New direction

Better management of frequent service users is one way this multispeciality community provider is changing the face of healthcare

Erewash is a borough in Derbyshire built on the former coal mines and railways and iron work industries that were once the backbone of its local economy. Around 75% of its 111,000 strong population live in its principle towns of Long Eaton and Ilkeston that straddles the Nottingham/Derby greenbelt.
Although the heavy industry has declined in the last 30 years the local authority suggests the area has adapted well to the economic challenges it has faced and it boasts a strong manufacturing base that provides 22% of all jobs in the borough – twice the UK average including a renowned centre for upholstery in Long Eaton.

Despite this, the area suffers from higher than UK average levels of unemployment and a lack of affordable, quality housing. This is a contributing factor to the health of the local population that suffers from generally poorer outcomes than those of the national average. Death from cardiovascular disease, stroke and cancer remain a challenge in the borough and smoking prevalence is higher than the England average. Like other areas in the UK the borough has a growing and ageing population. In Erewash, by 2020, 21% of the population (22,000) will be over 65, an increase of 17% from 2013.

The model
To respond to the challenges facing the borough, commissioners joined forces with its local care providers, Derbyshire Community Health Services NHS Trust and Derbyshire Healthcare Foundation Trust, as well as the local out of hours and NHS 111 provider, Derbyshire Health United, and local GPs to build a joint bid to be at the forefront of developing new ways of working from the new care models team at NHS England.

The successful vanguard application means the area can now accelerate its plans to move specialist care out of hospitals and into the community, equipping people with the support they need to take responsibility for their own care with access to specialist support from community health teams. The borough has become one of 29 sites to be awarded the prestigious [vanguard] status.

The vanguard project was launched with a two-day site visit from NHS England and partner organisations. During the visit the local team were able to showcase successes and talk about the challenges faced during implementation of the services. Those challenges include changing mind-sets of the staff and patients that care cannot be delivered in the same, traditional ways as before.
The new models of care need a transformation of minds as well as services.

Programme of change
The Erewash bid was based on a very well designed programme of change. The focus of the work is to wrap care and services around patients and their families, and break down the current barriers between different organisations that traditionally have worked in silos and not in a joined up way.
GP practices across the area now hold multidisciplinary team meetings where social care staff, community matrons and GPs come together regularly, alongside physiotherapists and occupational therapists to discuss what a patient needs and respond to those needs. It allows specialists to share their knowledge and experience of a patient with fellow professionals from different organisations. It is hoped this will not only build a more cohesive service for patients but will also develop stronger respect and rapport between health professionals.

Locality hubs based at the main towns will act as coordinating centres where resources can be managed so that the right staff can be allocated based on patients’ needs. The Welcome Home service provides a parachute service for patients discharged from hospital care who need extra support at home. Similar schemes in care homes are helping to keep people out of hospital by directing community care before patients reach crisis that often leads to a hospital admission.

The support is comprehensive and well planned. It includes outreach and community nursing to meet the medical and rehabilitation needs of patients but in the future will also include drop in services such as clubs and classes that help build social independence and reduce isolation.
The care package will be able to extend to support with housing and benefits advice and information and the availability of short-term residential bed provision for rehabilitation needs.

Commissioners admit that this will need a major change in the way service providers look at services they are commissioned to provide – looking at the whole person and not just their immediate medical or social needs. It will require providers to look at a patient’s family and circumstances.
The long-term aim is to have joined up electronic care records and to target patients who need the most intensive care support. It is estimated there are around 30,000 families in Erewash and 5% of the population costs the commissioners and providers around 45% of the spend on NHS and social care services. The vanguard project will bring together major community and mental health services alongside GPs to develop a proactive approach to these patients with a team made up of health and care staff, including GPs, advanced nurse practitioners, mental health nurses, extended care support and therapy support.

The scheme delivers services to people with long-term conditions including diabetes, chronic vascular disease and chronic lung conditions. They also plan to extend GP access. The scheme focuses on improving information by sharing between clinical staff so that treatment plans of the most vulnerable people will be available to emergency and out-of-hours staff. Health professionals will talk frail and vulnerable people’s concerns through with and support them to remain in their homes if they do not require specific hospital treatment.

Health care hubs will bring medical, nursing and mental health professionals together to share information and knowledge about patients with long-term conditions and acute medical needs so they get the best care possible to stay well for longer. Partners also hope the status will lead to further development of telehealth technology to help people with long-term conditions to manage better – particularly for people with cardiovascular disease, respiratory diseases and diabetes.

Key to commissioning effective health services is the role of the voluntary sector. Within Erewash there are already groups that help people from cradle to grave. There are support services for parents before and after the birth of a child, through a home visiting service. There is support for mums with mental health issues and there’s a winter survival scheme that supports vulnerable people to keep warm and clear their paths during adversely cold weather. The clinical commissioning group’s partnership with the voluntary sector has even been nominated for a national award and the plans for the services across Erewash include developing this partnership further.

Patient engagement
Patient engagement has played a major role in the vanguard project. Without knowing how health services are being received it would be impossible to measure its success or impact. Having a strong patient engagement structure of patient participation and stakeholder forums has strengthened the bid.

Winning vanguard status is recognition that the partnership model in Erewash is working. There’s no question about the value of support the new care models team will bring.

Being part of a greater pool of likeminded partnerships across England will help the Erewash team to hone its model so we can learn from other areas and they can learn from us. The share in the £200 million fund is clearly a huge boost and testimony to those who have been driving the changes over the years that it has all been worth it.

Rakesh Marwaha, chief officer for Erewash Clinical Commissioning Group.