Iain Macbeath: The original aims of our Vanguard were three-fold really.
We have seen a lot more people from care homes being admitted to hospital, which was a concern.
GPs had told us that they found people's needs were increasing in care homes.
Actually, when we asked care providers what their staff wanted training on, it was more
clinical issues than it was about social care.
So we knew the level of needs was rising and we wanted to better support people to stay
at home which happened to be in a care home.
Sharon Elton: In the original pitch, the four key elements were around increasing knowledge
and skills of staff in care homes, multidisciplinary team approach, rapid response and increasing
our investment in technology.
IM: Rapid Response comes in many forms, one of them is the Early Intervention Vehicle.
That's a partnership between the county council and the Ambulance Trust.
Jaymi Murphey: What we're able to do now is assess at home and try to keep somebody at
home rather than take them to hospital just because it's not safe at home.
My experience of being a part of the Vanguard process has been a really positive, quite
an exciting one.
It's a very unique environment to be working in as an occupational therapist.
I wouldn't usually have the opportunity to work in a 999 front-line service and I think
working integrated with the ambulance service has been a fantastic experience and one that
really seems to have benefited patients as well.
Dave Jackson: I had a particular fall and this Vanguard team turned up, checked me over
and the occupational therapist that was on board with them checked me as well, looked
around and suggested various pieces of equipment: first of all grab rails for my bed and also
equipment for the kitchen and chairs and they actually went out to the van and got these
things and brought them in and installed them.
It's been the best thing that ever happened.
IM It's prevented 70% of people who have been responded to by that car from being conveyed
to hospital and that's 2000 people.
I suppose the most practical thing we put in place is enhanced training for care home
staff.
Sharon Davies: What we have had to do is we have had to engage the managers as well: it's
about leadership.
Those managers have had to understand that what they are doing is they are up-skilling
certain members of staff; those members of staff will be able to cascade that information
through the rest of the staff teams.
Pawel Michalewicz: Champions take a great pride in delivering training sessions and
spreading the knowledge and experience with the gain through HCPAs and Vanguard programme.
Donella Clarke: Its means that I can support my residents better.
I can spot changes that may need more attention for medical personnel and hopefully treat
them within the home, again, rather then send them to hospital.
Ruth McGregor: I think it gives us all a bit more confidence in actually being able to
do the job that we are here for.
SE: We have had to kind of refine the programme and be really clear round what the priorities
were.
IM: What we found is as we got into the project were there were other NHS services that were
available but just weren't linked up with the care home.
For example, pharmacy.
We've employed two or three extra community pharmacists to help care home staff specifically.
Over 15--16,000 bits of medication have now been checked in.
We've been able to reduce the amount of medication people in care homes are taking by about 17%
and that saved about £400,000.
But when people do end up in hospital, and some people do need to go and do need to stay
for a while, it's important we get them home as soon as possible.
SD: We looked at the problems of getting people out of hospital, and that was very much around
looking for somebody that would be trusted in the hospital to act impartially to carry
out any assessments for the care home and save the care home the time of going backwards
and forwards to hospital.
SE: We've seen about £350,000 bed-day savings as a consequence of that project thus far.
IB: The impact we've seen is a lower number of admissions to hospital, so that's what
we were really aiming for.
The care homes who were the original cohort who have been running the Vanguard streams
the longest, have seen a 45% reduction in people being admitted to hospital which is
fantastic.
It means they're at home, not going to hospital, the hospital bed is empty, and we've calculated
that has saved about £1.7 million with the reduction in the cost of the beds at the hospital
and the medication that people are no longer taking.