Our Covid-19 Journey - An Open Letter from Gail McGrath

Our Covid-19 Journey

Back in March 2020 I received an urgent phone call from a West Midlands hospital that we had been working with for 2 years. They said they wanted us to be their ‘Saviour’!  They had received a letter from NHS England, informing them of the emerging effect of COVID-19. The letter was clear each NHS Trust needed to urgently create capacity to deal with the emerging threat of COVID-19 and the additional pressure this was likely to add the health and social care system.

On receipt of the letter, an urgent system meeting was convened with all partners including Local Authority, CCG, Acute Trust, Voluntary services, Housing & me, representing How to Find Healthcare. The aim was simple, to work out a way to completely change their discharge processes to enable rapid flow out of the Acute Hospital and safely discharge patients into the community. Within the system, we were sighted that domiciliary care was already struggling to meet the current demand of discharges and community cases. Therefore, the hospital needed to think differently.

We began by completing a scoping exercise, looking at current capacity in the care home market, approaching care homes to see if they would consider accepting patients who were COVID+. Most of the care homes were frightened at the mention of COVID and 99% of them would not contemplate accepting COVID+ patients into their home. My team and I intensively worked to eventually find a home that would become a ‘hot COVID home’. We completed this work within a matter of days and provided the required information. During the coming weeks a large piece of work happened across the system with meetings, training, and negotiation. We supported this by attending care home training sessions, arranging meeting with executives and managers to enable faster discharges.

By the end of our campaign, nearly all the homes we worked with had extended their cut off times so that patients could be discharged up to 9.00pm and 87% of the referrals we received were discharged from hospital the same day.

We also had the task of persuading homes to take much later in the evening, over the weekends but more importantly all admissions had to the same day. Something that the homes were not used to. But these were unprecedented times and COVID didn’t stop in the evenings or at the weekend! By the end of our campaign, nearly all the homes we worked with had extended their cut off times so that patients could be discharged up to 9.00pm and 87% of the referrals we received were discharged from hospital the same day.  We had communicated the need for homes to step up to the plate and work in a totally different way that they were used to.

We were instrumental in bridging the gap between the system and the private sector during these talks. Eventually an agreement was reached, with How to Find Healthcare negotiating the contract rates, delivering hands on training to the care and nursing team at the care home, as well as sourcing and procuring much needed PPE. The scheme was successful and supported over 150 COVID+ patients to be discharged into a care home setting, during the first wave.

All of this was a fantastic example of collaborative working. We found ourselves being involved in meetings with the Hospital Trust, the CCG, Social Services, and Care Home providers. We all worked well together, and our role was to ensure that homes were found, all the agencies informed, and the goal was same day discharge.

During the early months of the pandemic, it was recognised by the hospital that processes would need to be streamlined to allow discharges to proceed at the required pace. During these times, rules, recommendations, and advice was changing sometimes by the hour.  As a team, we had to adapt quickly. We remained flexible and we were kept informed of the new guidance for care homes as it happened, and we would ensure people were safely discharged. We supported the system by sharing new guidance in real time daily to ensure care homes were sighted on changes and asks.

From the initial phone call in May 2022, we reduced the medically fit for patient delays from 100 to 10 within 3 weeks. The Acute Trust felt the benefit of this massively, with at one point 25% of medical beds across the site were empty.

My team and myself worked 7 days a week and into the evenings (even being on call 24/7) to ease the pressures the hospital was facing daily. It was a very intense time which required stamina, skill and dedication from the team at How to Find Healthcare. I am very proud of what we achieved and that we enabled this hospital to continue to treat the very sick. I shall never forget that time and will always be grateful we were able to make a significant difference.

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