Do you deserve to have your wishes heard? Do you want to have a say in the healthcare you receive? If so, why should our relatives and loved ones living in care homes be treated any differently?  

BACKGROUND:

Coordinate My Care (CMC) is an NHS service, sharing urgent care plans electronically between healthcare providers allowing for coordinated patient care and improved care outcomes. CMC was started by Professor Julia Riley, a palliative care consultant who had seen her own sister-in-law struggle to have her wishes followed as she died from cancer. Recently featured on channel 4 News, this pan-London service that has been awarded National Innovator Accelerator (NIA) status by the NHS. It’s the first electronic patient care plan record all healthcare providers can access 24/7, including the London Ambulance Service. An economic evaluation report has also found the average cost of treating patients with a CMC care plan is £2,102 lower than non-CMC patients in the last six months of life. There is great importance of reducing end of life care admissions from care home as part of the national frailty agenda – scaling up some of the learning from the Vanguards who have reduced admissions from care home by 20-30%.  

CH4 Link

CHALLENGE: 

The care home sector continues to be an under resourced, overstretched and faced with ageing population. In many boroughs only a handful of CMC care plans have been created for care home residents. Across London there are over 13,000 nursing home residents, not including residential homes. It is stated for nursing home residents’ the probability of surviving beyond one year is 48.6% (Hicks, Black & Rabins, 2010). This means that one can estimate half the residents in the nursing home will die within the year, suggesting all residents in the nursing home should have an urgent care plan.

For CMC to reach its full potential, it is essential care home staff can view and (where appropriate) edit resident’s CMC records. This is a crucial enabler for patient empowerment and to optimise quality care. Information Governance has historically been the main barrier for care homes. Currently only 1% of care homes are considered IG compliant.  A timely breakthrough with a new and improved Information Governance toolkit by NHS Digital is a major development. Completion of the toolkit is paving the way for more care homes to move away from paper notes and outdated processes, and venture in to the digital world. This will improve efficiency, patient empowerment and join up communication channels between care homes and NHS health care providers through CMC. 

AIM:

The Health Innovation Network (the Academic Health Science Network (AHSN) for south London) is working with CMC to make it a reality for many frail & vulnerable residents living in care homes to firstly have a CMC record – and crucially have it accessible by the care home team.  We are starting by working with two nursing homes, Wandsworth CCG, care home staff, Marie Curie and the care home GP to implement CMC. Innovative models have been developed to allow care home staff access to CMC in both Information Governance (IG) compliant and non-IG compliant care homes. 

PHASE ONE: The pilot study is phase one of the project which will cost £3000. Funding will pay for two Marie Curie nurses to provide training and support to the care home staff, IT equipment and promotional material needed to engage the residents and their families. This will equate to 90 residents across 2 nursing homes having a high quality CMC record created. The records will then be reviewed and updated as needed by the care home GP and care home staff.   

PHASE TWO: Completion and learning from this pilot will inform our approach on how we support other care homes (nursing and residential) to adopt and embed CMC in a high quality, cost-efficient way. £27,000 will be used to support further care homes to engage in the project to successfully embed CMC. Modifications of the model, variations in the approach to be taken and financial support required by each care home will be dependent on the type of care home, local authority, CCG support, resources required, training needs and Information Governance compliance levels. The ambition is to support at least 12 care homes in South London, approximately 540 residents.

Alongside this work, we will develop an effective and accessible “Peer Support” network for care home staff, managers and stake holders to continue the momentum behind embedding CMC within the care home sector.

MEASUREMENT:

Feedback from the care home staff, residents and their families will be collected to monitor the experience for those involved. We will learn what worked well and what can be developed to continually improve the experience for our care home residents. Quantitative data will be collected to measure the number of CMC records being completed through the project.

THE BENEFITS

Your support to secure Q funding is essential for CMC to be embedded across the care home sector and give these residents a platform to have their wishes heard.  We require £30,00 to deliver this project in support of training, project management and measurement. This exciting project is pushing the boundaries, working to address the blockers and barriers (both large and small) and deliver quality improvement between health and social care. We intend to demonstrate that care homes CAN be revolutionised and inspire much needed change across the whole care home sector.