Will care home improvement plans work?
Featured article -
24 October 2016
By SCIE’s Ewan King, director of business development and delivery
NHS England’s new framework for enhanced health in care homes provides a plan to improve the experience of thousands of people. But will it work? Taking what works well in one place, and making it happen elsewhere, is not always straightforward. But bringing good practice to scale - in this case excellent care homes - is the goal of NHS England's enhanced health in care homes (EHCH) framework.
There are six enhanced ‘Health in Care Home vanguards’ which are currently testing out the framework and which aim to offer older people better, joined-up health, care and rehabilitation services. The framework offers practical advice on how to implement it locally in a coordinated, sustainable way, and at scale.
Many parts of the model we would all recognise as longstanding features of good practice in social care: reablement; having multi-disciplinary teams; enhanced access to primary care; good medicine reviews; and co-production with residents. But bringing these components together, especially in a sector under financial pressure, has always been challenging. The sector also faces workforce shortages, fragmentation and poor IT.
To overcome these challenges, the model provides a blueprint for how the whole community can work together to bring such models to scale, using the collective skills and resources of the NHS, local authorities, communities and care providers. It outlines high level principles and useful illustrations, but leaves a lot of room for local areas to work out the best way of delivering the changes.
If successfully implemented, the model can bring about better outcomes and experiences for residents and families. According to Nigel Edwards, Chief Executive of the Nuffield Trust, "The care home vanguards combine a series of evidence based interventions in a very practical way that has direct benefits for care home residents. Work in vanguards, and by others working in a similar area, shows it works.”
Because there is much that is good out there that we can build on. In Sunderland they are rolling out an award winning information system which helps professionals spot early signs of illness amongst care home residents and Sutton’s Care Home Vanguard ‘Homes of Care’ – which SCIE and SQW are evaluating - has introduced a ‘red bag’ scheme which is a way to help people keep all their vital information in one place if they have to leave the a care home for hospital or vis versa.
Developing evidence suggests that, as well as many technical and practical improvements, the model also needs to be underpinned by good leadership, relationships between professional groups, and co-production with communities. In short, the right culture needs to be fostered. We already know from the evaluation we have started of the Sutton Vanguard, that good relationships are vital to the success of the initiative.
Viccie Nelson, Programme Director of the Sutton Homes of Care Vanguard, says they welcome the recent launch of the framework as a way of really transforming the way that health care is delivered across residential and nursing care homes nationally. Sutton Homes of Care has been implementing improved ways of collaborative working across health and social care as a key element of the vanguard programme, focusing on residents receiving the best quality of care. They are working with SCIE and SQW to evaluate the success of our vanguard programme and hope that our work will guide other CCGs in driving real change across local care homes.
Bringing enhanced care in homes to scale is a daunting challenge, but one we can start to overcome with coordinated effort and a clear evidence based to build from.