Hospitals: Voluntary Sector and Emergency Readmissions
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I begin by thanking my noble friend Lady Scott for tabling this important topic for debate and for introducing it so ably. The Government appreciate, as all speakers have acknowledged, that voluntary and community sector organisations make a substantial contribution to the delivery of high-quality local health and social care services. They have a strong track record of designing, providing and supporting services, based on their insight into people’s needs, and they are often well placed to respond in a flexible way to those needs. Their unique understanding of local communities also means that they are ideally placed to reach those vulnerable and sometimes hard-to-reach groups that statutory organisations might struggle to reach.
Moreover, social action and volunteering contribute to every sphere of health and social care and are fundamental to building strong and resilient communities. For example, the Royal Voluntary Service—mentioned by my noble friend Lady Thomas and the noble Lord, Lord Bradley—is a charity that supports older people to live well at home, in the community and in hospitals. With a network of more than 40,000 volunteers nationally, the Royal Voluntary Service uses its strong community links as a platform to deliver a range of services that improve the hospital experience for older people and their relatives, reduce hospital readmissions by linking hospital and home-based services, contribute financially to patient and community services, and provide people with practical and accessible information about local services. These types of schemes can help to avoid unnecessary emergency readmissions.
The report mentioned by a number of noble Lords makes very interesting reading. The conclusion of the report is that, in the RVS’s estimation, this support could save tens of millions of pounds in public money. That needs testing, as the noble Lord, Lord Bradley, indicated, as there are a number of important assumptions underlying the figure that it quotes. Nevertheless, it points the way to the usefulness and value of the voluntary sector in all the areas that I have mentioned. There are many other voluntary sector organisations that do similar work—for example, Age UK.
I shall now set out the range of actions that the Government are taking to improve integration of care to ensure that people can receive the care that they need and avoid emergency admissions and readmissions, including through use of the voluntary sector. The better care fund is a £3.8 billion pooled budget between health and social care, with areas choosing to pool £1.5 billion extra to bring the fund to £5.3 billion. The vast majority of this is being spent on social care and out-of-hospital community health services, which aim to keep people out of hospital and support them to leave safely as soon as they are well enough to do so.
Underlying the new approach are improvements in seven-day working across health and social care to help quicker, more appropriate discharge from hospital. One of the metrics for the fund is the number of people supported to remain at home at least three months after discharge from hospital. Plans project that, over two years, 11,860 older people will be supported to remain at home at least three months after discharge from hospital. This equates to a 33.7% increase over two years. Schemes in plans typically focus on things such as increasing capacity in reablement or intermediate care services, or multidisciplinary emergency response teams, which focus on avoiding unnecessary admissions to hospital.
We know that the voluntary sector can also play an important role in providing advocacy to people who need it. One of the drivers for the better care fund is to stop people having to undergo multiple assessments and telling their story repeatedly. Having someone to represent them and to help them navigate their way through often confusing health and care services can be invaluable. For example, in Greenwich the hospital ward support scheme trains volunteers to engage with people in hospital to support them to do practical things such as maintaining hygiene or engaging in conversation. The scheme prepares people for discharge, with volunteers on hand to support those identified as socially isolated who will be leaving hospital. Doncaster’s better care fund plan sets out a comprehensive falls prevention programme, through which Age UK Doncaster is being commissioned to help increase physical activity levels in older adults to increase strength, stamina and flexibility. That reduces the risk of falls and fractures, which are a major reason for hospital admissions and readmissions.
As well as providing services directly, we know that the third sector is represented at the strategic decision-making level in better care fund planning, with Nottingham and Southwark being just two examples of the many areas with voluntary sector representatives as members of their integrated care programme boards, as well as the health and well-being board itself.
The £2 million social action fund has delivered improved engagement with the independent, voluntary and community sectors. Eight schemes are being funded, aimed at supporting frail and elderly people. The aim is to scale up and robustly test interventions that use social action to reduce demand on hospital services, with funded projects making their impact over the course of winter 2014-15. We hope to be able to mainstream the most successful interventions down the line, and all evaluations and learning will be shared widely with the sector. The projects will help develop the potential of services that use social action to help older people stay well, manage their conditions or recover from illness or injury, thereby reducing growing pressure on hospitals. Currently, such services are small in scale and piecemeal, and often are not robustly evaluated. By March 2015, the aim for each project will be to contribute to a significant impact in the local area over the winter of 2014-15, develop a robust evidence base on its effectiveness through evaluation by the Nuffield Trust, and lay the foundations for the service to continue and grow on a long-term basis.
I am conscious that I have mentioned only a very few of the many voluntary sector organisations that are relevant to this issue, focusing primarily on the generic services provided. There is also a wide range of different, more condition-specific services provided by the voluntary sector—for example, some of the support provided by charity helplines that enable people to manage their conditions at home. There are also the very important services provided by voluntary sector hospices that support people at the end of their life within their homes, thereby avoiding unnecessary hospital admissions.
I shall highlight one particular example of where I have observed fantastic contributions made by the voluntary sector. Last month, I visited a medical practice in Hertfordshire to see how the role of developing well-being services within local NHS communities works. The Wellbeing Service was developed in order to support patients’ physical, psychological and social needs through improved health and well-being. The practice has engaged with a number of voluntary organisations to help prevent readmissions. I was particularly struck by the help that the volunteers give patients in navigating their health journeys, and I commend their tremendous work on this.
The noble Lord, Lord Bradley, asked whether there would be any spend on the voluntary sector from the additional £700 million of winter funding. Planned spend by system resilience groups identified for voluntary sector organisations is approximately £3.9 million. Approximately 110 independent and voluntary sector schemes are planned across the country, covering the expansion of capacity to provide care at home, hospital-to-home aftercare, out-of-hours cover and beds in care homes, the community and hospices. These plans include voluntary sector providers referenced in plans, such as Age UK, the British Red Cross and various hospices and smaller providers. Many schemes are focused around helping with improved hospital discharges, support for patients on return to their homes, community care provisions, and longer-term work to reduce readmissions and prevent admissions in the first place. I think we can be encouraged by that picture.
I conclude by saying that I recognise that the voluntary and community sectors make a substantial contribution to the health and care system. This has been an excellent short debate. Like my noble friend, I regret that there have not been more speakers, but the issues raised by those who have spoken have brought to light what value is available from the voluntary sector in a range of fields in health and social care. I thank my noble friend for having given us this opportunity to look at those areas. I encourage commissioners to engage with voluntary sector organisations to understand the kind of support that they can deliver to prevent emergency admissions, looking at some of the excellent examples that we have heard about this afternoon.