New care models
New Care Models: Learning from the
care homes vanguards
William Roberts
25th May 2017
Our values: clinical engagement, patient involvement, local ownership, national support
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards
#futureNHS
www.england.nhs.uk/vanguards
#futureNHS
Our core values
Clinical
engagement
Patient
involvement
Local
ownership
National
support
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards
#futureNHS
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50 vanguards selected
5 new models of care with a total of 50 vanguards:
9
Integrated primary and acute
care systems
14
Multispecialty community
providers
6
Enhanced health in care homes
8
Urgent and emergency care
13
Acute care collaboration
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards
#futureNHS
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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
• In the first nine months of full operation those
implementing the model most comprehensively
have reduced emergency hospital admissions per
care home resident by 1.8% whilst in non
vanguards these have increased by 2.1%
• £125-305 per resident drug savings reported
• 7% reduction in oral nutritional support usage
• Reductions in ambulance call outs
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Our values: clinical engagement, patient involvement, local ownership, national support
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Vanguard
sites
What is the EHCH model about?
• Providing joined-up primary, community and secondary, social care to
residents of care/ nursing homes and Extra care Living Schemes (ECLS) via a
range of in-reach services.
• To deliver person-centred integrated preventative care that promotes
independence and supports individuals in an appropriate housing option of
their choosing
Why are we doing this?
• To improve the quality of life, healthcare and planning for people with LTCs in both care/ nursing homes, ELCS and the community
“I want to live as normal
a life as possible”
“I get the best clinical
outcomes possible”
“I want to feel part of
a community”
Our values: clinical engagement, patient involvement, local ownership, national support
www.england.nhs.uk/vanguards
#futureNHS
Vanguard
sites Enhanced
Health in Care Homes (EHCH) care model
Care element
1. Enhanced primary care support
Sub-element
Access to consistent, named GP and wider primary care service
Medicine reviews
Hydration and nutrition support
Access to out-of-hours/urgent care when needed
2. MDT in-reach support
Expert advice and care for those with the most complex needs
Helping professionals, carers and individuals with needs navigate the health and care system
3. Re-ablement and rehabilitation to support
independence
Reablement / rehabilitation 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
5. Joined up commissioning and collaboration
between health and social care
Co-production with providers and networked care homes
Shared contractual mechanisms to promote integration (including continuing healthcare)
Access to appropriate housing options
6. Workforce development
Training and development for social care provider staff
Joint workforce planning across all sectors
7. Harnessing data and technology
Linked health and social care data sets
Access to the care record and secure email
Our values: clinical engagement,Better
patient
local ownership, national support
use of involvement,
technology in care homes
www.england.nhs.uk/vanguards
#futureNHS
Vanguard
sites
• Based on the common coordinated
interventions being delivered in the
vanguards
• Significant research base to support
the model
• Framework published 29th September
• Aims to describe the care model and
describe plan for spread
• Care model has 7 core elements and
18 sub elements
• Intention to spread the care model
across England next year
Our values: clinical engagement, patient involvement, local ownership, national support
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Why
implement the
care model
Why implement the EHCH care model
• To provide equitable access, to high-quality NHS
healthcare for those who need it most
• To address growing acuity and complexity of need in an
underserved population
• To make best use of scarce resources and create costsaving opportunities
• Reductions in ambulance call outs; A&E attendances; and
non-elective admissions
• To implement proven changes, in a systematic and
consistent manner across England
Our values: clinical engagement, patient involvement, local ownership, national support
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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
•
Opportunities to apply the care model wider than just care homes
Our values: clinical engagement, patient involvement, local ownership, national support
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Learning from the
Vanguard sites
Getting started
• Spread of the EHCH care model isn’t about
decommissioning existing services where these work
well and fit local circumstance.
• You should build upon good practice that is already in
place in many areas, recognising differing levels of
existing provision against each element of the model.
• Other local factors such as clinical services available,
mix of system providers, digital and physical
infrastructure, and the local employment market will
also influence the pace at which each area can
implement the model.
