Christine Harger on the vanguard work in Sutton in improving quality of care for care home residents, especially residents who frequent hospitals

Older woman and younger woman, nurse, smiling at each other

Accident and emergency departments across the country are at capacity this winter and struggling with the demand of very complex patients. This has resulted in huge pressures on hospital beds as patients are staying longer.

In Sutton, a simple pathway involving a red hospital transfer bag and standard documentation was implemented. The pathway is a link that supports care homes, the ambulance service and the local hospital to meet the requirements of the National Institute for Health and Care Excellence guidance on transition between inpatient hospital setting and care home.

The development of this pathway was built around communication, education and passion, and as a result some of the biggest issues with flow from residents in care homes have been addressed.

Communication as key

That experience for care home residents in Sutton was often fragmented in approach and there were some distinct barriers that were disrupting the flow along the way. These caused delays and breakdowns and often resulted in a poor experience and sometimes poor outcomes, for the resident communication was key in the development of our Red Bag Hospital Transfer Pathway.

The Care Home Managers Forum was designed to bring care home managers and senior staff together with partners across health and social care to provide a support network and an opportunity to share experiences, discuss challenges and identify education and training needs

Making time to sit down and talk to those involved in the care home to hospital transfer and to identify those blocks that were causing lost information and belongings, delayed discharges from hospital and overall fragmented care. Communication was established and facilitated through two important regular meetings – our Joint Intelligence Group and Care Home Forums.

The JIG was introduced as a way of enabling agencies across the borough to identify areas of potential risk in the care homes and agree to an action plan where appropriate to support the care homes. The membership of the JIG included representation from all partners involved in care home resident care, especially in hospital transfer.

By working together in a collaborative way and sharing both hard data and soft intelligence, the JIG has supported the assurance of the quality of care homes in Sutton, helping to maintain a strong focus on performance and safety.

The Care Home Managers Forum was designed to bring care home managers and senior staff together with partners across health and social care to provide a support network and an opportunity to share experiences, discuss challenges and identify education and training needs.

Having a good understanding of partner’s roles and developing relationships has led to many of the successes of the vanguard programme, including the infamous ”Red Bag Pathway”. The iconic Red Bag symbolises the communication barriers we were able to break down through meeting with and developing relationships with partners.

Within these established meetings as well as informal conversations it became clear that there were a few simple issues that were contributing to significant disruptions, and in the end substantial delays on discharge of residents we hadn’t been previously aware of.

A few things of note were the belongings of residents going missing; the hospital having a lack of knowledge of the patient coming into hospital leading to challenges with treatment and diagnosis, the care home being excluded from discussions and not being included in the discharge process.

It isn’t widely known that care homes, although caring for some of the frailest and most vulnerable people in society, sometimes do not have any clinical staff. They are majorly run by carers who have access to nurses, doctors and those with clinical expertise when needed.

Best practice

A series of resources have been produced in collaboration with our care homes and partners to provide up-to-date and immediate information about appropriate referrals to services and guidance on best practice in providing care. The resources have led to better decision making by care home staff, which has resulted in better health outcomes for the residents as well as significant benefits for the wider health economy.

Communication and education have been essential, but the spark that has made the vanguard possible is people within the pathway taking the initiative to say – “this isn’t working and we need to fix it”

We commissioned a Care Home Support team to provide a more proactive, collaborative and integrated training offer for care homes. Our Care Home Support team is built with ambassadors within their respective field who are passionate about improving resident care through upskilling and working with the care home staff in a “Do with Approach”.

The team is made up of liaison nurses, physiotherapists, occupational therapists, dieticians, care home pharmacists and end-of-life specialist nurses. Issues such as falls, UTIs, catheters, sepsis, medication and malnutrition have been at the forefront of this model along with identifying and supporting residents to achieve a good end of life.

The goal of the team is to empower the non-clinical staff currently working within care homes to have the skills and tools necessary to respond and treat simple ailments or identify issues before residents need to go to the hospital.

Communication and education have been essential, but the spark that has made the vanguard possible is people within the pathway taking the initiative to say – “this isn’t working and we need to fix it”. It’s important to not become fixated on outcomes but to analyse the chain of events that is leading to that outcome.

Examine yourself and your organisation, how your organisation is run clinically and non-clinically and note where those little blocks and breakdowns are happening – and start there, celebrating small improvements along the way.