1. TIPS REGARDING FORMATTING
Title of
Care Home Trusted Assessor Scheme – Havering Care Association
Jane Sproat and Mike Armstrong
Enhanced Health in Care Home Programme and Havering Care Association
Reducing Length of Stay through improved transfers of care to care homes
Transfers of care to care homes from acute trusts often cause delays in discharge due to waiting for care home teams to visit the trusts to assess patients to ensure that the care needs could be appropriately met. Trusted assessors models of care do not appear to be fully embedded within BHR and therefore not maximising the impact on reducing length of stay and wider system efficiencies releasing time to care both in the acute system and in a care home setting.
Lack of trust and poor communication across the care pathway cause unnecessary delays and complications to assessments being undertaken this was compounded by lack of early discharge planning with engagement with the social care providers results in challenges to 7 day discharge and safe discharging of patient with an often poor patient and staff experience.
The system has been given the aim to reduce length of stay for each trust by 25% ensuring effective discharge planning and pathways to improve efficiency in patient flow to be a vital part of local improvement work. Effective transfers of care are supported by trusted relationships enabling clear communication and early discharge planning, the trusted assessor model supports this by creating a role that aligns across the health and care system.
How Healthy London Partnership’s Enhanced Health in Care Homes Programme supported this work?
1. Bringing Partners together across Health and Social Care
Healthy London Partnership has delivered a number of partnership workshops for the BHR system bring health and care providers together to make a commitment to work collaboratively to improve early discharge planning and improving transfers of care to care homes. These events have been well attended with good feedback from partners **insert quote”
This work has enabled us to introduce further Enhanced Health in Care Homes initiatives such as CarePulse (Care Home Capacity Management System) in partnership with Havering Local Authority and BHR CCG.
2. Facilitated Co-Design of the Havering Care Association Trusted Assessor Model
Building on the Lincolnshire Care Association Model we have worked with Havering Care Association and their members to design a model which allowed the local care home managers to be involved with all aspects of the scheme from designing a single assessment form, to job descriptions and interview questions and finally being part of the panel interviewing for the positions of Trusted Assessors. This has helped grow the initial cohort of 18 homes to over 20 care homes all with a commitment to making this work for their local area.
3. Developing a Partnership Agreement across Health and Social Care
At the core of any Trusted Assessor scheme is the need for trust and an understanding of everyone’s roles and responsibilities, these are all outlined within the partnership agreement which ensures that all aspects of the scheme support the care homes to feel that they are confidently complying with the CQC requirement with a clear route of escalation should there be concerns at any point supported by the Trust and Local Authority Joint Assessment and Discharge teams.
4. Supporting implementation
Funding has been provided for an initial 12 month period via the Better Care Fund and National Hospital to Home Programme with addition programme management support from the Enhanced Health in Care Homes team. Implementation has been led by Havering Care Association.
Partnership Workshop April 2018
Co-Design of Havering Model with local care homes
Recruitment to post November 2018
Implementation of Scheme January 2019
TIPS REGARDING FORMATTING
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Partnership working – agreeing together the principles for Trusted Assessor across health and care partners
Improve the quality of discharge experience for those that need to use our services.
Ensure the quality of information used to determine a resident’s needs, leads to better, safe and quicker discharges.
Provide support that enables residents and patients to feel that they have as much control over what happens in the next stage of their life
Support local dialogue and information exchange to inform better strategic decision making developing services and supporting quality improvement.
Coordinate health and social care enabling local partnerships to collaborate more effectively across the BHR system of care.
Ensure the local care home teams are heard and involved in collaborative work to develop the Trusted Assessor model.
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