1. Diabetes in Care Homes Dr Nicky Williams Deputy Clinical Chair – East & North Hertfordshire Clinical Commissioning Group Hertfordshire Diabetes Conference

2. Diabetes in Care Homes The Current Picture When Marie moved to her care home a year ago, she had type 2 diabetes as well as COPD. During her stay, developing cognitive impairment meant she was increasingly dependent on staff who were not always informed or confident in caring for her diabetes. Marie’s frustration at losing responsibility for her own care led to depression and, without a comprehensive care plan in place, there was little improvement in her weight and mobility. When Marie experienced a complication from her COPD, care home staff were unsure what to do and called an ambulance to take her to hospital which Marie found distressing and disorientating. PATIENT STORY

3. Diabetes in Care Homes The Current Picture Care Home Diabetes Audit (2014) No comprehensive assessment, monitoring or provision of specialist care Limited skills & knowledge among care home staff Ineffective communication with GPs and other services Likelihood of hospital admission when a resident is unwell

4. Care Homes - Demographic Background 4 Diabetes in Care Homes 25% of residents have diabetes

5. ACCESS Managed crisis Enhanced Support (ST) Enhanced support (LT) Enabling Independence Self-care Functions: Short term care with rapid assessment and responsive service. Functions: Short term care required Functions: Long term care, case management with pro active care. Functions: Episodic short term care Functions: Information, advice and signposting Cohort: In crisis or at risk of requiring admission to a hospital set Cohort: Following deterioration of health/increa se in need Cohort: Multiple long term conditions with complex care needs. Cohort: Single long term condition or low level support required. Cohort: People fully managing their needs themselves within the community. User accessProfessional access Care Navigation Proactive Care Co-ordination Diabetes in Care Homes

6. Vanguard – Enhanced Health in Care Homes’ At its core are the principles of coordinating care around the needs of the individual, and working to proactively address health and social care issues Our Vision: “To deliver an enhanced model of health and social care to support frail elderly patients, and those with multiple complex long term conditions in the community in a planned, proactive and preventative way” Partnership working Coordinating care around the needs of the individual

7. Diabetes in Care Homes Vanguard – Projected Benefits At its core are the principles of coordinating care around the needs of the individual, and working to proactively address health and social care issues Partnership working Coordinating care around the needs of the individual

8. Diabetes in Care Homes Vanguard – ‘Enhanced Health in Care Homes ’ Developing skilled and confident staff within the care home to enable them to care for increasingly complex patients with more confidence. This will allow residents to receive better care in their care home, and help staff support residents to die in their preferred place of death 1. Confident Homecare Staff Delivering effective planned, proactive and preventative care for care home residents from primary, community and acute care 2. Effective multi-disciplinary teams Providing effective alternatives to 999 services when a resident’s condition changes suddenly, so that the right professional can support that patient as quickly as possible, and attendances and admissions to hospital are avoided wherever possible 3. Rapid response services To underpin the care model, crucially allowing clinicians to access records in the patient’s care home, and allowing homes to access expertise remotely through telemedicine 4. Effective technology

9. Diabetes in Care Homes Complex Care Premium Patient presents with Complex Characteristics Referral Accredited Care Home Top up Payment Quality care for complex patients The Patient 1. Confident Homecare Staff

10. Diabetes in Care Homes Vanguard – Complex Care Premium Advanced Nutrition Champion Pathway – ensures: 1.Procedure in place on nutritional care 2.Catering arrangements that promote choice and special diets 3.Access to specialist equipment 4.Regular auditing 5.Staff knowledge of nutritional problems 6.Working together with GPs, pharmacist and dietetic support 5 Champion Pathways:

11. Diabetes in Care Homes Investment in two Homefirst teams of social care, community health & mental health staff o Virtual wards o Rapid response Enhanced Primary Care Support – dedicated GP practice for each care home Medicines Management Team covering 60 care homes Interface Geriatricians – rapid access frailty clinics, telephone advice line and outreach to care homes 2. Multi-Disciplinary Teams 2. Multi-Disciplinary Team

12. Diabetes in Care Homes 3. Rapid Response Homefirst Rapid Response – assessment within 1 hour of referral, to include nursing, therapy, social work or domiciliary care Rapid Response Car for Elderly People – acute focussed care that is an alternative to 999

13. Diabetes in Care Homes 4. Effective Technology GP access to clinical records MedeAnalytics – community health, mental health, acute and social care data to risk stratify and track patients’ use of services Telemedicine based on the Airedale Foundation Trust model for a rapid alternative to acute care

14. Diabetes in Care Homes The resident GPs Skilled care home staff Clear care procedures Community health, social care & mental health Supportive technolog y End of Life care Emergency care & crisis response Bringing it all together: ‘Coordinating diabetes care around the needs of the individual’

15. Diabetes in Care Homes Questions?