Pioneering home alteration project between NHS and Council helps get people home from hospital sooner

A pioneering project where a team of ‘bob the builders’ make super quick home alterations for people returning home from hospital is saving millions for the NHS and helping people get home.

Mansfield District Council’s ASSIST scheme means homes are made safe and accessible for a patient’s return from hospital – this could include fitting a ramp, grab rails and key safes, making sure their heating works, or moving furniture to make space for a hospital bed.

Some people also need to stay elsewhere temporarily while housing more suitable for their needs is found or for homeless people a new home. They also give advice on money and benefit entitlements and even food and clothes to help them get back on their feet.

Across the NHS, 14 Integrated Care Systems (ICS) are seeing NHS and local government join forces to pool resources and budgets yielding patient and public benefit. Spreading this approach will be a key part of the 10 year plan for the NHS that is being drawn up over the coming months.

The Nottinghamshire ICS is proving that savings can be made when councils and the health service work together.

ASSIST runs at King's Mill Hospital in Sutton-in-Ashfield in conjunction with Mansfield District Council, Nottinghamshire County Council and is funded by the Mid Nottinghamshire Clinical Commissioning Group.

Since October 2014, Assist has helped more than 3,000 people and is expected to save the NHS around £1.3m a year. This is being reinvested back into front line services to the public. Some say the service has saved or transformed their lives.
Cancer sufferer Russell Cooper said: "It is down to the dedication and hard work of all of these amazing people that I am able to stand here and share my story.

"Without them I firmly believe I would not have had the strength to fight the cancer and I would have given up, lay down and died. My cancer is now in remission and I can now look forward to the future."

Two ASSIST team members who make the scheme run like clockwork are Mansfield District Council employees Carol Fickling and Kathleen Moore. They find patients who need help and liaise with the council’s housing department who send their repair men in to help.

Carol said: “All I need to do my job is a pair of legs and a phone and expertise in dealing with people. We are a responsive service and my working day is spent assisting with any queries to ensure that patient discharge is safe and timely. Ongoing support is given at home on a transitional period by the Assist team, and beyond if required.”

Kathleen said: “I have established excellent working relationships within the authority, and a good rapport and engagement with all multidisciplinary teams involved in the hospital discharge process of patients from hospital. This can include liaison on a one-to-one basis with all partner teams or departments, patients and their families.

“We have received some wonderful testimonials from people whose lives we have turned around, often with such simple and easy measures, which includes joined up working together with our in-house teams and partners and also in the local community and beyond.”

David Pearson, Nottinghamshire Council Director of Adult Social Care and Integrated Care System leader, said: "Recent research suggests spending extra time in hospital can reduce muscle strength for older patients by five per cent each day, which reduces their mobility, independence and quality of life.

"This project is reducing delays when it is not suitable for older people to go back to their home but gives them a home environment with the support that they need to regain their independence."

The NHS is teaming up with councils to improve health through better housing all over the country with the cost of poor housing to the NHS estimated at £1.4 billion per year.

Cold housing can lead to chronic diseases like lung and heart diseases and poor mental health as well as heart attacks, strokes and falls.
Reducing excess cold in homes to an acceptable level would save the NHS around £848 million a year and reducing all falls in the home could save it £435 million.

NHS costs could be reduced by £2 billion per year if poor-quality homes with health hazards, such as cold, damp and falls hazards, were brought up to standard.

ASSIST has often led to a huge increase in the quality of life for the extremely vulnerable discharged patients it has helped.

Vulnerable patients are identified in hospital by nurses and social workers who refer them to ASSIST. This support could see a patient returning to their own home after minor adaptations are made, moving into the council's temporary ASSIST housing or given help to find appropriate accommodation that meets their needs.

Hayley Barsby, chief executive at Mansfield District Council, said: "This scheme has been very successful and it shows just what can be achieved when councils and health service work together.

"We all know that people recover better at home, but for some people their accommodation is just not suitable for their needs. This project has helped so many vulnerable people to move from hospital and begin the transition home."

Case studies

Russell Cooper

Mr Cooper was admitted to hospital and diagnosed with bowel and liver cancer after living, prior to his admission, in a privately rented property which had had no heating or hot water for six months, due to a faulty boiler, and which had sewage dripping from leaking pipes from the flat above.

He had been withholding his rent until the boiler and leaks were fixed - and had even contemplated living in his allotment shed rather than endure the conditions at his flat. But while Mr Cooper was in hospital, his landlord evicted him, changing the locks and dumping what few possessions he had in bin bags outside the property.

In hospital that left Mr Cooper with nowhere to go on being discharged so ASSIST stepped in to find a solution.

He was offered temporary ASSIST housing which initially he was reluctant to accept because he had a dog, Sam, who could not go with him. However, ASSIST arranged for Sam to stay in kennels until permanent accommodation for Mr Cooper - and Sam - could be found.

"I arrived at the temporary accommodation in my hospital pyjamas, which was all I owned," said Mr Cooper. "The first thing the MDC support worker did was make me a hot meal, as I had not eaten."

Mr Cooper stayed in the temporary home for six weeks, during which time ASSIST helped him acquire clothes and food, attend medical appointments and got his benefits reinstated after he had lived for a year without any income at all.

In January this year, he was taken to view his new council home - a ground floor flat.

"I was absolutely overwhelmed," said Mr Cooper. "I broke down in tears at the generosity and kindness I had been shown and the help I had been given by all of the officers involved. For the first time I felt that there was light at the end of the tunnel for me and Sam."

ASSIST's support did not end there. It also helped Mr Cooper move into the property, and arranged for a local furniture project and charity to deliver some home essentials, including a new washing machine and cooker.

Mr Cooper said: "It is down to the dedication and hard work of all of these amazing people that I am able to stand here today and share my story.
"Without them I firmly believe I would not have had the strength to fight the cancer and I would have given up, lay down and died and Sam would have died with me.

"My cancer is now in remission and I can no look forward to the future. Sam and I have been given a new beginning and I want to thank everyone from the bottom of my heart."

Kiko Giles

Kiko was just 15 and studying for his GCSEs when his mum suddenly fell ill and had to be rushed to hospital.

She ended up have a leg amputated which put an abrupt end to her job and life as a pub landlady. And that also meant she and Kiko were suddenly homeless.

ASSIST stepped in to ensure that Kiko, now 16, and his mum moved into one of its temporary homes while a suitable property for a disabled person could be found for them.

Council officers ensured the family received all the benefits to which they were entitled and also helped in other ways, such as clearing furniture the family owned out of the pub accommodation, and ensuring a carpet was laid in their new accommodation.

"They played a fundamental role in giving my mum and myself the life we have now," said Kiko, who praised the council's staff for their care and compassion.

"The hard work and graft that Mansfield District Council put in ensured that not only did we have a suitably adapted home, but they made sure it was in a suitable area, too.

"The understanding and compassion from everyone at Mansfield District Council made it happen. Everyone seemingly came together, just for me and my mum."

27 Jul 2018