North East Residential Provider Forum 15 th January 2019 9 am to 12 pm

1. North East Residential Provider Forum 15th January 2019 9am to 12pm

2. Visit the Marketstalls IRN and Bed Finder System Health in Mind Single point of access with St Helena

3. Introductions Patrick Higgs Director for Local Delivery North Patrick.Higgs@essex.gov.uk

4. Agenda 09:00 – 09:30 Refreshments and Marketstalls 09:30 – 09:40 Introductions & upcoming issues 09:40 – 10:00 Winter update 10:00 – 10:20 Trusted Assessor model update 10:20 – 10:50 Enhanced Primary Care Model 10:50 – 11:20 End of life and palliative care 11:20 – 11:50 ECA training opportunities 11:50 – 12:00 Closing

5. Winter update Lauren Rochat, Service Manager Lauren.Rochat@essex.gov.uk

6. Winter & Capacity Updates Delayed Transfers of Care Reablement changes Soft launch of Home to Assess 17th December Discharge to Assess block beds Winter Acceptance payment Bridging service Dom in Lieu of reablement Additional contingency / emergency beds

8. Additional initiatives Residential reablement Single referral form Reciprocal assessment with Ipswich Sourcing challenges – SPT heat map

9. Discussion: Looking ahead Major incidents such as weather pressures, norovirus etc • Emergency planning - How can we work as a system together to respond to this and support each other? • Mobilising staff as a system

10. Trusted Assessor Dawn Taylor – Project Lead • dawn.taylor13@nhs.net

11. Background: The principle of a Trusted Assessor is one profession or service, trusting the assessment of another profession or service and acting on it. Feedback from local domiciliary and care home providers reports variable reliability and quality of information received on discharge from the acute provider and the sense of ‘hand-off’ once the patient has returned to a community setting. What would work in NEE?

12. Background: Initial engagement with care home providers and domiciliary care providers. In NEE we have approx. 202 care homes, varying in size and care remit. Of these 76 provide care to over 65’s caring for up to 3000 people. The other 126 are a combination of learning disability and mental health homes, caring for roughly 1300 people. Numbers of domiciliary care agencies vary and numbers of people receiving care unobtainable.

13. The Red Bag initiative has been adopted by the North East Essex Clinical Commissioning Group (NEECCG) as part of the national Vanguard programme (an NHS England New Care Models programme) to improve the quality of care for the frail, elderly and vulnerable residents in our care homes, as well as to better support communication between our local care homes, ambulance service and hospitals.

14. What is the Red Bag Scheme: • The “Red Bag Scheme”is a simple initiative to help people living in care homes receive quick and effective treatment should they need to go into Colchester hospital in an emergency. • The "Red Bag" keeps important information about a care home resident's health in one place and easily accessible to ambulance and hospital staff. • The “Red Bag” contains standardised information about the resident's general health, any existing medical conditions they have, medication they are taking, as well as highlighting the current health concern.  This means that ambulance and hospital staff can determine the treatment a resident needs more effectively.

15. Red Bag Feedback: • We obtain valuable feedback from across the system (patients, carers, care homes, ambulance, hospital) around what is working well and how we can improve. • Feedback from our care homes identified issues around the reliability and quality of the information received on discharge. Poor discharge information Missing medications Transport issues Referral to community services Poor communication to relatives and providers The sense of ‘hand-off’ once the patient has returned to a community setting. • Consequence there are anxieties around accepting discharges from the acute providers without individually assessing the patient first. • This leads to a poor patient experience and delayed transfers of care. • The experience of domiciliary providers is similar

16. Trusted Assessor Model • One of the processes to address this is via a Trusted Assessor Model. • The principle of a Trusted Assessor is one profession or service, trusting the assessment of another profession or service and acting on it. • The use of a Trusted Assessor Scheme can reduce the numbers and waiting times of people awaiting discharge from hospital through comprehensive assessment and discharge planning, together with an effective wrap around package once established back into the community to reduce the likelihood of readmission (NHS England). • Since January 2018 the CCG has extensively scoped the implementation of Trusted Assessor Schemes adopted nationally and heralded as exemplars.

17. Trusted Assessor in NEE • NEE acknowledges that there isn’t a ‘one size fits all’ Model. First Steps • Standardised Red Bag process/contents • Based on local engagement with stakeholders, initially agreed standardised assessment paperwork that offers a comprehensive needs assessment to improve reliability of information flow. • The aspiration is for care homes and domiciliary providers to accept patients based on this paperwork, trusting the assessment of colleagues in our local hospital, coastal beds, CHC team & Hospice . • Lessons learnt from ‘test and learn’ will help the inform the next steps to rolling out this aspect of the project.

18. Busting the myths A provider cannot be forced to take a patient based on ‘trusted assessment’ Should be cost neutral – using existing resources Not about changing outcome – but speed it up Not about denying people a full assessment If it’s slowing the transfer process, it is being done wrong Not about moving people from hospital without correct support or consent/best interests Not about discharge before they are clinically ready

19. Next Steps What would work for you? Single point of contact in hospital Buddy System Sharing experiences and understanding pressures between hospital and community.

