Barnsley Care Navigation /

Telehealth Service

Paul Hughes – Care Navigation / Telehealth

Service Lead

The Care Navigation / Telehealth Service

■ Telephonic Service

■ Patients diagnosed with Long Term Conditions

■ Promote Self Care

■ Promote Positive Behaviour Change

■ Support Front Line NHS Clinical Services

■ Skill mix within service of both qualified clinicians

(Nurse Care Navigators) and non qualified support

(Clinical Support Officers)

■ Staff trained in the deployment of Motivational

Interviewing

What does the Care Navigation /

Telehealth Service do?

Information Signpost Advocate Empower/

build skills

Care Navigation

Telemonitoring Health Coaching Post Crisis Support

Elements of Service provided by

the Care Navigation / Telehealth

Service Interchangeable and mutually supportive

Barnsley Care Navigation / Telehealth

Service

Care Navigation / Health Coaching

Pathways

Care Navigation / Health Coaching

Pathways

Nurse Care

Navigator works with

patient to identify

the appropriate

pathway to follow

Patient does

not identify

areas to change

Patient does

identify areas

to change

Care

Navigation

Health

Coaching

6 calls

12 weeks

6 calls

5 months

Barnsley Care Navigation / Telehealth

Service – Initial Outcomes

Potential benefits for the patient

Improved

understanding

of their illness

and raises

awareness of

useful services

Encourage

behaviour

change & self

care

Assists with the

reduction of

patient anxiety

Improved

patient

experience

Potential benefits for the NHS providers &

Commissioners

Potential

reduction in

hospital re-

admissions &

length of stay.

Ability to

prioritise

clinician

visiting

schedules

according to

need.

Ability to

potentially

reduce demand

on GP services.

Assists with the

management of

the increasing

prevalence of

LTC’s by

enabling

Specialist

Nurses to hold

larger clinical

caseloads

Results of Service Evaluation

(Bassetlaw CCG Area) Approximate 40% reduction in GP attendances of those

accessing Care Navigation / Health Coaching pathways.

Approximate 64% reduction in community nursing

emergency face to face contacts for those patients

accessing Care Navigation / Health Coaching.

Above data is based on a sample period of 6 months pre

and 6 months post service intervention.

Barnsley Care Navigation / Telehealth

Service – Referral Criteria

Care Navigation / Health Coaching Referral Criteria

Those diagnosed with a Long Term Condition who are:

– Over 18 years.

– Registered with GP within the Barnsley borough or resident.

– Need more information about their condition in order to become more self managing.

Why Refer?

Patient needs:

– More information about local services, self help programmes, financial services, social services etc, to meet their individual needs.

– help / support in accessing services (advocacy).

– regular telephonic support to comply with advice/treatment.

– help with motivation and confidence.

– help to change behaviour.

Service Contact Details / Hours of Operation

Barnsley Care Navigation / Telehealth Service

c/o Ward 2

Mount Vernon Hospital

Mount Vernon Road

Barnsley S70 4DP

Tel. 0800 612 1976 Email: carenavigators@nhs.net Web site: www.takecontrolbarnsley.co.uk Service operational: 7 days per week, 9.00 a.m. to 5.00 p.m.

Barnsley Care Navigation /

Telehealth Service – Patient Stories