Author: Beke Tshuma Implementation Lead – Older Person’s Care Older People Programme - Enhanced Health in Care Homes (EHCH) Framework January 2019 Author: Beke Tshuma Implementation Lead – Older Person’s Care

To ensure the provision of high-quality care Three principal aims: To ensure the provision of high-quality care To ensure that, wherever possible, individuals who require support to live independently have access to the right care and the right health services in the place of their choosing. To ensure that we make the best use of resources by reducing unnecessary conveyances to hospitals, hospital admissions, and bed days whilst ensuring the best care for residents. Working with and through providers to deliver initiatives from NHS England.

LAS conveyances to acute hospitals from Central, H&F, and West CCG areas demonstrate more variation than the NW London total

Attendance at NW London A&Es from Care Homes in Central London, H&F, and West London CCG areas have tended to be stable, with increased activity in winter

What the data tells us: LAS Conveyance Activity for period 2016/17-2018/19   Central H&F West London NW London Monthly average number of conveyances 34 35 43 534 Change in number of conveyances (16/17-18/19) -32% +10% +66% +2% Conveyance Rate 79% 88% 82% 84% In hours (0800-2000) 73% 74% 76% Out of hours 27% 21% 26% 24% Change in Attendances, Admissions, LOS April-November 2016/17-2018/19 A&E Attendances Emergency Admissions Total LOS Central +7% +13% +20% West +23% +19% +22% H&F +44% +53% NW London +5% +12% +8% 0-day stays as % of total admissions Central H&F West London NW London 16/17 16% 22% 21% 17% 18/19 18% 20% Stays of 15 or more days Central H&F West London NW London 16/17 22% 18% 12% 19% 18/19 14%

North West London Key Aims and Initiatives

Key Aims and Update/ Next Steps: Key Aims and Initiatives: Reduction in LAS calls and conveyances from participating care homes . Reduction in non-elective admissions for the care home cohort. Reduction in length of stay for the care home cohort. People are able to die in their preferred place from participating care homes. Improved resident/family experience of care from participating care homes. Reduced care home staff turnover from participating care homes. Improved financial sustainability of care for participating care home residents. Current priority work streams for North West London Education - Leadership - Recognising and Action on Signs of Deterioration (RASD) & - Bespoke training including - End of Life Care, falls, continence. Urgent Care Telemedicine (Last Phase of Life) – 111*6 to provide 24/7 direct access to clinical advice to care home staff in 130 care homes. - Video Consultation, first wave launched in January in 8 care homes in six CCGs; one Enhanced GP Network in Brent) Key Aims and Update/ Next Steps: -

Key Aims and Update/ Next Steps: Key Aims and Initiatives: Reduction in length of stay for the care home cohort. People are able to die in their preferred place from participating care homes. Improved resident/family experience of care from participating care homes. Reduced care home staff turnover from participating care homes. Improved financial sustainability of care for participating care home residents. Hospital Transfer (Redbag) Scheme - collaboration with local primary care teams; acute trusts and care homes to facilitate the implementation of a standardised hospital transfer pathway to and from care homes. Frailty - Response at time of crisis, acute frailty services at the Hospital front door. Home First – - Development of a local discharge to assess model Key Aims and Update/ Next Steps: -

Key Aims and Update/ Next Steps: Key Aims and Initiatives: Reduction of poly-pharmacy. Effectiveness and efficiency. Quality and safety. Medicines Optimisation – dedicated pharmacists to provide a person centred approach to safe and effective use of medicines to enable the best possible outcomes for care homes residents. Falls Management End of life Care Key Aims and Update/ Next Steps: -

Key Aims and Update/ Next Steps: Integrating the initiatives into systems that are supporting the care pathways. Embedding the initiatives in practice so that they become business as usual. Evaluation – - Measuring the impact - Lessons learnt - Sharing good practice and standardising the principles of care across North West London Key Aims and Update/ Next Steps: Thank you

Current Initiatives for North West London for delivery from a STP footprint perspective: