Leading change

The Advanced Nurse Practitioner at North Staffordshire Combined Healthcare NHS Trust led on the development and implementation of a new Care Home Coordination Centre (CHCC) to support people living in care homes to remain in their homes where safe and appropriate to so do. This clinical pathway redesign is resulting in reduced hospital attendance and admission and supporting people to be seen at home.

Where to look

Quality Watch (2015) estimated that around 325,000 older people live in care homes in England representing around four per cent of people aged 65 and over. These residents have both health and social care needs. The report highlighted that care home residents have 40-50% more attendances at A&E and non-elective admissions to hospital than the general population aged 75 and over.

The Advanced Nurse Practitioner identified that hospital admission rates from the 87 care homes in North Staffordshire and Stoke on Trent was increasing, reflective of an ageing population. Whilst investigating the admissions, the advanced nurse practitioner identified unwarranted variation in practice regarding services working collaboratively with the care home sector to adequately meet the complex health and social care needs of this growing cohort.

What to change

North Staffordshire Combined Healthcare NHS Trust is a provider of mental health, social care and learning disability services in the West Midlands. The nursing leads identified that there were several services providing community based interventions for care home residents. Through discussion with the local care homes it was identified that support to care homes in the area would be welcomed in a bid to increase effective co-ordination, capacity and appropriate clinical governance. Together, this could result in a reduction of avoidable hospital admissions and provide holistic care including improved end of life care. The GP Federation successfully bid for funding to commence a 9-month project to implement change and embed a new coordination service.

How to change

Working collaboratively under the local Alliance Board consisting of the GP Federation, Staffordshire and Stoke on Trent Partnership Trust (SSOTP), North Staffordshire Combined Healthcare Trust (NSCHT) and the local councils in conjunction with the Clinical Commissioning Group (CCG) a service outline was agreed. The service’s primary aim was to support people living in care homes to remain in their homes where safe and appropriate.

A Care Home Coordination Centre (CHCC) was established consisting of a small team of nurses covering all 87 residential and nursing care homes for older people in North Staffordshire and Stoke on Trent. The 28 care homes with the highest admission rates were identified as the pilot cohort. Community GP services, local hospices, community home physiotherapy and care home pharmacists were also involved and engaged with the scheme.

A Band 7 Advanced Nurse Practitioner (ANP) from older person’s mental health services with experience of working in care homes was allocated to support the leadership and development of the project supported by a Band 7 Clinical Lead Nurse to the CHCC.

Formed in December 2017, the Care Home Co-ordination Centre (CHCC) was rolled out as part of the CQC Local System Action Plan designed to address this need and other local issues. The CHCC service includes:

• Visiting the care homes to introduce the service;
• Providing a direct telephone referral route into the service;
• A daily supportive call to the 28 identified care homes;
• Establishing a robust triage process;
• Devising a poster/leaflet to promote the service;
• Developing effective collaborative working with the GP’s attached to the team;
• Contributing to the updating of the Care Home Resource Pack;
• Utilising Skype for remote face to face consultations;
• Co-ordinating GP visits to the care homes;
• Enabling GPs to promote good end of life care; and,
• Offering care homes support from a care home pharmacist to initiate Homely Remedy policies and training for their residents.

Adding value

Better outcomes – Initial results have been encouraging and a comparison of the 28 care homes selected for the project and other care homes has shown a 10% reduction in A&E attendance and admission to hospital. The service has contributed to improved comprehension of the interface between primary and secondary care and care homes. The coordination role has also had positive benefits on the care homes’ access to the range of community services available to residents.

Better experience – Qualitative case studies have reflected better experiences of care home staff and residents. These include: greater trust between care home staff and health staff; residents are more likely to be treated in and, therefore stay in, their own home; and, empowering patients and care staff to be actively involved care.

Better use of resources – A co-located service delivery has led to reduced duplication which is likely in the long term to have positive cost implications. Support can be tailored now that patterns and trends of referrals from care homes are established. A comprehensive understanding of the different needs of care homes has had positive implications.

Challenges and lessons learnt for implementation

The programme has led to a better understanding of the challenges faced by care homes as well as the complexity of the system in which they work.

The nursing leadership has been an essential element of this project and key to its success.

Due to the success of the pilot further options such as a Skype digital venture are being implemented for consultations in care homes.

Find out more

For more information contact:

• Claire Barnett, Advanced Nurse Practitioner, North Staffordshire Combined NHS Foundation Trust, Clairel.Barnett@combined.nhs.uk
• Stephanie Zahorodnyj, Care Home Liaison Team Manager, North Staffordshire Combined NHS Foundation Trust, Stephaniej.Zahorodnyj@combined.nhs.uk