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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 East and North Hertfordshire Clinical Commissioning Group

Jamie Sutterby
Director of Integration
Hertfordshire County Council

The Better Care in Care Homes Vanguard programme in east and north Hertfordshire is supporting care home staff to increase their confidence and knowledge to look after residents when they become unwell.

Jacqueline Costantini has been a senior care worker for five years at Burleigh House in Baldock. Through Vanguard she completed training in general health, and falls prevention, becoming the home’s champion in each.

“I thought I was too old to learn anything new,” she said. “But I have learned so much and it has made me feel so much better about myself as well as helping me to care for our residents better”.

“I’ve also learned to mentor others. I did lots and lots of training, and it was hard. We had a lot of homework which I had to do alongside the job, but it has definitely been worth it”.

Our Vanguard is a partnership between three health and social care organisations– Hertfordshire County Council, NHS East and North Hertfordshire Clinical Commissioning Group and Hertfordshire Care Providers Association.

The programme has many strands – all aimed at keeping frail, elderly residents healthy, independent and in the care home as opposed to having to go to hospital.

The early focus was on workforce development –increasing the skills of care home staff to give them more confidence in not only supporting residents with complex health conditions, but also communicating more confidently with clinicians. The training is concentrated on six areas – dementia, falls, nutrition, engagement, wounds and general health care, including end of life care.

The new knowledge was not just retained by the ‘champions’, but  cascaded across teams in each home, so ultimately all staff and residents have benefitted.

Many staff have been inspired by the training they received and staff retention has improved in some homes.

Another strand of the programme was to support patients returning from hospital to care home as soon as they are well enough. A new role of Impartial Assessor was introduced in the local hospital. An experienced nurse was recruited to liaise with the patient, their family, hospital discharge team and care home staff and carry out a comprehensive patient assessment. In just nine months since the Impartial Assessor has been in post, nearly 200 patients have been assessed resulting in 393 hospital bed days being saved. A second Impartial Assessor has now been appointed.

Other projects within the programme include the Early Intervention Vehicle which provides immediate response, via screened 999 calls, to elderly residents in east and north Hertfordshire with the primary role of keeping them safely in their own homes. Patients are assessed by the crew – normally a senior paramedic and an occupational health professional, physiotherapist or social worker to see whether they can remain at home with community support and assistive equipment.

The CCG’s pharmacy team, working with GPs aligned to the care home, and care home staff, have reviewed 1,155 care home residents and 10,782 medicines. Fourteen per cent of all medicines have been stopped and direct drug cost reductions are almost £250 per patient.

Feedback from homes has shown us:

  • Hospital admissions have reduced and homes are now more prepared and confident to support residents to remain at home.
  • Falls have decreased and when they do occur, care home staff are more confident in responding to the situation and speaking to NHS staff, including paramedics
  • Ambulance call outs to care homes have reduced
  • Calls to out-of-hours NHS and social care services have reduced. A case study highlighted a situation where one home no longer needs the District Nurse to call following staff training.

The Vanguard programme is a real example of how working in partnership across health and social care, and building trust between organisations can improve the health and wellbeing of residents in our community. Those involved are now exploring ways to ensure these services can benefit the wider, elderly population of Hertfordshire into the future.




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