Working across health and care – collaboration between hospitals and care homes

Case study: Doncaster and Bassetlaw Teaching NHS Foundation Trust

Background to learning

The COVID-19 pandemic has emphasised the need for strong relationships between health and social care. During the pandemic, nursing colleagues in care homes and hospitals have collaborated to address shared challenges around infection, prevention and control (IPC) and the assessment of priority patients in care homes and safe discharge from hospital.

At Doncaster and Bassetlaw Teaching NHS Foundation Trust (DBTH) important systems and processes were already established and provided a strong base from which challenges such as disruption to discharge models, or outbreaks in care homes, could be tackled. This case study focuses on how these existing collaborative arrangements were enhanced to better support local care homes.

Learning and advice to be shared

A senior community IPC from Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH) was already in place and working with care homes across the patch. In preparing for the pandemic an additional matron from DBTH and band 7 hrs from RDASH were put in place to support the relevant work across health and care during the pandemic and an additional band 6 nursing role was added to create a new team. This team was able to build on established links with care homes across the patch to offer enhanced support in managing this extraordinary challenge.

The support offer included:

• A nominated single point of contact for advice and support for care home staff as an when required.
• IPC training delivered virtually through Zoom sessions.
• Support for fit testing of personal protective equipment in care homes.
• Support establishing safe visiting processes within homes ensuring this reflected national IPC advice and guidance

A multi-disciplinary team approach to discharge planning was already in place at the trust and effective IPC arrangements were designed to enable social care colleagues to continue to fully participate in discharge planning and keep discharge support on track.

Would it be beneficial to retain these changes?

This approach has received extremely positive feedback from many stakeholders and DBTH is considering with partners how these COVID-19 adaptations can be maintained and mainstreamed moving forwards. Many of the outputs of this collaboration, such as education packages around IPC, can be built on and used into the future.

An intense focus on enabling discharge through the provision of appropriate community support is crucial to supporting better outcomes and experience for those who can recover where they feel best – in their own homes. This strengthening of relationships between hospitals and care homes provides a collaborative backdrop for nurses across health and care coordinating and planning safe discharge.

Additionally, as restoration work continues, it remains important to ensure pathways to discharge are clear so that vulnerable groups, wherever they are, continue to be able to access optimal quality care.