The pace is much slower than on a general ward

Ellen McKivett made it to the ripe old age of 93 before she was taken to hospital for the first time in her life.

Consultants at Darent Valley Hospital's accident and emergency department diagnosed a serious infection in her hand.

It was decided that she needed a course of intravenous antibiotics.

But instead of being admitted to one of Darent Valley's 460 beds, a member of Dartford, Gravesham and Swanley Primary Care Trust's (PCT) rapid response team offered Ellen a choice of care.

She could be treated at Darent Valley or be transferred to Livingstone Hospital Rehabilitation Unit, a 38-bed former community hospital run by a consultant nurse and overseen by a GP specialising in geriatric medicine.

Ellen said: "I'd never been to hospital before and the Livingstone just struck me as a calmer, friendlier place.

"It was also more convenient for my daughter to come and see me."

Working together

On average patients, mostly elderly, stay at Livingstone Hospital for about 15 days.

The environment is a lot more conducive to helping an older person rehabilitate properly Debbie Lindon-Taylor Nurse consultant

When Ellen was fit enough to leave she was given a package of health and social care help in her warden-assisted home.

This was specifically designed and delivered by the hospital's multi-disciplinary community team which includes physiotherapists, pharmacists, social workers, nurses and GPs.

Not only do patients seem to thrive at Livingstone, the project has also had a positive effect in relieving pressure at Darent Valley.

Emergency admissions to acute beds are down, and the number of delayed discharges have dropped from 54 to four or five a week.

That has helped reduce the PCT's costs and allow it to spend money on better care for other patients.

Long stays

Previously, when Livingstone was used solely for GP referrals, it wasn't uncommon for patients to spend six months to a year in the 38 beds available for respite care.

Deaths in the hospital were also frequent because there was no co-ordinated attempt to rehabilitate patients and return them to their homes or family.

Debbie Lindon-Taylor, nurse consultant for intermediate needs care, said the whole philosophy of the unit had changed.

"In the past there was no planned care strategy. It was a case of 'we don't know what to do with this patient, so lets put them in Livingstone'.

"Now we have a much more integrated approach, and it has had a big impact.

"From the patient's perspective the environment is a lot more conducive to helping an older person rehabilitate properly.

"It's a much slower pace, a lot less frightening, and a lot more friendly. It enables older patients to get back on their feet by working at their own pace with a support team."

Professor Ian Philp, National Director for Older People, was impressed by the unit when he visited.

"It epitomises the future of care for older people," he said.

"It is a story of team-work, co-operation, choices, early intervention, prevention and making better use of the buildings we already have."