Care Homes Support Transformation Presentation to the CCG Governing - - PowerPoint PPT Presentation

Care Homes Support Transformation

Presentation to the CCG Governing Body

Introductions

Kieran Houser – Head of Out of Hospital Care and Transformation (CCG) Dr Rachel Tunbridge – GP at East Croydon Medical Centre and CCG Clinical Lead for Care Homes

• 131 homes
• 2,700 beds

Purley and East Croydon have highest number of nursing and residential homes Croydon has the largest care home market of any London council:

The case for change

Croydon has among the highest rate of ambulance call out rates in London: 2115 incidents in care homes between March 2017 and March 2018. Between March 2017 and March 2018, care home residents accounted for:

• More than 2,000 non-elective admissions – 90% of these at Croydon University Hospital
• 16,000 acute bed days

There are normally considerable delays in getting care home resident back to the their home – 2,300 delayed days in 2017/18 (24% of all delayed days). Non-elective admissions for care home residents tend be long – the average acute length of stay for a care home resident in 2017/18 was 11.8 days. People who are over 65s from care homes, more likely to be admitted than patients who are not from care homes. Outcomes for patients who remain in hospital for an extended stay are likely to be poor: hospital acquired infections, de-conditioning, risk of falls etc.

The case for change

Croydon Local Authority (LA) and Croydon Clinical Commissioning Group (CCG) fund approximately a third of all care home residents in the borough:

• Another third are funded by other local authorities
• The final third is made up of those who fund themselves.

There is no existing competency and training framework for care home staff

National evidence shows that up to a quarter of care home residents will die within 1 year

• f admission (30% for nursing home residents, 22% for residential home residents).

So transforming support to care homes to reduce avoidable admissions and improve quality of life for residents is essential – both for the residents of the borough and for the local health system.

Residential home residents are increasingly frail and complex – 45% of care homes admissions are nursing home residents.

How are we proposing to address these challenges?

Desired Outcomes

• Nursing and residential homes supported to provide more care in the

home, rather than conveying

• Fewer Ambulance call outs
• Fewer A&E attendances and Non-elective hospital admissions

Reduced demand for GP Primary Care in and out of hours

• Fewer calls to NHS 111
• Enhanced Local Directory of Service
• Prioritised Community Services delivered with greater efficiency

Supported and sustainable care home model

• Positive CQC inspections – Reassurance for relatives and carers
• Reduced LoS following admission

Current model

Planned support Proactive care Un-planned support Re-active support

Telemedicine support

24/7 access for care homes to clinical triage hub via HD video phone

• Integrated into local DoS
• Well connected to local services such as

rapid response and complex care support

• Significant reduction in unscheduled

demand on GPs

Co-ordinated specialist and enhanced primary care planned support Effective bed commissioning

)

• Support to care homes coordinated based
• n GP networks
• Complex care support team supporting

care home residents

• Different teams/agencies inputting into

care homes aligned to move towards MDT support

• Joint CCG/Local Authority commissioning

strategy

• Combined bed requirements mapped and

more efficient use of bed stock

• Commissioning based on outcomes with

strengthened accountability

• Commissioning linked to workforce

development Three tier response when homes have an concern about a resident: 1. 24/7 clinical triage via HD videophone available through telemedicine 2. If face to face contact needed following triage, rapid response or GP (in hours) or OOH GP called 3. 999/conveyance to ED only if appropriate. If triage or face to face response deems no conveyance necessary, then appropriate follow up support organised as part of MDT support

Workforce development

Regular training programme provided with investment from CCG:

• Designed and led by clinicians
• Aligned to CQC domains (with ambitions to seen

endorsement from CQC and accreditation from a university)

• Improve confidence and competencies of

workforce

Target operating model

Adopting national best practice

• Introducing ‘red bag’ scheme to Croydon

homes, to improve flow through Acute system

Coordinated urgent response

Timeline and next steps

• January to June 2018 – business case developed
• July 2018 – care home strategy board (plus sub-groups) established
• September 2018 – business case sign-off
• October 2018 – red bags delivered to care homes for use by nurses/carers/residents
• November 2018 – other initiatives go into implementation
• March 2019 – evaluation of red bags and further roll-out
• March 2019 – evaluation of implementation to date and further actions taken

Any questions?