Greetings from Copenhagen! I am spending a couple of days in Denmark and Sweden visiting a number of patient hotels with colleagues from CCG commissioning teams, health trusts, CQC and care providers and finding how this model of delivery fits into the health and care architecture in these countries – and of course lessons to be learned for the UK in terms of future delivery of health and care.
Today, we visited one of the early Patient Hotels, co-located on the Odense University Hospital site. The vision for the patient hotel came forward to provide additional support for the hospital to reduce the length of stay within the acute setting – enabling people to stay there in pre and post admission situations. Over time this has emerged into a model where this continues to be part of the role, but there is an increasing use of the hotel to provide space for people who are receiving outpatient treatment and have either travelled for long distances to receive the treatment, or are using it during the day whilst they have sporadic periods of treatment such as IV antibiotics.
The first lesson appears to be around flexibility. It has been essential that the patient hotel has been able to adapt it’s offering over time. It has had to repurpose the building as numbers of rooms have reduced, times and services required within the hotel have changed, and the needs of patients and relatives staying with the rooms have also shifted. Many of the changes have also been driven by enhancements in the delivery of medical services, with a much greater emphasis on day surgery, and new ways of working in the delivery of outpatient services.
The next lesson relates to the relationship between the hospital and the hotel. At the OUH patient hotel, the flow into the hotel is driven by the hospital, and therefore the success or otherwise of the hotel is not within their gift. The hotel in this instance was run as an in-house operation, which potentially presents limitations on the ability to influence the flow into the hotel through independent means.
In 2018 there was a directive from the Danish government for all municipalities in Denmark to develop an acute team. The responsibility for the team was to sit with the municipality – and the team was again to focus on prevention – looking at how an acute team of nurses and para medics could redirect people either away from hospital, or out of the A & E departments within the hospital. The outcomes of the team are impressive – and provide a model of acute support for people with short term needs (2 to 5 days).
There were some real lessons around integration in this model. Firstly, the funding of the team was through the municipality (the local authority for the area) and secondly that the team was physically co located with the Accident and Emergency department in Odense. This physical location of the team greatly enhanced the understanding and potential of the team to address those who were coming into A & E. The funding and ownership of the team at municipality level ensure that the referral routes onto longer term services were more straightforward and direct. In essence – they offer a bridge between the comparatively boxed in services.
There were some early comparisons to be made between this particular acute team and a number of models within the UK including the work around Home First, and colleagues from the Health Trust shared their experience of their Home from Hospital Team and I was reminded of the interesting work that Hilton Nursing Partnership have been offering across parts of England. However, the funding and therefore ownership of the medical team by the local authority appeared to create significant opportunities for integration that should not be ignored.
In addition – what struck me was the way in which both the Acute Team and the A & E team were seeing this integrated approach between secondary and community services as offering opportunities to reach out to wider stakeholders – with a particular focus on how they could support residential and nursing homes. The Acute Team were working actively with nursing homes to support them through training and coaching them to ‘talk the talk’ with medics, so that they could accurately and effectively communicate changing needs and requirements of the people they support. The A &E team were also beginning to consider how they might send their emergency paramedics directly to nursing homes to assess on site.
There is much to learn – and I am looking forward to tomorrow – where we head to Sweden to see how the patient hotel model has developed further…
Keep up to date on Vic’s trip by following her on twitter – @vicrayner