Can volunteers help bridge the divide between health and social care?

Source: National Health Executive Jan/Feb 2015

David McCullough, chief executive of the Royal Voluntary Service, talks to NHE about the innovative way that volunteers are helping ease the pressure on hospitals facing rising patient re-admissions and delayed discharges. David Stevenson reports.

In recent weeks, hospitals across England declared ‘major’ or ‘significant’ incidents as they struggled to cope with unprecedented demands on their services, especially in A&E, coupled with staffing problems and discharge delays.

NHE caught up with David McCullough, chief executive of the Royal Voluntary Service (RVS), who believes that while volunteers aren’t the solution to the national A&E crisis, they can help health and social care function better together.

He said one of the underlying causes of the recent A&E problems has been the “reduction in the provision of social care”.

“This is less about an A&E crisis than it is about a lack of social care provision – a shift in demographic and primary care availability, which ends up with people being stuck in hospital beds when they are ready to go home,” said McCullough.

To help tackle the issues of rising patient re-admissions and delayed hospital discharges, the charity worked with University Hospitals Bristol NHS Foundation Trust (UH Bristol) to provide volunteer services to support vulnerable older patients.

Profits from hospital shops and cafes

By releasing part of the RVS ‘gifting money’ generated by its shops and cafes in the trust’s hospital, the trust is now funding a range of services, including RVS’s Home from Hospital scheme and the Good Neighbours befriending service.

McCullough told us: “We have shops and cafes within the trust and we use the profits from those to fund the scheme. It is quite a nice virtuous circle: there’s an existing relationship with the trust, supporting staff, patients and visitors through the shops, cafes and the food trolleys, but rather than that money going to rent or shareholders, it now funds some social care in the system.”

The partnership with UH Bristol, which started in late 2014, comes on the back of successes in Leicestershire, where only 7.5% of users of the RVS Home from Hospital scheme  have been re-admitted as an emergency within 60 days, compared with national rates of 15% of over-75s within 28 days.

The programme in Leicestershire has been running for nearly a year, and has received some council funding. It also forms part of a national scheme, funded through the Reducing Winter Pressure Fund, looking at the role volunteers can play in easing the pressure on hospitals (see box out).

Jumping into action before the patient is discharged

RVS’s Home from Hospital volunteer schemes help support older people after a stay in hospital, making sure their house is safe and warm, helping with meals, and providing  transport to follow-up GP appointments.

However, the programme starts much earlier than when a patient is discharged.

“We try to work as part of the team when older people are first admitted into hospital, so we’re aware of what the sort of timescales are likely to be,” said McCullough. “By doing this, you get an early clinical viewpoint giving us a reasonably good sense of what support this older person will need once they’ve been treated and are ready for discharge.”

The charity’s volunteers can then get themselves ready in advance, but as with all of these projects it revolves around the relationships between people. For example, it revolves around an effective relationship between the admittance and discharge teams in the hospital, the RVS management organising the volunteers, and liaison with the social care teams who need to understand whether there is a more complex package of care needed.

Under the Home from Hospital scheme, volunteers support patients for up to six weeks, but this varies based on individual needs. Unlike some other schemes, once the six-week period elapses, the support does not automatically disappear.

“It is during this period that we try to integrate the patients into our Good Neighbours scheme,” NHE was told. “Our experience has revealed that you can get people over the initial hump of being ok and not being an ‘unplanned re-admission’. But how do you integrate them back in to the community?

“What we try to do with the Good Neighbours scheme is encourage people to come to our lunch clubs or some of the social events to create a wider network of support. It is funny how by doing this someone can suddenly move from being a recovering patient to someone who is fully functioning within their community again.”

These schemes are a natural extension from the work that RVS has always done in hospitals and communities across the country, said McCullough, who joined RVS as chief executive in 2011, replacing the outgoing Lynne Berry OBE – who is interviewed in connection with a separate project on page 23.

Going forward, McCullough believes that the schemes offered by the charity, which is one of the largest voluntary organisations in Britain with more than 40,000 men and women helping people in their homes, community and hospitals, have the potential to be “really significant” in bridging some of the gaps between health and social care.

Reducing Winter Pressures Fund

Through the Reducing Winter Pressures Fund, the Cabinet Office and the National Tripartite group (which actually has four members: NHS England, Monitor, the NHS Trust Development Authority and the Association of Directors of Adult Social Services) are funding projects that use social action to help older people stay well, manage their conditions or recover from illness or injury, and thereby reduce pressure on hospitals.

The objective of the fund is to scale-up and robustly test a small number of volunteer supported services over winter 2014-15, with a view to mainstreaming successful interventions. The Nuffield Trust will evaluate these projects.

The organisations receiving funding are:

  • Westbank Community Health and Care (based in Devon)
  • Royal Voluntary Service (based in Leicestershire)
  • Age UK South Lakeland
  • Age UK Cornwall and Isles and Scilly
  • Age UK Oxfordshire
  • Age UK Leeds working with British Red Cross
  • British Red Cross Society (based in north Derbyshire)
  • University College London NHS Foundation Trust (partnered by British Red Cross and Good Gym)

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