How blurring the lines between health and social care can benefit local communities

Hertfordshire has a proud record of working in partnership across health and social care. It’s not something new, and they have been doing it for over a decade as Iain Macbeath, Director of Health and Community Services Hertfordshire County Council and part of the East and North Hertfordshire vanguard explains in this blog following a session at The National Children and Adult Service Conference today (2 November).

In 2012 we pooled resources between local government and health through the Better Care Fund, giving us more opportunities to work together on a much bigger scale.

This financial year we pooled £230 million, giving us one of the largest funds in the country and next year the figure will rise to £580 million.

One of the areas where this is having a significant effect is our enhanced health in care homes vanguard, which is part of the national new care models programme.

Our vanguard has many strands – all aimed at keeping our frail, elderly residents healthy, independent and, importantly, out of A&E and hospital beds.

East and North Hertfordshire has 92 care homes with around  3,000 older residents, and just over 2,000 receiving care in their own homes.

In 2014, with our partners – East and North Hertfordshire Clinical Commissioning Group and Hertfordshire Care Providers Association (HCPA) – we successfully secured funding for our vanguard programme, based on our belief that together we could deliver some real change to the sector and build much needed capacity.

Our aim is to deliver an enhanced model of health and social care to support frail elderly patients, and those with multiple, complex long term conditions, in the community, in a planned, proactive and preventative way.

The programme has been running for 18 months and has started to deliver results.

Along with HCPA, we have delivered a programme of training to 165 ‘Champions’ in 22 care homes as part of the ‘Complex Care Premium’ which specifically targets people with increasingly complex needs in terms of dementia, falls, nutrition, wounds and general health care, including end of life care.

Our care home pharmacy team has reviewed 846 care home residents and 7,872 medicines. 12 per cent of all medicines have been stopped and direct drug cost reductions are around £133 per patient with potential savings on hospital admission costs  of £292,160*.

‘Home First’, a rapid response service which supports people to remain at home has been rolled out in two of our localities and is scheduled to be introduced in the remaining four as part of the vanguard programme.

Home First brings together health and social care services to deliver:

  • improved access to rapid support with care from the right professional
  • better communication between people using services and health and social care professionals working as part of the same team
  • reduced A&E attendance and unplanned hospital admissions or residential care
  • rapid discharge from acute hospitals.

Another initiative aimed at keeping elderly people at home is our ‘early intervention vehicles’. Working with East of England Ambulance NHS Trust, we have introduced two vehicles providing immediate response, via screened 999 calls, to elderly residents in east and north Hertfordshire with the primary role of maintaining independent living in their own homes.

In the first 15 weeks, 75% of the calls attended resulted in patients remaining at home, an estimated net saving of £109,025 (based on 93 A&E attendances of which 70 (75%) will be admitted).

Another new service is our ‘trusted assessor’, employed by HCPA and working with the Lister Hospital discharge team (part of East and North Herts NHS Trust) to conduct assessments on behalf of care homes. This replaces the need for busy care home managers to visit residents in hospital to make their own assessments and so speeds up patient discharge.

Without the close working relationships, universal support and understanding with our partners and the input of a whole range of professionals, including our local mental health trust, community nursing, pharmacy, these schemes and many others would not be possible.

Our vanguard project is work in progress, but it is a real example of how blurring the lines across health and social care, and building trust between organisations can work for the benefit of residents in our community.

*Using Rio tool.

Iain Macbeth

Iain MacBeath is Strategic Director of Health and Wellbeing at Bradford Metropolitan District Council.

Previously Iain was Director of Health and Community Services for Hertfordshire County Council with responsibility for adult social care, integration with NHS services and adult learning.

Iain started work as a civil servant for the Benefits Agency (as was). He then worked for social services in his home town of Barnsley in both children’s and adult’s services. After moving to Hertfordshire in 1999, he spent five years working for the Probation Service, returned to social services for London Borough of Barnet and became Assistant Director of Adult Care Services for Hertfordshire in 2008. He became director in 2013.

Iain sits on the national Executive Committee of the Association of Directors of Adult Social Services and is secretary and vice-chair of the eastern region branch. He has served as a governor for West Herts College and volunteers with the Samaritans.

Follow Iain on Twitter: @IainMacbeath.