The Vanguard experience

CLAHRC East of England Connecting with Research, June 2016

Vanguard sites

Multispecialty community providers [14]

Acute care collaboration vanguard sites [13]

Integrated primary and acute care systems [9]

Urgent and emergency care [8]

Enhanced health in care homes [6]

Care home vanguard sites (CH6)

Challenges for the Care Homes - nationally

“One in six people aged 85 or over are living permanently in a Care Home. Yet data suggest that had more active health and rehabilitation support been available, some people discharged from hospital to care homes could have avoided permanent admission.”

“Similarly, the Care Quality Commission and the British Geriatrics Society have shown that many people with dementia living in care homes are not getting their health needs regularly assessed and met. One consequence is avoidable admissions to hospital.”

NHS Five year Forward View, October 2014

NHS Five year Forward View, October 2014

East North Herts Demographic background

People in Care Homes… …are forgotten and are one of our most vulnerable groups yet: Access to other services poor and varied

Seen as a problem- DTOCs, Safeguarding, media horror stories

Undervalued workforce

For around 3,000 people in East and North Hertfordshire ‘home’ is a care home.

Most residents are elderly, many have complex health conditions and on average, take seven prescribed medicines a day.

Every hospital visit has the potential to be confusing and disorientating so our project focuses on upskilling staff to avoid emergency hospital admission wherever possible.

But…

Intermediate care in care home for past decade providing excellent care in partnership with community services

Strong local CHC presence

Small projects making a difference EOLC, Falls and APC

Good local partnerships

Our Vision

To deliver an enhanced model of health and social care to support frail elderly patients, and those with multiple complex long term conditions in the community in a planned, proactive and preventative way

“

”

We want to: 1. Develop skilled staff who can look after residents with complex

needs with more confidence, improving wellbeing and quality of life

2. Work more closely together – to plan better care for patients

3. Be responsive – quickly getting the right professional to a patient to prevent that person having to go to hospital if they don’t need to

4. Improve our technology – so that clinicians can securely access records in the patient’s care home.

Enhanced Health in Care Homes

• 999 calls

• A&E attendances

• Emergency admissions to

hospital

• Short stays in hospital

• Calls to the out of hours GP

service from care homes

• ‘Delayed transfers of care’

• Medication errors and

problematic polypharmacy

If our project is successful we would expect to see:

• People living healthier lives

for longer in care homes

• Calls to NHS 111

• Staff, residents and families

reporting feeling satisfied

with care

• Care home staff choosing to

stay longer in their jobs

• People dying in their

preferred location

Our Partners

Confident staff

in Care Homes

Multi-disciplinary Team

Rapid Response

Effective Technology

1. Complex Care Framework 2. End of Life ABC training 3.Workforce

8. Rapid Response 9.Early Intervention vehicle 10. Red Bag 11. Trusted Assessor

12. Integrated data and analysis using MedeAnalytics

13. Technology in Care Homes 14. Targeted support for care homes

4. Medicines Optimisation 5.Aligned GPs 6. Frailty service 7. HomeFirst

Programme Overview

Confident staff

in Care Homes

Multi-disciplinary Team

Rapid Response

Effective Technology

1. Complex Care Framework 2. End of Life ABC training 3.Workforce

8. Rapid Response 9.Early Intervention vehicle 10. Red Bag 11. Trusted Assessor

12. Integrated data and analysis using MedeAnalytics

13. Technology in Care Homes 14. Targeted support for care homes

4. Medicines Optimisation 5.Aligned GPs 6. Frailty service 7. HomeFirst

Programme Overview

Complex Care Framework

What is complex patient?

More involved care conditions

Not Continuing Health Care eligible

Fall into one or more of the following:

1. Dementia

2. Falls Prevention

3. Nutrition

4. Wound Management

5. Health Care

The Complex Care Premium An ‘enhanced rate’ of £70 per

eligible patient

Home eligible to receive payment from 1st Oct 2015

Paid weekly per patient

To be used for the direct benefit of the patient and the home

Payment not subject to means testing

Complex Care Framework training model

14

“(We’re) learning really useful ideas…(this will) cut

down on district nurse callouts”

“It’s hard work because of the calibre of the training but it’s

worth it…staff are empowered and it’s meaning better days

for residents”

“It has changed our home’s culture. Staff are up skilled

and the six Champions work together as a professional team to give the best care

for complex cases”

“From what I can tell, all the Champions have found the experience rewarding - the champion’s additional training was obvious”.

Complex Care Premium - Feedback so far

Technology in care homes

“Care homes in the UK are 15 years behind those in Canada and the US in adopting technology that can

help free up nursing time and improve care, according to a leading technology provider.”

Nursing Times, Nov 2015

A survey of the 50 top care home groups found:

80% felt technology could help with care planning

About 56% said it could improve medicine management

Nearly 44% felt it could help with staff planning and rotas

16% participants said they already used electronic health care records or care planning software. Of those:

87% said it had improved access to information

81% said it had improved outcomes

Nearly 63% said it led to improved care

Nearly 63% said it had made documentation more efficient, including reducing duplication

Some secure access to patient records A free electronic patient records system (via the

SystmOne care home module) Secure NHS email Access to end of life and (when established) care

plans used by other professionals.

Possible benefits:

Some practitioners coming into the home do not have easy access to patient records.

Homes receiving new residents from hospital often report that the info which comes with the patient is not comprehensive, nor can homes see any case history.

Homes currently will be working on a variety of systems (IT or paper) for keeping records, none of which is accessible to other agencies who wish to support.

End of Life planning and personal care plans tend to sit within NHS systems and are not obvious or accessible always to homes

Concerns:

Costs - Setup and ongoing Information Governance Training

Risks:

Already happening…

Duplication Efficient use of time Partnership working Prompt action Secure

Impact so far

45 antipsychotics for BPSD reviewed with GP

drug cost reductions £54,528 p.a. (£125/patient)

14 Care Homes visited so far: 1,188 interventions

452medicines stopped including 70that are linked to increase in falls

Medicine Optimisation Complex Care Framework

CCP (Wave 1)

CCP (Wave 2)

Complex Care Fountain

Complex Care Access

Completed

In progress

In progress

Due to start

437 patients records reviewed by Pharmacists

71 patients seen by Early

Intervention vehicle

66 complex care staff champions trained in care

homes (2015/16)

60 complex care staff champions currently being trained in care

homes (2016/17)

Replication and Scalability

21

Replication The Care Home 6 (CH6) have and continued to work closely to share ideas, project successes , failures and lessons learnt. To avoid duplication , wasted time and money, there are some initiatives that have been adopted, these are either: Lifted (from one area) and shifted (to another area) Lifted (from one area) and tailored (for that area’s

idiosyncrasies) Scalability The Care Home 6 have also been tasked with consideration on how to increase the scale of these projects to other areas beyond Care Homes

Gateshead Care

Home Project • Homecare/Community beds

• Virtual ward rounds

• Designated GPs

Gateshead

• Hospital Transfer Protocol

• Engagement

• Standard Assessment

Form

• End of Life Care

Sutton • CCP

• Aligned GPs

• MDT

East & North Herts

CCG

• MDT

• Social aspect

• Dealing with isolation

Wakefield

• Hub/TeleHealth

Airedale

• SystemOne in care homes • Integrated Assistive

Technology service • Joint commissioning • Transfer To Assess beds

Nottingham City Council

Commissioning Group