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Cynulliad Cenedlaethol Cymru |
National Assembly for Wales |
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Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon |
Health, Social Care and Sport Committee |
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Ymchwiliad I wasanaethau Nyrsio Cymunedol a Nyrsio Adal |
Inquiry into Community and District Nursing services |
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HSCS(5) CDN02 |
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Ymateb gan Fwrdd Iechyd Prifysgol Betsi Cadwaladr |
Evidence from Betsi Cadwaladr University Health Board |
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Betsi Cadwaladr University Health Board response to the Health, Social Care and Sport Committee inquiry into community and district nursing services. |
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Contact |
Gill Harris, Executive Director of Nursing and Midwifery |
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Date: |
25.02.2019 |
The development of Primary and Community services within BCUHB will be embedded in the Care Closer to Home element within the Health Board’s system-wide strategy for health, well-being and healthcare, Living Healthier, Staying Well.
Care Closer to Home is age inclusive, recognising the need to adopt a life-course approach. This is a joined-up approach, with an emphasis on education and early intervention, aiming to address any implications early for long term health gain. The approach views health as a life-long journey, rather than separate disconnected stages.
The “What Matters” conversation is a simple, yet profound concept that is key to creating deeply personal engagements with individual’s, carers and their family members, a deeper understanding of what really matters to them, and is the foundation of developing genuine partnerships for co-creating health.
Asking about “What Matters” will improve the individual’s care plan and enhance the patient’s relationship with their health care provider and in some cases, improve health outcomes. The ambition is to increase clinicians’ awareness of important issues in their patients’ lives that could drive customized plans of care.
The scope of the Care Closer to Home programme is very broad; it places the person and carer, wherever appropriate, at the centre with all available primary and community services inputting care and support when appropriate to meet identified needs. These range from information, advice and education through to more specific interventions such as diagnostics, minor injuries services, community-based inpatient “step up” and “step down” care and respite.
The overarching aims of all our work should be to support wellbeing, improve health and address inequalities in health.
The broad scope of the overall Care Closer to Home programme reflects the need to address the broader factors that influence health. Crucially, the programme is one which extends beyond the role of the Health Board in isolation; it embraces work undertaken by partner organisations and importantly communities themselves. A ‘place based’ approach will be used in the development and implementation of the strategy for the future, as each local area will have different needs and also differing assets within the community.
The primary and community services elements of this programme cover a broad spectrum of care and support for all ages. This includes a wide network of services and teams: General Practice (General Practitioners – GPs - and the wider practice team), Pharmacists, Optometrists, Dentists, Therapies, Health Sciences, Community Nursing and Health Visiting teams, End of Life Care and Palliative Care Support, Primary Mental Health Services, Intermediate Care, “step up” and “step down” care, as a bridge between community and hospital care, Community Inpatient Care and Rehabilitation. Integrated Health and Social Care services are also an important part of this network, as is close working with Third Sector, Independent Sector and Community Groups, which are important assets within the community setting.
The vision for better and more sustainable healthcare rests on community based models that are co-ordinated around people’s needs and what matters to the individual.
The Health Board have 35 district nursing teams.
Headcount as follows (inclusive of current vacancies):
– Registered nurses (Band 7 – 5) = 346
– ANP/trainee ANP/NP = 21
– HCA (inclusive of Assistant practitioner at Band 4 and band 3 HCAs) = 115
– Matrons = 6
– Deputy Head of Nursing = 3 (1 vacancy)
– Administrative support within teams and senior levels = 27
We currently have registered nurses vacancies of 559.77 FTEacross the whole of BCUHB and for District Nursing RN vacancies (inclusive of Band 5 -7 DN and ANP) is 37.1 FTE, this number is included in the above total vacancies.
The Data for the past 5 years Inclusive of registered and unregister District nursing staff are:
2014 – 403.82 WTE
2015 – 425.24 WTE
2016 – 477.73 WTE
2017 – 490.95 WTE
2018 – 494.98 WTE
It must be noted that the service has extended to become 24/7 in the last 2 years with additional staff recruited.
As part of the development of the Care Closer to Home strategy, there is the development of the Community Resource Teams (CRT) where the district nursing workforce plan will sit and develop. Community Resource Teams will provide integrated care (health, social care and third sector services alongside other partners) to people closer to their home and community. A CRT is consistent with Setting the Direction (2010), a locality based multi-agency, multi-disciplinary care model, enabling and enhancing the ability of GPs and the team to provide more care for people at home by promoting earlier discharge from hospital or preventing the admission altogether. This service will also facilitate more efficient use of acute and community inpatient beds whilst treating the right patient in the right place with the right skills. There will be close working relationships between primary and community care and strong links with secondary care. Third sector services will be used to complement this provision and opportunities to commission further services when gaps exist in current provision will be identified.
The CRT will have the skills and competences to meet the needs of the population outside hospital. The purpose of the work that will be to develop an efficient and integrated working model within which community services operate, covering 24 hours each day, 7days per week, supporting more individuals to be cared for in their own homes (including in care homes). The integrated teams will deliver more coordinated, person centred, seamless services to individuals. There will be improved communication, care coordination, integrated assessments and an emphasis on early intervention and “What Matters” to the individual to meet their stated needs.
Referrals into the CRT will be assessed in a timely manner by the multidisciplinary team and the appropriate level of care determined, dependant on need and a care plan developed appropriate to the person’s needs; with a focus on enabling and reinstating independence.
CRTs will include the previous Enhanced Care, Intermediate Care, District Nursing, District Nursing out of hours teams, Therapies, Social Services and the 3rd Sector to ensure a multidisciplinary approach. Mental health practitioners will also be part of the core team. This integration offers further development of the trusted assessor role and discharge to assess principles, which will be embedded in the ethos of the teams’ working culture.
A CRT builds upon the wide range of existing mainstream health, social care and third sector community services available. The team focuses on a shared vision to achieve the best outcomes for the individuals within their own communities.
The CRT will provide a skilled workforce working together across the whole patient journey, reducing fragmentation and disorganisation with robust and consistent governance arrangements. The development of a CRT will ensure specialist advice is always available such as Advanced Nurse Practitioner (ANP) cover.
The development of the Health and Social Care Generic Worker which are already key roles within the CRT role gives an exciting opportunity to develop a post that spans across both organisations, in supporting many aspects of a person’s needs. In addition, the role of the Assistant Practitioner into the team will support the nurse and therapy roles in particular, in the delegation of nursing and therapy tasks across both the acute admissions area in the hospital site and in community.
By building a greater capacity of staff, nursing skill mix and clinical expertise, care will be improved, resulting in the ability to support more complex patient’s either in their own home or closer to home. The CRT will be able to react flexibly to the changing needs of the patient within their own community setting. For Example in North Wales HCSW with additional training and competencies administer Insulin to patients in the community under specific criteria.
The District Nursing Principles will also influence the District Nursing workforce, in North Wales we have made significant progress in meeting the Principles and will be fully compliant by Late 2019.
Conclusion
In conclusion the vision for Community Nursing is clear in BCUHB with the Care Closer to Home Strategy as the main driver, this model is being led by the Executive Director of Community and Primary Care.The CRT model is being established across North Wales with District/community nursing at the heart of the CRT development and critical to its success.