NHS Waltham Forest Clinical Commissioning Group s Annual Nursing Conference Feedback

Transcription

1 NHS Waltham Forest Clinical Commissioning Group s Annual Nursing Conference Feedback November 2016

2 Document revision history Date Version Revision Comment Author/Editor Document approval Date Version Revision Role of approver Approver Director of Nursing, Quality and Governance Helen Davenport Page i

3 Contents 1 Context IT, communication and Engagement Discharge and Patient Journey Care Home Pilot Secondary Care Medicines Training and Education Quality Questions and Answers CCG Comments 4 Page ii

4 1 Context NHS Waltham Forest Clinical Commissioning Group (WF CCG) held their second Annual Nursing Conference on 28 November Key speakers included Dr Jackie Morris, Vice President and Heather Eardley, Director of Development for the Patients Association and Judy Downey Chair of the Relatives and Residents Association. Attendees included WF CCG staff, colleagues from North East London Foundation Trust (NELFT); Whipps Cross Hospital staff, colleagues from care and nursing homes and students from Leyton Sixth Form College. In this report the feedback has been compiled and themed and is included under the appropriate sub heading. 1.1 IT, communication and Engagement Updating appointments after leaving permanent address, appointment sent to previous address single computer system needed. Single Computer system across services to ensure information is correct. Better communication needed with CQC, patients and relatives There is no communication shared for/ within house services Language help for residents, communication needs, translators needed at the care home Some boroughs have forums to share good practice Should be a forum for voice of relatives/ carers CCG Comments: Healthwatch Waltham Forest were created by the Health and Social Care Act to represent the views of the patients and public Please see link to Carers First Waltham Forest website _Waltham_Forest 1.2 Discharge and Patient Journey Key issue- transfer of patients notes from GP to GPs incomplete PM HX Hospitals do not always send discharge papers CCG Comments: These should always be followed up. Whipps Cross Hospital has a discharge alert system whereby concerns regarding a discharge will be investigated. You can contact the CCG for the contact address. Hospital discharge are often late on Fridays and time is needed to assess plan of care CCG comments: Discharge should always be well planned and as we move towards 7 day services across health and social care the expectation is that discharge from hospital whether it be to home, a nursing home or residential home will happen seven days a week. However discharges late in the evening should be avoided if possible. A key issue is discharge summaries often having a lack of detail. CCG comments: A discharge alert should be raised but you should always contact the discharging service direct for any required information. Streamlining the discharge pathway/ transition from hospital to community Page 1

5 CCG comments: work is underway across our local health and social care system to work on how we integrate our services in a much simpler way that makes more sense for patients & residents of Waltham Forest. There will be information about how some services will work more collaboratively to support hospital discharge over the next couple of months. There is ongoing work to improve the continuing healthcare assessment process from assessment to placement. There needs to be far more community services to support patients out of hospital CCG comments: Plans from the Better Care Together Programmes and the Transforming Services agendas are redesigning system and processes that means more services are in the community rather than in hospitals. The plans have started to be implemented and are far ranging for instance running Out-patients in a different way to managing end of life care in the community to reduce the number who die in hospital. LD, language, culture, religion. This should be regularly included in pathway redesign Hospital discharge are often late on Fridays and time is needed to assess plan of care D2A model does not factor in 3 bed, should be home first CCG comments: The CCG have adopted the Red Bag Scheme which was initially piloted in Sutton. The red bag scheme easily identifies a resident who lives in a nursing home, provides standard paperwork about their medical history, current condition and personal belongings/ clothes for discharge. The scheme should allow the acute trust to begin discussions on discharge from an early point, resulting in shorter lengths of stay and a smoother transition between the home and hospital. The standard paperwork has a section for the acute hospital to complete prior to discharge which should eliminate current issues around the lack of discharge summary. 1.3 Care Home Pilot Within the care home pilot to look at increased involvement with patients families CCG response: This will be a priority for as it is important patient s families have involvement in local services. 1.4 Secondary Care Special needs patients to be fast tracked through A&E 1.5 Medicines More robust policies around administration of medication All are homes and hospital to have better integration re pharmacy medicines polypharmacy CCG comment: We hope the red bag will aid better practice in terms of medication errors and polypharmacy Should have named GP per patient, patient will see up to 5 different GPs, don t look at prescribing history. Medication review should be rolled out to other care homes Page 2

