NHS England and partners have published six Quick Guides to bring clarity on how best to work with the care sector. They can be accessed at www.nhs.uk/quickguides Want to find out how the care sector can support local systems in the run up to winter? Want to break down barriers between health and care organisations? Want to find out how Leicester has achieved a 60% reduction in care home admission costs? Want to finally break down the myths around sharing patient information and assessments? Want to use other people's ideas and resources? Webinar outcomes: Introduction to the care homes quick guides Two examples of models referenced in the guides: - Angela Dempsey, Baker Tilly on the Quest4care tool - Dawn Moody on MDT working and a model implemented in a CCG Guest Speakers: Nicola Spencer and Emily Carter - NHS England

1. www.england.nhs.uk
Long Term
Conditions
Lunch & Learn
Clinical input to care homes
with Nicola Spencer and
Emily Carter - NHS England
20 January 2016

2. www.england.nhs.uk
LTC Framework
Commitment
to Carers
Frailty
Health Ageing
Guide
Fire Service as
an asset
Care Homes
Quick Guides
Care & Support
Planning
Navigating Health
& Social Care
Self Care
Ambitions for
End of Life Care
Our Declaration
Delivery Models
Planning for Change:
• Capitated Budget
• Contracting
• Simulation Modelling
Patient and
Service
Selection
Planning for Change:
Workforce
Whole Population
Analysis;
Understanding your
population
LTC Dashboard LTC Toolkit

3. www.england.nhs.uk
Long term conditions resources
Simulation model
Unbundling recovery simulation model

4. www.england.nhs.uk
7
Using behavioural
change to open minds
#A4PCC – Action for Person-Centred Care
Person with
long term
condition
o Make a declaration at
www.engage.england.nhs.uk/survey/ltc
-declaration
o Tell your teams about our work
o Encourage them to make a declaration
o Ask them to feed back thoughts and
ideas
o Use our hashtag – #A4PCC – when
you see work that is relevant to
person-centred care for people with
LTCs
o Let us know of any events, activities or
social media opportunities that we can
join forces with you

5. www.england.nhs.uk
Date Topic Led by and details of session Venue
10 February
11.30am
Health Coaching in the community-
the role of non-clinical staff and
people with lived experience as
coaches
Anya De Iongh & Jim Phillips Via WebEx
TBC Self-management in the community
and on the Internet
Peter Moore, The Pain Toolkit Via WebEx
LTC Virtual Learning Community Lunch & Learn webinars:
Sharing and Learning …

6. www.england.nhs.uk
Long Term
Conditions
Lunch & Learn
Clinical input to care homes
with Nicola Spencer and
Emily Carter - NHS England
20 January 2016

7. www.england.nhs.uk
Nicola Spencer
Programme Support Manager- End of Life Care
NHS England
Emily Carter
Assistant Head of Planning Delivery
NHS England
Quick Guide: Clinical Input Into Care
Homes

8. www.england.nhs.uk
• Published series of quick guides to support local health and care systems.
• Practical tips, case studies and links to useful documents, which can be
used to implement solutions to commonly experienced issues.
• The guides will:
• bring clarity on how best to work with the care sector
• help you to find out how people across the country are working to
reduce unnecessary hospital admissions/delayed transfers of care
• break down commonly held myths, i.e. sharing patient information
across integrated care teams and continuing healthcare assessments
• allow you to use other people’s ideas and resources
• enable you to breakdown barriers between health and care
organisations
Overview of Work

9. www.england.nhs.uk
• The Quick Guide we’re going to talk to you about
today is: Clinical input into care homes.
• http://www.nhs.uk/quick-guides

10. www.england.nhs.uk
Some facts and figures
about this cohort – what we
know

11. www.england.nhs.uk
3 million aged
80+ - projected to
double in the
next 30 years
Majority of residents
living with complex
co-morbidities
16% of people
aged 85+ in the
UK live in a care
home
Median period from
admission to the
care home to death
is 15 months
> 75% of people living in
care homes in England,
Wales and NI have
dementia/severe memory
problems
Two thirds of residents –
immobile/or in need of
assistance; two thirds
are incontinent
Median number of
medications per
resident is 9
No common framework for
describing the differing
services and staffing
20-30% of
ambulance calls
from care homes
are due to falls in
the elderly
Workforce issues

