What we need from health services

The enhanced health in care homes (EHCH) framework has been in place for over 3 years and is a national model. It enables joined-up social, primary, community, and secondary care and provides an opportunity to implement a shared strategic and operational approach.

In Norfolk and Waveney, this has been renamed the 'enhanced health and wellbeing in care framework' so that it may support the wider care provider market.

The seven core areas in the framework will help to ensure that people receiving care have access to enhanced primary care and to specialist services to maintain their independence as far as possible by reducing, delaying, or preventing the need for additional health and social care services.

The seven core areas of the framework are:

Enhanced primary and community care support

This aligns homes with primary care networks so that every home is aligned with a GP practice that performs home rounds (either virtually or face-to-face). Personal health care and support plans are developed with the individual and their circle of support. This includes the undertaking of structured medication reviews, hydration and nutrition support, and access to out-of-hours and urgent care.

Oral health access is proving problematic due to the national shortage of dentists, but some providers are reporting access to dentists. A small project in the west of the county has seen a mobile dentistry service in operation.

Multi-disciplinary team support

Multi-disciplinary team (MDT) support brings together a number of resources and training for care workers, including continence promotion and management (including UTI and continence training and bowel care pathways). Training in wound care, leg and foot ulcers, including diabetic foot care is also available.

The Cambridge diabetes education programme is available to providers and consists of a modular system to be used as a training course but also to be dipped into as a resource. It is made up of a number of levels, from basic to specialist.

Carers' support and breaks for carers are also important elements of this core area.

Falls prevention, reablement and rehabilitation

A lot of work is ongoing in this core area, both in fall prevention, safe falling and lifting, and post-fall management. 268 Mangar lifting cushions have been distributed along with training in the ISTUMBLE algorithm to determine whether to lift an individual. ISTUMBLE refresher training has also been available, and there are several community fall initiatives for early identification of individuals to build resilience and independence.

Palliative and end-of-life care, mental health and dementia care

There are video resources covering 13 topics and rolling level 3 ReSPECT courses.

Commissioning and collaboration between health and social care

There is joint work on a number of initiatives, especially in the areas of:

• Falls
• Single-handed training
• Nursing care

Workforce development

There are a number of initiatives, either as direct courses (including bitesize sessions), videos, or e-learning, on a range of subjects including:

• Diabetes
• Medicines management
• Signs of deterioration

There are also a number of champion networks in operation, and there are plans to expand them.

Data, IT, and technology

This is a constantly evolving area and includes NHSmail for care homes offering secure communications, assistive technology that may prompt the taking of medicines, and pressure mats, for example.

Technology, whilst often something social and health care specific, such as shared care records or Alcove, also includes using mainstream tech such as 'Alexa' or 'Google assistant' in a new or bespoke way. There are also a range of apps offering a variety of services, depending on the support needed.

There are a number of pilots in this core area exploring a number of ways to use technology effectively with care providers, carers, and individuals.