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Enhanced Health in Care Homes Vanguards

In the quest to develop new care models, NHS England are piloting six enhanced health in care home vanguards with the aim of offering older people better, joined up health, care and rehabilitation services. These vanguards were selected following a rigorous process, involving workshops and the engagement of key partners and patient representative groups. Over the next few issues of Care Talk we will take a look at each of the vanguards.

This month we hear from Nottingham City Clinical Commissioning

Alison Watson, Care Homes Vanguard Project Manager, NHS Nottingham City CCG

Nottingham City Clinical Commissioning Group (Nottingham City CCG) was chosen as one of the six enhanced health in care home (EHCH) national vanguards sites working to improve the quality of life, healthcare & health planning for care home residents.

The vanguard in Nottingham City is working to achieve this goal by focussing primarily on two key work streams: clinical pharmacy and assistive technology.

Clinical pharmacists are working across the city’s 52 care homes conducting individual resident medication reviews to pinpoint which medications are no longer necessary and also to identify any drug interactions that may cause additional health problems. This is aiming to reduce avoidable admissions to hospital.

Some of the key assistive technology initiatives that have been introduced to make a difference to Nottingham City care home residents are:

  • Telemedicine –a clinical hub to provide 24/7 clinical support to care homes via a video conferencing suite. Care home staff report feeling more supported and feeling that residents receive faster more efficient care.
  • Telehealth devices –the devices enable blood pressure, oxygen saturation, temperature and pulse readings to be transmitted via blue tooth to a hand held device. A score is generated using the National Early Warning Score system which provides a clear escalation procedure for the resident. These readings should be taken regularly to enable any deviations from the residents “normal” levels to be recognised early, and enable proactive care and prevent further deterioration.
  • On site urine testing – to enable early detection and treatment of Urinary tract infections.
  • Care homes are being supported to gain access to nhs.net accounts, Patient Online and SystmOne which will improve communication across all organisations to ensure vital information travels with the resident.

In addition to the two key work streams the vanguard is improving quality for residents by introducing the following:

  • A programme of training to include restraint and challenging behaviour; recognising deterioration of the unwell resident, delivery of chair based exercises to residents; activities for activity coordinators; nutrition and must training; end of life care; wound care and tissue viability.
  • Provision of sensory and reminiscent equipment for care homes.
  • Red Bags to accompany the resident throughout any journey in and out of hospital. These include personal belongings, medications and essential transfer documentation.
  • bariatric equipment to care homes to facilitate discharge of this patient group.
  • Tablet devices and support materials to enable staff within care homes to develop personalised music playlists for residents. Research suggests this been shown to enhance communication and engagement of residents and enhance quality of life particularly in residents with dementia.

Alongside these interventions/initiatives the vanguard has been working on a dashboard to illustrate data for care homes including quality elements (i.e. CCG and CQC scores, number of falls, pressure damage, medication errors). The data can be analysed at an individual care home level or grouped into interventions to support care homes and the commissioning of services.


Edel Harris





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