Health and social work services

Tender description

NHS Brent CCG are considering their future commissioning strategy for the provision of a community bed service. The community beds service is a pathway of care for patients transferred from an acute inpatient environment, or where a patient requires a greater level of care than can be provided in their home, to an intermediate care inpatient setting to continue a period of rehabilitation or recuperation with an aim of returning to their usual place of residence. The aims of the service are to provide sub-acute clinical care and rehabilitation for patients with a range of general conditions in order to assist them to achieve their: — maximum potential for physical, cognitive, social and psychological function, — to provide an alternative to treatment in the home or acute hospital for those patients requiring sub-acute clinical and/or rehabilitation support, — to enable timely patient discharge from acute hospital at the earliest opportunity, — to enable early transfer for rehabilitation. Brent CCG intends to commission access to step up beds in the community that are aligned to the new landscape of primary care homes and GP networks. With evidence that a significant proportion of acute hospital admissions are avoidable, access to step-up beds are seen as an effective initiative that avoids unnecessary emergency admissions. To achieve these aims, the objectives of the service are to provide: — integrated health and social care in a bedded intermediate care setting — a medically led multidisciplinary team with comprehensive baseline assessment of need/function and dependency levels — nursing care in a therapeutic environment to support sub-acute clinical care and rehabilitation — access to therapy specialists to meet the patient’s needs in a timely manner for up to 28 days (or longer by exception) — supporting patients carry out Activity of Daily Living (ADL) tasks; — supporting successful transition back into community based provision, — disability management to reduce and prevent secondary complications. Service requirements: — the service will offer admission avoidance or supported discharge to patients with sub acute clinical care and/ or rehabilitation needs requiring bedded rehabilitation who do not require acute hospital care, — the service will be focused around SMART (Specific, Measurable, Achievable, Realistic, Timed) patient goals with the aim of enabling patients to reach their optimum function in order to return home safely, — the bedded rehabilitation service should provide a fully nursed therapeutic environment which supports daily rehabilitation with a view to moving the patient on to their normal place of residence as soon as they no longer require inpatient support and within their set goal timeframes or a maximum of 28 days, — the provider will be responsible for ensuring that the appropriate clinical cover is provided with capability and capacity to deal with sub-acute issues and that therapy interventions are initiated and maintained in accordance with care plans with input over the 7 day week, — the service must take into consideration the patients’ mental as well as physical health needs and potential for rehabilitation. The service will be provided from its current location on the Willesden Centre for Health and Care site and is for 35 community beds including general rehabilitation and step up beds.