975 1726 3069 36%
2010-2011 5087 1586 3501 31%
2011-2012 4750 1257 3493 26%
2012-2013 5662 1563 4099 28%
2013-2014 5457 1586 3871 29%
Introduction
2009-2010 2010-2011 2011-2012 2012-2013 2013-2014
Advocacy by LHSS 110 1361 4562 5433 5268
Re Starts POC 287 378 414 271 333
HFH/WH/Rea 409 532 503 598 494
Carers Support 70 538 533 1678 2177
Information Packs 3550 5029 4750 5662 5456
3. 3
The above graph demonstrates the years of our work and we have identified more carers
this year, with 40% of our referrals receiving information on the carers support available.
Each year we aim to improve our output and effectiveness. This year we have worked hard
with wards, which has resulted in a large reduction in the number of inappropriate referrals
and the number of patients that have declined our service, both standing at only one
referral. The number of patients that are discharged before seen has increased this year to
4.4% of referrals we do not get to see an increase of .62% on last year. Our practices are
timely, we plan on seeing the patient the next working day after we collect the referral, we
are concerned that the service these patients miss out on could help them and potentially
prevent a readmission into hospital. We understand the bed pressures in the hospital and
work closely with wards to reduce length of stay and we have been monitoring wards this
year and feeding back at meetings on the wards where these discharges are taking place.
There will be a number of reasons why the patients leave before we see them which has
been discussed at our meetings, however we welcome the opportunity of working with eve-
ryone on how this can be improved.
LHSS is Commissioned by:
0
1000
2000
3000
4000
5000
6000
2009-2010 2010-2011 2011-2012 2012-2013 2013-2014
Advocacy by LHSS
Re St art sPOC
HFH/ WH/Rea
CarersSupport
Inf ormat ion Packs
0
50
100
150
200
250
300
2009-2010 2010-2011 2011-2012 2012-2013 2013-2014
Inappropriate Referrals
Declined
Discharged Before Seen
4. 4
To quantify the impact and wider social value of the overall service we have drawn upon our
experience of producing Social Return on Investment (SROI) reports as part of our
evaluation. SROI measures social, environmental and economic outcomes and uses
monetary values to represent them. This enables a ratio of benefits to costs to be
calculated. For example a ratio of 3:1 indicates that an investment of £1 delivers £3 of social
return.
Whilst this is not an exact science, if we use the national average unit cost indicators the
low average cost for all patient stays is £1,526 and the average stay for older people in
hospital is 11.1 days (NHS 2010)
This service directly helped 3,871 older people go home an estimated average of 3.2 days
earlier. This equates to annual cost saving of £439.00 per patient and £1.7 Million in total.
Source: http://www.pssru.ac.uk/uc/uc2010contents.htm
The current contract value or investment is £165,000 per annum and using this calculation
the Leaving Hospital Support Service has a social value ratio of 10:1 indicating that this
service delivers £10.00 of social return for each £1 invested. We believe these are conser-
vative cost estimates due the increasing complexity of hospital stays and longer term care.
Wider benefits
We understand that SROI is only one method at looking at wider social value and the
savings generated are not cashable in hospital settings where demand always outstrips
supply. However, the key benefits of the service where there are efficiency gains in
supporting health and social care colleagues meet their broader key performance targets
not least of which is safe and speedier patient discharges from hospital.
For example, achieving a year-on-year reduction in referrals to social services through
timely interventions such as filtering self-funders, doing lower level care assessments and
arranging low level support through local carers and voluntary agencies enables social
services to focus their resources on those with significant care needs.
Evaluating Our Service
5. 5
Regular case studies are forwarded to each authority which demonstrate the various levels
of input the service assists with.
The other way we monitor our service is through the feedback we receive from our
comments cards. As the below tables shows, this year we received 31 cards.
