Bradford: Helping reduce hospital delayed discharges

• Supported housing providers run an intermediate support accommodation service for patients being discharged from hospital or frequently attending A&E
• The service is available for those who are homeless, at risk of homelessness or with unsuitable accommodation due to the changing health needs
• The saving to the NHS is estimated to be up to £47,000 per person
• Bradford Council’s housing provider, Horton Housing Association, runs a range of supported housing services. They include services for rough sleepers and those who have criminal convictions, as well as dedicated accommodation for 16 to 18-year-olds and specialist services for women.

But perhaps the most unique is the Bradford Respite Intermediate Care Support Services (BRICSS). It was launched in 2013 to support people who were ready for discharge from hospital, but who are homeless, at risk of being homeless or those who are unable to return to unsuitable housing.

The service provides accommodation and clinical care from a 13-bed ground floor building, which used to be a care home, with four bungalows also available to provide step-down accommodation.

There are nine staff that work at the site - three housing support workers, four wardens, a cook and manager - who work alongside NHS-commissioned health support provided by Bevan Healthcare, which includes a dedicated GP alongside other health professionals.

A specialist in-reach team at the hospital work with the wards to identify people who may be referred. Those who are are offered a placement for up to 12 weeks to allow them to recover without taking up a hospital bed. However, if needed then longer stays can be facilitated in exceptional cases.

People are supported with a range of issues from fractures and other orthopaedic traumas through to neurological conditions and liver and kidney problems alongside people who are experiencing disabilities for the first time because of things like amputations.

BRICSS Manager Magda Dziurkowska said:

 These are very complex patients - alongside their health problems, they can have drug and substance misuse and mobility issues. The service we provide is a really important part of recovery and a stepping stone, which without it people would face very long stays in hospitals or be discharged on to the street and then you get into the revolving door of re-admissions."

And because of the nature of their health and complex lives we can find some have to stay for much longer than 12 weeks. We have also had people referred to us who have been diagnosed as terminally ill after we have accepted them and are at an end-of-life stage and unfortunately, we are unable to provide any palliative care as we don’t have the right support services.

But if we feel we can support them and there is nowhere suitable for them then we do our best alongside Bevan Healthcare, district nurses and sometimes the local hospice. It is a very homely environment – we have a chef, so they get home-cooked meals – alongside our support and the clinical care that is provided by Bevan Healthcare. People generally do really well here.

We have a GP who comes in once a week from Bevan Healthcare and then there is extra support from nurses, a psychotherapist and occupational therapist, who helps organise any equipment or activities that are needed.”

The savings are significant. Work by the York Health Economics Consortium found typical costs of a BRICSS stay was just over £5,600 – a saving of between £11,000 to nearly £47,000 if the patients they care for had stayed in hospital.

One of those who has received help is Andrew (not his real name), 59, who arrived at BRICSS after being treated in hospital following a street assault. He had suffered fractured ribs and a punctured lung and was also struggling with respiratory disease. He had spent the previous few months sofa surfing and also had a history of drug and alcohol misuse and was underweight.

The service’s GP saw him soon after he arrived at BRICSS and a plan was put in place to help him manage his injuries and illness and he was referred on for pulmonary rehabilitation. He engaged well with the specialist team, which visited him at BRICSS. He also received stop smoking and mental health support.

His diet improved thanks to the meals from the cook and he was given help to sort out his financial problems and access personal independence payments (PIP). Within a few months he was in a position to move out into general supported housing.

Beverly (not her real name), 50, is another person who was supported. She arrived at BRICSS after being treated in hospital following a domestic abuse assault and was also struggling with alcohol dependency.

Staff worked with her to build her self-esteem and confidence, getting her to join in activities. They also helped her apply for PIP and she continued to receive support for her alcohol dependency.

She suffered a relapse at one point, being admitted to hospital after she stopped taking her medication. A new care package was provided and she slowly began making progress. Eventually she was able to move out into social housing, but continued to receive support from the BRICSS team for a short period of time.

The service is commissioned by the adult social care department. Housing Related Support Contract and Quality Manager Adam Clark said this arrangement is particularly beneficial for the service.

“BRICSS is a non-regulated service and as such does not deliver direct care, but it sits as a bridge for those people who are at risk of homelessness and are in between assessed care need and supported accommodation.

“The service draws on external care providers when required and our team are able facilitate close links with other social care services. For example, we link in with other health teams supporting care homes and have been able to link the BRICSS service up with some end-of-life training for the staff, given they have supported a few people who required palliative care.

BRICSS is providing a fantastic service and offers support to a very vulnerable group of people. It has even started accepting referrals for people who would otherwise be admitted to hospital. The service has then been able to intervene to ensure their needs can be met in the community. This sort of preventative work is invaluable.”

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