Wakefield finds itself in a unique situation where it benefits from two of the five vanguard types.
The Enhanced Health in Care Homes and the primary care led Multispecialty Community Provider (MCP) vanguards have their own story to tell about how they have improved and integrated services for patients and communities. Under the Connecting Care banner, both vanguards set out to deliver "right care at the right time, in the right place and delivered by the right person".
Under the Connecting Care banner, both vanguards set out to deliver the 'right care at the right time, in the right place and delivered by the right person'.
Connecting Care means doing things more effectively and ensuring services work together as one. Developing new models of care and creating joined up services for patients involves many local services. Connecting Care is no exception and is comprised of three NHS organisations, the local council, regional charities and social enterprises, GP Federations, the local fire service and housing. Leaders credit the strength of the partnership between local organisations, describing the strength of partnership as ‘phenomenal’.
Leaders credit the strength of the partnership between local organisations, describing the strength of partnership as ‘phenomenal’.
Wakefield faces its own set of health challenges, and these local challenges have helped to shape the way that services work together. The area has an estimated population of around 337,000 and ranks as the 65th most deprived district in England. A fifth of children in the district are from low income families and the area has a lower life expectancy figure than the national average, with significant variations visible along a single bus route. Recent work to improve health and wellbeing has had a big focus on smoking – 42% of teenage mothers in the district smoke. Partners agreed that a local care system must meet and support the needs of local people, built around an understanding that social connections make a big difference to health and care.
As part of a recent visit to Wakefield for health, social care and local government leaders, representative from the partnership organisations which make up Connecting Care outlined the challenges and the successes of two of its vanguard types, the Enhanced Health in Care Homes vanguard which seeks to offer older people better, joined up health, care and rehabilitation services, and the MCP vanguard which aims to move specialist care out of hospital and into community or home settings.
Enhanced Health in Care Homes Vanguard
Wakefield launched its Connecting Care Enhanced Health in Care Homes Vanguard in March 2015. The first cohort included 15 care homes and two supported living schemes. The initiative was then expanded in 2017/18 to take on 12 additional homes and six supported living schemes, with the first cohort helping to develop a replicable blueprint that allowed NHS Wakefield CCG to secure further funding for the rest of the project.
The care home vanguard is designed to tackle loneliness and fragmented care by joining up services for older people in supported living schemes and care homes. All of the homes use holistic tools to help deliver person-centred care. For example, colleagues from South West Yorkshire Partnership NHS Foundation Trust run Portrait of a life sessions, which focuses on using props to deliver life-story work, to support care home staff to engage with residents. During the visit, we were invited to reminisce with residents at a local supported living scheme about our school days, which resulted in renditions of nursery rhymes and school assembly tunes.
The vanguard helps to build stronger relationships between care home management, staff and residents, and has since created stronger links with GPs by beginning to develop a “one GP practice one care home” model. The vanguard is also making use of technology to improve efficiency and patient experience through an online bed state tool, which provides real-time data as to the beds available in local homes to help minimise delayed transfers of care.
The vanguard is also making use of technology to improve efficiency and patient experience through an online bed state tool, which provides real-time data as to the beds available in local homes to help minimise delayed transfers of care.
The vanguard has seen a 13% reduction in emergency admissions, a 6% reduction in A&E attendances, a 28% reduction in bed days and a 5% reduction in ambulance call-outs. The Care Home Support team is also helping to reduce the number of falls and ambulance conveyances through providing ad-hoc training to care home staff, including Staying Steady training.
Improving access to services
The Connecting Care success story also includes its MCP vanguard which is improving the way people access services and support through a better ‘care navigation system’. The MCP programme includes the development of services such as extended operating hours for GP services, and the development of Connecting Care Hubs which allow multiple organisations to work together more seamlessly as ‘one unit’ to support patients with complex needs who could otherwise receive disjointed care. Alongside this, it is improving the way patient information is shared among local services, through the development of a Personal Integrated Care (PIC) record.
The MCP vanguard is developing Connecting Care Hubs which allow multiple organisations to work together more seamlessly as ‘one unit’ to support patients with complex needs who could otherwise receive disjointed care.
A particular success includes a new physiotherapy pilot service, PhysioLine. Since June 2017, the practices piloting Physioline have seen a 41% reduction in first appointments to community physiotherapy and a 34% reduction in follow-up appointments. In contrast, the rest of the district has seen a 3% increase in first appointments in the community physiotherapy service and a 7% reduction in follow-up appointments.
As the national vanguard programme comes to an end, health and care leaders will want to learn from the successes and challenges of the vanguard sites. Wakefield is unique as it has navigated its way through two vanguard types. It is also one of the few vanguards who have used funding to collate robust evaluation data and outcomes.
Connecting Care has proven that strong partnerships, patient and staff engagement and developing a local plan based on the needs of the community leads to a better experience for patients, with more choice about where and what services they can offer. These lessons will be central to any efforts to replicate these successes elsewhere.
Read our briefing series: Learning from the vanguards.
Find out about further visits in our series.