IMPORTANT INFORMATION

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Home First - A New Model for Intermediate Care

 

Overview

NHS Barnsley CCG, together with our local partners, is proposing a new model for intermediate care to be implemented from 1 June 2021. Below is an overview of the work that we have undertaken to date in relation to developing intermediate care services across Barnsley and our proposed way forwards.  

Background

Intermediate care services provide support for a short period of time to help people recover and increase their independence. It is a form of active rehabilitation supporting people to:

  • Remain at home when they start to find things more difficult
  • Recover after a fall, an acute illness or an operation
  • Reduce the risk of admission
  • Decrease the length of a hospital stay
  • Reduce the risk of a readmission
  • Reduce the risk of admission to a care home.

Based on a person’s current health, abilities and wishes, they agree and work towards personal goals. The person is supported by staff trained to maximise their mobility and observe, encourage and guide, so the person can do things themselves, rather than to intervene or carry out tasks for them.

There are four types of Intermediate Care Services in Barnsley. These are:

  • Reablement - commissioned and provided by Barnsley Council and funded through the Better Care Fund. 
  • Home based - commissioned by NHS Barnsley Clinical Commissioning Group (CCG) and provided by the South West Yorkshire Partnership NHS Foundation Trust (SWYPFT). The team is called the Neighbourhood Rehabilitation Service (NRS).
  • Bed based - commissioned by NHS Barnsley CCG and provided in two care homes with GP medical oversight provided by Barnsley Healthcare Federation. This includes the Acorn Unit, where BHNFT provide nursing and therapy. The bed base has is in-reach from the NRS.
  • Crisis response - commissioned by NHS Barnsley CCG and provided by SWYPFT. The team is called the Crisis Response Team.

For the CCG commissioned services, care is co-ordinated by the RightCare Barnsley team. Their job is to work with the patient, carer and healthcare professionals involved to determine what level of support someone may need and therefore which service is best for them at that time.

As the list above suggests, intermediate care is something that involves all health and social care organisations working in Barnsley and is a key part of supporting patients as they go into and come out of hospital to make sure that patients receive the right care, at the right time, in the right place. 

Proposals for the new model – home first

Together with partners, NHS Barnsley CCG is proposing to redevelop how intermediate care services are delivered. These partners include: Barnsley Council, Barnsley Hospital NHS Foundation Trust, Barnsley Healthcare GB Pu 21/01/12 6 Federation and South West Yorkshire Partnership NHS Foundation Trust. A review of intermediate care services came about in February 2020 however the progression of proposals was paused during the first wave of the coronavirus pandemic to enable focus on response. The opportunity to review the current provision came about as the contracts for the intermediate care bed bases within the independent sector were due to expire on 31/03/21. These contracts have been extended to 31/05/21 to alleviate pressure on the health and social care system. The contracts cannot be extended beyond this date.

Intermediate care services can currently support 120 people at any one time: 

  • 70 people who are in their own homes (including those people who reside full time in a care home)
  • 50 people who are having a stay in a care home for rehabilitation. Currently, two care homes sites are used for this.

The proposed changes are that the service supports the same number of people but more in their normal place of residence (their home) and fewer in an intermediate care facility. The changes are proposed to come into effect at the earliest possible opportunity, with procurement timescales and contract dates; this would be 1 June 2021.

The proposal is that local services would still be able to support a minimum of 120 people across the pathway at any one time with a re-provisioning of the current model: 

  • Minimum of 90 in people’s own homes
  • 30 people who are having a stay in a care home for rehabilitation. The proposal is that one care home site would be used for this and this would become a specialist unit. This would mean that those people who reside within a care home, requiring additional levels of support, they would still move into the specialist unit if their condition requires this as would anyone else still living within their own home.

The proposed changes would mean that overall the same number of patients (or more) would be supported. The services would be resourced in a different way and be re-provisioned so that more resource is put into delivering care in people’s home.

Over the pandemic there have been changes to the bed base, including the number of sites reducing from four to two. This includes the Acorn Unit moving out of Barnsley Hospital to the Buckingham Care Home so that the ward could be used for critical care. Currently the intermediate care facility is provided over two sites across Barnsley by carers in care homes with input from nurses, therapists and other healthcare professionals. It is proposed that in the new model, care in the bed base would be delivered by NHS staff (nurses and therapists) with input from other healthcare professionals. It is hoped that this would provide better outcomes for patients requiring intermediate care. These nurses and therapists would be from the Acorn Unit, which is a current intermediate care facility. The Acorn Unit was originally based in the hospital but had to be relocated during the pandemic. This unit would become a specialist intermediate care facility to care for these patients.

