What transforming care looks like

The national new care models programme brings together local health and care systems as vanguards to radically redesign care for the local populations they serve. Tom Lindley used last week’s National Commissioning and Contracting Training Conference, to explain how the technology used in Airedale and Partners vanguard is changing care for people in care homes.

Here, in one of the most rural parts of the National Health Service, our clinicians are not just blessed with an excellent bedside manner. Increasingly, they are also becoming skilled in having a “webside manner” – as we harness the full potential of telemedicine to test out and develop a new model of care for the NHS.

We have adopted the same technology that NASA uses to ensure the health and well-being of their astronauts, like Major Tim Peake, as they orbit the Earth.

But our approach is generating significant benefits not in space but much closer to home, as part of a project that is unprecedented in its size and scope.

Everyone connected with the Airedale and Partners enhanced health in care homes vanguard is excited by the progress we have made since launching 18 months ago.

We are committed to improving the care – and end of life care – of no fewer than 7,500 people living in more than 200 nursing and residential care homes across our district.

It’s an area which spans more than 1,000 square miles and takes in part of three counties – North and West Yorkshire, and East Lancashire.

Our innovation is built around a 24/7, 365 day per year digital hub that provides care homes with immediate video access to a clinical advice service provided by senior nursing staff, supported by clinicians drawn from a range of specialties.

Our vanguard is already contributing to the delivery of the triple aim. We are doing this by reducing emergency activity, by keeping people safe and well in the place they call home, for longer; and ensuring that as far as possible, the right resources are deployed at the right time to care for people, enabling people to take greater control of their own care.

We are delighted to have the support of a wide range of cross-county partners – four clinical commissioning groups, three acute trusts, three local authorities, two community and mental health providers, more than 130 GP practices, a number of third sector organisations – such as Alzheimer’s Society and Sue Ryder – universities and colleges and more.

Differences in knowledge, understanding, priorities, ways of working and even language added to the sheer complexity of what was in front of us.

Not everyone has been on the same page at the same time, but through a shared view that we need to radically reconsider and redesign how we work together to provide care for the most elderly and frail in our society, we are making significant progress.

This autumn, the Care Quality Commission (CQC) praised the service as “outstanding”, “effective”, “immediate” and “expert”.

And as our robust evaluation of our work matures, the initial indications are proving very encouraging. Our latest five-month period revealed that we received 2,602 calls from care homes who, without our service, would have contacted a GP. Our intervention ensured that no referrals were made in 40 per cent of these cases, ensuring the resident could remain at home.

One of the greatest surprises has been how well the vast majority of elderly care home residents has adapted to talking with a nurse through a video link.

Most have not batted an eye at the prospect of sharing their stories in this way – perhaps showing up some of us in the next generation for our slow adaptation to technology and digital applications.

One of the challenges of our vanguard is to demonstrate that telemedicine really can work at scale, and can fit with and support local primary and community services as they undergo significant transformation. This isn’t about taking over from GPs, district nurses and specialist teams, it is about how we work together as a health and social care system and use different approaches to meet the ever growing demands of our population.

Working as part of the family of vanguards is inspiring – there are 50 of us in total – and we are learning and sharing with others and keeping each other motivated and enthused when the challenges seem insurmountable.

Added impetus has come from the recent launch by NHS England of the enhanced health in care homes framework, which sent out a strong message across health and social care.

By maximising opportunities in three key areas – clinical care, IT and technology, and workforce and commissioning – the care homes framework lays out a clear vision for the delivery of high quality and financially sustainable care.

New models of care, including the work of the vanguards, will also be key to the delivery of sustainability and transformation plans which are being developed across the country.

This shared approach feels like new ground for the NHS, but it is imperative if we are going to be able to continue to drive and innovate in the face of the current financial challenges.

Being part of the vanguard isn’t always easy, but I can confidently say that it has been a very rewarding year, and we are looking forward to the challenges that the new era ahead holds for us.

Tom Lindley

Interim Deputy Director – Strategy and Business Development Airedale NHS Foundation Trust.
Tom launched his NHS career with a number of roles as a mental health nurse, before joining the NHS Graduate Management Training Scheme. After roles working for Rotherham, Doncaster & South Humber NHS Foundation Trust; NHS England; and the Yorkshire and Humber Academic Health Science Network, he joined Airedale NHS Foundation Trust earlier this year and is closely involved in advancing the potential of its expanding range of telemedicine services.

The Foundation Trust has the lead role in the Airedale and Partners vanguard, which is using telemedicine in more than 200 care homes to help reduce GP call-outs and unnecessary hospital admissions for a cohort of more than 7,000 residents.