‘Test of Change’ model of care in Drumclay Care Facility transitions to ‘Hospital at Home’ model of care

30/03/2021
Drumclay Resident with Staff

On 10 September 2018 the Western Trust was advised by the Ebbay Group of their intention to close Drumclay Care Home, Enniskillen in December 2018.

Following a significant Pathfinder engagement programme across Fermanagh and West Tyrone in 2018/2019, there was a very strong voice from the people in the area to look at new ways of delivering services closer to the Community.

Therefore in April 2019, the Western Trust piloted a ‘Test of Change’ to utilise the facility and entered into a short-term lease agreement with the Ebbay Group, for a period up to 31 August 2020 and then extended to 31 March 2021.

In the ensuing period, the Drumclay Care Facility successfully cared for and rehabilitated over two hundred service users enabling the majority to return home independently with greater self-confidence. The service was nurse led, with day-to-day input from physiotherapy, occupational therapy and pharmacy and including medical support whenever needed from local General Practitioners, hospital consultants and specialist teams as well as voluntary groups and social navigators such as mPower.

The combination of hospital and community teams enabled the service to care for patients from elderly wards, medical, surgical wards and Emergency Department and has successfully operated without daily medical input. In addition, since April 2020, the facility provided support during the Covid-19 Surge, supporting the recovery and rehabilitation of COVID-19 patients.

This ‘test of change’ model of service, designed in partnership with the community, has enabled Trust teams to now move to the next stage of development, one that is supporting patients who would benefit from acute and longer term rehabilitative care in a homely setting, to receiving that sub-acute care in their actual home, in ways that will prevent them from going to hospital in the first place, as well as to facilitate their discharge more quickly should they be in hospital. For anyone who lives in a residential or nursing home, this service will equally provide for their treatment and rehabilitative needs.

Therefore the transition in the model of care offered through Drumclay Care Facility by the Trust to the new ‘Hospital At Home’ model of care, which has been in pilot phase since December 2020, is now underway and will continue in 2021 as the size of the team expands. The short-term lease agreement which the Trust had undertaken for Drumclay Care Facility up to 31 March 2021 will thus cease from the end of March.

On discussing the transitional move from Drumclay Care Facility to the new model of caring for people in their own homes, Dr Bob Brown, Director of Primary Care and Older People’s Care and Executive Director of Nursing, said: “Over the past 18 months the Drumclay facility has operated as a Pathfinder exemplar, supporting people to return home by improving their functional ability and re-building their self-confidence.

“Our experience of operating Drumclay as a hospital avoidance and step down from hospital service has now provided the vision for how services should be developed in the future. It has emphasised the need for a model of care for older people with services that are centred around communities and a focus on maintaining older people safely at home for as long as they wish.”

The Hospital at Home service has been welcomed by the public, having been developed in the middle of the COVID-19 pandemic as a way to provide support to Care Homes. This is both a key element of the future regional model for Intermediate Care as well as the ‘Enhancing Clinical Care into Care Homes’ regional initiative. This transition to an innovative future model, which developed in Drumclay, is thus in keeping with local need, Pathfinder engagement feedback and regional policy.

Speaking about the early success of the Hospital at Home Project, Dr Monica Monaghan, Western Trust Consultant Cardiologist explains: “I have been delighted to be part of the launch of the Hospital at Home Pilot initiative to transform the care of our patients and creating an alternative pathway for the treatment of acutely unwell patients.

“We recognise that we have an increasingly elderly population and patients who remain in hospital for what can be longer periods of time than we would like and thus are at increasing risk of hospital acquired infections, loss of their confidence and social connections with their family and local community. They are also out of their home environment and for some people of older age who experience frailty, they can be at increased risk of delirium and falls.”

Explaining the “Hospital at Home” model of care

In November 2020, a Hospital at Home Development Group was formed. With support from the South West Acute Hospital Medical team, Pharmacy and the Rapid Response Nursing team a pilot hospital at home service was established on 14 December 2020.

This initially involved working with 4 Care Homes in Enniskillen, including, Millcroft Care Home, The County Care Home, Meadow View Care Home and The Graan Abbey Nursing Home.

Through this model of care the team assess and treat residents in these Care Homes to avoid the need to attend Emergency Department and an admission to hospital. It is also the Western Trust’s intention in the year ahead to expand the Hospital at Home service, over time to all of Fermanagh and West Tyrone, in keeping with the Pathfinder vision.

Dr Kate Ryan and Dr Rizwan Haq, are the Speciality Doctors for the service and they are supported by the Rapid Response Nursing team in Fermanagh.  Clinical Leadership to the service is provided by Dr Monica Monaghan, Consultant Cardiologist South West Acute Hospital.

The Western Trust will deliver services in line with an Integrated Model for Prevention & Management of Chronic Disease (informed by the King’s Fund model), with greater emphasis to be placed on developing and enhancing Intermediate Care services.

Intermediate Care services will act as the bridge at the transition in a person’s life, in particular from hospital to home and hospital avoidance, from illness or injury to recovery and independence with a strong emphasis on providing personalised health and care to the service user in their own home or usual place of residence.

This is in line with regional strategic direction which is summarised below:

The commissioning priority for unscheduled care is to have effective integrated services organised around the needs of individual people and provided at home, avoiding the need for hospital admission and to support safe discharge from hospital.