The Hospital Transfer Pathway (HTP) – more affectionately known as the red bag initiative – has been one of the major successes of our enhanced health in care homes vanguard to date, and I’ve been thrilled to be a part of its development.
The red bag was born from one of the vanguard’s care home manager forums; a bi-monthly opportunity for care home managers to get together in a safe, informal space, share experiences and discuss issues being experienced in the area. It’s the visual identity of the HTP; a pathway of care that enables care home managers to share important information about residents with hospitals upon admission and discharge. It’s a true example of collaborative working, with involvement from care home staff, the London Ambulance Service, local hospitals and community services.
A collaboration between health, third sector, local authority and other agencies has been set up to reduce demand on emergency services by frequent flyers. It bases itself completely within the prudent healthcare premise, working with the patient at every step of the way. It reduces unnecessary investigations, streamlines resources, protects the emergency stream and reintegrates patients into local community support. It enables working without walls, bringing unique solutions to entrenched problems, whilst ensuring that an extremely vulnerable cohort of patients is supported through changes to their multi layers of need.
Up to one in four people admitted to hospital do not need to be there and could be looked after elsewhere if better use was made of services available to treat people in the community, council leaders stressed today.
In January 2015, the NHS invited individual organisations and partnerships, including those with the voluntary sector to apply to become vanguard sites for the New Models of Care Programme, one of the first steps towards delivering the NHS Five Year Forward View (5YFV) and supporting improvement and integration of services.
One of the vanguard types is the enhanced health in care homes (EHCH) care model which offers older people better, joined up health, care and rehabilitation services.
Six sites across the country – known as vanguards – are working across health and social care to test new ways of providing coordinated, high-quality care and support to care home residents.
We have captured the work they’re doing in the framework, it identifies a range of different elements that, when delivered together, make significant improvements in the quality of care and support provided to care home residents.
A couple of notable examples in the framework include: Connecting Care – Wakefield District vanguard, which has been using multidisciplinary teams across both health and social care.
The national new care models programme brings together local health and care systems as vanguards to radically redesign care for the local populations they serve. As part of this work, NHS England has set out details of the framework – what good looks like – for enhanced health in care homes. A lead nurse and a GP from the Gateshead Care Home Project vanguard provide an insight into their work and the role they play in this new model of care.
Includes section about integrated primary and acute care systems that are part of some vanguards. Cites Salford example that has social care at its heart. Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai
The Redbridge HASS has a greater focus on early intervention and prevention and delivers high quality integrated care.
It has an improved single point of access for people over the age of 18 with community health or adult social care needs and it delivers an integrated service at a local level to the following people:
• vulnerable older people;
• adults with a learning disability and/or on the autistic spectrum;
• adults with a physical and/or sensory disability;
• adults with a mental health issue. We have made it easier to access our services and reduce the number of calls and number of assessments a person has to undergo.
The social work service based at the RLH hospital operated a 9-5 Mon-Fri service and was not set up to prevent unnecessary hospital admissions. Based around the transfers of care, it responded more to the sections 2s and 5 referrals to arrange the efficient and safe discharge of patients deemed to be medically from the acute wards.
To tackle this problem – we developed a new service that would operate a preventative service linked to the A&E, Acute Assessments Unit (AAU), and Clinical Decision Unit (CDU).
The Out of Hours Social workers within the Acute Assessment Unit (AAU) and ED now respond to referrals within the hour, commission support and discharge patients who do not have a clinical need to be in hospital.
By commissioning community services that allow patients to return home, we are able to join up services seamlessly and discharge patients safely.