E n h a n c e d h e a l t h i n c a r e h o m e s

Enhanced Health in Care Homes

the art of the possible….

Bridget Fletcher CEO Sponsor

Airedale & Partners Vanguard

E n h a n c e d h e a l t h i n c a r e h o m e s

First cohort Vanguard sites

2

Care model Applicant

PACSWirral University Teaching Hospital NHS Foundation

Trust

PACSMansfield and Ashfield and Newark and Sherwood

CCGs

PACS Yeovil Hospital

PACS Northumbria Healthcare NHS Trust

PACS Salford Royal Foundation Trust

PACS Lancashire North

PACs Hampshire & Farnham CCG

PACS Harrogate & Rural District CCG

PACS Isle of Wight

Care model Applicant

MCP Calderdale Health & Social Care Economy

MCPDerbyshire Community Health Services NHS

Foundation Trust

MCP Fylde Coast Local Health Economy

MCP Vitality

MCPWest Wakefield Health and Wellbeing Ltd (new GP

Federation)

MCP NHS Sunderland CCG and Sunderland City Council

MCP NHS Dudley Clinical Commissioning Group

MCP Whitstable Medical Practice

MCP Stockport Together

MCP Tower Hamlets Integrated Provider Partnership

MCP Southern Hampshire

MCP Primary Care Cheshire

MCP Lakeside Surgeries

MCP Principia Partners in Health

Care model Applicant

Care Homes NHS Wakefield CCG

Care Homes Newcastle Gateshead Alliance

Care Homes East and North Hertfordshire CCG

Care Homes Nottingham City CCG

Care Homes Sutton CCG

Care Homes Airedale NHS FT

Airedale & Partners

E n h a n c e d h e a l t h i n c a r e h o m e s

Building on our innovation

What will the future

look like?

New models of care:

… in some places the

future is already

emerging, for example in

Airedale…

E n h a n c e d h e a l t h i n c a r e h o m e s

Building on our innovation

TeleconsultationPrison health care

Care in patient’s home

Nursing & residential care

End of life patients 24/7 clinical hub Integrated Care hub Gold Lineenhancing resident & carer

experience improving end of lifechanging patient flowreducing costs

E n h a n c e d h e a l t h i n c a r e h o m e s

Care Home Feedback“A very good service. It made me feel confident within my job so I could do the best I can for our residents. This service takes the pressure off us as we have access quickly to a health professional…”

“The Doctor was fantastic when one of our dementia patients fell and hurt herself. I would have called an ambulance and she would have endured an A&E visit which would have terrified her. Your consultant saved her from this and reassured me that the cut was superficial and she was fine...”

“Definitely has reduced admission rates. Telemedicine is an asset to the home with benefits Out Of Hours and weekends”

E n h a n c e d h e a l t h i n c a r e h o m e s

GP Feedback

"Of all the changes in the 15 years I have been working this is the greatest change which has reduced workload I can remember. I don't mind the extra "late" duty doc visit as this is more than made up in the drop in other visits. A big thank you to all involved."

E n h a n c e d h e a l t h i n c a r e h o m e s

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Without TM With TM

Accident & Emergency Department Attendances

Before

After

0.64 (45%)

0.35 (31%)

Cost

Per care home bed/yrBefore TM After TM Difference

With telemedicine 1.13 0.78 -0.35

Without telemedicine 1.42 0.79 -0.64

E n h a n c e d h e a l t h i n c a r e h o m e s

0

0.5

1

1.5

2

2.5

3

3.5

Without TM With TM

Emergency Admission Rate (2012-2014)

Before

After

1.07 (37%)

0.73 (32%)

Emergency (episodes)

Per care home bed/yearBefore TM After TM Difference

Without telemedicine 2.26 1.53 -0.73

CH without telemedicine 2.93 1.86 -1.07

E n h a n c e d h e a l t h i n c a r e h o m e s

Key

Care HomesHospicesHospitalsMedical CentresOwn HomesPrisons

Replicable Model?

• 220 Nursing/Residential Care Homes

+ further 113 in implementation

• Supporting > 6500 residents

E n h a n c e d h e a l t h i n c a r e h o m e s

Right Care:

Airedale & Partners Vanguard

E n h a n c e d h e a l t h i n c a r e h o m e s

Scale of our opportunity

E n h a n c e d h e a l t h i n c a r e h o m e s

What are we going to do?

Our shared objectiveto enhance the quality of life (and end of life experience) of thousands of nursing and care home residents living in Bradford, Airedale, Wharfedale and Craven and East Lancashire

E n h a n c e d h e a l t h i n c a r e h o m e s

What will this enhanced health

& social model look like?

