Update on the progress made by Airedale and Partners Enhanced Health in Care Homes Vanguard

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1 Report by the Programme Director for the Airedale and Partners Enhanced Health in Care Homes Vanguard to the meeting of the Health and Social Care Overview and Scrutiny Committee to be held on 24 March 2016 AU Subject: Update on the progress made by Airedale and Partners Enhanced Health in Care Homes Vanguard Summary statement: This report provides the committee with an update on the first 12 months of the Vanguard work which is an NHS England sponsored programme to install telemedicine into care and nursing homes to improve residents access to care and support when they need it, and to provide support for the care home workforce Portfolio: Report Contact: Helen Bourner Programme Director Airedale and Partners Vanguard Phone: / helen.bourner@anhst.nhs.uk Health and Social Care Overview & Scrutiny Area: Health and Social Care

2 1. Summary The committee received a report at its meeting in April 2015 about NHS England s New Models of Care initiative through which Airedale NHS Foundation Trust and partners applied to become a Vanguard scheme, installing telemedicine into care and nursing homes across the district to improve access for residents to health care, and supporting the workforce. This paper details the progress made by the Vanguard in the last 12 months and sets out the key aspects of the plans for 16/17. NOTE: in the remainder of this report, the term care homes will refer to residential, care and nursing homes, with or without EMI (elderly mental infirm) beds. 2. Background Airedale and Partners Enhanced Health in Care Homes Vanguard shared objective is: to 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 The work of the Vanguard extends beyond the boundaries of Bradford, and is working with Airedale Wharfedale and Craven CCG and care homes in the area and the East Lancashire CCG and care homes. The aim is to install telemedicine into all 240 care homes that are providing care for those over 65 years of age, with a maximum residential population of 7678 people. Bradford Districts and Bradford City CCGs recognised the contribution that telemedicine can make to supporting care home residents and care home staff in 2014 and funded installation of the service into a 49 homes across the city, particularly targeting those homes where there had been a significant number of A&E attendances, or a very high level of GP call outs. The CCGs used non recurrent monies to invest in telemedicine and are now keen to continue this investment as it aligns with the Complex Care work that will be introduced later this year which will see a targeted care home team created to work specifically into care homes. The Vanguard aims to fund the remaining 50 care homes for a period of 2 years (16/17 and 17/18) so every home will have access to telemedicine. NHS England has particular interest in telemedicine as they are keen to understand what impact it has in preventing the often unnecessary and stressful transfer of a care home resident to an A&E department, and ensuring that where other clinicians are called to a care home, it is the right clinician with the right skills at the right time. 2

3 3. Report issues 3.1 What is the telemedicine service? The Airedale Hospital telemedicine service provides a video link to care homes 24/7 which enables access to trained nursing staff. Care Homes can use this to get advice and guidance if they are concerned about a resident s health or general well-being, and in the case of a resident feeling unwell, or an incident such as a fall, the nurses in the telemedicine hub will carry out an assessment directly with the resident using the video link. At the end of the call, the staff will enter the details into the SystmOne clinical record, which is viewable by the resident s GP, thus providing immediate information for a GP on a resident s health. Where possible, and it is safe to do so, the aim of the service is to keep the resident in the care home. This is important as a transfer to an A&E department, and the possibility of an unavoidable admission to an acute hospital is enormously stressful for a resident, and if the resident needs an escort, can be challenging for the care homes, potentially leaving them understaffed. Once the nursing staff in the telemedicine hub have undertaken their assessment, if they believe that the resident can be kept in the care home they may ask care home staff to undertake a number of test or observations so the nursing staff in the telemedicine hub can monitor the resident over a number of hours. 3

4 If necessary, the telemedicine staff will phone for an ambulance to transfer the resident to hospital, or phone for a GP visit, or liaise with the district nursing staff. To help understand how the usage of health services by residents of care homes has been changed through the installation of telemedicine, at the end of each call, nursing staff ask the care home what would have happened if telemedicine had not been available to them. The responses since 7 December 2015 are set out below. Response Calls Called an ambulance 298 (11.6%) Contacted a GP 2007 (78%) Contacted a community nurse 125 (4.9%) Done nothing 137 (5.33%) Total incoming Calls 2567 Total Calls including follow up / monitoring call etc Part of the work that we will be doing in 2016/17 is bringing together all the data that is held in different parts of the NHS to enable us to understand the full impact of telemedicine on care homes and care home residents. This will involve information from: GP practices and Out of Hours GP services about the number of visits they have been asked to make to care homes, and the reasons why Ambulance services about the number of emergency blue light transfers to A&E departments from care homes A&E departments about the care home residents that attend, and the main causes Hospital medical admission departments to investigate the reasons that some care home residents are admitted, and how long they stay for The telemedicine hub for the calls that they receive, and the main reasons why 3.2 Scope of the Vanguard programme The Vanguard programme will seek to install telemedicine into the remaining 50 homes in Bradford, bringing the total installed in Bradford to 99. It is expected that this will be concluded in March/ April This is being done in conjunction with the CCG to ensure that telemedicine will be useful and supportive. In the cases of some homes where CQC inspections have highlighted particular issues, it may be that the installation will be deferred until required improvements are made. 3.3 Progress of the Vanguard Programme 15/ care homes now have the telemedicine link across the Vanguard catchment area Programme governance arrangements agreed, and monthly programme advisory group meetings have taken place since July 2015 (now bi monthly). There are more than 18 partners involved in the Vanguard, including the 4 CCGs in the area, three acute Trusts, GP practices (there is a nominated GP partner to represent the more than 130 GP practices across the patch), community/mental health provider, the University of Bradford, Alzheimer s Society, and Carers Resource A number of Engagement events have been held with care homes in all of the 4 CCG 4

