Hospital in-reach

Intake

The co-location of project staff in the hospital enables digital support to begin before the patient is discharged.

Referrals are made by hospital staff, which requires some awareness raising around the project and the benefits to the patient and their recovery.

Assessment

Cyrenians provide hospital in-reach to help prevent people becoming homeless upon discharge. Being able to assess this risk and providing digital support and advocacy can help people sustain their tenancy while they are in hospital so that they don’t become homeless on discharge, causing further distress.

Assessment in a hospital will depend on the date of discharge, and how support needs to be prioritised.

Projects providing hospital in-reach have highlighted the importance of assessing the risk of providing a device to a patient on discharge. This has been raised as an issue that patients have brought up in discussion. The risk can relate to selling the device on discharge or having a high value device in a setting (e.g. a B&B) that would make them feel vulnerable. This requires a conversation and an understanding of what kind of setting the person will be returning too. Learning from this programme suggests that the risk of a device being sold is reduced when someone understands the wider value of being digitally included beyond the cost of the device. A basic ‘burner’ phone is sometimes provided on discharge if there is a likely risk of it being sold.

Device and connectivity

Access to a device in the hospital can play a significant role in reducing isolation. One project noted that it can cost almost £10 per day to hire a TV in one hospital, so having access to a digital device can help reduce boredom and minimise the risk of patients trying to discharge against medical advice.

Hospital in-reach services primarily use tablet lending libraries for the duration of someone’s admission. Projects have noted that tablets offer a broader range of support in this setting, not just for recovery and harm reduction support, but also for creative pursuits and tackling boredom. The tablet is returned on discharge and a smartphone or basic phone with connectivity is provided on discharge, depending on risk assessment.

Cyrenians noted that some people they support start medication assisted treatment for opiate dependency whilst an in-patient. The provision of a smartphone on discharge means they can send people bus tickets, offer a connection to the key worker and provide reminders for appointments.

Digital skills support

Digital skills support can start in hospital, depending on the duration of the admission, and continues with further support in the community after discharge. Cyrenians offer 1-3 introductory sessions in hospital and a further 3-6 sessions in the community, depending on the level of need.

Cyrenians also noted that some patients requested group session in hospital. Peer support sessions were initiated as a way of people supporting each other when the project team wasn’t there delivering sessions.

Digital skills support can include help with recovery and harm reduction apps such as Addiction Recovery Companion (from Edinburgh HSCP) and SURE Recovery.

Opportunities

Completion of treatment: The provision of a digital device during a hospital admission is not only beneficial to the individual, but also to the provision of healthcare. Reducing boredom and isolation can minimise the risk of someone discharging themselves against medical advice.

Independence: Access to a digital device after discharge can help promote independence for people. Being able to manage appointments and get there independently without a support worker reduces the amount of staff time needed to accompany people which can be used instead for direct support provision.

Integration of digital apps and tools: Apps such as By My Side could be integrated in digital inclusion support to help build confidence in accessing digital harm reduction support.

Challenges

Service awareness: Referrals to hospital in-reach support are dependent on hospital staff having knowledge of the service. This requires a level of understanding of digital inclusion and making a quick assessment of eligibility for support.

Workforce resilience: Hospital in-reach services requires partnership working and co-location arrangements, which can be impacted by staffing changes in the project. Compared to community-based services, hospital in-reach is often dependent on specific staff with authorisation to be present on the wards.