Update from HIN: Red Bag, Pioneers, 111*6 Josh Brewster Health Innovation Network The red bag is a simple innovation but as you all know, implementing it locally takes a great deal of hard work and collaboration. Many of you here have been instrumental in adopting the red bag pathway in your area and we are keen to use this opportunity to learn from each other and share good practice.

Academic Health Science Network Improve lives Save money Drive economic growth Talk about Croydon starting the Airedale Model and Red Bags Airedale - too soon to know how successful it has been, but HIN have offered light touch support with the evaluation and keen to hear how it progresses. Croydon care homes to be involved in the next phase of our CMC project Spread and adopt best practice in South London

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Red Bag Evaluation - Use in Care Homes The HIN surveyed 31 Care Homes and held a focus group with care home managers Is the red bag being used? Majority of care homes are using the red bag all of the time In majority of cases, ambulance crews are aware of the red bag Reasons for not using red bag Ambulance crews need to transfer quickly – cannot wait Night staff have less resource / capacity Lewisham and Greenwich Red Bag We found that across the 3 areas, the majority of care homes reported they were using the red bag as intended all or most of the time. In the focus group with care home managers we also heard that there were some occasions when it was more difficult use the red bag – principally when ambulances arrived quickly and could not wait for the bag or the paperwork to be packed; or at night when the administrative staff were not around to help with the paperwork. I’ll come back to this, but this may explain why hospital clinicians told us that sometimes the correct paperwork was missing, or there was no red bag with the patient. “It makes a big difference (if the emergency is at night) as we have less staff on and the administrative staff are not there.” (Care Home Manager)

Care Homes – Perspectives on Discharge Two-thirds of care homes told us that on the whole the red bags and personal belongings are being returned either all the time or most of the time. However only a third said that the Discharge Summary was always returned with the resident and some managers told us this created problems for care homes. Two-thirds of care homes said Discharge Summaries are returned ‘sometimes’ on discharge, compared to a third who said they were ‘always’ returned “The only thing for us is, when they are discharged, there is no discharge letter, no documentation, the form from the hospital is always empty” [Care Home Manager]

Learning from Implementation – Care Home Transition to new paperwork Day vs Night callouts Tracking down lost bags Dissatisfaction due to continued poor discharge For care homes, the learning from the evaluation has been that for some homes the transition to the new paperwork system has been a challenge and has required a lot of staff training. There was a recognition that for smaller homes managing call outs and paperwork at night was more challenging. Tracking down lost bags was really challenging and for some managers the continued difficulties with discharge information was leading to dissatisfaction with hospital Lambeth Red Bag “ “We still get phone calls from the hospital, but it’s happening less now with the red bag. It’s an excellent system” Care Home Manager

Going forward… Please do check if all your staff feel confident to complete all the standardised paperwork – night staff, agency staff too. If a bag is lost or discharge papers are missing – please alert your CCG/LA commissioner straight away (monitoring form) Let residents and relatives know about the red bag on admission and reminder at meetings Ongoing work also happening at Hospital to improve the pathway Report: https://healthinnovationnetwork.com/news/evaluation-into-red- bag-hospital-transfer-pathway/ Three boroughs, 90 surveys received in total from range of stakeholders etc. etc. and then explain the you will pick out the points most relevant to care homes. It’s important that they understand that there is another whole set of recommendations for the hospitals, and we are not singling out care homes as the only area for improvement

Care Home Pioneers – Leadership Development Programme Aims Raise confidence Gain leadership skills Use a variety of tools to aid team communication Create a support network Care Home Pioneers – Leadership Development Programme Pioneers 2018

Lambeth and Southwark Pioneers, 2018 and 2019 Anura Kalubowila - Purley view nursing home Brenda Skinner - Beth Ezra Trust 2019 Veronica McCleary - The Manse Residential Care Home Grazyna Urbaczewska - Hill House Nursing Home Verna Kaunda - Shepherds' Corner Graduation Day – November 2019, all invited Check if any of them are in the room and give them the opportunity to share their experiences

111*6 Line Project in partnership with the End of Life Care Clinical Network and the 3 Academic Health Science Networks for London Pan-London project to help prevent unnecessary admissions 2 strands: Feedback from those people using *6 – Surveys, Focus Groups, Interviews Listening to Calls – Understand Process Outcome: Key learning and next steps

111*6 Discussion Thoughts and experience of 111*6 When and why do you use 111*6? What do you use instead of 111*6? How could it be improved? For Croydon as they have commissioned Airedale which I believe it their first port of call if it’s not a 999 emergency. I’d just keep it very open and ask for their experiences of using 111 *6

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