HSJ Value Awards 2018: Improving Value in the Care of Frail Older Patients

Winner

Walsall Clinical Commissioning Group and Walsall Healthcare Trust: Enhanced Health Care Model for Nursing Homes

Data showed that nursing homes admissions to accident and emergency in the Walsall area usually involved the ambulance service being called and 90 per cent of these admissions were due to five reasons – chest infection, fall, urinary tract infection, constipation and end of life care.

Walsall CCG and Walsall Healthcare Trust, with input from nursing home managers, the West Midlands Ambulance Service Foundation Trust, GPs, nursing home residents and their families, designed an enhanced care model for nursing homes.

This involved enhanced primary care support with a GP practice team linked to each home, a dedicated case management service, access to a rapid response team, increased partnership between primary and acute services and high quality end of life care. The project partners also recruited an advanced nurse practitioner and nursing home case manager, who would undertake frailty assessments, provide training to care home staff etc.

Standardised protocols for managing chest infections, UTIs, end of life care, constipation and hypoglycaemia were developed. This model has decreased the number of 999 calls from nursing homes by 91 per cent, with 95 per cent fewer residents conveyed, resulting in time, money and resources saved by the ambulance service, and by acute care facilities.

While the model costs £389,000 a year, savings from avoidable hospital admissions were £1,420,000 in 11 months. This model is extending to neighbouring clinical commissioning groups, as well as ongoing work to promote admission avoidance care pathways and to enhance skills within the nursing home teams.

Read a detailed case study about this project at HSJ Solutions