Serco: Minimising hospital admissions in Newham
Newham in East London is one of England's most deprived areas, with higher levels of mortality
Many people in the borough live with long-term, often debilitating conditions: over half of GP conditions and over 70% of hospital admissions are a result of conditions such as diabetes, heart disease and lung damage.
For the local primary care trust, the costs are significant. 80% of the costs and two thirds of NHS activity relate to just one third of the population with the highest needs. It commissioned Serco to look at setting up a community matron service to help people cope with these conditions better at home, thereby reducing the numbers of expensive and unnecessary hospital admissions. This readiness to re-think the balance of care between primary and hospital-based care is the sort of positive change which the NHS needs to ensure it can continue to provide quality care at lower cost, as the CBI outlined in the report Best of health: improving lives through smarter care.
Serco sought to improve the skills of the existing health visitors and create a team based around ten community matrons, each looking after 50 patients with care and support in their own home. Serco's clinicians worked with the health visitors to develop new ways or working with patients in order to foster best practice. Team members had additional training to enable them to dispense prescriptions in their new roles, saving much-needed time. The scheme went live in 2007.
With this change in working patterns - building care around the patient in an environment they are familiar with - patients are encouraed to become partners in their own care, working with the matrons. The matrons, not the local A&E department, are the first point of contact if a patient feels their condition needs addressing. The community matrons are given laptops that connect wirelessly to a central records system, so records can be updated on the go. Forms that used to take two hours to complete now take just forty minutes. Being connected means that managers can also allocate matrons better, based on the priority patient needs on any day.
Evaluation of the project showed emergency admissions were reduced by a quarter. Non-routine contacts with the PCT fell by more than half. These represented significant cost savings for the NHS. GPs and patients have been equally supportive of how Serco's system has improved patient care.