The ‘crisis’ facing both health and social care is having a considerable impact on older people, as some of the most vulnerable members of society. While politicians look at how to alleviate the pressure on services, there is a significant role care homes can play now.
Residential care has, in the past, been regarded as the ‘Cinderella service’ separate to, and apart from, other community-based or acute services. However, with an ageing population whose experience of limiting and long-term conditions is increasing, residential and nursing care services are playing a greater role. This means that they need to work more closely with health to support people and create solutions to ease the pressure in the system.
The first steps are already being taken. Enhanced Health in Care Homes (EHCH) is one of the new care models set out in the NHS’ Five Year Forward View. The aim of EHCH is to tackle the disconnect between care, health and rehabilitation services to improve health outcomes for those in residential care.
While the framework to achieve this joined-up approach, developed following the experiences of ‘vanguard’ projects across England, was published last September, it is currently just an option for clinical commissioning groups (CCGs) and local authorities to commission.
In the meantime, care home operators can be proactive in developing their own mutually beneficial relationships with primary care services.
Working with GPs
Care homes’ links with GP services have, and continue to have, their share of tension, but there can be great benefit to both sides in negotiating a working practice.
The majority of residents in a care home are likely to be registered with the local GP surgery. The doctors there are known to them and have an understanding of the person’s history. This is particularly important when supporting elderly patients with complex needs or cognitive impairments, such as dementia.
Visits to homes to see individual residents can be time-consuming for GPs and escorted visits to appointments in surgeries impact on available resources for home managers. As such, establishing a weekly ‘clinic’ at a care home can be an efficient use of time and resources for both parties. We are finding this arrangement at our Loughton-based home, Woodland Grove, is resulting in residents’ care being better managed. With regular access to GPs, issues can be monitored and referrals to secondary care are greatly reduced.
Of course, the resources available to GPs to provide services to care homes vary greatly.
However, strong relationships with local practices help to develop the will and the understanding of the benefits to all concerned.
Greater involvement with CCGs is another way forward for independent care providers, as an increasing number of CCGs are taking on the full or joint commissioning of GP services.
Easing primary care pressures
Residential care also plays an increasingly beneficial role in easing the demand on hospital beds that winter and other pressures bring. With unprecedented levels of demand on NHS services, particularly in A&E, winter pressure bed contracts with CCGs can be mutually beneficial.
A care home bed has the potential to represent around a 50% saving on a stay in hospital. Given this is such a significant amount, it is surprising that there have not been more examples of the NHS and care homes working together.
In our experience, these contracts become transition beds for those who no longer need hospital care, but are not yet ready to go home. This means that the hospitals taking advantage of these beds can reduce the instances of delayed transfers of care that they experience and improve system flow.
Care homes benefit from a fixed source of income and a known number of occupants that resources can be planned for. However, the challenges come in deciding how many beds to make available and managing the end of a contract to minimise wastage of resources.
As part of our commitment to connected services, we issue a weekly bulletin to local CCGs highlighting bed availability for these arrangements. This ad-hoc approach is not ideal and it would be far better if there was a framework for us to feed into. However, it is better than nothing at all.
Collaborative working can also help to increase primary care services’ understanding of residential care and the needs of people living in it. This includes the fact that residents often have complex health needs and multiple medications. There is also an opportunity for care providers to help develop primary care’s understanding of the sector and its clients at the earliest stage and become involved in the education of its staff.
To help with this, we are working in partnership with universities to develop a nursing excellence programme. Students will be offered a placement as part of their degree course working at our homes to get a good understanding of the care of older people.
This knowledge can then be shared, whether they work in primary or secondary healthcare, or within the care sector itself and, therefore, improve the way in which nurses gain a more holistic view of primary and social care.
Having well-qualified and well-trained staff within care homes improves their ability to act as a primary triage service within homes, minimising the need for contact with community health services.
It also allows for more effective communication with external teams. Staff are more confident in their knowledge and their professionalism, which ultimately leads to a better outcome for residents.
Limited by funding
It must be acknowledged that the care sector’s ability to adapt its working practices and invest time and resources into collaboration is currently limited by the funding crisis.
Although an additional £101m was announced in December to help spread EHCH and the other new care model vanguards, the sector really needs to see investment from the Better Care Fund now, to develop a long-term strategic view of how care homes and community health services can work together to the benefit of those that need them most.
Whatever the wider situation, building relationships and having positive conversations with those most closely involved with your home can bring significant benefit for little outlay, and strengthen your position in readiness for a joined-up approach to health and social care provision.
Harnoop Atkar is Chief Executive Officer of Oakland Primecare. Email: firstname.lastname@example.org
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