The introduction of care navigators has revolutionised services for a London mental health trust’s older patients. Caroline Leveaux and colleagues explain.
The care navigator role was a product of NHS London’s Leading Workforce Transformation programme, which ran from 2009 to 2011. The programme was developed for GPs (both as primary care clinicians and commissioners), primary care trust commissioners, clinicians, and other senior managers and educators to equip staff with the skills to plan and develop new roles for a modern NHS.
Several navigator models in the NHS aim to address the challenges of complex systems, usually directed at those with long term conditions. The variations, delivered by health trainers, navigators and district nurses, include a service for homeless people and, at Central and North West London Foundation Trust, the development of a mental health model.
The key components of the Leading Workforce Transformation model are:
- delivering support to people with long term conditions and/or to their carers;
- delivering care via referral from the primary care team;
- providing information about health, social services, third sector or other community provisions in equal measure;
- supporting personal budgets and being available whether the client qualifies for benefits and personalised budgets or not;
- providing “live” feedback on service quality to the commissioner
- including a paid role (band 5/6) with training and mentoring to maintain uniformity and quality (does not need to be a clinician);
- recruitment and management undertaken by any of the partners – primary care, third sector partner (as with these navigators), social care or secondary services.
At Central and North West London we identified a common interest in addressing the unplanned use of services by older people. A mapping exercise in Kensington and Chelsea confirmed that, while there are services provided by the statutory and third sectors, people simply cannot find their way around what is available, are worried they may have to pay for services and believe they do not qualify for support.
Work on the adult social care transformation programme in the borough, known locally as People First, had come to a similar conclusion. A major project within this programme focused on improving information and advice on adult social care in order to develop a comprehensive offer that is accessible to all local residents, including self funders.
A new People First website, backed by a council run information and advice service, came into operation in autumn 2010 but evidence suggested some groups – self- funders in particular – would be unlikely to access this unless signposted by another agency. Evidence from focus groups and consultation with a range of local agencies all pointed to GP practices being best placed to take on this role.
Sourcing necessary funds
Funding from the council’s social care reform grant covered half the costs of the initial navigator pilot, matching a grant from the Leading Workforce Transformation programme. A year on, follow-up funding for a further two years is likely to be agreed through the local allocation of NHS funding for “social care services to benefit health”.
Since the pilot began evidence supporting such interventions is growing. A report by the Audit Commission published in December lists interventions that may help cut high or rising admissions to residential or nursing care including housing advice and provision for older people, carer support and projects to tackle social isolation. These are all services we agreed were core to the signposting work of our care navigators.
There are two navigators in the borough of Kensington and Chelsea. Both are placed with GPs – one in the north in an area of high social need and diversity, and one in the south where there are many older people living alone, often as owner/occupiers or private tenants. One post was funded for a year via the LWT programme, and one through the Royal Borough of Kensington and Chelsea.
A third navigator is being recruited to work as part of a primary care mental health team – an integrated service across primary and secondary care. This will be hosted by Central and North West London Foundation Trust. A fourth has been funded and we are seeking a placement for them within an integrated care pilot. Continuing funding for three posts is being sought from the Royal Borough of Kensington and Chelsea.
Navigators receive mentoring from the University of East London and Barts and the London Trust. The project has been overseen by a steering group comprising members of the LWT group including mentors, Age Concern, RBKC and the two navigators.