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Business Clinic
Virtual care home – innovation in integration

A Surrey care provider is piloting a virtual care home to help with the cost-effective integration of health and social care for older people, whilst ensuring it is person-centred at the core.

Simon Whalley, Chairman of Birtley House in Surrey and Vice Chairman of Surrey Care Association is looking to work with Royal Surrey County Hospital, Surrey Heartlands Sustainability and Transformation Partnership, Guildford and Waverley Clinical Commissioning Group and local domiciliary care services and care homes to develop a virtual care home pilot.

Developing the virtual care home

Simon explained how the idea came about, ‘I developed the concept following discussions with Royal Surrey County Hospital, Surrey Heartlands Sustainability and Transformation Partnership and Surrey Care Association.

‘The model has been developed to facilitate the cost-effective integration of health and care for older people, whilst also ensuring that appropriate and person-centred care is maintained.

‘It’s still at the conceptual stage, however, it has been well-received by all involved in discussions held to-date. We’re currently exploring ways in which to deliver potential savings for the NHS and adult social care.’

The initial pilot, which is being driven by Simon, will be used to build an evidence-base for future roll-out and delivery of the model.

Simon added, ‘A pilot is being prepared. However, key personnel within the public sector keep disappearing, which makes it very challenging.

‘Those involved recognise the issues that arise from the constant movement of key people in the NHS and the siloed-thinking that is common within the public sector, but it’s often a case of one step forward and two steps back.’

Aims of the project

The concept is called a virtual care home because the services of the care home can be delivered in a number of settings and monitored by technology. However, it also aims to give all those supported a sense of belonging.

On an operational level, it aims to: help people get out of hospital sooner; manage care to reduce unnecessary admissions to hospital; help older patients go home and remain living there in a fully supported way; and prevent readmissions to hospital.

‘We want to centralise the dialogue between all parties,’ Simon explained, ‘and, as a result, reduce the number of obstacles people face, duplication and the opportunity for time to be wasted. By doing this, we hope that the concept will save hospitals money, enable them to use local health resources more appropriately and support the pooling of funds from local authorities and the NHS.’

There will also be a central role for technology to reduce overheads and enable communication and interaction between all parties to support the individual throughout the process.

How it’ll work

It is intended that Birtley House and Royal Surrey County Hospital will work together to plan and deliver a step-down pathway for older people, to help them move into a more suitable setting.

The system will be built around the care home as the central driver and co-ordinator for the approach.

Birtley House also has the potential to manage a ‘step-down’ ward in the hospital to support individuals in preparing for discharge.

Supported for a maximum of six-weeks, individuals may be discharged into the care home or homecare services, with ongoing support and assessment. Wherever located – in a hospital ward, Birtley House or any individual’s own home, there will be ongoing support from the relevant medical professionals, including consultants, geriatricians, community nursing staff and GP surgeries.

Simon explained, ‘The virtual care home will combine visits from professionals and technology. The aim is for medical professionals to see patients in the care home, but with the ability to access them at home via technology. We currently work with MED e-care and are looking to continue to develop this as the concept evolves.’

On a social level, individuals, whether in Birtley House or being supported at home, will have access to the home’s day club to encourage social interaction, meaningful activity and also enable staff to monitor them and ensure their health and wellbeing is improving.

Simon continued, ‘Too often people feel isolated. With both technology and personal contact, we want them to feel connected and enjoy more social interaction, as well as care support in their own home and access to all that goes on in the community.’

It is hoped that if an individual’s condition deteriorates, it will be picked up quickly by the care home, homecare staff or day club. The individual can then be cared-for in the care home, with the support of medical professionals, to avoid readmission to hospital unless completely necessary.

Next steps

Simon is in the process of getting agreement from Royal Surrey County Hospital, Surrey Heartlands Sustainability and Transformation Partnership, Guildford and Waverley Clinical Commissioning Group and local domiciliary care services and care homes to develop the virtual care home pilot.

Simon continued, ‘I would like to see the pilot in place by the second half of 2018. We already have many of the key elements in place, such as a day club. The next objective is to ensure that any budget can follow the patient, in order to broaden the concept to those who cannot afford their own care.

