How community-based nursing in Scotland can ease pressure on the NHS

By Diana Hekerem
Divisional Business and Service Development Manager for Scotland


Diana Hekerem, Divisional Business and Service Development Manager for ScotlandWith hospitals experiencing the highest demand on their emergency services in 10 years and NHS services in crisis, a long-term solution lies in shifting resources from acute services out into the community so people can be cared for at home if they have no clinical need to be in hospital.

Despite a mild winter and an additional £300million injected into the NHS to help ease the extra demand, NHS emergency services are in crisis. Cuts in social care budgets have hampered the ability of hospitals discharging those who are terminally ill, frail and elderly. Many do not require hospitalisation but cannot be discharged without adequate provision being made to care for them at home. This exit block means new patients arriving in accident and emergency cannot be admitted and so the vicious circle continues with hospitals becoming gridlocked.

A long-term solution lies in shifting resources from acute services out into the community so people can be cared for at home if they have no clinical need to be in hospital. With these services in place, the process for discharging patients from hospital could become more streamlined, overcome exit block and reduce costs to the NHS. We know from the Nuffield Trust’s Exploring the cost of care and the end of life that community nursing services like the Marie Curie Nursing Service can provide high-quality care and reduce the cost of providing that care in the last months of life by around £487 per person.

Community-based nursing in action


Marie Curie’s nursing service has a number of community based models of care. This includes a supported discharge model that speeds up the process of discharging patients from hospital to be cared for in their homes. The Fife and North Glasgow and Lothian case studies shows how this operates in practice. In North Glasgow, for example, the service reduced the time patients spend in hospital by shifting resources to better support people in their own home or another place of care.

North Glasgow and Lothian


The fast-track discharge service in Glasgow is a partnership between Marie Curie, NHS Greater Glasgow and Clyde and other local providers. As well as assessing patients’ care needs, making discharge arrangements and organising support for the period immediately after discharge, a team of senior Marie Curie health and personal care assistants are available to support patients for up to three days. The service also takes referrals to prevent avoidable admissions of patients with palliative care needs to hospital or hospice. A similar service in Lothian saw 80% of people dying at home, their preferred place of care.


The service has benefitted almost 500 people with palliative care needs since it began in 2012. It was also shortlisted for the prestigious Health Service Journal Care Integration Awards.
“Our North Glasgow fast-track discharge service, in partnership with Marie Curie, continues to demonstrate that we can identify and offer patients a choice in where their palliative care needs can be met. The fast-track service supports patients and families with palliative care needs in their own home by providing a service which meets both their health and social care needs. People at the end of life who wish to die at home are enabled to do so thereby reducing length of stay in actute beds”

Lorna Dunipace, Head of Primary Care and Community services, NE Sector, Glasgow Community Health Partnership

Fife


In Fife, services were needed to support more patients in community settings, especially people at the end of life with a non-cancer diagnosis. However, difficulty organising discharge packages and complexity of care needs were compounding delays in transferring people to their preferred place of care.

In collaboration with local services including GPs and district nurses, the Marie Curie Fife Service offers tailored care to people with any terminal illness. Marie Curie Health and Personal Care Assistants help terminally ill people to manage at home, giving the extra support they need immediately after their discharge from hospital – usually a time of high anxiety for them, and their families. The team also helps people who are already at home but who need extra support so they can avoid admission, or readmission, to hospital.

The results


The supported discharge services in all three areas have:

  • helped terminally ill people spend their final weeks at home rather than in hospital or a hospice

  • facilitated patient’s safe and timely discharge from hospice or hospital to their homes, as well as providing a short package of care post-discharge

  • offered general nursing care, including symptom control, personal care and emotional support


We also know that:

  • 99 emergency or hospital admissions were prevented in Glasgow during 2013/14

  • 210 patients were discharged from Glasgow hospitals and the Marie Curie Hospice

  • 188 patients were discharged in Lothian


Find out more how Marie Curie works in partnership in the community