End of Life Care
Advance Care Planning - Haringey
This small pilot investment provides an Advance Care Planning Facilitator (ACPF) to support staff in three care homes in Haringey. The ACPF provides training to care home staff so that they can better engage with patients to collaboratively plan their end of life care. Through training and support, the facilitator helps staff complete advance care plans, which can ensure that a patient’s wishes for their care at the end of life are understood and can therefore be followed. The pilot project has successfully enabled more patients to have plans and has been associated with a reduction in unplanned hospital admissions, allowing the initial investment to be fully repaid to the Fund in summer 2019. The approach and learning is now being incorporated into a wider programme of support for care homes.
Rapid Response End of Life Care Nursing - Hillingdon
The End of Life Care Integrator is supporting Your Life Line 24/7, which provides 24/7 telephone advice and support to patients identified as having palliative care needs or who are approaching the end of their lives. The service is designed to coordinate palliative care in Hillingdon and to support patients to receive dignified end of life care at home, including rapid access to nurses who are able to visit patients in their homes and support them in crisis situations. To date, over 90% of those supported by the service have been able to die in their usual place of residence, better meeting their preferences for care at the end of life.
Tele-support for Care Homes - North West London
Care home staff can often face challenges to providing personalised, high-quality care to residents approaching the end of life. Staff may be faced with needs which they are not familiar with and homes often struggle with high staff turnover. To help address this issue in North West London, the Fund has invested into a dedicated phone and video conferencing service. This links care home staff with experienced nurses, in order to provide additional advice and support. Through better trained and supported staff, residents are able to receive better and more appropriate care in the community, and only receive hospital care when needed.
System Integration - Waltham Forest
Waltham Forest has one of the lowest rates in the country of people being supported to die in their usual place of residence. Partners in Waltham Forest have developed a vision for developing integrated end of life care, so that the system is better able to recognise patients approaching the end of life, record their wishes and provide care that enables their wishes to be met. The Fund has invested into the first step of this vision, by supporting the launch of an Enhanced Community Palliative Care Service (EPIC), which will enable more residents in Waltham Forest to have access to specialist advice and greater support in their home.
Community and Primary Care
People with the most complex needs and more severe loneliness often require more long-term support than is offered by services which focus on signposting people to activity. To address this, the Fund has invested into Reconnections, a pilot community response to loneliness in Worcestershire which works with individuals on a one-to-one basis to help them improve their confidence and connect them with the types of local activities which they are most keen to engage with. Reconnections supports people holistically, with around 150 volunteers and a small team of paid staff, aiming to reduce loneliness and improve individuals’ health and wellbeing. Over the first four years, around 1,500 older people have been supported by Reconnections and it has exceeded its expected impact on loneliness. Further pilots in other parts of the country will be launched in 2020.
Oomph! is a social enterprise that exists to improve the quality of life of older adults and disadvantaged members of the community. Their work targets three areas of wellbeing: physical mobility, social interactions and mental stimulation. Oomph! provides training to care home staff to run exercise classes and activities, and provides a subscription-based minibus service to allow care homes the capability to run a varied programme of out of home activities. The Fund is particularly supporting the development of the Out and About minibus service, which by summer 2019 is supporting around 425 older people a month.
Symphony Healthcare Service (SHS)
Good primary care plays a fundamental role in supporting the health and wellbeing of individuals and the population as a whole. Yet GP surgery closures across the UK have reached an all-time high, affecting an estimated half a million patients in 2018. Over the next five years it will be important to fundamentally strengthen many primary care practices; to enable people to receive a greater range of support without needing to go to hospital and to ensure that people’s needs are met in the round. This will require greater collaboration, innovation and making better use of resources.
SHS is seeking to strengthen the overall system of care in the area in which it operates (South Somerset). It is owned by the NHS, and aims to be a platform for sustainable and innovative primary care. The Fund is supporting SHS by investing in key building blocks (HR and Finance systems, timely management information, wider data analysis) to drive broader transformation, improving access to quality primary care services for the local community.
As the population becomes frailer and more people are living with multiple long-term conditions, it is vital to support district and community nursing services to be able to meet this increasing need. At the same time, however, the number of district nurses has fallen by around half over the last decade, and community nursing as a whole is under pressure.
The Fund aims to support the development of stronger neighbourhood teams of district nurses, which are better able to meet a wider range of patients’ needs, strengthening the relationship with patients rather than moving people across multiple services. The Fund has made a small seed investment into SK Nurses, a start-up social enterprise which aims to support the development of self-managing teams of community nurses, inspired by a successful Dutch model (Buurtzorg).