Health & Wellbeing Wirral Community Health & Care NHS Foundation Trust Wednesday 24 July 2019

1. Health & Wellbeing • Wirral Community Health & Care NHS Foundation Trust • Wednesday 24 July 2019 Karen Howell, Chief Executive

2. We had so many case studies to choose from… • CardioFit • FIT club • Home First • A&E streaming • Neighbourhood development with system partners • Development of population health • Admissions Avoidance Schemes

3. Teletriage Service • Transforming healthcare within nursing and residential homes An award winning service at the NHS Cheshire & Merseyside Digit@LL Awards 2019 in the Empowerment Category Emma James, Teletriage Nurse Clinician

4. The local picture • Wirral faces a significant increase in the number of people needing treatment and care • Unprecedented demand in A&E • Some of the pressure in A&E is because people aren’t sure where to go for the right help, so resort to dialling 999 • Care home staff can sometimes face the same dilemma and often call 999

5. Collaborative working Supporting care homes to care for their patients through collaborative working • Worked with key stakeholders including Wirral Council, Wirral Clinical Commissioning Group and Wirral University Teaching Hospital • Looked at innovative ways of working and mobilising staff to meet the needs of local people and support care home staff

6. About the Teletriage Service Project aim: to reduce unnecessary hospital admissions • Operates 24 hours a day, 365 days a year • Senior nurses provide healthcare advice to care home staff, helping to manage any health concerns they have about their residents • Use of digital technology (Skype on iPads)and innovative ways of working to empower everyone involved • Supports communication between healthcare professionals

7. How the Teletriage Service works • If a care home is concerned about a resident, they call the Teletriage Service • Using iPads the senior nurse carries out a virtual rapid assessment of the patient determining action required • Senior nurses coordinate the appropriate care • advice and support to care home staff • referral to other services such as GPs, the falls team, geriatricians, community nurses • emergency ambulance

8. Results Transforming healthcare, improving patient outcomes and reducing pressure on A&E • Rolled out across 76 care homes across Wirral • Positive impact on elderly care home residents, care home staff and the pressure in A&E • Cultural shift to a shared understanding that hospital is often not the most appropriate place for care home resident • Unnecessary admissions having a severe physical and mental impact • Some people don’t regain the level of function they had prior to admission

9. Results • Care home staff receive direct support and on-going clinical supervision • Provides an alternative to the NHS 111 service • Improvement in how patient information is shared, resulting in people accessing the care they need quickly and easily • Its introduction has proved that many care home patients were going to hospital because there was no alternative pathway • Un-well patients are now supported within their care home, rather than facing the prospect of ambulances and hospital

10. Results • The service receives about 280-300 calls a month from care homes • Of these calls 12% of patients require hospital treatment - usually for an X-Ray • Over a 12 month period the service helps avoid over 3000 unnecessary hospital admissions • Residents are given the treatment and care they require in their own familiar and comfortable environment, rather than facing the frightening and disruptive prospect of ambulances and hospital departments

11. Service developments • The service model has been adapted to ensure training is repetitive to support the high level of staff turnover within care homes • Data is shared with NHS111 to inform them of the reduction in hospital admissions • Plans to enable teletriage staff to start prescribing medicines for care homes and provides hands-on clinical assessment for patients who need it