Enhanced Health in Care Homes: Progress and learning William Roberts, EHCH Care Model Lead @WilliamR0b3rts

Enhanced Health in Care Homes Vanguard sites Enhanced Health in Care Homes 6 exemplar sites across the country Providing joined-up primary, community and secondary, social care to residents of care/ nursing homes and Extra care Living Schemes What the vanguards are doing differently is trying to do this is a joined up way across a place and population The how is as important as the what £125-305 per resident drug savings reported Care Home Vanguards Non-NCM Change from baseline period Emergency Admissions -0.5% 4.6% Bed Days -4.4% 1.5%

Significant research base to support the model Vanguard sites Based on the common coordinated interventions being delivered in the vanguards Significant research base to support the model Framework published 29th September 2016 Aims to describe the care model and describe plan for spread Care model has 7 core elements and 18 sub elements Clear signal to spread the care model

EHCH Care Model Framework and time to implement Learning from the Vanguard sites EHCH Care Model Framework and time to implement Care model element Sub-element Core or enhanced EHCH model Indicative pace of implementation (from standing start) Clinical elements 1. Enhanced primary care support Access to consistent, named GP and wider primary care services Core < 1 year Medicines reviews Hydration and nutrition support Out of hours/emergency support 2. MDT in-reach support Expert advice and support for those with the most complex needs 1 year – 2 years Helping professionals, carers and those with support needs to navigate the local system Enhanced 3. Reablement and rehabilitation to promote independence Aligned and effective rehabilitation and reablement services Developing community assets to support resilience and independence 4. High quality end of life care and dementia care End of life care Dementia care Enabler elements 5. Joined-up commissioning and collaboration between health and social care Co-production with providers and networked care homes Shared contractual mechanisms 1 year – 3 years Access to appropriate housing options 1-5 years 6. Workforce development Training and development for care staff Joint workforce planning 7. Harnessing data and technology Linked health and social care data sets 1-3 years Access to care record and secure email Better use of technology

Learning from the Vanguard sites What have we learned from the care home vanguards Person centred approach essential and focus on the populations health Build collaborative system leadership and relationships around a shared vision for the population Care homes critical partner in the work at all stages Able to see very quick benefits for residents, providers and wider system Not one change that makes a difference, requires a coordinated approach to improvement as isolated initiatives may create unwanted consequences Opportunities to apply the care model wider than just care homes with homecare, extra care housing and wider complex care needs management adaptable to the model Can drive and develop better relationships between commissioners and providers Great work goes on all over the country, but it needs building upon and coordinating

Why we want to spread the EHCH care model What to spread To provide equitable access, to high-quality NHS healthcare for those who need it most To improve the quality of care the individual receives across the system To address growing acuity and complexity of need in an underserved population To make best use of scarce resources and create cost-saving opportunities for commissioners and providers Reductions in unnecessary NHS activity and increase time spent at home To implement proven changes, in a systematic and consistent manner across England

What have we learnt from trying to spread the model Learning from spread What have we learnt from trying to spread the model There is a huge appetite to spread the model wider Many local areas have strong foundations on which to build The care elements of the model are more widespread then the enabler elements Care home provider engagement is variable nationally Coordination of multiple initiatives appears to be key locally Learning and sharing in communities of practice and care is an essential part of the process

CCG Self-Assessed RAG Ratings Against Sub-Elements of EHCH Framework Learning from spread CCG Self-Assessed RAG Ratings Against Sub-Elements of EHCH Framework The chart below depicts the national RAG rating against each sub-element as per the data in the previous table. Not in place In place - requires change Implementation already In place No. of CCG Response Our values: clinical engagement, patient involvement, local ownership, national support www.england.nhs.uk/vanguards #futureNHS

What support is needed to implement the model Implementation A. Getting started support Access to FutureNHS Platform EHCH resource guide EHCH Framework Getting Started Pack B. Materials Vanguard Learning Guide Low Cost/High Impact opportunities Access to relevant NCM products Tips for engaging care homes providers C. National policy National policy support on areas that support delivery of the model D. Regional resource Named contact in national team and signposting to national and regional expertise Links to regional NCM team members E. Network learning Calls/ webexes with national or regional team Connections and networking support to link sites with wider ALB colleagues F. Bespoke support Face to face visit from national and/or regional colleagues Bespoke local work to develop solutions

Learning guides to support spread Implementation Co-produced with clinicians, commissioners and project managers from across CCGs and local authorities, with input from NHS England expert teams. Provide detail on how the care model element supports the model, vanguard service models and innovation, things to consider and avoid, a ‘to do’ list, and how these interventions benefit care home residents, staff and the wider system. Include links to a wide range of service specifications, job descriptions, vanguard tools and other materials. Aligned with ‘Quick Guides’ produced by NHSE Hospital to Home team (formerly OHUC). A range of Learning from Vanguards guides now available on Kahootz for all to access. We also have a ‘Low Cost/High Impact’ guide in development which outlines quick win’ interventions from the Enhanced Health in Care Home vanguards that can be implemented rapidly and with little to no funding.