What's new in care models: Rethinking the care home

Is it time to rethink the ‘care home’ model?

I haven’t written enough about the enhanced health in care homes vanguards.

EHCHs are easy to overlook because they are about improving a single (albeit very important) pathway, rather than transforming an entire sector as MCP, PACS and acute care collaborations seek to do. They also pose fewer difficult questions about the business model of primary care, or about regulation, organisational form and contracting – all topics of endless fascination in health policy world.

National leaders are pretty optimistic about the care home vanguards. Perhaps part of the reason for that is that the various elements of the EHCH model can be set up quickly and without too much cost.

Belatedly reading the policy framework document NHS England published last month, what is striking is how quickly the bulk of it can be put in place: of the 11 “core” elements of the model, all but two can be implemented in less than a year, while the others will take no more than two.

Improvements to data and tech are not part of the “core” model – instead, linking health and social care records and allowing care homes to use a secure nhs.net email service form part of an “enhanced” EHCH model.

That means the core of the model can be brought in everywhere before anyone has to get bogged down wrestling with record systems or information governance rules. That is sensible: although the full model is tricky to put in place, it means the core EHCH is more approachable and achievable.

What’s so good about EHCH? Regular readers will know that I never tire of complaining that while there is a seemingly inexhaustible seam of anecdotes about how brilliantly the vanguards are doing, there is little hard evidence in the public domain.

What little data I have seen about EHCHs has come from individual sites and can’t be used here because: it’s very piecemeal, and looks likely to have been cherry picked to put the best possible spin on the model; I can’t compare the results to the rest of the NHS; I haven’t had a single dataset for all the EHCHs and therefore can’t verify whether any success is down to the model or other factors unique to one place.

A few months ago I reported that EHCHs were going to be added to the vanguard “dashboard”, which monitors progress against the NHS as a whole. That was delayed due to a data issue – suggesting that linking health and social care information is as difficult nationally as it is in a local health system.

So we’ll just have to trust that national leaders have good reason to believe they are working.

NHS England does appear to be keen that the EHCH model be adopted widely, fast.

The policy framework says: “Our ambition is for every area of England to have a deliverable, credible and affordable plan for implementation of the EHCH model in 2017-18 – recognising not everything is new, and some areas will already be implementing parts of the model.”

Is there a delivery mechanism for this? There is mention of future guidance, so maybe it’s on the way. But the policy framework also says: “The initial impetus for action, investment costs and returns all fall to CCGs.” I wonder if all CCGs have read the document, or if they’ve been a bit busy on STPs over the past month? It does seem strange that the emphasis there is on CCGs, not STPs, since the very existence of the latter suggests a lack of confidence at the centre in the effectiveness of the former.

As usual with these things, the most interesting stuff is right at the end.

There’s a paragraph about how aligning and funding rehabilitation and reablement services will involve a level of coordination in the local system that will “have implications for both NHS and social care budgets”.

And: “Close cooperation around commissioning also holds the potential to help change the shape and sustainability of local markets for social care, in terms of the mix of provision.”

Better still, this may involve “hybrid care homes including rehabilitation facilities; nursing, residential and extra care settings”.

The government’s stated and unelaborated upon ambition is for integrated health and social care services by 2020. Is NHS England beginning to describe what that might look like?

Scaling primary care: GPs unhappy

When I launched this newsletter, I said I’d like for it to be a dialogue, so it is with great personal delight that I can share a thoughtful reader comment with you. Last week, I wrote about how GPs do not seem to want to create fully integrated providers spanning primary and secondary care, as per the forward view. In response, a GP reader raised some interesting points about primary care at scale: “This GP is watching to see how things play out (plus I am awaiting the mystical MCP contract) [aren’t we all?]. Nobody is going to hand things over to the acutes with all that entails without all the information of what else is on offer.

“Sadly, the smart strategic move is heading towards bigger and bigger super-partnerships. Become too big to fail and eventually form your own MCP.

“Saying that, there has been a definite pushback by NHSE against the formation of super-partnerships by GPs. The RCGP, etc have been promoting GP at scale but it is noticeable NHS England seem to hate it and have been blocking an increasing number of mergers as a more powerful bloc of GPs is a big problem in their eyes.”

Anyone with details of NHS England resisting GP led moves to scale up primary care can get in touch with me in confidence: david.williams@emap.com or 020 3033 2780.