Tucked away in a small office at the Bethlem Royal Hospital is a small team of dedicated staff that is working hard to bring down delayed discharge across South London and Maudsley NHS Foundation Trust (SLaM).
Commissioned as a pilot in February 2017, Look Ahead’s housing and advice workers (HAWKs) work alongside clinicians to help patients whose housing problems are delaying their discharge from hospital.
The housing and advice service was commissioned by SLaM as the result of an internal report which had found that 16 per cent of patients on acute wards were delayed discharges, and that nearly half of these individuals could not be discharged due to a lack of suitable housing.
An essential part of the recovery pathway
To me, it makes perfect sense for a team of housing experts to be available within a hospital. Navigating the system to access housing is difficult for those who are physically and mentally fit, so for those who are being discharged from a long-term stay in a mental health service, it is hugely challenging.
If we look at Maslow’s hierarchy of needs, the foundation of safe, secure housing is the bedrock from which we can grow and develop. We know that housing is an essential component of the recovery pathway. We also know that clinical teams are stretched and the NHS needs to understand that social care and housing professionals can alleviate some of the strain by helping avoid delayed discharge and a revolving door of readmissions to mental health services.
Through the HAWK service, patients are supported to move on from Bethlem Royal Hospital to supported living, the private rented sector, council properties or hostel accommodation. Our team helps them to access the required funding, legal advice, benefits and other services that will enable them to leave hospital. They then directly support patients to move into their new accommodation and ensure that they sustain their tenancies or placements.
I recently met Clara, the team leader of the HAWK service, as she and her colleagues were awarded one of Look Ahead’s quarterly staff awards for excellence. What really struck me was the clear mutual respect that exists between health and housing in this service. For example, one hospital ward manager said that she felt the service was “worth its weight in gold” and “should be spread to other services”.
So why isn’t this happening more? Look Ahead works across 30 local authorities and health trusts, and while we are certainly seeing pockets of good practice and innovation within some great local NHS services, the speed of adoption is still slow.
I think there is something around the lack of evidence or base data. Traditionally, we in the housing and care sector aren’t good at collecting and sharing outcomes about the value we add.
Cost wise, small services such as HAWK, made up of a housing expert on a ward, cost very little. But I’ve calculated that if we could collectively pull together to reduce delayed discharge by just 1 per cent across the NHS, we could save around £17 million – NHS providers’ audited accounts for 2016/17 estimated that delayed transfers of care cost providers a total of £173 million.
I do believe that while we are making small steps, social care is still seen as the Cinderella service and we still experience a lack of understanding of the value that social care and housing can add.
At a senior level, we have seen great progress with commissioners who are increasingly understanding the value of social care in mental health pathways. But the experiences of our staff working directly with NHS colleagues directly responsible for delivering services suggest that those on the frontline are often not so enlightened. This is why it was so good to hear the Bethlem Royal Hospital ward manager speaking so positively about our HAWK service.
Tower of Babel
Part of the problem is that social care and health speak different languages. When combining health and social care, you need a glossary of terms to get by. Take the words we could use to describe a person, for example. In primary care, a person is a ‘patient’, in secondary care, they are ‘a client’, and for us at Look Ahead, they are ‘a customer’ or ‘service user’.
However, to begin making the huge difference we are capable of, we must not only get to grips with our partners’ jargon, we must also spread examples of good practice. We have to begin fostering a belief that health and social care are equals; two sides of a coin. We need one another.
Only then are we truly going to save the public purse money and deliver services that have long-term sustainable impacts and better outcomes for patients.