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Rapid response teams part of drive to shift care into community

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Community-based rapid response teams will be expected to swing into action within two hours to prevent vulnerable patients being taken to hospital as part of efforts to provide more care closer to home.

The goal is among those set out in the long-term plan for the health service in England, which provides more detail on how the government intends to achieve its much talked about ambition of shifting more care from hospitals into the community.

It confirms plans – previously announced by prime minister Theresa May – to create new urgent response teams to help reduce unnecessary hospital admissions.

According to the NHS Long Term Plan, the teams, which will work across primary care and local hospitals, will also provide recovery support to help people back on their feet after a health crisis.

Over the next five years all areas of England will be expected to ensure these flexible teams, which will include GPs, district nurses, mental health nurses and therapists, are poised to respond within two hours of getting a referral – in line with best practice guidance set out by the National Institute for Health and Care Excellence, said the document.

In addition, it added that all parts of the country should be delivering “re-ablement” care within two days of referral.

“This will help prevent unnecessary admissions to hospital and residential care, as well as ensure a timely transfer from hospital to community,” said the plan, which explains the goal is to save more than one million hospital bed days.

“This will help prevent unnecessary admissions to hospital and residential care”

NHS Long Term Plan

Plans to boost out-of-hospital care are among the core changes to the NHS model envisaged in the long-awaited plan, which promises to “finally dissolve the historic divide between primary and community health services”.

It confirms plans – also previously flagged up by Ms May – for new multi-disciplinary teams to provide dedicated support to care home residents, as well as setting out a range of measures designed to support people “to age well”.

Theses measures include more home and community-based support for those living with long-term physical health conditions and dementia.

The plans come alongside what has been described as a major boost in funding for community healthcare, which will see the proportion of the NHS budget spent on community services increase. According to the document, spending on these services will be at least £4.5bn higher in five years’ time.

“This is the first time in the history of the NHS that real terms funding for primary and community health services is guaranteed to grow faster than the rising NHS budget overall,” the plan stated.

This is a “floor” level of investment that is likely to be supplemented further by local clinical commissioning groups and integrated care systems, it added.

“In many parts of the country, functions such as district nursing as already configured on network footprints”

NHS Long Term Plan

It highlights the “multiple challenges” currently facing general practice and community health services and the fact there are “insufficient staff” to cope with rising demand with widespread shortages of GPs, practice nurses and district nurses.

In order to address these problems, it proposes a wholesale redesign of community services across the country based on the results of trial schemes tested over the past three years.

As well as enhancing community-based crisis services, this will see the creation of wider multidisciplinary teams aligned with groups of GP practices – along the same lines as many district nursing services currently operate.

According to the document, “the result will be the creation – for the first time since the NHS was set up in 1948 – of fully integrated community-based health care”.

Under the long-term plan, teams of professionals will be aligned to primary care networks – or groups of neighbouring GP practices – which will typically cover a population of 30-50,000 people.

“Expanded neighbourhood teams will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs such as physiotherapists and podiatrists/chiropodists, joined by social care and the voluntary sector,” said the plan.

“In many parts of the country, functions such as district nursing as already configured on network footprints and this will now become the required norm,” it added.

“It will be imperative for investment to reach the front line, and to address the workforce challenges”

Matthew Winn

The plan also confirms the national rollout of a successful pilot that has seen teams of healthcare professionals assigned to care homes.

It cited NHS England’s Enhanced Health in Care Homes (EHCH) scheme as having reduced the number of frail and elderly care home residents needing to be rushed to hospital and helped ensure their needs are being properly assessed and met.

For example, in Nottinghamshire, care home residents in a pilot scheme experienced 29% fewer A&E attendances and 23% fewer emergency admissions than a comparison group, said the document.

According to the plan, the goal is for the EHCH model to be rolled out across the whole country over the next decade to ensure it reaches all care home residents that need it by 2023-24.

“This will ensure stronger links between primary care networks and their local care homes, with all care homes supported by a consistent team of healthcare professionals, including named general practice support,” said the document.

“As part of this, we will ensure that individuals are supported to have good oral health, stay well hydrated and well-nourished and that they are supported by therapists and other professionals in rehabilitating when they have been unwell,” it said.

Other measures outlined in the section of the plan covering community care, include boosting targeted work with people most at risk of health problems such as heart disease, dementia and frailty.

“The number of district nurses employed by the NHS has almost halved since 2010”

Donna Kinnair

GPs are already using electronic systems to identify and support people with “severe frailty” but will be expected to expand this approach to encompass those with “moderate frailty” in a bid to address problems earlier.

Again, integrated primary and community teams will be expected to work with older people to help maintain their independence, such as preventing falls.