Number of patients who use the current pathways

Reviewing data from the 2019/20 financial year intermediate care services receive around 3,000 referrals per year however this includes referrals between the different intermediate care teams for the same patient, for the same episode of care. The number of individual patients who access the service is a maximum of 1,500 per year. Due to the nature of intermediate care, people who access the services can often be older people or people who are frail. 

Development of the new model

In developing the proposed new model for intermediate care the following has been considered.

Reviewing national best practice - National best practice has been reviewed, in this case learning from other areas including the Newcastle Gateshead CCG vanguard for intermediate care, to help inform proposals for a future model. Newcastle Gateshead CCG has implemented a ‘home first’ model meaning that the resource is focussed in home based teams and the bed based was reduced. Health and social care professionals, patients and carers have fed back that this model is working well.

Reviewing the clinical needs of those who currently access the services - There is confidence that the new model is fit for patients clinically having reviewed clinical thresholds and health needs for past and present service users.

Reviewing what health and social care professionals have told us - The proposals have been reviewed by a number of clinicians so far, and there is broad support for the changes outlined. This includes input from the CCG’s Clinical Forum and Management Team.

Reviewing what patients and the public have told us - As part of this work, we have reviewed what people have told us about healthcare services relevant to intermediate care. In addition to the existing patient and public feedback already gathered, we will adopt the approach of mobilising the project and building in as a key component of an outcomes based service specification, a dedicated and defined process to scrutinise and review the changes on a regular basis from a patient and carer experience perspective. This will enable us to truly understand how it feels for the people who are in receipt of intermediate care services and the family members and carers who are supporting them and enable services to flex and adapt where required. The proposal is to mobilise the patient experience data capture as soon as practically possible so this data can begin to be obtained and to influence service delivery without delaying the implementation of the new model. In December 2020 this approach was reviewed and signed off by the Barnsley Overview and Scrutiny Committee and Healthwatch Barnsley.

From these different points, it is felt that the proposed ‘home first’ model is appropriate in terms of best outcomes for patient care and overall is something that is supported. The engagement and ongoing collection of patient experience data will add to collective understanding and we will provide further updates here. 

Public Involvement & Consultation (s14Z2)

A patient and public participation assessment form (s14Z2) has been completed and is available upon request.

The approach to public involvement is summarised below.

A briefing was provided to the Barnsley Overview and Scrutiny Committee (OSC) and Healthwatch Barnsley on 18/11/20. On 01/12/20 Barnsley OSC confirmed they were happy with the proposals for GB engagement in relation to the intermediate care work and on 08/12/20 Healthwatch confirmed the approach.

A summary of the information provided is included below.

From review of current available information, it is known that:

  • Patients and carers feel supported and like the current service provision.
  • The broad principle of receiving care closer to home has been supported by people in Barnsley through the feedback we have received to previous engagement work 
  • Health and social care professionals we have spoken to so far including GPs, nurses and carers support the proposals for the new model for intermediate care.

The CCG sought advice from The Consultation Institute on 30/10/20 in order to discuss the potential scale of communications and engagement activity required. Based on information and feedback already received through prior engagement it was felt that a suitable and proportionate approach to take in this instance would ideally be to plan and undertake a period of targeted engagement with people who have directly accessed or who are accessing the services outlined above and their carers or family members as well as obtaining the views of staff working across health and social care. Following this conversation, the partner organisations met to discuss how the above could realistically and meaningfully be carried out and achieved at the current time and within the current climate without this feeling tokenistic towards capturing patient views and feedback and crucially without placing additional stress on front line staff to allow them to focus on delivering care. It is acknowledged that the patient cohort in relation to intermediate care tends to be mainly older people and vulnerable residents and again due to the current constraints around social distancing and infection prevention and control, being able to gain access to speak with the right people in order to obtain their views at the current time would need to be through front line staff who are already being asked to take on additional duties, roles and responsibilities and make adjustments where necessary just to keep local services functioning at this critical time.

In view of the above constraints and alongside the need to work at pace in order to ensure that local services can flex and meet the current demands required to support some of the most vulnerable members of our local communities in addition to the existing patient and public feedback already gathered, the proposal was to adopt the approach of mobilising the project and building in as a key component of an outcomes based service specification, a dedicated and defined process to scrutinise and review the changes on a regular basis from a patient and carer experience perspective. This will enable us to truly understand how it feels for the people who are in receipt of intermediate care services and the family members and carers who are supporting them and enable services to flex and adapt where required. The proposal is to mobilise the patient experience data capture as soon as practically possible so this data can begin to be obtained and to influence service delivery (noting the constraints listed above) without delaying the implementation of the new model.

All supporting communications, engagement and experience activity will be  coordinated in partnership with those who provide the current services: South West Yorkshire Partnership NHS Foundation Trust (SWYPFT); Barnsley Hospitals NHS Foundation Trust (BHNFT); Barnsley Council and Barnsley Healthcare Federation.