Sue Lott, Head of Community North and County Acute & Prisons, Adult Social Care, Lancashire County Council

In January 2021 Lancashire County Council, NHS England and University Hospitals of Morecambe Bay recognised that there was an opportunity to develop a new offer that would enable some people to go home from hospital in a safe and timelier way, that would benefit hospital flow and limit the need for formal care at a time where health and social care services were under increasing pressures due to the pandemic.

Through the organisations working closely together, the Hospital Discharge Home Recovery Scheme is aimed at people who need some support to recover or recuperate and which could be met through informal care, either entirely or alongside reduced formal support. There are two elements to the scheme, one is to enable family and friends to provide informal care where there are challenges in them doing so, for up to 6 weeks to support someone to return home quickly to recover and recuperate via a grant of up to £1200; and the second is the purchase of one-off items or services.

The scope of the scheme sets out that any proposal must be aligned to the Hospital Discharge and Community Support: Policy and Operating Model; it must be person centred; and must not duplicate available existing supports or services. The scheme also incorporates the principles of personal health budgets.

The support for informal carers is delivered through the Lancashire Carers Service. They offer a rapid referral process, contact the informal carer, understand and apply the solution they need, and support them for up to 6 weeks through weekly check ins. The Carers Service then also offer continued support beyond the 6 weeks where appropriate.

The following is an example of how the scheme supported an informal carer:

The daughter of a lady being discharged from hospital was supported to care for her mum for 11 days until a formal package of care was put in place. The scheme enabled the daughter to provide this care by covering the costs of the unpaid leave she took from work and her travel expenses to stay with her mum (she lived outside of Lancashire). The lady was able to return home sooner and did not have to enter a short-term residential home placement, plus during those 11 days at home her recovery was such that the formal package of care could be reduced at implementation.

To compliment the support for carers the scheme also has the option to purchase one off items/services that a person needs to enable them to return home sooner.  These cannot be care related or be covered via an alternative funding route or existing service unless the existing service would cause a delay in a timely discharge.

The following is an example of how the pilot was able to purchase a one-off item/service:

The local district council handyman service was unable to move furniture from upstairs to downstairs in a person’s home for 10 days.  The scheme paid for an alternative provision and the person was able to be discharged next day, reducing the need for an extended stay in hospital or having to transfer to a residential placement until the furniture could be moved.

The initial pilot phase of the scheme ran for three months linked to two hospitals to understand what could be achieved. It was relaunched in September 2021 in the same area because of the mounting pressures in the hospitals and from December it is now expanding across Lancashire, commencing with the purchase of one-off items first and will be closely followed by the carers’ element. Lancashire County Council is working closely with three other Local Authorities to extend the scheme across the Lancashire & South Cumbria Integrated Care System.

To date we have supported 26 people to return home more quickly, of which 15 people were during the initial phase the pilot, spending a total of £4,419 but saving a total number of 67 hospital bed nights (an average of 4 per person). Using the assumption of £800 per night’s stay in hospital, the financial ‘saving’ is £53,600.

Although the numbers are small so far, the potential of the scheme is significant, not just for the release of bed nights in the hospitals, but importantly in better and more personalised outcomes for people.

Sharon Doyle, (nurse by background) – Discharge Lead Royal Lancaster Infirmary

“The Morecambe Bay Pilot came along at an opportune time for the discharge team across the acute and community footprint, it was a difficult time within both the community and acute sector, and the pilot gave us a contingency plan, a different angle to do things that we couldn’t do previously. In all honesty it gave us the ability to offer support to people who needed it the most, without having to apply through various pathways which was often time consuming.

The team were seeing high levels of people requiring support for simple things, a microwave, equipment to store medications such as insulin, supporting patients who needed support with a safe for medications but had no means to obtain these themselves and no family to support.

It reduced the hospital stay, but also enabled people to stay at home, but the biggest thing was it gave people a feeling of worth that someone cared enough to do this for them.

The carers service also provided support to families that couldn’t get to loved ones due to other commitments, and to be able to say that we can help made a massive difference.

This enabled the team to do the right thing, at the right time and facilitate home as the discharge destination – Home First always”.

Kirsty Williamson, Social Worker Lancashire County Council

I have utilised the discretionary fund for hospital avoidance, this has given the opportunity for my service user to remain at home.  Previous to this fund it was a timely process by means of applying to various charities, crisis funds etc and responses varied, if at all.

It took the whole of 5 minutes to fill and email to a nominated champion. A response was emailed the same day with acceptance and guidance on where to look for white goods etc.

Without this funding, I feel my service user would have ultimately returned to hospital.

Kate Buffery Head of Personalised Care, NHS England-Improvement North West

The discharge pilot in Lancashire has demonstrated how using personal health budgets to empower people, their families, and carers to access flexible and creative solutions can improve outcomes and experience. Work is underway to scale up this approach locally and increase spread across regions. Well done to all involved!

Karen Thomson, Social Care Support Officer, Lancashire County Council

It is very helpful during pressured times to be able to enable family members to support their significant others. In this case the pilot enabled the daughter of our lady to take time off work and covered travel costs. This reassured both the lady and her daughter that appropriate care and support would be available and also that by daughter supporting that it would not be to any financial detriment to her.

Rebecca Armstrong- Team Leader North Lancashire – Lancashire Carers Service

I have been working alongside our NHS colleagues to support the timely discharge of patients back to their homes. We have worked together to identify a family member who has been willing and able to provide support to the discharged patient whilst they recover and convalesce within their home surroundings. I have checked in with the family member each week to monitor progress towards full recovery and been able to put in place practical support when required to assist the recuperation process. I have also been able to access funding through the local authority, when appropriate, to support, the family member with costs associated with the short-term care they are providing.