New care models Enhanced Health in Care Homes

New care models Enhanced Health in Care Homes: Progress and learning William Roberts, EHCH Care Model Lead @William. R 0 b 3 rts Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

Where did this start? The NHS will provide more support for frail older people living in care homes Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards 2 #future. NHS

Real challenges • England 3 x as many beds in care homes as there are in the NHS but reduction in numbers of nursing home beds this year + increase in care home closures • Social care faces significant financial pressures • Care homes residents are a frail, vulnerable population with increasingly complex needs & dependency • Hospital-based interventions have limited effectiveness for this population • Ageing population with 1 in 7 over 85 living in a care home Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

Vanguard sites • Based on the common coordinated interventions being delivered in the vanguards • Significant research base to support the model • Framework published 29 th September 2016 • Aims to describe the care model and describe plan for spread • Care model has 7 core elements and 18 sub elements • Clear signal to spread the care model Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

Learning from the Vanguard sites EHCH Care Model Framework and time to implement Care model element Sub-element Core or enhanced EHCH model Indicative pace of implementation (from standing start) Clinical elements Access to consistent, named GP and wider primary care services 1. Enhanced primary care support Core < 1 year Hydration and nutrition support Core < 1 year Out of hours/emergency support Core < 1 year Helping professionals, carers and those with support needs to navigate the local system Aligned and effective rehabilitation and reablement services 3. Reablement and rehabilitation to promote independence Core 1 year – 2 years Enhanced 1 year – 2 years Core < 1 year Core Developing community assets to support resilience and independence 4. High quality end of life care and dementia care < 1 year Medicines reviews Expert advice and support for those with the most complex needs 2. MDT in-reach support Core End of life care Dementia care 1 year – 2 years Core < 1 year Enabler elements Co-production with providers and networked care homes 5. Joined-up commissioning and collaboration between health and social care Shared contractual mechanisms Access to appropriate housing options 6. Workforce development Training and development for care staff Joint workforce planning Linked health and social care data sets 7. Harnessing data and technology Access to care record and secure email Better use of technology Core Enhanced Enhanced < 1 year – 3 years 1 -5 years < 1 year – 2 years 1 -3 years < 1 year 1 -3 years Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

Airedale telehealth service. Scale of the opportunity 220 homes 7500 residents Annually: 7000 A&E attendances 4500 hospital admissions Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

Aims of the service § Provide, safe, effective high standards of care § To support residents to stay at home § Support residents/nurses/carers in the planning, and delivery of care § Escalate to community teams out of hours Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

right care today Teleconsultation Electronic shared record connecting primary & § Prison health care secondary care now § Care at home connecting whole health & § Nursing & residential care social care economy tomorrow § Supporting end of life patients 24/7 clinical hub improving patient experience changing patient flow reducing costs Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

GP triage § Clinical assessment by Hub nurse § Onward refer if required to HCP for home visit § Request prescription § GP surgery informed by NHS secure mail Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

Remote training and clinical support § Support for care home staff using the VTR § Support for DNs and community teams – do they need to attend? § Overview and clinical support of care home staff developing enhanced roles § Remote outpatient clinics Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

What have we learned • Technology needs to support great care • Any intervention needs to be linked to other interventions and a coordinated approach • Technology can be used to do more than one thing • Important to work with care home providers to implement any changes • Benefits can be achieved but need to be clear on focus Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards 11 #future. NHS

Vanguard sites Enhanced Health in Care Homes- have we been successful? We now have • 6 exemplar sites across the country • These 6 sites are providing joined-up primary, community and secondary, social care to residents of care/ nursing homes and Extra care Living Schemes • Better relationships between commissioners and providers • Improved access to NHS services for care home residents • Provider improvements for staff and organisations Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards 12 #future. NHS

Learning from the Vanguard sites • • What have we learned from the care home vanguards Person centred approach essential and focus on the populations health Build collaborative system leadership and relationships around a shared vision for the population Care homes critical partner in the work at all stages Able to see very quick benefits for residents, providers and wider system Not one change that makes a difference, requires a coordinated approach to improvement as isolated initiatives may create unwanted consequences Opportunities to apply the care model wider than just care homes with homecare, extra care housing and wider complex care needs management adaptable to the model Can drive and develop better relationships between commissioners and providers Great work goes on all over the country, but it needs building upon and coordinating Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards #future. NHS

Learning from spread What have we learnt from trying to spread the model • There is a huge appetite to spread the model wider • Many local areas have strong foundations on which to build • The care elements of the model are more widespread then the enabler elements • Care home provider engagement is variable nationally • Coordination of multiple initiatives appears to be key locally • Learning and sharing in communities of practice and care is an essential part of the process Our values: clinical engagement, patient involvement, local ownership, national support www. england. nhs. uk/vanguards 14 #future. NHS