Isle of Man News - POSTED Mon 06-11-2017

New service to help bridge gap between hospital and home

by LC

A new all-Island service to help bridge the gap between care provided in hospital and people’s homes has today been unveiled by the Minister for Health and Social Care, Kate Beecroft MHK.

The ambitious scheme will strengthen the Island’s ability to provide ‘intermediate care’, generally targeted at older people who become unwell.  Its aim is to help people either stay in their own homes or to return home more quickly from hospital.

Explaining the need for the new service, the Minister said: “We have a duty to make sure that patients get the right care, in the right place, at the right time.  With a growing older population which often has long-term and complex health needs, it is becoming increasingly difficult to ensure this. 

“It has been clear for some time that a fundamental shift is required in care services so they can adapt to meet the evolving needs of older patients in particular.  Indeed, this is a key driver of the five-year health and social care strategy.

“Improving ‘intermediate care’ in the Isle of Man represents an exciting and significant development that will modernise how we deliver health and social care while improving outcomes for patients.”

Consultant-led care in the community

The service will be led by a consultant doctor specialising in medicine for older people along with the support of an additional speciality doctor.  Both will work closely with colleagues who care for older people in the community, such as residential care staff, GPs and district nurses, meaning these professionals can access more readily available specialist medical advice.  As a result, more people will be able to have treatment at home, benefiting from quicker and more appropriate care and avoiding potentially unnecessary admissions to Noble’s Hospital as well as 999 calls and attendances at the Emergency Department.

Initially, Dr John Thomas, currently Consultant in Older People’s Medicine at Noble’s Hospital, will lead the service while a second consultant is recruited, doubling provision in this specialist area for the Island. 

Having two consultants will enable better on-Island peer support and means that the need for a locum doctor to provide occasional cover for the current single post will be reduced, saving around £43,000.

Investment in Ramsey with new step-up, step-down unit

There will still be instances where people require inpatient care and support, but not necessarily at the acute level provided by Noble’s Hospital.  An expanded ‘step-up, step-down’ 31-bed inpatient service will therefore be established at Ramsey and District Cottage Hospital for those with moderate care needs.  This is an increase of 10 beds, compared to the 21 currently available in Ramsey, representing a significant investment.  The beds will be available to all Island residents.

Instead of being admitted to Noble’s Hospital, older people with medical problems will be able to ‘step-up’ from home to the new unit in Ramsey if their condition requires it.  This should further help reduce admissions to Noble’s Hospital, 999 calls and Emergency Department attendances. 

Discharges from Noble’s Hospital should also be faster, as patients who meet the criteria will be able to ‘step-down’ to the new unit in Ramsey as their condition improves, with support and rehabilitation available before they return home.

Currently, an average of around 20 patients are medically fit for discharge from Noble’s Hospital at any one time, but become ‘stranded’ due to a lack of capacity to provide ongoing care.  The new service will help alleviate this.

It means that Noble’s Hospital will focus on delivering only the most complex and specialist healthcare on the Island.

This new approach means a fundamental change to how inpatient services are provided at Ramsey and District Cottage Hospital.  In addition to duties in the community, the new consultant doctor will also take on leadership of inpatient services in the Ramsey hospital.  They will have overall responsibility for the triage of referrals to ‘step-up’ and ‘step-down’ patients as well as establishing a new outpatient clinic in both Ramsey and at Noble’s Hospital for frail patients and older people with orthopaedic problems. 

It means that GPs from Ramsey Group Practice will no longer provide inpatient care from February 2018.  However, their normal GP duties will not be affected.  The fee previously paid to the GPs for this service will be used to fund the new consultant and speciality doctors, so will be cost neutral while increasing the number of beds in Ramsey by 10.

The new service will be closely integrated with existing services that aim to rehabilitate patients and maximise their independence, such as reablement, which helps people to re-learn skills that will keep them safe and able to live at home.

The Minister added: “This development will bring about real and lasting change in how we care for older people and meet their needs.  Investment in community-based care, outside of Noble’s Hospital, will help us realise our ambition of supporting people to remain healthy and independent in their own homes where possible and appropriate.  In turn, Noble’s Hospital can focus on caring for the most acutely unwell people in our community.

“This investment demonstrates the Department of Health and Social Care’s commitment to Ramsey and District Cottage Hospital, and illustrates its vital and ongoing role as a national asset for the benefit of our whole community.  I would like to place on record my sincere thanks to the doctors at Ramsey Group Practice – past and present – for their commitment and dedication to the hospital and its patients.”

The new service will launch in February 2018.

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