The National Market Development Forum New Models of Care – Working together to provide older people in care homes better more personalised health and care services Chris Badger – ENHCCG and HCC

Looking after 3,000 residents at any one time 92 care homes 3,200 beds Spent on residents in care homes in 2012/2013 2,205 £49m Care homes – the current picture in East and North Hertfordshire

£5.76M ,794 visits to A&E admissions to hospital from care homes 1, hospital stays of less than one day 23 hrs The A&E attendance rate is 0.96 per 100 population in the over 65 age group residing in care homes. This compares to 0.34 A&E attendances per 100 population of the general over 65s population. Care home patients on average have 7 prescribed medicines 7 Nationally, on any given day 70% patients experience at least one medication error (Barber ND et al 2009) Pharmacist visits to care homes can reduce reported errors 22%

The resident GP to each home Skilled care home staff Interface geriatrician Community health, social care & mental health Supportive technology End of Life care Care home pharmacist Emergency care & crisis response Co-ordinating care around the needs of the individual Bringing it all together

If our project is successful we would expect to see:

Each care home nominates staff ‘champions’ to complete advanced training in five strands: Dementia Nutrition Falls prevention Wound management Continence, end of life, neurological and respiratory conditions ‘SMILE mentor’ in each home to help deliver interesting activity and exercise programmes for residents All staff with extra training supported by a manager to make sure new ways of working are embedded in the care home Complex Care Premium

Accept ‘complex’ referrals within fixed timeframes and at weekends Receive a weekly ‘enhanced rate’ of £70 per patient for direct benefit of eligible patients Payment not subject to means testing In addition – living wage being supported with negotiated uplift on LA and CHC rates Complex Care Premium Accredited homes:

Progress to Date Medicine Optimisation team Complex Care Framework 9 Aim = minimum 60% of all homes by 17/ Patient clinical medication reviews Key: Complex Care Access Complex Care Premium Complex Care Foundation Medicines reviewed Frailty service recruited to run an acute frailty ward clinic and provide clinical support to care homes Complex Claim Premium claims Care Home referrals Care Homes aligned to single GP practices. 100% of homes (14) surveyed responded that this arrangement has improved resident care Pharmacists recruited to the Care home medicines team Numbers of beds open on the acute frailty ward supported by Geriatricians 157 patients seen in Frailty clinic over phone calls for advice. Integrated Rapid Response HomeFirst

Impact So Far: 2015/ Patient clinical medication reviews Medicines reviewed Pharmacists recruited to the Care Home medicines team 20 antipsychotics for BPSD reviewed with GP Bone protection initiated for 18 patients 12 patients prescribed antibiotics at time of review were checked against local guidance 100% compliance 208 medicines stopped including 22 that are linked to increase in falls Annualised direct drug cost reductions £18,295 (£126/patient reviewed) TOTAL 469 clinical interventions made

Monitor – All Care Homes

Monitor – CCP homes CCP training commenced CCP training completed