Our Successes
Question Great Good Fair Poor Total
How would you rate the service 15 12 2 2 31
How clear was the information or
advice provided
15 12 1 3 31
How well were your needs met 14 11 4 2 31
Question Yes No Not
Stated
Total
Would you recommend the service? 27 4 31
6. 6
We received seven comment cards that expressed a ‘poor or fair’ result. When
investigated:
◊ One patient was dissatisfied as they had not received any Physiotherapy and
this is the reason why they rated how well their needs were met as fair, they had
rated our service and information as good.
◊ One patient had received an information pack from A & E and our service had
not been requested. When we spoke to the patient we established that they had
waited in A & E for 3 hours with no support and then were passed the info pack.
They apologised for being angry and said it was not fault of our service.
◊ One patient felt we should have spent more time with them at the initial meeting
but rated information as good.
◊ One patient would have liked contact made before they were in hospital and
rated us fair for how well needs were met but good for the service and our
Information.
◊ One patient rated service and how well their needs were met as good, but fair
for information.
◊ One patient rated all questions as fair but this patient had been passed an
information pack and there was no face-to-face meeting with our service.
◊ One patient referral was passed to social services as there was no Welcome
Home available.
Some additional comments that have been made on our cards are:
◊ Time spent with me was extremely valuable, comforting and reassuring.
◊ Very smooth change from hospital to my home, thank you.
◊ Michelle was a very caring person and put my mind at rest about going home.
◊ I thought the service was very quick and efficient. Full Marks.
A further compliment was given by a thank you card - “Dear Michelle, thank you for
everything you have done for me, I can't begin to tell you how grateful I am to you, I would
be lost if it was not for the help of you, thank you for all your support and believing in me, I
will never forget you, as like I said in Lisa’s ward you are a very special wonderful lady
and there should be more people like you in the world it would be a much better place,
you have given me a second chance at life and I am not going to mess it up this time,
thanks again.”
7. 7
Stability of service
At the end of December we have had one staff member leave to start a new life in
Amsterdam. We recruited within bcha and our new staff member brings experience, skills
and knowledge that will be beneficial to the service.
As expected staff absences due to sickness has decreased over the year with staff’s
increased length of time in the service and building up a level of immunity with the hospital.
However one staff member has been off since the middle of December following an
operation. There has been no absences due to work reasons.
All staff have six weekly supervisions and have undertaken an annual review.
Training
BCHA are committed to develop staff by training and in 2013 launched an e-learning
system which compliments the face-to-face training. The e-leaning training can be used as
refresher training and staff are encouraged to access these courses to enhance their
knowledge.
E-leaning undertaken has been:
Diversity, Equality & Disability, Benefits and Bullying & Harassment
The courses that have been attended are:
1 x Assertiveness
1 x Breakaway
1 x Customer First
1 x Safeguarding Adult refresher
1 x Mental Capacity update and practice ideas
2 x Dementia Awareness
2 x Dementia & Challenging Behaviour
1 x Continuation of NVQ3 in Health & Social Care
5 x Good to Great Mary Gober Psychology of Service
A Responsible Employer
8. 8
Outcomes
We continually strive to improve and look for ways to promote our service. Over the past
year we have :
◊ Had a visit from Paul Boult from the Department of Health who read our case studies
in National Housing Federation Health publications. He was very impressed with our
service and its potential for other areas.
◊ Piloted a project for No Fixed Abode patients by attracting an additional £75,000
◊ funding from Department of Health to develop the service.
◊ Promoted our service with Southampton Hospital and the benefits to all
customers.
◊ Attended discharge groups to ensure we are an active part of the discharge process.
◊ Promoted the service through the League of Friend’s magazine and have contacted
Care Choices to be added to their next publication.
◊ Continued development of staff through training and one-to-one coaching.
Future Plans
We are looking to secure further funding for the No Fixed Abode project as this has been
very beneficial to the patients we have assisted.
We will continue to deliver our service in line with the Core Specification and work with com-
missioners with changes that constantly occur in the Royal Bournemouth Hospital to make
sure we deliver a high quality service that meets the demands of the contract.
Paul Thomas and Carol Owen
BCHA
The Future
