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

2. 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
£ 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%

3. 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

4. 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
Better use of technology

5. 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

6. 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

7. 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

8. 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
#futureNHS

9. 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

10. 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.