Irene* is 93 years old. She has lived independently until she had a fall and needed hip surgery. After the successful operation, she was very distressed to learn that her discharge plan included moving her bed into her front room and having a commode put in. All she wanted was to be able to see her garden from the bed: she wanted to sleep in her back room but felt no one listened to her at the hospital. Luckily our Nightingale Service manager discussed her discharge plan with her and managed to tailor it to her needs. Before Irene’s discharge, Age UK Richmond’s handyperson service moved her bed into the back room which was close enough to the downstairs bathroom, so she could get there using a walking frame. Our handyperson service has also fitted grab rails to make Irene’s bathroom more accessible and a key safe outside so carers could enter her house as required.

Six weeks after returning home, Irene is walking confidently with the aid of her frame. She is now keen to go outside the house and a Nightingale Service volunteer is supporting her to slowly build her confidence. Of great significance to her is that her privacy and dignity have been respected, as she no longer requires a commode. Irene feels very strongly that the Nightingale Service has helped her to maintain independence. By moving her bed to the back room, she is comfortable in her surroundings at home and managed to retain a sense of normality. This has prevented her feeling isolated, and improved her mental health and wellbeing. The bed is next to a large window, giving a clear view of her garden and gives her extra natural light to read her books, something that gives her great pleasure.

With the rise in the number of older people, hospitals are encountering unexpected challenges in discharging older patients: in some cases, the patients can’t return to their homes because they would have no one to support them while recuperating or their home environment needs adapting to meet their changing needs.  Age UK Richmond upon Thames’ Nightingale service was set up to help these older patients in the Borough of Richmond upon Thames. The service works with Kingston, West Middlesex and Teddington Memorial Hospital and provides a single point of contact for older people resident in the borough upon hospital discharge.

The service is completely free, making it possible for older patients to return to their homes after a stay in hospital and continue to live independently. The Nightingale Service takes a holistic approach to the patients’ needs and works with them to identify the support they need. It offers not just short term practical support but a much broader ranging service looking at their lifestyle in a wider context, addressing social, emotional, physical and practical needs to improve their independence.

We are working, with the help of our volunteers, to enable patients to get back on their feet as quickly as possible. The service, based around a personalised support plan, makes sure the patients’ concerns are addressed and their mental health and physical wellbeing are supported alongside more mundane needs, such as help with shopping and transport, assistance with benefits or making their homes more accessible. This in turn allows patients to improve the quality of their life and help keep them out of hospital.

What have we achieved so far?

The service has been an overwhelming success — within the first six months of the pilot, demand exceeded the original plan over a 12 month period. Here are some of the key outputs in the 18 months since launch**:

  • 541 older people have an improved quality of life and wellbeing
  • 462 individuals received timely discharge from hospital
  • 168 bed days saved from fitting key safes saving the NHS £250,000
  • 74 hours saved in helping take deliveries
  • 650 hours saved from other Handyperson and Housekeeping Service visits
  • Value of Welfare Benefits awarded as a result of intervention approximately £20,000
  • Age UK Richmond has delivered an illustrative saving of £330,000

 The service has also achieved positive social outcomes for older people, including:

  •  Worry and feeling of isolation alleviated
  • Smooth transition home from hospital
  • Coordinated discharge improved wellbeing
  • Ability to remain independent at home
  • Reduced readmission rates

Feedback from Healthcare Professionals and clients themselves is very supportive and demonstrates the service has become intrinsically embedded within the older people’s discharge process.

“The Nightingale Service has become the go-to service, bringing everything under one umbrella.” Christina Richards, Clinical Services Manager for Older People and Head of Therapies, WMUH

“The presence of the Nightingale Service results in bed days saved, making beds available to new patients, allowing us to treat more people and prevent harm.” Jenny Tomas, Interim Programme Director, Kingston Hospital

 “The discharge process is now slicker, it causes less stress and anxiety to families and less professional tension between service providers.” Anne Stratton, Associate Director, Adult Acute Services and Operations Lead for NWL, HRCH

The future

There is no doubt that this service is much needed and with growing numbers of older people in the borough year on year, there will be even greater demand for Nightingale support in the future.  We hope to help even more individuals get back on their feet after a stay in hospital in providing support when they need it most.

 “The Nightingale Service not only provides reassurance in the discharge of older people from hospital to home, but it also helps to get them back on their feet.”

Aiden Buckley, Chief Executive Officer, Age UK Richmond upon Thames

The service has been funded by Richmond Parish Lands Charity (RPLC), the Clinical Commissioning Group (CCG) and The Better Care Fund (Local Authority).  Referrals must be made by a healthcare professional (GP, consultant, Occupational Therapist for example).

For further information please contact:

Aiden Buckley, Chief Executive Officer, Age UK Richmond upon Thames

* Name has been changed for confidentiality purposes

** Charity Log Data relating to the service 1/9/15—31/3/17