Value in Healthcare Awards: Value and Improvement in Community Health Service Redesign

Hounslow and Richmond Community Healthcare Trust: Integrated Community Response Service

The judges said: “The team’s energy, positivity and commitment to patient care really shine through. They are highly skilled to offer the range of support needed to avoid hospital admissions and enable discharge.”

The Integrated Community Response Service was set up in June 2011, to address the increase in demand on acute services and, in particular, the unnecessary occupation of hospital beds through emergency admission.

The service is comprised of a team with a diverse set of skills and includes daily GP cover, senior nurses, community matrons, occupational therapists, physiotherapists, healthcare assistants, a social worker and a handyman. Operating 7am to 7pm seven days a week the team all have a general skill set alongside their specialist one in order to maximise staff capacity.

The team works with patients for seven days and has the task of assessment, stabilisation, and long term planning with patients and carers to minimise future acute episodes. Patients are provided with solutions to support care at home such as hiring one off equipment.

The service also looks to prevent readmissions by providing acute medical, functional and social needs to a patient in their home; this helps to prevent excessive GP home visits or referral to hospital. Once patients and carers know about available professional services they are able to refer themselves back to the service at any time as part of a self-referral plan.

A discharge service is also supplied and since the team’s launch it has supported 857 patients with complex discharge plans to leave hospital earlier. In the past year there has also been a prevention of 1,021 admissions; leading to a potential saving of £2,024,000.

• See all the winners of the Value in Healthcare Awards 2015
• See the full list of award judges

Finalists

• Ipswich and East Suffolk CCG – The i-van
• Anglian Community Enterprise, CIC: Community Rapid Assessment Service
• North East London FT / London Ambulance Service: Patient Centred Falls Response Service – Providing home based care and encouraging independence through integrated team approach
• Northern Devon Healthcare Trust: Exeter Community Nursing Centre provides an innovative service to patients previously visited in their homes by community nurses
• Northumberland, Tyne and Wear FT: Community Transformation
• Oxleas FT: Very first prison pulmonary rehabilitation project
• Pennine Care FT: Integration of sexual health services in Bury
• Pennine Care FT: Trafford Community Enhanced Care Service
• Your Healthcare CIC: Your Healthcare Co-Responder Pilot Project in partnership with London Ambulance Service, commissioned by Kingston upon Thames CCG