‘I believe that the concept can be demonstrated over a three to six-month period. However, having a full year would help to identify savings. Ultimately, I would like to see the virtual care home rolled out across the entire county, although the nature of the concept means that it is also applicable to adjacent counties, too.’

Over to the experts…

Is this an innovative approach to integration? Could it ease delayed transfers of care and reduce unnecessary admissions? Could it help older people get back into the community quicker? Are similar pilots happening in other Sustainability and Transformation Partnerships? Is there any shared learning that can help get the virtual care home pilot up and running? What does our panel think?

There are things that you can do

Simon, welcome to the world of complexity: where the path to success is rarely linear; where you’re having to work across boundaries with people with different perspectives and priorities, and who don’t see it as their job to unite around your position; and where it can feel messy, time-consuming, and (sometimes) like trying to push water uphill. We can’t wish complexity away, but there are things that you can do.

Use what you have. This includes the evidence base that what you’re proposing works. In Nottinghamshire, an integrated care model linking primary care, care homes and community services has seen a 48% reduction in admissions to A&E from those homes taking part, along with better quality of life for residents. There were similar results from a GP-led scheme with 28 care homes in Staffordshire. Other Enhanced Health in Care Home vanguards have successfully connected care homes with hospitals, making them integral to the system, in the same way you’re proposing. So there’s a good chance this will benefit the whole community.

Use the evidence to develop resonant stories of what this means for the individuals involved, not just for the bottom line. The money is important, but it’s the stories about people that will drive change.

Work with a coalition of the willing who can be effective messengers and do some of the heavy-lifting, so you don’t feel you’re back to square one every time someone leaves (as they will keep doing).

This is not to say this will be plain sailing, but we know that these techniques can work in enabling you to negotiate the path and, eventually, get to where you want to be. Hang on in there.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre 

Worthy of trial and wider attention

The concept seems a positive way to respond to the changing role of care homes. The thousands of homes across the country could be, and should be, much better utilised (and supported) than they are, as they are often well-placed to act as key community link sites within a multi-disciplinary team and to provide hub and spoke services for a range of needs.

This project, which aims to combine the skills, experience and resources of multi-disciplinary professionals to provide improved pathways of care, is worthy of a trial and wider attention.
The principles are sound and involve collaboration between the various parties that can help prevent hospital admissions from, and manage better discharges into, a community-based setting; preferably, the person’s own home. The introduction of technology as a further element in this model shows how we can better incorporate technology into these pathways and maximise the use of increasingly scarce skills, people and facilities in the right place, at the right time and to produce the best results.

Across Agincare, we are successfully managing several new models of care projects (both in and out of care home settings) and unfortunately, I can empathise with Simon’s fear and frustration about the changes in key personnel hindering the process. In the constantly changing face of local authority and NHS structures, we must not let the system and bureaucracy stifle innovation and become the reason why different ways of working cannot flourish.

Independent care providers play a vital part in society and, through pilots such as these, the full potential of our contribution to the health and social care structure can be realised.

Raina Summerson Group Chief Executive, Agincare  

Let’s hope innovation is embraced

It’s great to see organisations and areas innovating, and evaluating that innovation. We recently published a report, with Nesta, on how we take innovative examples of health, care and support and bring these to scale so that more and more lives are improved.

Our work indicates that there are real added benefits in terms of outcomes and cost-effectiveness if services and commissioners think differently. Innovative care homes and other organisations are increasingly seeing the need to offer more person-centred and community-centred care; and they’re starting to use approaches such as Progress for Providers, Making it Real and My Home Life as ways to develop more person-centred care.

The virtual care home might be seen as an example of intermediate care. Intermediate care ranges from bed-based services to community-based services, but seeks to keep people well for longer in their own homes, living fulfilling lives. System leaders and commissioners of integrated services can be at the forefront of developing models of intermediate care that work locally. Our paper on this topic highlights good examples of practice. If you get a virtual care home model, like the one planned for Surrey, it can reduce not only delayed transfers of care, but also increase patient and service user wellbeing.

It is also good to see that these plans recognise the important role technology can play. Our resource, on using technology to support people with dementia, has some great advice, including films, about how technology can provide support, without compromising care, so people can stay independent. Let’s hope innovation is embraced and the best bits made more available.

Ewan King Director of Business Development and Delivery, Social Care Institute for Excellence 

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