How did the project come about?
Frail, older people living in care homes have high levels of health and personal care needs. In Gateshead, 1500 people currently live in care homes.
Newcastle Gateshead CCG recognised that there was a need to improve the care delivered to their care home residents through the introduction of enhanced primary care support, multidisciplinary management and anticipatory care planning. This new model of care has improved the quality of care delivery to care home residents and has seen a sustained reduction in hospital admission from the care home population over a number of years. It was this that led to them becoming part of the national Care Home Vanguard Programme.
One of the key elements of the programme has been to improve the health and wellbeing of care home residents through changing care delivery and the introduction of technology enabled care solutions [TECS]. On the basis of this a piece of work is underway linking nutrition and hydration care and TECS. Metrics for the whole programme have been agreed with NHS England and in relation to this work particularly the focus is on reducing avoidable hospital admissions for those with urinary tract infections [UTI].
The maintenance of good hydration and nutrition status in older people living with frailty, i.e. those living in care homes has been promoted through a ‘food first’ approach. This has been successful in reducing avoidable hospital admissions for those with a UTI and has seen a reduction in the prescription of oral nutritional supplements for care home residents. Aside from the introduction of TECS to support nutrition and hydration the CCG are also introducing TECS alongside recognition of the deteriorating patient through the use of the national early warning score [NEWS].
To help embed a food first approach within the wider workforce, the CCG developed a technology programme to roll out tablets, apps and associated nutrition and hydration guidance/education into care homes. Initially the focus has been on the introduction of national early warning score into care homes as risk assessment tool to support clinical decision making and the development of a nutrition and hydration app to support care home staff in their daily practice.
The apps and technology have been developed in partnership with Solcom.
As a consequence of the above a key aspect around the implementation of NEWS is evaluating the relationship between an individual’s NEWS score, level of frailty, cognitive impairment, functional abilities and treatment outcomes. A comprehensive evaluation of the programme to help understand the impact and benefits of introducing the technology is being undertaken by Northumbria University.
The CCG understood the importance of working with care homes to promote the benefits of using the technology, understand their needs and to identify any technological and operational barriers that could impact on introduction of the technology.
In terms of rolling out of the programme, the CCG has funded a practice educator (a nurse by background) as per the recommendation made by Northumbria University in the conclusion of a parallel piece of work undertaken regarding workforce. The practice educators role is to lead on care home engagement, training and education of care home staff, and manage the roll out and implementation of the technology.
Introducing the Technology
The CCG is at the beginning of rolling out the programme. There’s been quite a lot of preparatory work over the last year and lots of knowledge gained to support an effective roll out programme.
Newcastle Gateshead has also linked in with neighbouring CCGs who have looked at introducing technology including NEWS scores to help them identify key successes and challenges to inform how the technology is developed and the programme rolled out.
When looking at development of the nutrition and hydration app and the functionality required, the CCG took time to understand the care home requirements (i.e. local authority and CQC standard inspection requirements), as well as what they wanted to achieve. The CCG also undertook a comprehensive literature review in partnership with Northumbria University in order to understand the evidence and knowledge base which was used when developing the contents of the app.
The plan is roll out the technology (tablets and apps) to all care homes within a year. The first five care homes will act as a pilot and on evaluation recommendations will be taken into account for the wider rollout.
In terms of introducing technology into care homes, two evaluations are being undertaken. One regionally by a consortium of universities regarding technological use and the context of wiliness/readiness to change.
The second evaluation is specifically related to the CCGs work regarding NEWS and hydration and nutrition as described above and will include ‘observed practice’ and holding ‘focus groups’ with care home staff. The remit is to explore the role of digital and technology solutions in relation to key aims and objectives of the programme.
This will include reviews of care home documentation and qualitative semi- structured interviews with key stakeholders.
In terms of return of investment, this won’t be available until final programme evaluation given older people with complex needs need multi-faceted approaches to be at their optimum levels of health and wellbeing. Therefore, improvements in avoidable hospital admissions have to be considered alongside the use of alternative services such as dietetics, GPs and community nursing. Notwithstanding are the quality outcomes such as those reported by patients and their families as well as the care home work force.
Throughout the Vanguard process, the CCG is considering sustainability for the project.
There maybe an issue from a commissioning point of view as we have provided the tablets to the care homes. There is an expectation that they will take responsibility for those devices, which will be addressed going forwards. This includes looking at how care homes could use the technology to identify other issues that would be useful for them e.g. falls prevention and management.
- Don’t believe the headlines; expect impressive changes from initial pilots but always seek robust evaluation and enquire about sustainability and long term gains.
- Don’t underestimate the value of work force engagement which is crucial for successfully testing out any new concepts such as the above.
- Consider investing in a practice educator or similar dedicated post to introduce new concepts such as the above.
- Find your champions; those who truly understand the needs of older people and the complex system needed to meet their complex needs e.g. Newcastle Gateshead CCG has a Pathway of Care group to help develop the clinical elements of the programme [as well as forums for residents, their families and the work force through other work streams]
- Remember that all the Care Home Vanguard metrics relate to clinical care delivery hence without the knowledge of clinical engagement superstars who understand scientific evidence, softer intelligence /knowledge, pathway development and evaluation methods, the process and learning may not be as robust
- Learn from when technology introduction hasn’t worked e.g. what is different on this occasion is that it’s not being rolled out by technological people, its being rolled out by a clinical person going out and talking to other clinical people which it is anticipated will make the difference between the equipment being used in the right way, rather than being left in a cupboard as has happened with other such projects.
Lesley Bainbridge, Lead Nurse, Care Home Vanguard Programme, leads one of six work streams; Pathway of Care, focusing on all clinical aspects of the programme
Chris Davies, Therapy Lead, Care Home Vanguard Programme, leads Technology Enabled Care Solutions [TECS] task and finish group
Claire Laing, Business Intelligence Lead, Care Home Vanguard Programme, leads mainstreaming data to care delivery and clinical care to metrics working closely with the Pathway of Care Team
Mandy Mitchinson, IM&T Lead, Newcastle Gateshead CCG, supporting Care Home Vanguard Programme