For two years, 82-year-old Mary had lived happily in a care home in Bath, just half a mile from her family. One afternoon Mary, who has Parkinson's disease, fell and ended up in hospital. After 10 days on a ward, she was discharged. But to her dismay, instead of going back to her care home, she was placed in a nursing home. She could get medical attention there, but it was 20 miles away, leaving her cut off and isolated.
Mary's is not an actual case, but social workers say the scenario is all too common. They hope to prevent older people from being forced into nursing homes in future with a new initiative that brings front-line nursing staff into ordinary residential homes.
Traditionally, older people in need of round-the-clock care have no choice but to live in a nursing home - often after a short hospital stay. A project in Bath plans to change that and bring services to the person through the creation of a 24-hour mobile nursing team.
This rapid-response team will provide intensive support to residents of care homes and sheltered accommodation in what is being seen as a revolution in the way older people are cared for. Social services and health managers say such a move will avoid the need to relocate a seriously frail person to a new home when they are at their most vulnerable. It also promises to reduce hospital admissions and the length of time older people spend on wards.
Plans for the pilot have been enthusiastically received by the government, which has promised £1.3m in grants over the next three years from its "invest to save" budget - a joint Treasury/Cabinet Office initiative targeted at pioneering projects. All schemes supported by the budget carry a risk factor, but have the potential to produce better quality public services and promote work collaborations.
The Bath initiative, which will support three new registered care homes, is the brain child of Jane Ashman, strategic director of social and housing services for Bath and North East Somerset council. She says the project sprang out of a desire to improve the health of older people living in the city.
At the moment, people in residential homes who become physically ill may receive care from a GP or district nurse, who are limited in the support they can offer. Anyone needing intensive support faces either hospital or a nursing home. "Social services have been working with the PCT (primary care trust) on how to improve health pathways for older people for a while. Long waiting times at the Royal United Hospital NHS trust in Bath meant old people were spending a long time in A and E," Ashman says.
"At the same time, the council decided to replace its seven existing care homes for the elderly with three new ones to meet new care standards. These would be a combination of sheltered units and extra care, and some nursing care. While we could come up with ways of offering sheltered accommodation and extra care, we wanted to find another way of meeting people's nursing needs. We thought there must be something better than the traditional nursing home model."
It didn't take long for Ashman to come up with the idea of a mobile nursing team. This, she says, will not only bring care to older people in familiar surroundings, but offer better quality care. It is an idea that has won the support of local people and professionals.
"The initiative has wide implications. I think it will attract better quality nurses," Ashman says. "These will be people who want to join a team at the cutting edge of nursing care, rather than those who end up in a nursing home out of convenience."
The team will support 15 people with nursing needs across the three homes, which will be known as "centres of excellence". Supporting the nursing staff will be new health and social care workers - care assistants who have received extra medical training on the local authority's NVQ training programme. Bath and North East Somerset and two neighbouring local authorities have been awarded £321,000 in funding from the Training Organisation for Personal Social Services (Topss) for development of the new workers.
Crucial to the success of the mobile nursing team will be the partnership that Bath and North East Somerset's social services and housing department has formed with the local PCT, the local mental health trust, the Avon Registered Care Homes Association and a leading registered social landlord.
But Ashman admits the scheme would never have got off the ground without support from the National Care Standards Commission (NCSC), which has relaxed regulations to allow the project to go ahead. Under current rules, a registered home providing nursing care must have a nurse on the premises 24 hours a day. This has been waived by the NCSC, which is supporting the project and will monitor its progress.
Ashman, who says such rules are "inflexible and expensive", hopes the project can be extended to the independent sector in its second year. Considerable savings should follow. With residential beds costing £300 a week and nursing home places an extra £73, the support offered by the nursing team to care homes should allow home owners to reduce their nursing cover and cut costs. This, in turn, is likely to change the balance of nursing and residential homes in the region.
The creation of the team should also free up hospital beds. Latest figures suggest that 12 older people from council-run care homes are admitted to the Royal United every month, staying an average of 12 days. A study of their records shows that 30% of their time in hospital was due to delays in arranging post-discharge care. Such delays would have been avoided if the mobile nursing team had been in place.
Ashman says a special scrutiny panel will examine any savings made during the project. The Royal United trust will earmark any savings to the Bath and North East Somerset PCT for reinvestment in the nursing team.
Health managers will start recruiting nurses to the team in two or three months' time. Hazel Braund, director of intermediate care and commissioning for the PCT, says: "We have a shared aim with social services of keeping vulnerable old people out of hospital, so its very important that we get the right skill mix make the project work. "We need nurses who are experienced in community nursing for older people. The team also needs a good senior nurse leader who can work closely with the NCSC and its successor body."
The NCSC, which in April will merge into the Commission for Social Care Inspection, has been consulted about the project from its inception and has advised social services on design of the new care homes. Mark Dunford, NCSC locality manager, says: "It is a very exciting, radical set of ideas which probably mirror what government policy is doing and the realities of getting nursing staff to serve the community."
The results could lead to a change in the rules governing staffing levels of care homes, Dunford says. "If the project is successful, the local authority will no doubt push the Department of Health for a change in the law. They should be in a strong position as they can show they have already got another government department funding the initiative."
Weblinks
For more on the invest to save budget: www.isb.gov.uk
For more on Bath and North East Somerset council: www.bathnes.gov.uk
