The NHS in England recently set out planning guidance for local places, asking health economies around the country to prepare what it calls ‘Sustainability and Transformation Plans’ for the next five years. These plans, designed to help deliver the NHS’ Five Year Forward View, are expressly predicated on the NHS taking a broad-based approach, working in real partnership with social care, local government, voluntary and community services and other sectors.
Whilst there is understandable scepticism about how this will work in practice, some parts of the country have been trying it out for real, with social care playing an equal role with health.
New models of care
In particular, there is an NHS England New Models of Care Programme, where some 50 partnerships, called ‘Vanguards’, are trying out new ways of working in order to get better outcomes for service users. The aim is to stop people going into hospital when they don’t need to and to get them out of hospital as soon as they’re ready.
Within the Vanguards, there are six places that are looking at how to achieve better care for older people in residential care. They’re called the Enhanced Care in Care Homes Vanguards. They are: Airedale and Partners; the Wakefield Care Home Project; Sutton Homes of Care; the Gateshead Care Home Project; East and North Herts Clinical Commissioning Group; and Nottingham Commissioning Group. Some of these places have long histories of joint-working; others have come to collaborative working more recently, but all of them are committed to better services and outcomes for older people.
As part of their work, they need to show:
- Strong and inventive partnerships, including with the community and voluntary sector.
- A focus on residents’ capabilities (ie an asset-based model).
- In-reach services provided in partnership.
- Use of new technologies and telemedicine.
- Innovative approaches to local assets, including intermediate and respite care beds.
- Multi-agency and multi-disciplinary teams.
- Flexible workforce models.
- Redesigned hospital discharge processes.
- Training and support for staff and families around end-of-life care.
The social care providers involved in the groups, sometimes extending the offer to homecare, are doing just that.
The Wakefield Vanguard
In Wakefield, social care providers are linking up with the voluntary and community sector, housing associations, the local authority, emergency services and the NHS, to develop a much more holistic approach to people’s health and care. It’s not just down to medical issues; it’s about ‘somewhere to live; somewhere to love; something to do’ to optimise residents’ health and life experience.
This would mean, for example, that an older person in extra care housing could be supported to resume their hobby of walking following a hip replacement, helping to improve both their physical health and their quality of life.
The Wakefield Vanguard has set up a number of network hubs, looking at different service mixes and trying out new ways of operating. One network has a particular focus on working with a community geriatrician, with weekly GP visits to residents with complex neurological issues in specific homes. Two others involve advanced nurse practitioners acting as care co-ordinators for residents identified as high risk, with regular pro-active care visits and better links with GP practices. A fourth is prioritising better collaboration between primary and secondary care, and Age UK, with better use of video links and access to shared care records.
As a corollary, there has been more emphasis on skills development for care home staff, funded through the Vanguard, so that staff can deal with more complex medical needs and prevent emergency call-outs. There has also been a move towards multi-disciplinary teams working within care homes, with the registered manager being the pivotal figure, working with a range of health and social care practitioners including district nurses, social care staff, pharmacists and specialists in palliative care.
It is having a really positive effect. Outcomes from the pilots include a 25% reduction in ambulance calls; 30% reduction in A&E attendances, and at least 50 weekly visits to care homes by GPs – a significant increase. As a result of care reviews, 53% of residents saw changes in their medication, often with less medication required.
Airedale has placed similar emphasis on training and development for social care staff across its 248 care homes. This time with an emphasis on better use of technology and telemedicine. The aim is to have telemedicine in all care homes by April 2016 so that, for example, staff supporting a care home resident with Parkinson’s disease will be able to access clinical advice and support through secure video conferencing at any time of the day or night. This means that in the event of a fall, an experienced nurse in a tele-health hub will be able to assess them using a video link, and after discussions with an A&E consultant, will be able to arrange for them to be cared for in their familiar surroundings, rather than transferring them to A&E.
Gateshead and Hertfordshire
In Gateshead, providers are taking advantage of a ‘ward round’-based service that sees GP practices and community nursing teams aligned to care homes across the borough. In practice, this means fewer avoidable hospital admissions and better quality of care.
Across East and North Hertfordshire, the Hertfordshire Care Providers Association has brought providers on board to support enhanced training for care staff so that they can take on more flexible and skilled roles. The aim is to create dedicated multi-disciplinary teams for care homes that will include GPs, community psychiatric nurses, district nurses and community geriatricians. These will be alongside a rapid response service so that care homes have access to services in two localities with a combination of community nurses, matrons, therapists and homecare staff who can be deployed within 90 minutes if required. As a result, care home residents can be supported by staff who will be accredited because they have undertaken a package of education and training. In addition, residents will know that should their condition deteriorate, a team of experts is ready to respond to their needs before making an assessment as to whether they need to go to hospital.
In Sutton, providers working alongside local GPs, Age UK and the Alzheimer’s Society are involved in building a provider network to support training across local care homes, as well as a new model of care that enables people to get specialist support at home rather than having to go into hospital. Again, this is translating into enhanced education and training for care home staff, with specialist modules in dementia, diet and nutrition, falls prevention and management, diabetes and working with challenging behaviour.
Finally, in Nottingham, which has 83 care homes in the city alone, with residents generating 5% of all hospital admissions despite only accounting for 0.5% of the city’s population, a dedicated care co-ordinator role has been developed. People are already in post and are working across residential and homecare with new specialist teams, including a dementia outreach team, a care homes nursing team and a medicines management team. The care co-ordinators are supported by better links with primary care and more or better use of technology. Specific GPs are aligned with specific residential and nursing homes, and do regular ‘ward rounds’, supported by telehealth pilots that are collecting data for GPs and health professionals to do ‘virtual ward rounds’ when they can’t be in the homes in person.
None of this would be happening if social care hadn’t stepped up to the plate
None of this would be happening if social care hadn’t stepped up to the plate, with owners, managers and staff taking up their leadership role, both within their own organisation and working collaboratively with others, as true systems leaders. It shows the difference that real social care leadership can make to the quality of care, and quality of life, that people experience. It’s social care leadership that’s making the difference.
For more information about the Enhanced Care in Care Home Vanguards, visit www.england.nhs.uk and search Enhanced Health in Care Home Vanguards.
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