Test and learn in Frome, Glastonbury and Bridgwater

Temporary changes to test whether we can improve access to intermediate care or reablement services, improve outcomes for patients and improve flow through our acute hospitals

10 Year Health Plan

The 10 Year Health Plan was published in July and sets out how it will reinvent the NHS through three radical shifts. One of those shifts is a shift of services from hospital to community.

The 10 Year Health Plan sets out how the shift from hospital to community will be realised through the Neighbourhood Health Service that will bring care into local communities, convene professionals into patient-centred teams and end fragmentation. At its core, the Neighbourhood Health Service will embody our new preventative principle that care should happen:

• as locally as it can
• digitally by default
• in a patient’s home if possible
• in a neighbourhood health centre (NHC) when needed
• in a hospital if necessary.

Our trust and NHS Somerset are working together on a programme designed to deliver that shift. We are running two test and learn processes and NHS Somerset is inviting local people to shape how the NHS in Somerset shifts care to neighbourhoods to achieve better health outcomes and less pressure on acute hospitals.

The outcomes from the public engagement and the outcomes of the test and learn processes will help shape NHS Somerset’s new community services strategy which will enshrine the high-level principles of how the local NHS will deliver community services across Somerset.

Our test and learn in Frome, West Mendip and Bridgwater

We are making temporary adjustments to our current provision for patients who receive intermediate care or reablement services in their own homes following an acute hospital stay, or in a community hospital following an acute hospital stay, or need to move to a permanent care placement as their needs have changed.

We think we can improve patients’ access to intermediate care or reablement services, improve outcomes for patients and at the same time improve flow through our acute hospitals. These changes are temporary and reversible if they do not deliver improvements.

Current provision of intermediate and reablement services in Somerset

Patients who need intermediate or reablement services following a stay in an acute hospital receive it in three ways, depending on the level of support they require.

• Pathway 1 – a person’s own home, if possible, supported by care workers and therapists.
• Pathway 2 – a short-term in-patient stay, in a Local Authority-commissioned care home or NHS community hospital.
• Pathway 3 – a care home or community hospital with 24-hour support for patients with complex needs who are unlikely to be able to return to their usual place of residence.

We have looked at the provision and performance in Somerset of intermediate care and reablement services for predominantly elderly patients after a stay in an acute hospital. Based on what we have found, we do not think that we have the right balance of provision across these pathways, and we do not believe that they are adequately meeting the needs of patients and supporting flow through our acute hospitals.

We want to support people to return to their own homes where possible and studies show that people often recover faster in the familiarity of their own home. Being in a hospital bed creates risks for patients – it is widely acknowledged that ‘deconditioning syndrome’ can lead to reduced muscle strength and circulation, and increased dependence, confusion and demotivation, as well a risk of picking up a hospital-acquired infection.

Pathway 1

• More demand than supply.
• Target of 48 hours for people to access the service.
• In March, people waited an overage of 6.5 days.

Pathway 2

• Target of 48 hours to access a bed.
• In March, two out of a sample of 31 patients were transferred from an acute hospital to a community bed within the target 48 hours and 22 waited longer than eight days to transfer.
• In March, 42% of people who received their intermediate care service in a bed returned to their usual place of residence, compared to 78% of people who received their intermediate care at home.

Pathway 3

Currently in Somerset, we do not have a good solution for people whose needs have changed and are likely to need a long-term care placement (Pathway 3). These patients are currently discharged from an acute hospital to a community hospital and then often need to move again into a long-term care placement. We are working with Somerset Council to find a better solution for these patients which will hopefully mean they can go directly to their long term care placement.

Temporary changes - 12 week test and learn

This year Somerset has invested £1.6m to provide more reablement at home. We are making temporary changes and testing their efficacy in a test and learn process.

These temporary changes are:

• Expanding our Pathway 1 service to care for more people in their own homes, extending this service to care for 83 (from 67) new people per week.
• Spot purchasing 28 beds in care homes in Somerset so that people whose needs have changed can move directly from an acute hospital into a care home and will no longer need to move twice. In addition, there are some changes to the commissioning of care home beds so that it can move to a spot purchase model and the Council are leading on this element.
• Temporarily reducing the number of community hospital beds in three of our community hospitals:
  • Bridgwater Community Hospital – 30 beds to 24 beds
  • West Mendip Hospital in Glastonbury – 30 beds to 16 beds
  • Frome Community Hospital – 24 beds to 16 beds.

These temporary changes enable patients in Somerset to receive intermediate care at home, or in a community hospital, or move directly to a long-term care placement if their needs have changed. We think we can make real improvements and the outcome of the test and learn will tell us if that is so. These changes are temporary and reversible if they do not deliver improvements.

We plan to begin incrementally temporarily reducing the beds in those three community hospitals from Monday 11 August over a period of seven weeks. Following that, for an initial period of 12 weeks, we will assess whether they are improving outcomes for patients and supporting flow through our acute hospitals.

The measures that we are assessing include:

• The number of patients whose discharge from Yeovil Hospital or Musgrove Park Hospital is delayed. We are currently one of the worst performing areas of the country for “no criteria to reside’.
• How long patients’ discharge from an acute hospital is delayed.
• The length of time that patients wait to access intermediate care at home. The target is 48 hours but the average wait time in March 2025 was 6.5 days.
• Delays leaving either an acute or community hospital bed. We know that delays cause harm.
• Patients’ length of stay in a community hospital.
• The proportion of patients who need to be readmitted.
• Feedback from patients and colleagues.
• Patient outcomes including the proportion who are discharged home, able to remain at home, and what proportion require care packages.