Senate Forum Meeting

Clinical Senate Forum 25 May 2017: Enhancing health in care homes – leading a whole system response

The Clinical Senate Forum in January 2017 focused on out of hospital care and shared experiences and learning from a range of different initiatives being implemented across London, exploring factors that enable successful and sustainable change. We noted then that enhancing and expanding care out of hospital is a core, and critical, part of London’s five sustainability and transformation partnerships’ plans (STPs) and so we continued this theme in May 2017 and focused on improving health in care homes, which is a key part of the overall approach that STPs are taking to meet older people’s needs and one that requires an integrated, whole system response. Meeting the needs of a growing and ageing population is one of the key challenges for our health and care systems. Whilst overall London has a younger population than other parts of the country, the number of Londoners aged over 80 is rising and is predicted to increase by 40% over the next 15 years. As the greatest users of health and care services we need to consider how to best meet the needs of older people, particularly the frail elderly, supporting them to have the best possible quality of life and care. The recently published Next Steps for the NHS Five Year Forward View, describes the task clearly; “As people live longer lives the NHS needs to adapt to their needs, helping frail and older people stay healthy and independent, avoiding hospital stays where possible. To improve prevention and care for patients, as well as to place the NHS on a more sustainable footing, the NHS Five Year Forward View called for better integration of GP, community health, mental health and hospital services, as well as more joined up working with home care and care homes”. Many people living in care homes have complex needs, for example limited mobility, falls risks, dementia, incontinence, cardiovascular and cardiorespiratory disease, often with multiple prescribed medications. There is significant evidence that a more proactive approach and more responsive support can improve health and quality of life, breaking the cycle of emergency admission, delayed discharge, reducing independence and subsequent re-admission that many frail older people experience. Next Steps for the NHS Five Year Forward View highlights early results from parts of the country that have started doing this – the “care home vanguard” areas, which include the Sutton Homes of Care Vanguard in South West London, are seeing slower growth in emergency hospitalisations and less time spent in hospital compared to the rest of the country, with the difference particularly noticeable for people over 75, and meaningful savings from reducing unnecessary prescribing costs. Approximately 29,000 people live in nursing or residential homes in London, though there is significant variation in provision across our boroughs. It is well recognised that many challenges exist within the care home market,  and we need to acknowledge that challenges also exist in provision of domiciliary care. The framework for enhanced health in care homes, developed by NHS England’s New Care Models team with the six care home vanguards, describes the care and quality, financial and organisational barriers that in many parts of the country are holding back the care for people living in care homes or who are at risk of losing their independence. London is no exception. The framework provides an approach to tackling these issues with a suite of evidence-based interventions, which are designed to be delivered within and around a care home in a coordinated manner to improve the quality of life, healthcare and planning for residents. Enhancing health in care homes through more integrated working should be everybody’s business. Through this meeting we:

  1. Considered the needs of ageing and frail elderly Londoners living in care homes and the opportunities to improve their health and well-being as a key part of wider health and care transformation plans;
  2. Improved participant’s understanding of London’s care home market and the issues faced by providers of care and commissioners; and
  3. Shared examples of innovation and good practice to improve health and well-being, quality of care and care planning and the impact they are having and consider how these initiatives could be progressed at greater scale across London.

This programme for the meeting is available here. Professor Oliver Shanley OBE, Regional Chief Nurse, NHS England and NHS Improvement (London Region) opened the meeting, outlining the aims of this Forum and its relevance in supporting improvement across London (click here for slides).Suzanne Peppitt then very powerfully talked about making care homes a new beginning: a relative’s perspective. Aileen Buckton, Executive Director for Community Services, Community Services Directorate, London Borough of Lewisham & London ADASS Branch Chair, then gave an overview of London’s care home market (click here) and William Roberts, National Lead for Enhanced Care in Care Homes, New Care Models Programme, NHS England shared learning from the care home vanguards (click here). With the scene firmly set and the opportunities to enhance health in care homes and the benefits clear, nine examples of innovation and good practice were shared and discussed to explore and disseminate approaches, impact and learning. Information on each is included below. Sutton Homes of Care Vanguard, one of six care home vanguards within NHS England’s New Care Models programme, shared the vanguard’s overall programme of work with a focus on three key elements: Quality and Assurance; Workforce Education and Training and the Hospital Transfer Pathway (aka “the red bag”). The Health Innovation Network (HIN) shared an overview of the HIN’s work in residential and nursing homes and learning about developing a care home network and adoption and spread (illustrated through adoption and spread of “the red bag”). Health 1000: The Wellness Practice shared learning from supporting care homes in considered whether enhanced primary care in nursing homes in Havering is effective. Focused, coordinated care for people living with long term conditions. IUC Pilots: Fast Access to a GP via the *lines for health care professionals. Colleagues shared learning from pilots introduced last winter to respond to pressures across the urgent and emergency care system, which included testing an improved response to calls from care homes with Fast access to a GP. The Argyle Surgery in Ealing, North West London, shared outcomes and learning from a proactive multidisciplinary team approach to intensive management of nursing home patients four years on. The Argyle Care Home Service and  infographic. The London Dementia Network shared models of service delivery which have proved effective in supporting care home staff in meeting the needs of people with dementia and behavioural and psychological symptoms; and care pathway overview. St Christopher’s Hospice shared the approach and learning through reaching out to implement an end-of-life care programme in care homes (see the summary report). Mouth Care Matters – improving the oral health and general health of older adults. This is a programme developed by Health Education England to educate staff about the importance of identifying and meeting people’s mouth care needs, an area often neglected in care homes. Mouth Care Matters. The vital role our senses play in ensuring good physical and mental health are often overlooked. Colleagues from NHS England and the NIHR NWL CLAHRC discussed why good sensory health is important to quality of life and independence for older adults and shared models of delivery. Eye health needs for older adults; What Works – hearing loss and healthy ageing; Commissioning services for people with hearing loss.

A SUMMARY REPORT with reflections and recommendations from this Forum can be accessed here. It also includes key messages from each speaker; further information about the examples of good practice shared and discussed with contact details of colleagues leading their development and delivery; key points from STP group discussions and links to some further resources to support enhancing health in care homes.