20. Working together Improve communication with care providers Collaborative working – acute, primary care, social care, voluntary sectors, care providers To improve patient experience Maintain momentum of Red Bag scheme

21. Care Home Enhanced Service Sarra Bargent – Head of Clinical Quality of Primary Care • sarra.bargent@nhs.net

22. Background: As you have heard from the Red Bag Scheme and Trusted Assessor Project presentation, NEE CCG have been gathering ongoing feedback from local care providers around what would help support residents in care homes. These included, but were not limited to, improved access to primary care.

23. The Challenge: There is a National recruitment challenge in primary care which is exacerbated by the complexity and prevalence of an elderly population with co-morbidities within the local area. The CCG have been working with primary care colleagues to explore ways of developing the existing workforce and attracting new clinicians into primary care. With approximately 76 care homes in NEE, providing care for up to 3000 people – primary care colleagues need to look at new and innovative ways to meet and improve the quality of care to residents in care homes.

24. New pilot: In response NEE Clinical Commissioning Group are scoping a pilot for a Care Home Enhanced Service. We recently send out a survey to care home providers who provide care for residents over 65yrs. The results have contributed to the design of this new service.

25. The aim: • The aim of the service is to improve the parity and quality of primary care for residents in residential and nursing homes for the over 65s. • The service aims to offer a proactive and preventative approach to improve health outcomes for residents, • The service will improve the access for residents to see a primary care clinician, • It is also hoped that the service will improve the existing links between care homes and GP practices.

26. Service overview: • A multi-disciplinary team of nurses and other allied health professionals with input from a lead GP(s) will be aligned to a care home, • Weekly 'home' rounds will be delivered for proactive management, • There will be a nurse-led triage of minor illness (to be undertaken during ‘home’ round time), • The service will provide onsite advice and guidance to care home staff,

27. Next Steps The project aims to go live in May 2019, There is still some work to do in terms of refining the service, The Provider of the service will engage with all relevant care homes to ensure a strong relationship is developed and sustained, This will include a clear description of what the service will offer, We will continue to seek feedback on its success once implemented, There will be ongoing evaluation and your comments will contribute to the ongoing evolution and design of the service.

28. Dr Karen Chumbley Clinical Director St Helena kchumbley@sthelena.org.uk

30. Advance Care Planning in Care Homes • Improves quality of end of life care • Increased the chance of being cared for in preferred place at the end of life • Improves carer satisfaction • Increases the provision of care in line with the resident’s wishes • Decreases unnecessary admissions to hospital

32. Who can see My Care Choices? GPs Hospital Anglian Community Enterprise St Helena Out of Hours GPs Ambulance services

33. What do we know about people on My Care Choices? Over 3000 people have choices currently recorded 1 in 3 people in North East Essex in the last year of life have an entry in the register People on My Care Choices usually prefer to be cared for in their usual place of residence at the end of life and only a minority choose hospital as a preferred place of care People on My Care Choices are much less likely to die in hospital than people who are not on the register

34. How can your resident’s access My Care Choices?

35. Palliative and End of Life Care

36. What is Palliative Care? Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

37. What is End of Life Care ? GMC Guidance: Patients are ‘approaching the end of life’ when they are likely to die within the next 12 months. This includes patients whose death is imminent (expected within a few hours or days) and those with: advanced, progressive, incurable conditions general frailty and co-existing conditions that mean they are expected to die within 12 months existing conditions if they are at risk of dying from a sudden acute crisis in their condition life-threatening acute conditions caused by sudden catastrophic events

38. End of life Care Palliative Care

39. Palliative Care Prevention and relief of suffering by: 1. Early identification 2. Impeccable assessment 3. Treatment of pain and other problems; Physical Psychosocial Spiritual

40. Early Identification Suitable approach for all residents? Gold Standard Framework – prognostic indicator guidance

42. Impeccable Assessment

43. Treatment of pain and other physical problems

44. Psychosocial Needs Spiritual Needs

45. When do you refer to St Helena? How do you refer? 01206 890360

46. St Helena Services SinglePoint 01206 890360 24 hour triage and rapid response service Rapid response is for people in the last 3 months of life Not in replacement of primary care

47. St Helena Services Clinical Nurse Specialist Team For when a resident’s needs are not met by primary care

48. St Helena Services Inpatient beds Medical Team Breathlessness Team Chaplaincy Family Support team Bereavement support

49. Training and Education Opportunities Gold Standard Framework Care Homes Programme Foundations of Palliative and End of Life Care Communication skills Holistic Assessment in Palliative care Introduction to end of life care Promoting patient centred care at the end of life Nurse verification of expected death Symptom management Syringe driver training for registered nurses Understanding loss and bereavement

50. ECA Training Opportunities Simon Harniess, Director of Development, Essex Care Association simon.harniess@essexcare.org.uk