12. www.england.nhs.uk
• Experience difficulties accessing the right care at the
right time.
• Same rights to care as the rest of the population - but
frequently suffer
• Improving the clinical input into a home and tailoring
care around the diverse needs of individual residents
can improve the quality of care and quality of life for
people, and reduce unnecessary hospital admissions.
Care homes… Setting the Scene

13. www.england.nhs.uk
• Worked collaboratively with stakeholders across different
settings to develop this Quick Guide - comprises of case
studies, ideas and practical tips on how to improve the clinical
care for people living in care homes for commissioners and
providers.
• The contents – to be taken as pragmatic recommendations to
support local health/social care systems;
• Not mandatory; and should be read alongside the other Quick
Guides: Identifying Local Care Home Placements’ and
Technology in Care Homes.
Quick Guide: Clinical Input Into Care
Homes

14. www.england.nhs.uk
• Building effective relationships
• Multi-Disciplinary Team (MDT) working
• Enhancing nursing therapies
• How to improve general practice input into care homes
• Medicines management
• Supporting people with dementia
• How to improve oral health, hydration and nutrition in care
homes
• Improving end of life care
• Harnessing technology
• Promoting health and wellbeing
• Supporting and upskilling staff
The Quick Guide Focusses on
Several Key Areas:

15. www.england.nhs.uk
Embedded links throughout to useful documents, e.g.:
• Cornwall’s suite of clinical management tools
specifically developed for care homes
• North & East Hertfordshire’s single intermediate care
pathway
• North Staffordshire’s funding formula for GP services
in care homes
• Sheffield’s service specification for community
pharmacy in care homes
Full of Useful Resources

16. www.england.nhs.uk
• Part of longer term work to improve the clinical input into
care homes - led by NHS England in partnership across
the health and care system
• Link to the care home van guards to ensure learning and
models shared across the country
• Work plan for 2016/17 in development as part of the
Independent Care Sector Programme
• Introduce you to colleagues who are leading on two of the
initiatives featured in the guide………
Next Steps

17. QUEST4CARE
Supporting care homes to perform
Developed in partnership with

18. Why?
 Builds on our commitment and experience of working with the NHS as the largest provider
of audit, governance and risk services;
 Recognise the need for better data and effective benchmarking across care home sector;
 Utilises our in-house expertise of building and running governance software products and
benchmarking clubs;
 Genuine desire to help our clients gain better oversight and management controls within
the sector; and
18

19. Who are RSM UK
 RSM UK is one of the three principal mid-market professional services firms, with almost
3,500 partners and staff generating a fee income of over £300 million.
 Work with over 650 public sector clients
 Provide Internal Audit to over 90 NHS organisations
 RSM Software Solutions is our in-house software development team
 Our software clients include NHS, Local Authorities, Education and private sector
 Total licensed users of our products is over 95,000 users
19

20. What is it?
 Web-based, periodic self assessment questionnaire accessible on PC, smartphone or
tablet;
 Intelligent branching of questions;
 In built web links to good practice websites and national/local CCG policies;
 Weighted scoring of questions to create RAG reporting across each domain;
 Enables comparison across cohorts of care homes; and
 Fully flexible reporting which allows trend, peer group and comparison reporting via
standard and bespoke reports.
20

21. The Questionnaire
21

22. • Resident flow;
• Inspection regimes;
• Students;
• Audits; and
• Recruitment process for staff.
22
The Questionnaire

23. 23
• Pressure ulcers management;
• Falls prevention;
• Medication management;
• Adult safeguarding;
• Hospital avoidance; and
• Admission strategies.
The Questionnaire

24. 24
• Presence of policies/protocols and
• Induction/on-going training
• Nutrition and hydration;
• Infection control;
• Management of continence;
• Aseptic technique;
• VTE;
• End of life;
• Advanced care practice;
• Loneliness; and
• Individualised care plans.
The Questionnaire

