Leading the Way

Kate Smith is the Head of Intermediate Care Services in Somerset. She discusses the intermediate care set up, the integration of the Discharge to Assess pathway, and the value that her experience as an OT is bringing to the role

Intermediate Care in Somerset is an integrated collection of key services that support acute discharges and prevent admissions. The services within intermediate care include; rapid response services, all Discharge to Assess (D2A) pathways, community hospital beds, end of life care and the voluntary sector. All demand and capacity is coordinated through an integrated hub. The intermediate care model in Somerset was created following the publication of the Hospital Discharge Service: Policy & Operating Model in 2020. The Head of Intermediate Care post is a joint health and social care funded position. The post was created to lead the operation of the intermediate care model in Somerset, acting as one single point of contact across the integrated health and social care pathways. WHY WAS AN OT APPOINTED?

We had a Home First service prior to the pandemic but this was criteria-led and it didn’t encompass the full D2A principles: people still needed to be assessed in hospital to identify if they had ‘rehab’ potential in order to access the service. As an occupational therapist I knew the significance that embracing the D2A principles could have on people’s outcomes. I knew from practice that assessing people’s physical and cognitive needs was challenging in a hospital setting and that the ‘home is best’ mantra needed to be embedded across health and social care in order to truly be able to deliver the ambitions set out in the Hospital Discharge Policy Guidance. Any successes I’ve had in my career have always been based on simple solutions – things that we in OT call “common sense”. Embracing the D2A principles in Somerset seemed like common sense and the right thing to do. This led to me applying for the position of Head of Intermediate Care Services in Somerset.

VALUE OF OT IN A STRATEGIC LEADERSHIP ROLE

The role requires me to work on not only the obvious structural changes of setting up a service, but also the behavioural change necessary to shape the mindset of colleagues across a system in order to reshape the support we offer in people’s own homes. The values and principles of occupational therapy have supported me in my role to empower colleagues from across different disciplines to take positive risks in order to support patient choice and get more people back home from hospital. Using the ‘Embracing risk; enabling choice’ (RCOT, 2018) publication to support this cultural and behavioural change has been a good lever. As an occupational therapist, I have first-hand experience of the importance of working as part of a wider multidisciplinary and multi-agency team. Joint working and shared practice with a focus on person-led goals are principles which as an occupational therapist you learn early on in your career. We are trained to consider the person holistically and in conjunction with their support networks and their environment. This ability to holistically look beyond the presenting condition is a unique skill that often gets tainted as an unattractive and ‘generalist’ role. In an influencing strategic role, I have been able to brand these specialist ‘keyworker’ skills as worthy of system wide investment. As a leader who values the importance of multiagency working I have had the opportunity to support collaboration at neighbourhood level; across community nursing, social care, mental health, community and acute health professionals, care providers, primary care networks, community pharmacies and the voluntary

sector. Bringing the voice and intelligence of the community workforce into the decision making within acute discharge hubs has helped to close the long standing gap between community and acute services, where service-users so often fall between.

ACHIEVING GOOD OUTCOMES FOR PEOPLE

Intermediate Care Services in Somerset have seen an increase in the complexity of people’s needs. Despite this increased complexity, the service has supported over 40% more people in 2020 than in 2019 to return directly home from hospital, rather than be transferred to rehab beds. Since February 2021, Somerset has consistently reported 95% of over 65s going straight home from hospital, if you combine those going home on pathway 0 with no support and those going home with Pathway 1 D2A. The county also saw an 86% reduction in care placements from hospital during 2020, with no people being placed into care homes directly from hospital during the month of April 2021. Outcomes from intermediate care pathways are strong, with a large percentage of people remaining at home.

As an occupational therapist I have never lost sight of what makes a good service: this is through the achievement of good outcomes for people. So often in a role such as this, the national expectations and measures of a good service are based on managing hospital flow; saving beds and reducing length of stay. As an occupational therapist, I will continue to have a different story to tell; growing a service that makes a difference to people’s lives.