6 CCG comment: In 17/18 medication reviews will be offered to Care Homes in Waltham Forest when a need is identified. GP issues around GP knowledge of prescribing GP prescribing habits CCG response: General Practice have pharmacy support in order to improve prescribing habits. This will continue in 17/18. GPs not recording new medication on clinical system. Repeat scripts come back incorrect. Key issue not monitoring the use of medication, and if their necessary for the service user Not monitoring medication enough due to residents being sleepy through the day 1.6 Training and Education RRA s Keys To Care should be rolled out Need assistant practitioner roles Should be a national qualification, an NVQ includes placement Establish an academy- needs to be more than just talks Training and support across all care homes Consolidation of training- including practical and clinical supervision Lack of training is an issue, more investment needed. Student placements and shadow both hospital and community and align with journey across pathway Nurses in care homes should have formal training More people should have Keys to Care attached to training Care Academy with recognised qualification for students in sixth form. Roll out the keys to care to local care homes, starting with pilot sites underpinned by training Training- should be a care certification but require CPD along with integrated rotational programme for care home. Keys to Care implementation. Improve the career pathway Number of nursing programmes to rotate between care home and acute hospital Should be training for care home staff level 2 and 3 apprenticeship. Can they pull down apprenticeship level to skill up staff? Students work experience step into the NHS Young people key thing listening to stories and sharing. 6 th formers volunteering as befrienders links school for each care home? CCG comments: Significant 7 training has been offered to all pilot sites and will be spread to all care homes in Waltham Forest. The Significant 7 training will be offered on a train the trainer basis to domiciliary care workers. The CCG is scoping options to have local frailty training WF CCG are currently working on their Children and Young Peoples participation strategy in which Leyton Sixth Form College will be involved. Care homes will be given access to the key cards. Pilot homes have been given Significant 7 training which helps care workers to recognise the early warnings signs of deterioration in their residents, this training will continue in Page 3

7 1.7 Quality CCG needs to provide a layer of quality assurance between CQC and LA. Provide a quality improvement service to ensure homes can meet higher CQC standards CCG comments: The CCG and local authority will conduct quality visits to care/ nursing homes jointly. Any providers identified as raising a concern are placed on a performance improvement plan. Local Authority Contract Management and the CCG work closely with the provider to address the concerns raised. A follow up quality visit is conducted within an agreed timeframe, and a new RAG rating is determined. Monthly meetings are held by representatives from the CCG and local authority to share information and any soft intelligence on care providers. A spreadsheet of the care providers that are a subject of concern is maintained by the local authority contracts monitoring team, and updated at these meetings. Provider forums are held on a quarterly basis; these are utilised to highlight performance and quality concerns as well as an opportunity to identify and share best practice. Smaller provider focus groups have also been set up and these will look to develop approaches to improve service quality in key areas. These will then be shared via forums and other communication with providers. CCG Care Homes Pilot Scheme is in progress providing enhanced primary care support, the aim is to reduce ambulance call outs/conveyance to ED and reduced hospital admissions. Early indicators are positive. 1.8 Questions and Answers Q. Medicines optimisation presentation was excellent. Would like to know how this could be funded? A. The Medicines Optimisation (MO) team continue to be part of the enhanced care home project. If the home is included in the project, they will received support from the MO team. If they are not then this would need to be discussed with Helen and agree a work plan for all care homes that would work with current resources Q. How does discharge to assess support people returning to their residential care home? A. As well as discharge to assess the CCG have adopted the Red Bag Scheme which was initially piloted in Sutton. The red bag scheme easily identifies a resident who lives in a nursing home, provides standard paperwork about their medical history, current medical condition and personal belongings/ clothes for discharge. The scheme should allow the acute trust to begin discussions on discharge from an earlier point. 1.9 CCG Comments NHS Waltham Forest Clinical Commissioning Group would like to thank all who participated in our second annual nursing conference and for your feedback. We have shared and discussed your feedback within the quality and governance team to look how this can influence our future commissioning. Page 4