25. – .
25
• Resident feedback;
• Feedback; and
• Carers, relatives and other
feedback
• Staff feedback
The Questionnaire

26. 26
• Care;
• Compassion;
• Competence;
• Communication;
• Courage; and
• Commitment.
The Questionnaire

27. 27
• Working with CCGs so that pre-registration students can
have placements in Care Homes
• Working with GPs so that they have drop in clinics, ward
rounds and also pencil in 6 monthly reviews of all residents
• The developing of Reablement Suites
• Working with CCGs so that pre-registration students can have placements in Care Homes
• Working with CCGs to offer mentorship training to staff
• Supporting Care Homes that have asked for assistance for certain policies and training
• Conversations over bed management, where are the vacancies, experienced staff able to take
complex patients
• Care Homes offering to revamp their offering, ring fencing beds and recruiting more staff
• Care homes offering to give staff extra training to take complex patients
• Reablement, using Care Homes bed to support patients with OT and Physio support to get them
back home
The Questionnaire

28. CCGs 2015
York CCG
Has woven Quest4Care into their well-established Care Home Forum and uses the results to promote
dialogue and discussion. They have been working with particular homes to commission reablement beds
with an impressive average bed stay of 9 days from hospital, to care home and then to their own home. One
individual home has kept 66 patients out of hospital.
NHS Kernow
The CCG launched the tool on the 1st of November with a return rate of 90%. They have selected a cohort
of homes to go through the first tranche and are working towards Quest4Care being part of their contracting
assurance process. The Care Homes have signed up to a peer group taking part in the first cohort and
already one of the Care Homes has volunteered and been accepted to have a staff member as a Care
Maker. In addition, even at this early stage, several homes have made contact with the HEI to push to have
students in their homes as part of a wider co-ordinated drive around recruitment and retention.
28

29. Next Steps
• Working with NICE to accredit the tool
• Developed the tool to be used within NHSE detention centres to capture experience
• Queens Nursing Institute would like to work with us to support and nurture nurses in Care
Home settings 2016
• Working now to develop the possibility of residents/carers accessing a link to the tool to
also offer feedback
• Adding a section to sign post staff to the frailty index tools NHSE
29

30. Management reporting
30

31. Management reporting - Overview
The feature-rich online reporting tool
provides detailed analysis of the care home
responses
• RAG reporting;
• Peer group comparison by KPI;
• Trend analysis; and
• Data export facilities.
31

32. RAG reporting – Individual Care Home
32

33. RAG reporting – Peer Group
33

34. RAG reporting – Individual & Peer Group
34

35. 35
Define peer groups and compare their
performance.
Spot data trends so that appropriate action
can be taken.

36. www.frailtytoolkit.org 36
Supporting Nottinghamshire’s Older People
with Frailty to Self-Care
The Frailty Toolkit and Training Programme
Wednesday 20th January 2016
Dr Dawn Moody
@Moody_D_K

37. www.frailtytoolkit.org 37
What we are going to cover
• Engaging with stakeholders to specify the requirement
• Distinctive features of the programme
• The results are so far
• What we are planning to do next

38. www.frailtytoolkit.org 38
Through stakeholder engagement Nottinghamshire
LETC identified key local priorities
Enabling supported self-care
Multi-professional and multi-agency
learning and working
Consistent education and training
standards
Integrated assessment

39. www.frailtytoolkit.org 39
Objectives & requirements of the first phase

40. www.frailtytoolkit.org 40
What we are going to cover
• Engaging with stakeholders to specify the requirement
• Distinctive features of the programme
• The results are so far
• What we are planning to do next

41. www.frailtytoolkit.org 41
“Introduction to App is great and can’t wait to use it
”
FRAILTY TOOLKIT APP
93%
of training event participants said they were ‘likely’
or ‘very likely’ to share the Toolkit with colleagues

