Placing home at the heart of hospital discharge can pay dividends whether or not we are in a pandemic, says Matt Kennedy.
The Covid-19 crisis has cemented the importance of access to good quality housing and vibrant places that support our well-being. The link and crossover between the work of housing and healthcare professionals has long been a focus in the sector with innovative partnerships popping up across Wales. But with pressure on the NHS becoming even more intense in the response to the pandemic, we felt a fresh look at things was needed.
With that in mind we commissioned Gana Consulting’s Antony Kendall and Greg Thomas of CARP Collaborations to uncover some fresh insight about the role of housing advice in the hospital discharge planning process. They interviewed professionals working across housing, health and social care in a variety of roles in addition to gaining insight from patients and carers.
I think an important starting point is to some extent stating the obvious – not everyone who leaves hospital will need any form of housing advice. But for those who would benefit from it, but do not get it, the ramifications can be serious for both their ability to keep well at home and their ongoing use of NHS services, which during the pandemic is clearly under significant strain.
One clear pressure was that of limited temporary accommodation as a result of local authorities working to house people experiencing (or at risk of) homelessness. Whilst temporary accommodation could help in scenario’s where someone was medically fit to leave hospital but due to their condition adaptations to their home would be needed, or care arrangement put in place – the lack of housing options due to the need to protect people from the worst effects of the pandemic is having a lasting impact on how this is used to support patients to leave hospital sooner.
The research found that, generally speaking, staff do not follow a specific protocol when discharging patients – rather this is more subject to local practice and how services meet people’s individual needs. Those needs are often discussed and considered by multi-disciplinary teams (MDTs) made-up of a wide range of professionals, which can sometimes include housing expertise. Respondents who informed the research held these in high regard – although there was some evidence that where there aren’t good ties with housing professionals and the link in meeting people’s housing needs can still come too late.
Whilst MDTs were seen as generally working well for planning hospital discharge and ongoing patient care, the pandemic had clearly impacted these too. The research found that specialist staff had left the hospital setting due to Covid-19 and were often relying on non-specialist staff to feed in their advice and expertise.
The research also explored issues surrounding delayed transfers of care – highlighting that this could happen for quite a wide range of reasons. Quite often, this would be unrelated to a person’s housing circumstances and more connected to their condition or complications whilst in hospital.
The research did highlight, however, that factors such as delays in housing adaptations, the need to get a clearer sense of someone’s home environment and access to support services could all act as barriers. Importantly, the research highlighted that professionals across all disciplines who engaged in the research reflected positively on the role of support services funded through Housing Support Grant in preventing people from needing hospital stays in the first place and in getting home quicker when that had been the case.
The researchers spoke to a number of carers who had a mixed experience of hospital discharge. Challenges for carers included carers assessments not being offered, assumptions being made about what carers were able (and willing) to undertake and communication around care arrangements being unclear. There was no evidence that housing played any part in considering how well carers may be able to carry out their responsibilities.
The recommendations arising from the work are broad ranging, aimed at Welsh Government, local health boards and housing organisations. They include asking the Welsh Government to look at the supply and quality of temporary accommodation and local health boards to consider how anyone identified as needing housing advice is fast-tracked to the right information. It also suggests that all actors involved in the process should develop a joint protocol to underpin information sharing, the definition of housing advice and how assessments carried out with patients and carers consider housing need.
These recommendations represent small tweaks to practice that could make a huge difference if done with consistency across professional disciplines. Whilst housing advice is not going to solve the range of challenges associated with providing high quality healthcare – it is going to create space on hospital wards, see people return to a hospital setting less frequently, and most importantly provide patients, families and carers with holistic information that sees them remain well in a home that is able to meet their ongoing care needs. That feels like activity worth doing regardless of whether we are or aren’t in the midst of a global healthcare emergency.
Matt Kennedy is policy and public affairs manager at CIH Cymru