Enhancing Clinical Care Framework (ECCF) in Northern Ireland Care Homes

Enhancing Clinical Care Framework

The aim of the Enhancing Clinical Care Framework is to ensure that people who live in care homes are supported to lead the best life possible and that their right to access timely, integrated, equitable healthcare provision is observed. The Framework describes what “good” looks like when someone in a care home accesses multidisciplinary clinical care and support, in line with their needs and wishes, to support their health and wellbeing. The Framework is relevant and equitable for adults living in both residential and nursing homes and across the full range of categories registered by RQIA.

Strategic background

It has been apparent for some time that a greater proportion of care home residents have complex clinical healthcare needs than would have been the case in the past. Residents who would have been in hospital five years ago and receiving palliative or end of life care are often now cared for in nursing and residential homes. Residential homes are often now providing a level of care that would have previously been found in nursing homes.

Learning during the ongoing Covid-19 pandemic further highlighted the high level of frailty and clinical acuity of residents in care homes for older people and the pre-existing challenges faced within the independent care homes sector. 

On 17 June 2020, the Minister announced plans for a new framework for nursing, medical and multidisciplinary in-reach into care homes. The Minister asked the Chief Nursing Officer for Northern Ireland to coproduce the framework with the independent care home sector to be available for future COVID-19 surges and enable continuing safe, high quality and person centred clinical care within care homes.

The Project is one of the ten Key Actions under the No More Silos Action Plan which aims to develop an enhanced range of safer and more effective elective and unscheduled care services. The project will also incorporate the delivery of the Key Action to develop a regional anticipatory care model and links with the delivery of the Key Action to develop a regional Acute Care at Home model,

Project structure

Coproduction is at the core of the development of the framework and is represented in the membership of the project structures.

A Project Board has been established to oversee the development of the framework, supported by a working group to co-ordinate information and formulate recommendations for decision by the Project Board.

The project at this initial stage will comprise of three clinically led, managerially led or co-chaired main sub groups, which will report/feed into the Project working group:

  1. Multidisciplinary Working: to include Medical (primary care and acute), AHPs, Pharmacy, Nursing, to develop the following Clinical Pathways: rehabilitation, anticipatory care, long-term conditions, palliative care;
  2. Workforce Development: Career Pathways and Acuity Staffing; and
  3. Informatics and Digital Technology.

Project Membership

The membership of the project reflects a range of knowledge, skills and experience necessary to support successful delivery of the Project.  Membership of the subgroups will be kept under review to ensure suitable representation and may evolve as required as the work proceeds.

Project Board

Project deliverables

The project aims to ensure that people who live in care homes are supported to lead their best life possible, with their right to access equitable healthcare provision fully observed and other Human Rights protected.

It will include developing optimal clinical pathways that are integrated across the community, primary, independent and hospital sectors with the benefit of a stronger clinical model, and a robust partnership approach post COVID-19.

The key project deliverables are as follows:

    1. Streamlined processes and structures to provide safe, effective and person centred clinical care across boundaries between the independent sector and HSC organisations.
    2. A refreshed model of personalised healthcare building on the ‘frailty model’ focusing on ‘what matters most’ to residents, families and staff.
    3. Participation approach to decision making regarding and access to the right clinical care, delivered by the right person at the right time e.g. rehabilitation, anticipatory care, long-term condition management and palliative care.
    4. A workforce development policy which will include a new healthcare acuity tool to inform future nurse staffing requirements for the care home sector and career pathways that will enhance MDT working.
    5. Promotion and use of data and information technology in the care home setting.
    6. Enhanced primary care medical support model for care homes.
    7. Enhanced AHP support model for nursing homes.
    8. Enhanced MDT care model that meets the needs of both acutely ill residents and those with chronic healthcare and/or rehabilitative needs.
    9. Enhanced pharmacy model for care homes.
       

      Testing the Wellness Pathway

      The Enhancing Clinical Care Framework (ECCF) project will shortly be testing key elements of the Wellness Pathway in a “live” care home environment. The Wellness Pathway gives a visual description at Health and Social Care system level of the environments the ECCF project wishes to build for the clinical care framework - regional standardised gateways, tools and resources to support the assessment, monitoring and interventions for people living in care homes to enable them to live their best life possible, and the underpinning system and workforce enablers required.

      The Project acknowledges the unprecedented challenges that continue to be faced by care homes, their residents, families and staff from the ongoing pandemic of Covid-19. We are profoundly grateful for their support in testing the Wellness Pathway and their ongoing participation in the structures and wider work of the project. The project has been mindful not to add to workloads for care home and Trust support staff during the testing exercise.

      Requests for expressions of interest in participating in the testing process were sent to all care homes in Northern Ireland. The Wellness Pathway will be tested in a total of 35 care homes. Participating care homes come from across all five Trust areas. They include residential and nursing homes and vary in size in terms of resident numbers and organisational structure. All categories of care, as defined by the Regulatory Quality Improvement Authority have been included.

      To ensure the ongoing health and wellbeing of their residents, each participating care home will only test a specific aspect of the Wellness Pathway. Training and support will be provided to care home staff for the testing exercise.

      Consent must be given by a resident to participate in the testing exercise, or by their family where that is not possible. Further information on the testing exercise will be provided to those residents and their families who are taking part.

      The testing exercise will focus on enhancing the health and wellbeing of residents and be undertaken using a Quality Improvement (QI) approach. Testing is planned over two phases which will run from December 2021 to February 2022.

      Testing in selected care homes is planned to begin in December 2021 for the following:

      ·         Pre-assessment document including the Rockwood Frailty Score (Clinical Frailty Scale - Geriatric Medicine Research - Dalhousie University) 

      ·         Restore 2 and Restore 2 Mini (RESTORE2™ official (hampshiresouthamptonandisleofwightccg.nhs.uk)

      Further information will be provided as the testing of other key elements of the Wellness Pathway begins.

      Resources


Other work in this area:

Care Home Clinical Care Network

 

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