Abstract
Introduction: Ealing Community Partners delivers community services in one of London’s largest boroughs, including an enhanced primary care service for nursing home residents.
In early 2020 it was rapidly recognised that our care home residents were vulnerable and at substantially elevated risk of death from Covid-19.
Outbreaks within care homes were challenging to contain due to factors related to the homes, workforce, residents, and nature of Covid-19. Acute hospitals experienced significant demand and there was sustained need to discharge patients rapidly. Care homes raised alarm about risks posed from patients being (re)admitted from hospitals where they may have been treated for, or acquired, Covid-19.
Aims: West London NHS Trust opened the Mary Robinson Unit as England’s first dedicated Transitional Facility, with the support of the NW London Health/Care System (payer), Bupa (private care home provider), public health teams, and regulators (CQC). This involved identifying/procuring a site, recruiting/training a team of nursing/care staff, and establishing referral pathways from local hospitals. The unit was one of a number of supportive interventions commissioned.
We measured
-Patient characteristics, experiences and outcomes
-Information about outbreaks across care homes in context of local outbreaks
-Excess mortality in the local care home population over the subsequent 12 months
Key Findings:
-Between June 2020 - April 2021, MRU admitted 147 patients from across NW London’s eight boroughs. 79 (54%) from Ealing.
-Bed occupancy (≤22) mirrored population Covid-19 prevalence, with peak in January 2021.
-Mortality within registered nursing home population (~1250 beds) in Ealing has typically been ~30 deaths per month 2014-2019. The first peak of Covid-19 resulted in peak of 121 deaths in April 2020. Following this peak, there was a brief deficit in monthly mortality suggesting that some individuals died prematurely who may have died in subsequent months. Data for January and February 2021 (subsequent Covid-19 peak) supports our hypothesis that the Unit contributed to an absence of excess deaths in our local area.
-Patient experience was captured from 59 patients (40%). Of these 52 (88%) would recommend the unit. One said “I want to come on holiday here”.
Conclusions: Care home residents were especially vulnerable to Covid-19, but the development of a specialist unit to provide Transitional Care is likely to have been a significant contributor to the protection of other care home residents, whilst supporting acute hospital flow.
Implications: Our NHS-led model was rapidly mobilised and staffed with a high ratio of qualified nursing staff compared to typical care homes. Following the successful implementation of the vaccination programme locally, we decommissioned the MRU and transferred the patient pathway to a smaller unit hosted in a private nursing home with cheaper unit cost.
Subsequent to our project launch, UK Government policy required that every Local Authority in England commission a similar facility, and this requirement remains in place.
There may be learning applicable for the management of discharge pathways for other infectious diseases.