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Our values: clinical engagement, patient involvement, local ownership, national support
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Learning from the
Vanguard sites
Bringing together the local system and benchmarking
against the framework is useful before you start
CCG name:
Select CCG name here
Insert CCG contact name here:
Insert CCG contact email here:
Please provide details of the partners who assisted in completing this selfassessment:
CCG/local authority/acute/community/care provider/voluntary sector/primary care
Care model element
Sub-element
Clinical elements
Access to consistent, named GP and wider primary
care services
Medicines reviews
1. Enhanced primary care support
Hydration and nutrition support
Out of hours/emergency support
Expert advice and support for those with the most
complex needs
2. MDT in-reach support
Helping professionals, carers and those with support
needs to navigate the system
Aligned rehabilitation and reablement services
3. Reablement and rehabilitation to promote
independence
Developing community assets to support resilience and
independence
End of life care
4. High quality end of life care and dementia care
Dementia care
Enabler elements
Co-production with providers and networked care
homes
5. Joined-up commissioning and collaboration
between health and social care
Shared contractual mechanisms
Access to appropriate housing options
Training and development for care staff
6. Workforce development
Joint workforce planning
Current status (in place - no change
required, in place - requires change,
being developed, not in place)
If not in place, please state estimated
date of completion or no current plans
• Most areas will have
some elements of the
care model in place
• Not everybody will
know what services all
already in place
• This process helps to
prioritise where to
invest
• A shared approach
allows the area to
design the service that
will work best for
them
Linked health and social care data sets
7. Harnessing data and technology
Access to care record and secure email
Better use of technology
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Our values: clinical engagement, patient involvement, local ownership, national support
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Learning from the
Vanguard sites
There are a wealth of resources available to support
model implementation, both regionally and nationally
•
•
We have brought these
resources together in
one place to make it
easier for areas to
identify how to
implement the
framework
This has been aligned
to the elements of the
framework so it easy to
see how these
resources can be used
to fill the gaps in
existing provision
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Our values: clinical engagement, patient involvement, local ownership, national support
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Learning from the
Vanguard sites
We have developed a methodology for identifying
care home residents from NHS data
•
•
This allows us to
understand the
population better and
identify where the
model could have the
biggest impact in terms
of supporting local
areas to enhance the
health of their care
home residents
We have developed a
simple excel tool to
help local areas
understand their data
and the potential
benefits they may
realise
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Our values: clinical engagement, patient involvement, local ownership, national support
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Learning from the
Vanguard sites
Care homes data
NHS-England have developed an algorithm which uses primary care information and
the CQC list of registered care homes to estimate the number of older people care
home residents and associated hospital activity, emergency admissions and total bed
days. For the first time, this data has enabled estimates of hospital activity from care
home residents to be produced. Our data includes 270,000 permanent older people
residents
THE SCALE OF HOSPITAL ACTIVITY FROM CARE HOMES
• There are around 320,000 permanent older people residents - around 3.5% of the
over 65 population;
• An average of 0.7 emergency admissions per resident [225,000 in total]. This
represents around 9% of the 2.4 million 65+ population emergency admissions;
• For comparison the overall 75+ population have on average 0.4 EAs pa and 85+
population 0.5 EAs pa.
• An average of 0.9 (type 1) A&E attendances per resident [300,000 in total];
• An average of 6 bed days per resident [around 1.9 million in total];
• 95% of total bed days are emergency bed days [around 1.8 million in total];
• The average length of stay for each emergency admission is around 8.5 days.
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Our values: clinical engagement, patient involvement, local ownership, national support
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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
Access to consistent, named GP and wider primary care services
1. Enhanced primary care support
< 1 year
Medicines reviews
Core
< 1 year
Hydration and nutrition support
Core
< 1 year
Out of hours/emergency support
Core
< 1 year
Expert advice and support for those with the most complex needs
2. MDT in-reach support
Core
Helping professionals, carers and those with support needs to navigate the
local system
Aligned and effective rehabilitation and reablement services
3. Reablement and rehabilitation to promote independence
Core
1 year – 2 years
Enhanced
1 year – 2 years
Core
< 1 year
Core
Developing community assets to support resilience and independence
4. High quality end of life care and dementia care
End of life care
Dementia care
1 year – 2 years
Core
< 1 year
Core
< 1 year
Enabler elements
Co-production with providers and networked care homes
5. Joined-up commissioning and collaboration between health and social
care
Shared contractual mechanisms
Access to appropriate housing options
6. Workforce development
Training and development for care staff
Joint workforce planning
Linked health and social care data sets
7. Harnessing data and technology
Access to care record and secure email
Core
< 1 year
Enhanced
1 year – 3 years
Enhanced
1-5 years
Core
< 1 year
Enhanced
1 year – 2 years
Enhanced
1-3 years
Enhanced
< 1 year
Enhanced
use of technology
1-3 years
Our values: clinical engagement,Betterpatient
involvement, local ownership,
national support
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Sharing
learning
We have in place a dedicated EHCH team
• Will work closely to support regional and local colleagues
• Benchmarked data on benefits realisation, including indicative
savings and benefits for
• Best practice operating models, templates, contracts and tools
to support the core elements of the framework
• Shared learning opportunities for peer to peer learning and
support, with national and regional support
• Sharing EHCH learning to help guide STPs, CCGs and local
authorities in getting started
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Our values: clinical engagement, patient involvement, local ownership, national support
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