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Vanguards: support for care home staff

In the second article in our three-part series on vanguards, we look at care homes. Care home vanguards offer staff the opportunity to develop their clinical skills, resulting in fewer residents being sent to hospital for treatment or end of life care.

Care home staff often lack the support – and sometimes the skills – to keep residents out of hospital.

This will change if the joined-up working set out in NHS chief executive Simon Stevens’ blueprint for the health service in England, achieves its aims.

The Five Year Forward View is being implemented by organisations working together in new ways in vanguard areas, and supported by funding from a £200 million transformation fund.

Nurse Melanie Brannan (left) and care assistant Tracy Allen change a dressing for Bryan Hills at Hemsworth Park care home

Picture credit: Jim Varney

Six vanguards are working with care homes to improve care for residents and reduce the strain on the NHS. As with the other vanguards, the ultimate aim is to make their innovations the norm across England.

Many NHS services in the vanguard areas already had close links with care homes, but vanguard status – and its accompanying funds – is allowing them to expand this work.

In Nottingham, an arrangement to send community nurses into care homes to support residents for up to eight weeks following discharge from hospital is being extended across the city.

‘Before the service was implemented I would see people in their own homes and patients who were in a care home but it was very limited,’ says Nottingham district nurse Betty Murphy. ‘Now, the staff know we are there to help them.’

Joined-up services for care homes

Community nurses go into care homes to support residents following hospital discharge.

Specialist nurses assess newly admitted residents and provide a gateway to additional care.

They also:

Work in partnership with the community geriatrician.

Access hospital test results.

Hold training sessions for care home staff.

Pay care homes if they train staff to provide complex care.

Enable increased referral to services such as mental health, tissue viability and dietetics.

Improve communication with hospitals at residents’ admission and discharge.

Encourage contact with the community to prevent residents from feeling isolated.

The Nottingham care home vanguard is drawing on the skills of specialist nurses such as Paulette Wint, who assesses new residents and acts as the gateway to additional care. She ensures a care plan is in place and any problems are addressed early. ‘I work with the community geriatrician – we have a weekly multidisciplinary team meeting where patients are discussed. If more medical input is needed, doctors will do patient visits with me,’ she says.

Ms Wint has access to hospital test results and other information, which can help to spot problems in treatment. She holds training sessions for care home staff too.

Sustainability

Petra Davis, senior project manager for the care homes vanguard for NHS Nottingham Clinical Commissioning Group, says vanguard investment ‘will make care home services more sustainable.’ She adds it is important for the workforce in care homes to feel valued, to have the skills to meet patients’ needs, and be supported to make decisions.

The Sutton vanguard has community link nurses who work with care homes and help with training. They plan to train home staff to use syringe pumps, which would enable many residents to remain in familiar surroundings for end of life care.

Better-equipped staff should mean fewer hospital admissions. At least one vanguard plans to pay care homes a complex care premium if they meet certain criteria that include staff training.

In each nursing home in the Sutton area, two nurses are training to enhance their clinical skills, and to boost their confidence.

‘One of the things we are clear on is care home nurses are not second-rate nurses. We want to invest in them – they are working in a complex area,’ says Sutton project quality assurance manager Christine Harger. ‘It is not an easy job by any means.’

‘Links to specialists and the community are stronger now’

Hemsworth Park care home in Pontefract is one of those to benefit from the Wakefield vanguard.

Home manager, nurse Joy Allen (pictured) says it has helped her access staff training in how to record patients’ life experiences through Age UK.

Picture credit: Jim Varney

There are now discussions about how staff at Hemsworth Park might link up with NHS clinical skills training in areas including catheter care and venepuncture.

Ms Allen expects residents to benefit from the work of a multidisciplinary team being sent into care homes. Occupational therapists and physiotherapists, pharmacists and a geriatrician will visit, or consult via videoconferencing.

Care homes in the area are linking with each other to exchange ideas and spread best practice. And the home hopes to offer residents more contact with the local community and more tailored activities, especially for younger residents who risk feeling isolated.

‘I’m seeing a big difference for the staff and residents,’ says Ms Allen.

‘It is about nursing the person, not just their physical ailments.’

In Wakefield, West Yorkshire, work with 11 care homes has ensured all residents have a care plan, and most have a resuscitation plan. Medications have been reviewed, and 21 people have been referred to services such as mental health, tissue viability and dietetics. It is early days, but there seems to be some effect on the number of ambulance call-outs. The approach will be adopted in all care homes in the area later this year.

In Sutton, there is a focus on early intervention and identifying at an earlier stage that a person’s condition is deteriorating.

A ‘concerned about a resident’ tool directs care home staff to support from, for example, community nursing or palliative care teams in an attempt to avoid unnecessary emergency department attendance.

Better communication with hospitals at admission and discharge is another vanguard aim. In Sutton, older people go to hospital with a ‘red bag’ containing an assessment form, a record of how care has been escalated and everything they will need for a stay, including clothes, hearing aids, glasses and personal information.

Vanguards illustrate that any plan for an improved, affordable health service must take care homes into account. As RCN head of policy Howard Catton says: ‘Given what we know about the numbers of care home beds, pressures on funding, increased complexity and the challenge of staffing, it is important we work with care homes. We have not given enough attention to the role they play’.

Next week: how nurses in vanguards are extending their roles

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