5 areas to explain the Vanguard programme, benefits to them and how they can get involved. With such a large number of care homes we are keen to encourage care homes to work together on some of the pilot opportunities that we will be offering. Value Proposition (business case) submitted to NHS England for funds in 15/16 was successful Leads for the various work-streams confirmed: Enhanced Health (including technology and digital applications) Workforce Evaluation Communications Challenges we have faced in 15/16: The sheer scale of what we are doing with myriad partners has meant that relationship building has been a major part of our work, and taken more time than expected CQC inspections of care homes have found around 60% of care homes require some form of improvement and there have been a number of notices of closure. This has created some understandable tensions across health and social care, and has sometimes prevented care homes recognising the Vanguard as a positive opportunity 3.4 Plans for 16/17 A recent application to NHS England to pilot a social movement approach to supporting residents of care homes with dementia (and supporting their families and carers, as well as care home staff) was successful, and we will be testing this new way of working in a small number of care homes in Airedale Wharfedale and Craven. This will involve local organisations including private businesses; council services such as libraries; schools, and the various charitable bodies already working in this area. With the anticipated increase in dementia in care home residents (n. 5309), expected to rise by 14% by 2020, it is an urgent priority that we work together to find new ways to help manage dementia and its impact. Funding for this project is for 2 years (15/16 and 16/17) and we expect to start work by the summer 2016 Bradford Districts and City CCGs are developing a Complex Care service which will focus on improve the health of care home residents by creating a dedicated health team to work into all Bradford care homes. This will be supported by telemedicine so we are working together to scope the work required to ensure successful implementation. It is expected that this development will go live in one area of Bradford during Following on from recent CQC inspections which have found that 60% of care homes need to make improvements in some areas of the care they give to residents, there is a growing recognition that health and social care need to come together with care homes to co-produce a quality strategy for care homes. The Vanguard programme will coordinate and facilitate this work, and it is likely to be overseen by the Bradford Transformation Implementation Group (TIG). A proposal paper is being considered w/c March 14 th at the Out of Hospitals Programme Board (OOHPB). Establishing the two main work-streams as below, and some of the key work they will be developing and co-producing with care home managers and staff: 5

6 Enhanced health: including the testing of digital monitoring in a number of care homes to provide earlier detection of a resident s health deteriorating, which will enable earlier intervention (if appropriate). We expect to be in a position to agree pilot care homes in Spring 2016 Making outpatient appointments available through the telemedicine link to reduce the burden and stress of travelling to hospital/clinic. This work is being tested and is likely to go live summer Enabling 1-1 therapy and group therapy sessions through the telemedicine link which will enable the therapists in the area to do more as some of their travel will be reduced. This work build on the Out Patients work so will be planned for testing in Autumn Nurse prescribing, which will enable the nurses in the telemedicine hub to prescribe repeat prescriptions. This is often the reason for a GP call, so this service will improve speed for care homes, and reduce unnecessary demands on GP time. This requires completion by staff of a nurse prescribing training programme so is anticipated to go live when enough nurses in the hub have completed the course. Expected early Medicines optimisation, working with a lead pharmacist to review the medications prescribed to care home residents. On average residents are taking medications. Review will often bring this down to close to 6, and reducing medication is found to improve a resident s sense of wellbeing, and improve their mood and appetite. This work will require a joint working party with GP and pharmacy representation; it is hoped to start this work during the Spring. Deliver training and development programmes with care home staff that can be delivered through the telemedicine link, enabling them to access training at a time most suitable for them. Planning for this work is underway. Workforce Workforce planning to establish the needs of the care home sector in the future, in light of the soon to be implemented living wage, difficulty in recruiting trained and untrained staff Join forces with university and colleges locally to co-design skills training Explore joint employment opportunities between the NHS and care homes The Vanguard team has submitted a bid for 1.5m from NHS England for 16/17, no feedback has yet been received, although it is thought that ALL Vanguard funding bids will receive less than they have requested. 4. Options Members may wish to comment on any aspect of the report. 5. Recommendation 5.1 That the Committee notes the progress made in the first year for the Vanguard, and agrees to receive a further update in 12 months time. 6

7 6. Background documents None 7. Not for publication documents None 8. Appendices None 7