Hospitals are developing ways to ease pressure on A&E

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Media captionEddie Williams from Manchester has Parkinson's disease. He no longer needs to go to hospital twice a week as a community team visits him instead

It's been a tough winter in A&E departments across the UK.

More patients have come through the door, many of them elderly and very ill.

But problems in discharging them home mean pressure has built up across the system, resulting in long delays for some patients in A&E.

So what solutions have hospitals found to help ease the demands on A&E?

Treatment at home

Image caption Denise Vernon can receive the treatment she needs in her own home

One idea has been to treat more people at home, freeing up hospital beds.

Denise Vernon suffers from a long term lung condition and is undergoing a course of powerful antibiotics.

Normally that would mean a two-week stay in hospital but now - twice a day - Denise is visited at her home in Manchester.

She says: "For me it is a win-win, because you get very dedicated treatment, for two hours in the day.

"But I have all the benefits of being able to relax and be at home."

For Denise, a university lecturer, it means she can still carry on doing some work, which would be impossible if she was in hospital.

This particular project - delivering intravenous drugs at home - is run by the Central Manchester University Hospitals NHS Foundation Trust.

So far nurses have treated around 300 patients over 16 months.

They believe they have saved a staggering 2,800 bed days.

GPs in A&E

Image caption GP Ged Garbutt works alongside emergency medicine doctors

But what happens when patients arrive at A&E, but could just as easily be seen by a GP?

North Manchester General has one of the busiest units in the country, treating around 100,000 patients a year.

But it is estimated that at least 15% of patients could have been treated elsewhere, perhaps by a pharmacist or a GP.

So, since August of last year, family doctors like Dr Ged Garbutt have been working along side emergency specialists at North Manchester to filter out less urgent cases.

He says it works well because of it connects primary and secondary care.

"All of the GPs working here actually work in the local practice.

"Essentially it is our patients who we are treating here in secondary care, so we understand them, we understand their needs."

Coordinating care

Image caption Christine Laidlaw is keen to go home

At Newcastle's Royal Victoria Infirmary (RVI), improved coordination of care is helping older patients such as 73-year-old Christine Laidlaw.

She has already been in hospital for a couple of days, after developing a chest infection and she is now ready to go home.

Christine says: "You are desperate to get in [to hospital] because you are ill.

"But then you are desperate to get out when you feel a bit better, and they start to help you, with physio and all different things."

Some hospitals have struggled to discharge patients, particularly older people, because of problems coordinating community care.

"Delayed discharges" - also known as the less flattering "bed blocking" - feed back into A&Es, causing delays for patients waiting to be admitted.

But helping patients to go home when they are ready is not just about freeing up beds and easing pressure on busy A&E departments.

Older people stand a much better chance of making a good recovery if they are back in their own home.

So at the RVI a team of medical staff and social workers is coordinating community care to make sure there are no delays in discharging older patients from hospital.

Dr Steve Parry is an consultant geriatrician - a specialist in the care of older patients - and clinical director at the RVI.

He says: "We pro-actively roam the hospital, trying to find older people who are medically pretty good, ready-ish for discharge, or in the early stages of planning.

"We make sure that they safely get to a discharge, long before several weeks in hospital have taken place."

The Newcastle team are helped by the fact the hospital also runs community care services, but not every hospital trust is in the same position.

These solutions save money, are better for patients and help hard-pressed A&Es.

The challenge will be to spread them across a health service that is still struggling with winter pressures.

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