Hospital at Home: PACE in Bromley

In Bromley the acute Trust, and providers of community and adult social care have created a trans-disciplinary model of home care for older patients that is lower cost than the in-patient alternative and delivers outstanding patient satisfaction.

This new service started in 2009 as a pilot study led by Saigei and funded by NHS London. Although Government policy advocated the transfer of patients from hospital to their homes, research into clinical and financial efficacy of this model of care was ambivalent. Pilots were operated in two London localities to establish whether and if so what models of home based care were viable. The pilots were rigorously evaluated using a scorecard designed by Saigei expressly for healthcare. It includes six dimensions, namely:

• staff confidence
• clinical outcomes
• patient experience
• stakeholder support
• operational efficiency
• financial efficacy

One year on, clinical outcomes are still measured using validated instruments such as the Modified Barthel Index and the EUROQol EQ5d patient reported outcome measure (PROM).

Longer term monitoring of quality shows that readmission rates are very low and primarily relate to patients who are already recognised as high intensity users of acute services.

Patient satisfaction is measured using a Kings Fund validated questionnaire, and the results are extraordinarily positive.

The evidence is so compelling that the service was established permanently and saw more than 520 patients in its first twelve months. It is funded jointly by the acute trust, adult social care, and the PCT commissioner.

The PACE Service delivers value both by shortening in-patient care episodes and avoiding admissions altogether. This has allowed the locality to manage winter pressures smoothly and has supported the acute and primary care Trusts in delivering the acute Trust’s cost improvement programme.

Saigei is now partnering three more localities who are adopting similar models of provider collaboration. In each case building strong evidence for both the clinical and the economic efficacy of this form of collaboration between acute, community and social care providers.