The Twilight Service

A collaboration between VCS and public sector organisations to deliver services.  August 2010.

In 2007 the Carmarthenshire Health Social Care and Well-being Partnership identified a shortfall in service provision for older people, to accompany them home from Accident and Emergency and provide a home visiting service the following day. Menter Cwm Gwendraeth was asked to establish the ‘Twilight Service’ in October 2007 to meet this need through funding provided by Hidden Dragon and the Carmarthenshire Local Health Board. The service enables us to support the reduction of avoidable admissions which is important as older people who are admitted to hospital are at risk of extended stay; malnutrition; exposure to hospital acquired infection; reduced independence; functional decline and increased mortality. (Age Concern 2007). 

Twilight Service staff support patients on discharge and signpost them to other support agencies if required. These include Telecare, Canllaw, Care and Repair, British Red Cross etc. to ensure we promote the maintenance of independence thus avoiding the unnecessary use of hospital beds. This is a new approach that has created a holistic and responsive service for older people to reduce unnecessary hospital admissions.  There is good evidence, including a recently completed study by Bangor University, to show that this approach has been successful in delivering effective, joined up services and has created efficiencies for the health sector.

After safe medical discharge, two Support Workers provide transport via a lease car. They settle the patients into their home and complete a risk assessment to establish the need for further community support. They can refer to Canllaw, Telecare, British Red Cross, Home from Hospital scheme, Care and repair, Bobby van, Fire Service re alarms, Crossroads and other community agencies as appropriate.  The Twilight Service operates Thursday-Monday 2pm-10pm and each month transports over forty people (twenty of whom are avoidable admissions) and refers an average six people on to other services.

When the Support Workers are not transporting patients they provide a task oriented service in the Accident and Emergency Departments e.g. they take blood samples to the Pathology Departments, talk to waiting patients, escort patients to X-Ray, provide refreshment to patients as directed by nursing staff, collect medications from Pharmacy etc.

We were awarded the Welsh Language in Health Care Award 2009 (Voluntary Sector Category) and the service has been commended by many.   

The Organisations that make up the Twilight Service are:

• Menter Cwm Gwendraeth (Lead Organisation) employs staff, delivers service and links with all relevant partners particularly the British Red Cross.
• Carmarthenshire Local Health Board initially commissioned the service and has established a Steering Group, which monitors progress and outputs.
• Hywel Dda NHS Trust maintains profile of service with respective departments; assists with induction of staff and orientation training; communication links with Twilight Services Manager.
• British Red Cross provides Home from Hospital Discharge Scheme, which works closely with the Twilight.
• Multi Agency Forum developed to further extend the quality of support provided to sustain the clients in their home.

Keys to success:

• Close collaboration between hospital and Support Staff who understand the underlying principles behind the scheme.
• Overcoming problems as they arise with locality nurses by being flexible.
• Employing Support Workers who love the work they do.
• Employing an experienced Twilight Services Manager, a former Ward Sister, who has extensive  hospital experience.