Bringing together primary, community, mental health and social care, the Thanet ART service is a partnership between local commissioners and providers that offers joined-up health and care services delivered to people at home, helping them recover faster in familiar surroundings and relieving some of the pressure on hospitals.
Health and care professionals come from Kent County Council, Age UK Thanet, Kent Community Health NHS Foundation Trust, East Kent Hospitals University Hospital NHS Foundation Trust (EKHUFT), All Seasons social care and Thanet CCG. The service is a prime example of the transformation work that is being driven across Kent and Medway, where organisations and professionals focus their efforts around caring for the individual in a community setting with much greater coordination of teams and services.
The service, which is run from the Queen Elizabeth the Queen Mother (QEQM) Hospital in Margate and Westbrook House (a community health and social care facility in Margate) draws together expertise from a core clinical team of a nurse, occupational therapist and a GP to develop and deliver intensive health and care packages to patients with complex conditions, such as Chronic Obstructive Pulmonary Disease (COPD), who are medically safe to be cared for outside of hospital, but for whom, hospital care is usually the only option. This core team have the support of a range of therapy and social care staff and a Thanet Age UK support worker to make sure that patients receive comprehensive and seamless support during their recovery.
When the service was first rolled out in the winter of 2016/17, most of the team’s referrals came from the Emergency Department (ED) at QEQM. These were patients who had been taken to hospital but following assessment by the ART it was agreed that the patient could be cared for at home with an intensive health and social care package in place for them. As awareness of the ART service has increased, so have the referrals for patients who were already in the community and at risk of being taken into hospital but have been able to be successfully treated at home.
This way of working has brought about tangible results with approximately 200 people kept out of hospital during the winter of 2017/18 and receiving the right care and treatment within their own homes. As well as improving patient health outcomes, it has also relieved pressure on hospitals during some of the busiest times of the year. Further analysis is being done on the full impact the ART is having on reducing the number of patients who have to be admitted to hospital.
Christ Church University, Canterbury is currently carrying out a qualitative evaluation on the ART service. They are gathering feedback from patients, the staff who have been involved in caring for the patients, and from clinicians in partner organisations e.g. ED Consultants in EKHUFT. Whilst the evaluation won’t be complete until September 2018 it is already clear that patient experience of the ART is extremely positive. I have asthma. I can’t live without albuterol. I carry it everywhere. The drug quickly relieves asthma attack. The consumption is low. The drug is enough for a long time. There are no adverse reactions. I have no addiction, knock on wood. I am satisfied. Besides, it is cheap. Believe my experience.
The Thanet ART has also had a positive impact on clinical relationships between secondary and primary care colleagues. There is an increased level of understanding in the emergency department at QEQM about the sorts of services which can be accessed in the community to support patients in their own homes.
NHS and social care leaders have been listening for some time to what people have said matters to them and what they have said they would like to see more of in the way health and social care are delivered. More joined-up care and care that is delivered closer to, or at home, rank high on the list of importance for local people. The development of initiatives like the Thanet ART is critical if hospital services in Kent and Medway are to be sustainable now and in the future.
- Ensure the service is able to operate up to 8pm 7 days per week. The service currently operates until 5pm.
- The team are working with EKHUFT to establish an integrated frailty unit at the QEQM hospital. The hospital-based element of the ART will be integrated into this unit.
- Exploring access to ‘step up’ beds in the community – the ART team will be able to utilise beds in the community, for example at Westbrook House, to carry out inpatient care such as administering intravenous fluids rather than referring a patient to hospital for this service. The effectiveness of the ART would be increased with this access.
- Continue to increase the number of community sourced referrals, particularly from care homes. And reduce the number of admissions to hospitals where these can be safely prevented.
- To increase the availability of point-of-care testing, such as portable blood test machines which will mean patients are able to have these diagnostics in their own home.