“Fall prevention schemes, including exercise classes and strength and balance training, can significantly reduce the likelihood of falls and are cost effective in reducing admissions to hospital,” said the plan.

It also suggests there will be increased reliance on technology that patients can take home, which will help health professionals closely monitor their health, avoiding hospital admissions and allowing people to be discharged sooner.

This could include a set of digital scales to monitor the weight of someone post-surgery, home testing equipment for someone taking blood thinning drugs or a location tracker to help ensure someone with dementia is safe.

The plan also includes a specific pledge to improve care for people with dementia and delirium whether they are in hospital or at home.

“The significant challenge in delivering the long-term plan will be building up the workforce to achieve its diverse ambitions”

Crystal Oldman

This includes a “more active focus on supporting people in the community through multidisciplinary teams and the application of the NHS Comprehensive Model of Personal Care”.

Meanwhile, the Alzheimer’s Society will be supported to extend its Dementia Connect programme, which offers a range of advice and support to people following a dementia diagnosis.

Nursing organisations have welcomed the ambition of ensuring more people are able to access healthcare in the community and are supported to live independently.

However, they have raised concerns about the capacity of the nursing workforce to deliver long-awaiting changes in models of care given the rapid decline in the number of district nurses in recent years.

Donna Kinnair

Dame Donna Kinnair

Donna Kinnair

When Ms May announced plans to boost community care, Dame Donna Kinnair, acting chief executive and general secretary of the Royal College of Nursing, said investing in district nursing had to be a priority in order to ensure the plan would work.

“This announcement begs the question who will operate these bespoke support networks dedicated healthcare for care residents and rapid response teams,” she said at the time.

“The number of district nurses employed by the NHS, the backbone of the community health services, has almost halved since 2010, and the number of community nursing staff has dropped by 15%,” she added.

“In addition, cuts to training budgets have prevented nurses from joining the community nursing workforce prompting further staff shortages,” she noted.

Crystal Oldman, chief executive of the Queen’s Nursing Institute, said: “We welcome the acknowledgement that additional ring-fenced investment is needed in community and primary care services, which together account for around 90% of the one-million-plus patient contacts that the NHS achieves every day.

“It is in the community and primary care that self-management, health promotion and illness prevention are all centred,” she said. “Here also is the key to managing rising long term demand, reducing health inequalities, and delivering care that is at once integrated and personalised, as described in the new plan.

Queen's Nursing Institute

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Crystal Oldman

“The significant challenge in delivering the long-term plan will be building up the workforce to achieve its diverse ambitions. Health Education England’s workforce plan, to be published later in the year, must draw on the informed views and experiences of nurses and stakeholder organisations.

“Importantly, there needs to be a focus on understanding if the places for pre-registration undergraduate nurse programmes are truly oversubscribed with suitable candidates, as there is some concern that this may not reflect the reality of the 2018 intakes in every part of the country,” she added.

Matthew Winn, chair of the Community Network, which was set up by the NHS Confederation and NHS Providers, said: “It is extremely positive that community services, working in partnership with primary care, will play a central role in supporting a sustainable NHS for the long-term future.

“A shift in focus towards prevention and community care will help ensure people can live healthier, longer lives, and receive care in or close to their homes, reducing admissions and demand on already over-stretched hospitals,” he said.

“The commitment of at least an extra £4.5bn a year in real terms by 2023-24 for primary and community care is hugely welcome,” he said. “However, it will be imperative for investment to reach the front line, and to address the workforce challenges the sector must address if we are to make this ambition a reality.

Community Network

Matthew Winn

Matthew Winn

“Working together, primary and community health services will be able to make major changes in the way people are supported, especially those who are frail and vulnerable,” said Mr Winn. 

He added: “We now need to translate this plan into deliverable action, and with involvement from the front line, set out how these ambitions will be balanced against the other priorities in the NHS Long Term Plan and the funding available.”

The new 10-year plan for the health service was published at 12pm today, after being delayed since the end of last year – reportedly due to the chaos around Brexit.

The blueprint sets out how the £20.5bn annual budget increase for the health service, which was promised last summer by prime minister Theresa May, will be spent.

Ahead of its publication, some of the main aims and innovations to be included in the plan were revealed in a statement by NHS England.

Maternity care, children’s services, cancer care, mental health and heart disease were all highlighted as being set to benefit, along with funding boosts for digital technology and prevention.

The last time a 10-year strategy document was drawn up covering the whole health service in England was the NHS Plan, which was published in 2000 by the Labour government under Tony Blair.

  • More details on the NHS long-term plan can be found on a website created by NHS England along with the document itself.
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