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Easing the pressure on NHS beds

Published 24 junio 2015

A new initiative between a housing association and an NHS trust hopes to ease the pressure on NHS beds by creating a half-way house between hospital and home.

Cedarwood – a 29-bed ‘re-ablement’ facility in the grounds of Good Hope Hospital in Sutton Coldfield – has been set up by Midland Heart housing association and Heart of England NHS Foundation Trust (HEFT). Initial figures suggest the service saves HEFT some six bed days per patient.

Such an initiative has great potential, but anyone considering setting up a similar venture should make sure:

  • They have robust governance and quality assurance structures, so that patients with more pressing health needs are not inappropriately accepted for step-down;
  • The patient and families understand that the step-down service is not a healthcare facility;
  • There are clear, agreed patient pathways between the acute provider and the step-down provider, with clear roles and responsibilities, and effective communication and handover for both continuity of care and awareness of risk.

It also needs to be easy to re-engage the healthcare provider if the person’s condition deteriorates in the step-down facility – including access for re-admission where necessary. This is particularly key given that, unlike discharge home, the patient’s own GP will not re-engage with primary care provision while they are in the step-down facility.

The acute setting and the step-down facility must also agree the extent of any shared facilities and/or patient data to support the transition from one to the other. Indeed, care pathways must be clearly mapped throughout so that everyone is clear about who is responsible for the patient/service user at any given moment.

Finally, a robust governance and assurance structure must be put in place to ensure the patient/service user’s safety and a strong reporting and learning culture. As a registered provider of social care, such a step-down facility would be subject to CQC regulations and inspection, and as of 1 April 2015 must comply with the Fundamental Standards.

But when all this is taken into consideration and the model is delivered well, I believe it is capable of revolutionising care pathways and unblocking patient flow through health and social care services.

To discuss the issues raised in this article, please contact Corinne Slingo, partner on +44 (0)117 918 2152 or cslingo@dacbeachcroft.com.



Corinne Slingo

Corinne Slingo


+44 (0)117 918 2152

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