The nursing leads at Nottingham City Clinical Commissioning Group (NCCCG) led on the development and implementation of an Early Intervention Practitioners service for care homes. This programme of work has improved the experiences of residents as well as the use of resources across the region.
Where to look
NHS Nottingham City CCG commissions health services for the local population and this includes the commissioning of care homes within the city ensuring they meet the health and social care needs of approximately 1,500 residents. A learning event was held following identification of a reduction in the number of care home placements being available for the city’s residents. The learning event considered existing processes to support homes and looked to identify opportunities for collaborative working and quality improvement to ensure other homes remained safe and supported. The event highlighted that by collecting robust care home quality and performance data as well as feedback from care home providers, the CCG would be able to offer early support to the home to avoid further closures. This approach was supported by national serious case review recommendations related to care home residents.
What to change
The nursing leads identified unwarranted variation in the lack of a standardised approach to care home provider monitoring, as well as the support available to them should they need this across the city. In practice this meant that appropriate support and remedial actions weren’t always available for all care homes in a timely way which in turn led to increased pressure upon all parties to act fast.
It is widely acknowledged that care homes are integral to the transformation required around the out of hospital and personalisation plans and commissioners recognised their role in supporting this. NCCCG identified the need to develop systems and processes as well as offer an alternative approach in the shape of support and guidance to their care home providers.
How to change
An Early Intervention Practitioner service was commissioned to include nursing and social care staff and piloted within the region. The purpose of the service is to ensure robust support, advice and positive interventions are in place to support homes to improve the delivery of care within the residences. Overseen by the Senior CCG nurse, the commissioners were able to use the data and information gathered from the service to interpret performance and quality across the locality by feeding this into their digital care homes dashboard.
The importance of the Early Intervention Practitioner role was about building relationships between care homes and commissioning organisations working in partnership and understanding the needs and individual priorities; this particularly resonated with the nursing role.
The services offered include:
- Training for carers and nurses ensuring residents who may be at risk of a deteriorating health condition are fully supported.
- Coaching/mentoring and supervision
- Walk-arounds of the home to help advise and support staff to improve safety, cleanliness and engagement with residents.
- Shadowing and working alongside carers, nurses and managers.
- Role modelling good practice.
- Advice and support in implementing changes to process and procedure, such as handover, supervision, rotas and staff deployment.
- Brokering discussions between the care home and other agencies.
- Sign posting to external training and learning opportunities.
Better outcomes – The service has been embraced by care homes across Nottingham. Homes report the service has made a direct impact on residents’ experience and safety. An independent external evaluation has been commissioned which demonstrated key stakeholders felt the service had improved the quality of care and the experience of residents and relatives
There have been numerous examples of where the service has supported care homes who were experiencing difficulties affecting their ability to function effectively and this has been resolved so the home wasn’t forced to close and residents could remain in their homes.
Better experience – The new service has been shown to help improve the knowledge and confidence of the care staff within the home which in turn supports them in caring for the residents. The guidance and critical friend approach offered was welcomed and has been a real success of the service.
Better use of resources – Evaluation has highlighted the proactive nature of the service meaning that support is offered early and tailored to meet the homes’ needs saving time, resources and money.
Challenges and lessons learnt for implementation
Early intervention is key and this needs real time information sharing and data.
There are numerous demands upon care homes so there is a need to coordinate approaches to ensure care homes don’t become overwhelmed.
Active engagement from care homes and their managers is vital to sustained success of a programme such as this.
Having a clear protocol and pathway as to who qualifies for early intervention support and identify the key areas you are going to be focusing on is important so everyone is clear what is needed and when. This includes measurable goals and an exit strategy.
For more information contact:
- Rhonda Christian, Adult Safeguarding and Mental Capacity Act Practitioner, Rhondachristian@nhs.net