32 Exploring the difference made by Support at home 3. increase in leisure activities 1. Enabling safe discharge “Red Cross introduced me to the group, “It’s a nice way of getting rid of people’s which has raised my confidence level a hell anxiety and if there’s any problems upon of a lot.” (Red Cross service user) discharge, sometimes the hospital can sort of make ... assessment, but then when they get > People were more likely to have things they home it’s a different story. So, the Red Cross enjoyed doing with their time at the end of can also sort of highlight any risks as well the service. People spoke about the service there.” (Referrer) introducing them to places they could go, building their social confidence as well as > The NHS stipulates, as a fundamental giving them physical confidence to get out requirement of the discharge process and and about again. good practice, that hospitals identify at discharge, what patients need to enable a 4. improved coping skills smooth transition from the hospital level of care to another. Part of this information is “Honestly, I just like to appreciate everything obtained through discussion with patients or they have done for me.... I don’t know how their families about what is needed to support to thank him; he’s a gentleman. He gave me a the patient, including who will prepare meals, lot of support…. They listen and, as well, they provide transportation and undertake chores; feel how you feel and they understand your what activities they need help with; as well situation….” (Red Cross service user) as information on medication and diet. This discharge process does not often take place > An improvement in coping skills was found as effectively and efficiently as it should to be significant in one site only – our Wales (Glasby, 2003). service, which provides a longer-term source of support for individuals in crisis. Service users > Staff and referrers in this study talked about spoke about the service playing a big part in how the service supports and impacts the their lives by reducing the struggles they were health and social care sector by enabling safer facing, being there to listen to them, discussing discharge. They reported how it does this in a issues and offering support in finding solutions number of ways: to a wide range of problems, from debt, > Addressing potential unmet need – referrers to housing applications, to accessing local mentioned how volunteers, through their services and other practical and health related home visits, are well placed to flag up risks needs. in the home environment that may impact the person’s immediate and long-term The data reveals that Support at home does health and wellbeing. impact health and wellbeing outcomes for its service users to varying degrees. Although there > Providing referrers with reassurance and is evidence of some consistency across the peace of mind that their patients are being services, some outcomes are clearly influenced checked up on after discharge. 22 by the components of the programme on offer. > Allowing social services and hospital staff 4.3.2 Wider benefits of Support at home to focus on more complex cases – that is, supporting people with a higher level Wider benefits of the service were also observed of need. in the study, particularly in the interviews with staff, volunteers and referrers. These are: > Relieving some of the pressure on hospital staff by doing some of the smaller tasks associated with discharge (e.g. getting keys cut, chasing up family members). 22 Differences were observed between the five services, with the most significant outcomes (by site) reflecting the key components of the service on offer. In Wales – coping skills significantly improved following support. London’s hospital based “Next Steps” service saw a significant increase in ability to carry out daily activities, improved psychological wellbeing and a greater engagement with leisure activities, while for Yorkshire’s service which commonly supports people to change their anti-embolic stockings, daily activities emerged as the key significant outcome for participants.