New care model vanguards across England have been marking one year since the launch of the programme. The 50 vanguards, which are spread across different parts of the country, are redesigning and transforming care for patients, communities and staff. Vanguards are part of the national new care models programme which is playing a key role in the delivery of the Five Year Forward View – the vision for the future of the NHS. One year on, Nigel Edwards reflects on the progress so far.
While a lot of the focus of the New Models programme has been around integrated care, I have been especially interested in the progress of the areas working with care homes. They have made rapid and impressive progress and can already show tangible results.
There are a large number of people in care homes and they constitute a disproportionate share of the acute medical take and patients with extended stays.
What the vanguards and others who have invested in this area have discovered is that care homes contain a group of staff who are keen to improve services for their residents and who have often felt cut off from the wider NHS family.
There are several interesting lessons I took from working with them recently. Firstly, there is a bundle of interventions that can be defined and which can be adapted and put into use fairly quickly. These include:
Working to understand the needs of the residents and supporting carers and families
Improving care planning and ensuring regular review with a particular emphasis on end of life planning and advanced directives
A new approach to managing medications
Training care home staff and up-skilling GPs and other staff
Providing specialist input into homes to support the staff and providing real time advice
Aligning homes to one practice
Getting the ambulance service on board to reduce conveyance.
This is less complex than some of the things required to make the other Vanguards work. Yet while this list seems straightforward, the work required to convince GPs to change their practice, to gain the confidence of the staff in the homes and to understand the different approach of care home and social care staff should not be under estimated. Like other change processes of this type, developing productive relationships underpinned by mutual respect and a spirit of humble inquiry are important.
These models have already started to produce some impressive results. There’s been a 15 per cent reduction in emergency admissions to hospital and seven per cent fewer calls to 999. Fewer people are dying in hospital. Levels of Urinary Tract Infections, pressure ulcers, medication errors, and serious incidents have all fallen. And the reduction in the number of medicines being taken has saved £250 per resident.
These are powerful outcomes. One thing that struck me about meeting the people running this programme and others like it in the past is the extent to which they are clinically driven. But while the interventions are about systems and there are metrics galore, the stories that matter are about individual people, how they were cared for, where they died and how lives were improved and how it felt for them.
Edwards N (2016) ‘New Models of Care: one year on’. Nuffield Trust comment, 15 March 2016. https://www.nuffieldtrust.org.uk/news-item/new-models-of-care-one-year-on