Nottingham City Clinical Commissioning Group

The vanguard and the people it serves

This vanguard’s vision is to enable residents living in a care home to be healthier, have a better quality of life and to be treated with dignity and respect, focusing on their capabilities rather than their dependencies.

Organisations and networks involved in the Nottingham City Clinical Commissioning Group led programme include:

  • Nottingham City Council
  • Nottingham CityCare Partnership
  • Nottingham University Hospitals
  • Nottinghamshire Healthcare
  • Age UK
  • University of Nottingham

The population supported by this vanguard is approximately 1,500 Nottingham City GP registered residents living in 53 non-specialist residential and nursing care homes. The average resident has six diagnoses and takes eight medications.

Currently, care homes residents are 0.5 per cent of the city’s population but account for five per cent of all hospital admissions. 100 people were admitted to hospital from a care home every month last year, and 26 per cent of residents have a life expectancy of one year or less.

What is changing?

The vanguard programme is set to improve the way that health and social care services are delivered in care homes. It has a particular focus on applying the use of technology in care homes and in working with pharmacy experts on medicines management.

There will be greater use of healthcare assistive technology such as blood pressure monitors and modern communications such as video consultations. Residents will also be encouraged to take part in activities that maintain or improve their health and wellbeing.

Key benefits

  • Older people receive the best possible care, in the right place, at the right time and retain their independence for as long as possible
  • Appropriate care and support in care homes prevents residents being unnecessarily admitted to hospital and enables quicker discharge
  • Patients approaching end of life receive high-quality care that supports them to live as well as possible until they die, and to die with dignity.

Contact Nottingham City Clinical Commissioning Group

Email: petra.davis@nottinghamcity.nhs.uk

Case studies

1.    Improving care through the understanding of a life before dementia

The Nottingham City dementia outreach team has begun a programme of training for care home staff to help them better understand the needs of individual patients with dementia and reduce unnecessary hospital admissions.

Initially the dementia outreach team worked with one resident’s daughter to develop a profile of her 54-year-old mum, who staff had found to be acting in an aggressive manner.

The daughter provided a lot of family history including photos and by building up an understanding of her life story and why she was acting in certain ways, the staff were supported to change their approach and improve her care.

She said: “The team saw Mum as a young woman, who was put in the position of being a carer for her siblings, just as they care for residents.

“There were photos of her dancing and drinking and messing about. They also heard of the hardships she endured and of the courage she displayed in adversity. Suddenly, she came vividly to life for them. When hearing of how she was bullied and physically assaulted by a gang of girls in the toilets at work, they suddenly understood her reaction when four people came at her to deliver personal care in the bathroom. And from that understanding came empathy and compassion.”

The daughter is helping the vanguard share this learning and has spoken to the Care Home Managers Forum. The dementia outreach team is now hoping others will ask to repeat this care model.

2.    ‘Worry catcher’ helps improve wellbeing in care homes

Age UK was commissioned to pilot a ‘worry catchers’ service, initially in two care homes, with worry catcher representatives speaking to residents about how their health and wellbeing could be improved.

Linda Crick from Age UK Nottinghamshire said: “We know a lot of people in care homes feel quite lonely and low. They know the staff are always busy and they ‘don’t want to make a fuss’.

“But this is their home and we wanted to find a way to respect that. The role of the worry catcher was born out of some research we carried out through the residents’ representative service that we already deliver.”

In one home, for example, the worry catcher volunteer found that men who lived on different floors of the care home were unaware that they had shared interests.

“They each told us independently of their love for football, cricket, racing and boxing, and about how they missed getting together with friends to share these interests,” said Linda.

“In our regular report we passed this information to the home manager, suggesting a gentlemen’s club that could offer pub-style games and evenings, watching sport on TV or DVD, purchasing a ‘race night’ pack for the club and for fundraising, and related reminiscence work with the group.

“The home has taken this on board and is now hosting a weekly ‘gentleman’s club’, which appears to be working well. This has without doubt enhanced the quality of life for these residents and has helped to build friendships between residents with common interests.”