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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”
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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
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Revolutionising ways
of working
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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…