“…By promoting choice and control and maximising independence for the individual, we will look beyond residents’ dependencies to help them enhance their health and well-being capability, supporting them to improve their longer term health ambition and ultimately change their care utilisation…

..This enhanced health model will be enabled through technology…”

E n h a n c e d h e a l t h i n c a r e h o m e s

What can we achieve

by April 2016?

Self care support Shared models of proactive in-reach support Improved integration with social care and voluntary

sector Regular medication reviews, advice (and delivery)

utilising pharmacy expertise Tailored rehabilitation services delivered remotely Delivering more specialist services into care homes Access to virtual interpreter services Health education and training Remote out patients Enhanced recovery for residents who do require

hospital admission Enhanced support for people approaching end of life Support for out of hours care

and ultimately change their care utilisation…

E n h a n c e d h e a l t h i n c a r e h o m e s

Ensuring delivery• Strong programme management• Partnership approach • Leadership commitment for change• Resident & carer - involvement in design• Clinical leadership & engagement - in change models• Alignment - with local 5 Year Forward View Strategy & Plans• Closing the gap – between services• Key enablers – workforce, technology, OD, integrated digital

care record, IG, communication, improvement• Independent Evaluation • Integrated Governance• Technology maximisation

• Peer learning

• Learning laboratory conditions for innovation

• Investment

E n h a n c e d h e a l t h i n c a r e h o m e s

Measurement for

improvement

Learning and improving using a combination of transparent qualitative and quantitative measurement for improvement approaches

resident reported quality outcomes care home performance care utilisation KPIs resource utilisation

E n h a n c e d h e a l t h i n c a r e h o m e s

Revolutionising ways

of working

E n h a n c e d h e a l t h i n c a r e h o m e s

National support required

The ask!

National procurement framework National agreement with technology

providers National concordat with nursing

homes National shared consent protocol Commissioning levers Address perverse financial incentives Royal College Support Changes in health and care education

and training

E n h a n c e d h e a l t h i n c a r e h o m e s

Airedale & Partners Site Visit

National Team feedback Massive opportunity, very impressive

Strength of engagement “gives

confidence”

Well developed relationship with care

homes

Huge strengths in new model of care

– triple integration - this is not NHS

status quo

Need a focussed delivery plan with

full CCG support (match funding) &

agreement on national ask

Need to align Pioneer with Vanguard

Potential for national replicability of

current model

“…the future is

bright, the

future is here!” Sam Jones

NMOC Director

E n h a n c e d h e a l t h i n c a r e h o m e s

YEAR 1 TO MARCH 2016

Advance care plans in place & wishes recorded including

end of life choices

High level roadmap 15/16 – 16/17

Enhanced Health& Wellness

YEAR 2 TO MARCH 2017

Proactive Care Enabled by Technology

Infrastructure –Enabling ICT,

Facilities

Enhanced recovery & early supported

discharge

Medicines management service

Personalised wellness monitoring for care

home residents

Single point of access via hub, co-ordination

of out of hours services including GPs and NHS

111

Remote outpatients for care home residents

New transdisciplinary roles providing proactive care

Integrated training programme delivered to all Care Homes eg. Nutrition &

hydration, dementia

Training in more complex techniques

All senior clinical assessors trained as

non medical prescribers

Develop logic model

Develop Dashboards inc. Health & Wellbeing

metrics

Map existing services & partnerships across

locality

Engagement & visioning events,

including care homes & public

Further develop information pack for

care homes

Feedback mechanisms for carers, residents and

families eg. EBD

Ongoing communication &

engagement

Unified workforce keeping carers at work

Randomised Controlled Trials

Dedicated GP linked to individual care homes

Hub direct access to diagnostics inc. x-ray

Care homes developed into community assets

Tailored selfcareactivities enabled by

technology

Behavioural management plans for care home residents

Access to digital services platform

Expanded hub at Airedale operational

BUILDING BLOCKS IN PLACE INCLUDE:

• Telemedicine in care homes

• Shared patient record

• Integrated Care Hub

• GP Triage

• Goldline service

• Virtual interpreting

Implement e-shift model

Alignment across existing system transformation

programmes eg. Pioneer, GPGO

PDSA and generate ideas/plans for Year 2

Easy access e-prescribing &

dispensing

Care home staff & resident access to electronic record

Ongoing review and evaluation

Extend model to enable home care/assisted living

Integrated systems eg. SystmOne, Rio, EMIS,

VitruCare

Workforce & OD Measurement & Evaluation

Communications, Partnerships & Engagement

E n h a n c e d h e a l t h i n c a r e h o m e s

Lets not leave this to chance –We have a great opportunityto make a real difference…