Following publication of the third edition of the Enhanced health in care homes framework Dr Adrian Hayter reflects on how it has changed the way that primary care and social care work together, and how it can improve the way we care for people living in care homes.
The introduction of the Enhanced health in care homes (EHCH) Framework gave us an opportunity to deliver a more equitable service for those living in care homes. This realised the commitment in the NHS Long Term Plan to support the delivery of a proven model for people living in care homes, moving away from traditional reactive models of care delivery towards proactive care that is centred on the needs of individual residents, their families and care home staff. Its introduction during the pandemic also required us to consider how we care for these people in a different way.
Primary Care Networks must ensure that every care home is aligned to a named Primary Care Network and has a named clinical lead. A weekly ‘home round’ should be provided for residents who have been prioritised for review, based on clinical judgement and care home advice. Every resident should have a comprehensive personalised assessment of their needs and a personalised care and support plan within 7 days of being readmitted or admitted, into a care home.
From the outset we knew that delivering the same level of care to someone living in a care home through the EHCH model would require collaborative working between health, social care, voluntary, community and social enterprise (VCSE) sector and care home partners.
In my area the Enhanced health in care homes framework has enabled our local teams across health and social care to take a more multi-disciplinary approach. Our PCN has benefitted from employing clinical pharmacists through the additional roles scheme in primary care. Working with our clinical pharmacist has been invaluable. They provide Structured Medication Reviews, bringing time and expertise to help improve residents’ lives. They have helped us to improve the use and understanding of medications for residents as well as supporting the use of proxy access for care homes. This has led to better outcomes from improved medication use as well as supporting a ‘deprescribing agenda’ leading to less harm from medication for patients.
For our colleagues working in care homes, this set-up allows us to work together and gain a better understanding of how different professions from health and social care can support residents. Working in this way has enabled the whole team to come together, around the resident and deliver care that is really personalised to them.
For example, whilst rolling out the COVID-19 vaccination programme in my patch, the PCN and primary care vaccination teams collaborated with care home managers to ensure that our plans were practical and could be implemented in their homes. As a health and social care team working together, they engaged with staff and families on zoom calls to alleviate any concerns and bring vaccine confidence. This demonstrated the power of when healthcare and social care professionals come together and when they work with residents, carers and their families, how they can really deliver brilliant outcomes for residents.
I have recognised that the EHCH model has supported good shared decision making. I was recently involved in supporting a resident who wanted to adopt a comfort approach to her care and what was important to her was not taking a lot of unnecessary medication.
Through good shared decision making and with her having the capacity to make decisions we also involved her family. With our Practice Pharmacist we had carried out structured medication reviews and were able to start deprescribing medication according to her and her family’s wishes. Her long-term conditions were managed for several months with this approach and although she deteriorated slowly she was able to be supported by the care team, nurses, care assistants, kitchen and many others to be able to die peacefully in her own home – the care home. This approach took regular communication within the context of EHCH as well as support from community teams and her daughter. We worked as one team to offer care in the care home right up to the end of her life where she died in peace and with dignity.
This demonstrates the importance of the EHCH framework in bringing all of those concerned including individuals and their families to adopt a truly personalised care approach based on good communication underpinned by a care and support planning approach.
COVID was and is very challenging and teams across the country worked incredibly hard in difficult circumstances. But, it also changed the way we’ve worked together – and in many ways we’ve improved the way we work together for the better. It is clearer than ever that care can only be achieved through a whole-system, collaborative approach. The Enhanced health in care homes model is helping us deliver on this approach, strengthen our relationships across health and social care and crucially improve the quality of care we can offer.
If you’re interested in finding out more please visit NHS England » Enhanced health in care homes. This video outlines how teams work together to provide quality care for the people we care for. We also want to hear about how you and your colleagues are providing high quality care for care home residents –please email our team to share your stories.
The Enhanced health in care homes framework was first introduced in 2016 as a culmination of the work of the care homes vanguards, followed by a commitment in The NHS Long Term Plan to roll the EHCH framework out to all care homes in England by 2024. Version 2 of the framework was published in 2020, with associated contractual requirements for Primary Care Networks and community service providers starting soon after. Version 3.0 of the framework is published on our website.