Sutton Homes of Care is one of six enhanced health in care homes vanguards working to improve the lives of residents living in care homes. In this blog Jason Morris, a paramedic in Sutton, talks about his role in the development of the joined up working practices which have been making a real impact on the lives of patients.
“ I have been involved in Sutton Homes of Care vanguard, which has been working to improve services for care home residents, for the past four years. This partnership working led to Sutton Clinical Commissioning Group (CCG) being awarded vanguard status in 2015.
For me personally, it all began with a number of “frequent callers” to the ambulance service. I wanted to understand why the callers were constantly contacting emergency services so that we could put in place an appropriate intervention for the individuals. This resulted in me needing to work more closely and more regularly with community services.
Through my interactions with Sutton’s community services I met Pat Franklin. Pat is the Carshalton Clinical Integrated Locality Manager at Sutton Community Health Services. It wasn’t long before I realised that Pat and I had a great deal in common including the desire to improve the overall patient experience.
Pat was having discussions with the Quality Assurance Manager from Sutton CCG, Christine Harger. They were attending many safeguarding meetings and were interested in developing a more proactive approach to identifying risks in care homes and how to mitigate them. Pat invited me to a meeting with Christine Harger, Maria Patterson, the Adult Protection Specialist Nurse from Epsom & St Helier Hospital, and Paul Fevan from the London Borough of Sutton. This meeting highlighted the need for a strong focus on overall care needs of the resident and how we could make things better – this is how the joint intelligence group was formed.
It became evident through the early work focusing on frequent callers to 999 (who were not in care homes) that we were operating in a silo manner, there was a lack of information sharing and it was apparent we were all unclear on each other’s roles and responsibilities. An understanding of each other’s roles and ways of working and building relationships to foster a more patient focused approach enabled us to ensure that the patient received the most seamless and best quality care.
Pat developed a plan to bring both myself and the ambulance service as a whole into the community care setting as a means to break down barriers including sharing of data and information governance.
The main issue highlighted was the number of various healthcare professionals involved in a patients circle of care, this could include the ambulance service, primary care, and community services and we did not work together collaboratively or effectively; in fact, the communication between the services was poor. Work was often being duplicated due to the lack of communication; however this was improved through establishing regular calls with the GPs to discuss options of care for the frequent callers with a multi-disciplinary approach.
With the pre-vanguard work, we tasked ourselves with breaking down our organisational barriers. Initially, this was a micro movement, where we as individuals in the organisations decided to make small changes and initiatives in the care we provide for our patients.
Challenging at first, it was worth it. This initiative has led to a true partnership and a more integrated approach to patient care. There has been a positive impact on the patients’ experience of care and quality; this is very evident with the care home work with the vanguard.
Ambulance services and care homes use to operate separately and unilaterally, there was limited contact or communication. The contact we did was exclusively reactive and again there was very little understanding of each other’s roles.
When the ambulance service provided quality checks within various homes for the council, the care home managers did not understand our involvement. Today, through our efforts to sit down and establish a system of communication and joint working, and through the care home forum I now know all of the care home managers and there is no longer an ‘us and them’ mentality. The care homes and ambulance service have come to know what is expected from each other.
An example of this is the vanguards Hospital Transfer Pathway, affectionately known as the ‘red bag’. The ‘red bag’ is a handover scheme where a patients’ key personal and medical belongings and documents are all kept together in one place travelling with the resident from care home to hospital and back.
While the ‘red bag’ has gained much credit for its success in improving quality and coordination of patient care, I feel it has done far more than that. The ‘red bag’ has changed our working culture, promoting openness between different health care providers who are now more willing to work with each other. What has allowed it to work so well is the fact we have addressed the issues in the hospital transfer pathway from care homes and rolled out the initiative from the bottom up, we ensured that the process was adopted first and foremost by frontline staff, including care home managers and staff.
I have seen the difference first-hand for patients and their families in how the vanguard is delivering patient centred, high quality care now through joint working. Sutton’s senior population can be very vulnerable and unable to advocate for themselves due to the increasing prevalence of diseases such as dementia. It is often relatives or family members who tend to see the largest improvement and are so pleased with the effects of the ‘red bag’. Families appreciate that their loved ones medication, personal items and documentations are safe in the ‘red bag’ and that the ‘red bag’ is providing more seamless transitions in an already difficult time of going to hospital.
Understanding the benefits to patients, carers, care homes and healthcare professionals; joint and collaborative working needs to be a priority. Barriers, especially in London, for example, are a challenge in the sheer number of different commissioners and providers across the city, making sharing patient data more difficult. Technology can play a key role in supporting joint working. Within Sutton’s ambulance service, we are exploring the possibility of obtaining tablets for staff, which will allow for a substantial increase in integrated data sharing.
I believe systems must engage with ambulance trusts at an operational level. The ambulance service, and not only those within community, primary, secondary and social care need to be involved in a patient’s care in a joined up way. All stakeholders must listen to and understand each other’s roles.
By implementing integrated working, paramedics can work with A&E department to deliver care plans, rather than just readmitting patients. We can identify trends and notify community and other service providers if a patient is being repeatedly admitted.
By linking up different parts of the system and addressing the gaps between social care, primary care, and secondary care, ambulance services can play a critical role in improving patient experience and making the system more efficient. Sutton Homes of Care vanguard has made excellent strides in establishing a collaborative and integrated care network and we hope that it will inspire other care providers across England to rethink about they can work better together to improve patient experience. “
About the author:
Jason Morris joined the London Ambulance Service in 1999 where he qualified as a Paramedic before progressing to a Clinical Team Leader in 2010.
In 2013 he started working closely with partners focusing on frequent caller, care home and alternative pathways which lead to him getting involved with Sutton Homes of Care vanguard in 2015.