42. www.frailtytoolkit.org 42
I liked being able to network with other
organisations - knowing what is available
and how to access their skills
MULTI AGENCY TRAINING
EVENTS
“
”
89%
of participants said they were ‘likely’ or ‘very
likely’ to recommend training to colleagues

43. www.frailtytoolkit.org 43
Simple concept but works when seen
in a visual way. Good use of balance
FRAILTY FULCRUM
91%
of participants rated the ease of
understanding key messages as ‘good’ or
‘excellent’ for the Frailty Fulcrum animation
“
”

44. www.frailtytoolkit.org 44
Great self-care plan which is easy
to use.
SUPPORTED SELF CARE
PLAN
“
”
I liked the supported self-care plan and
feel it would be a useful tool alongside
our own assessment plan.
“
”

45. www.frailtytoolkit.org 45
Loved getting to grips with real-life
cases. Seeing the story through.
CO-DESIGNED CASE
EXERCISES
90%
of participants felt the case scenarios
were an ‘effective’ or ‘very effective’ way
to achieve learning outcomes
“
”

46. www.frailtytoolkit.org 46
Very innovative in looking at how impairment
affects function and, more to the point, of the
feelings associated with impairment
VIRTUAL REALITY
SIMULATION
“
”
90%
of participants felt that the VR simulation was
either ‘good’ or ‘excellent’ in terms of
helpfulness in building empathy / walking in
the shoes of an older person with frailty

47. www.frailtytoolkit.org 47
What we are going to cover
• Engaging with stakeholders to specify the requirement
• Distinctive features of the programme
• The results are so far
• What we are planning to do next

48. www.frailtytoolkit.org 48
Key facts from phase 1
300+ individuals
40+ roles
20+ organisations
92% of participants rated the training
‘very effective’ or ‘effective’ 90%
of participants were “likely” or
“very likely” to download,
recommend or share the Toolkit
and Training
Round-table networking
and multi-agency
working were the best
things about the day
Length or intensity of the
day was an issue for a small
proportion of participants

49. www.frailtytoolkit.org 49
• Add slide
Goal Cards

50. www.frailtytoolkit.org 50
Participants set themselves a range of post-
training goals
21%
18%
17%
15%
11%
10%
Train & educate others
More person-centred / Find out
more about the person /
understanding what's important
Use & share / promote the toolkit &
training
Self-care planning / using the
domains / integrated assessment
Promote independence / self-help
Involve family earlier / more

51. www.frailtytoolkit.org 51
What’s helping and what is getting in the way?
-60 -50 -40 -30 -20 -10 0 10 20 30 40
Available capacity ( me or resource)
Specific services or roles
Integrated working
Informa on systems - access, sharing and integra on
Mindset
Referrals, discharges and handovers
Awareness, experience & knowledge
Complexity, fragmenta on, silos and duplica on
Differing expecta ons, opinions and tolerance for risk
Communica ons
Funding arrangements and financial concerns
Approach
Policy & legisla on
Help or hinder themes from training events, # of men ons Help Hindrance

52. www.frailtytoolkit.org 52
Three biggest challenges for programme so far
Out of date technology has restricted access to Toolkit
Operational pressures make it difficult to release staff for
training
Reaching 700+ primary care
and social care providers!

53. www.frailtytoolkit.org 53
What we are going to cover
• Engaging with stakeholders to specify the requirement
• Distinctive features of the programme
• The results are so far
• What we are planning to do next

54. www.frailtytoolkit.org 54
Development of shorter training modules
• 2 hour sessions
• …. 1. Raising awareness
of frailty and
supported self-care
2. Case-based multi-
agency, multi-
professional team
experience

55. www.frailtytoolkit.org 55
Improving access and learning as we go
• Further investment in whole-day training events
• Offer shorter sessions to “hard to reach” parts of the system
• Widen access to the online Toolkit
• Invest in maintaining Toolkit with potential for further content
and functionality development
• Track and understand usage to guide future development
• Continue to work with Transformation programmes and
vanguard sites to support system change

56. www.frailtytoolkit.org 56
In summary…