ON THE face of it, it is the national NHS/social care crisis in action at two hospitals in north Hampshire.

Last week, The Gazette reported on Autumn Action at Hampshire Hospital NHS Foundation Trust, where a concerted effort was made over three days at the end of October to cut down emergency department waiting times and improve patient flow.

Part of this was reducing the number of beds occupied in the trust’s two departments which was a huge success - 80 beds were freed up reducing occupancy rates from 93.1 per cent to 84 per cent.

However, this was a short-lived bounce.

At the same Hampshire Hospital NHS Foundation Trust’s Board of Directors meeting, it was also said that 49 of those 80 beds freed up were filled again within six days of the end of Autumn Action on Friday, 20 October.

Where do the problems lie?

At the meeting, the reason for this was laid at the doors of the trust’s partners in social care, provided by Hampshire County Council, and community health services such as those managed by Southern Health.

Across the country, as heavy an effort as hospital trusts make from their end to reduce bed occupancy, if care plans for patients or the right services and facilities for follow-up care and treatment are not in place, patients inevitably bounce back to hospitals.

As Malcolm Ace, the trust’s chief financial officer put it at the meeting: “We cannot be the sponge that soaks this up. We have to hold our other partners accountable.”

But while bed occupancy and social care pressures are nationwide issues, there are also specific local causes in the north Hampshire area.

Julie Maskery, chief operating officer at the trust, told The Gazette: “We have a lot of pressures on provision in domiciliary care, nursing homes and residential homes. We don’t have as much capacity in north Hampshire as we do in cities like Portsmouth or Southampton and our countryside areas struggle.

“That’s a problem in our patch and there are longer term strategies in place to look at that.”

This is not to say that trust board members were blaming their partners – it was made expressly clear the pressures other sectors face, such as budgets for adult social care at Hampshire County Council (HCC), were fully appreciated.

After the meeting, Alex Winchfield, chief executive of the trust, added: “I’d like to say a big thank you to all of our staff and our partners in the community for helping to make Autumn Action a success. Like us, our partners remain under considerable pressure, so it was fantastic to work even more closely with them during Autumn Action.”

Julie also points out that the number of beds occupied should rise sharply in the wake of concentrated efforts such as Autumn Action as the trust and partners threw more resources at tackling the issue.

She added: “It is difficult to sustain those results as we don’t have the capacity to keep that up. We couldn’t sustain that everyday but there is a lot of learning to be had [from those days].”

So what is the ideal situation?

Alex adds: “At the moment, patients often remain in hospital when they are well enough to leave because they require some additional support in their home environment. Preferably, all patients would be able to leave hospital as soon as they no longer require the specialist care provided by our doctors, nurses and other clinical experts.

“Finding a way to achieve this is one of the biggest challenges we face in Hampshire. We will continue to work closely with HCC, Southern Health and our commissioners to find new ways of working together that help us to get our patients home, where they want to be.”

Action is already being taken - Basingstoke Hospital has opened Overton ward for patients between needing emergency treatment and non-hospital treatment, plans are afoot to get more patients discharged from hospital for assessment and certain respiratory patients could be cared for at home.

However, this looks to be a long-term process.

Julie adds: “You can’t change everything overnight but we can take small steps to transform services. We maintain our elective programme, for example, where some trusts cancel it. We try to balance the needs of both elective and non-elective, hence why doing things like Autumn Action is the best way to go.”

What partners had to say:

Councillor Liz Fairhurst, HCC’s executive member for adult social care and health, said: “Our staff work extremely hard to keep people out of hospital wherever possible, and get them safely back home again. Indeed, the vast majority of patients are able to go home straight away, and where there is a delay, it is usually no more than a few days.

“Over the course of the last few months, the county council has taken a number of measures to reduce delays in Basingstoke and North Hampshire Hospital, including the opening of specialist reablement accommodation, the Firs. We have, through good collaborative working with the hospital, and with our community partners seen the numbers of people delayed for social care reasons reduce in recent months.

“However, we are far from complacent about the challenges which exist to support the timely discharge of people from hospital, which is often a consequence of the lack of appropriate, good quality care in the community. The rising demand for health and care support from all age groups will continue to present significant challenges for both ourselves, and the NHS organisations with whom we work.”

The trust has set up a specialist team this year to help prevent frequent readmissions to hospitals by more frail members of the community.

The team has already helped more than 500 patients in the three months since it was launched.

Susanna Preedy, associate director of nursing and allied health professionals for Southern Health said: “We were pleased to support Autumn Action [the Hampshire Hospitals NHS Foundation Trust campaign to improve patient flow in its hospitals], which is a continuation of all the work we do throughout the year, working closely with Hampshire Hospital Trust, other NHS organisations and Hampshire County Council are striving for the best outcomes for our patients.

“In order to address the issues around hospital admissions, we set up a team earlier this year called Enhanced Recovery at Home. The team, which covers Basingstoke and Winchester, works with frail people who have been in hospital frequently.

“By preventing the need for a hospital admission, and supporting those already in hospital to return safely to their homes sooner, the team aims to take the pressure off busy hospitals this winter and provide care for people at the right time and place.

“While it’s still in its initial stages, we’ve helped more than 500 vulnerable patients in the past three months.”