Sutton Homes of Care is one of six vanguards on the national new care models programme who aim to improve the health, wellbeing and lives of residents living in care homes. In this blog Sarah Stacey a care home manager for Crossways Nursing Home in Sutton talks about her experiences in changing her approach to caring for residents, what it has been like to be a part of the new care models programme and what her hopes and fears are for the future.
I’ve always had a good relationship with the CCG but I didn’t know too many of the partners from any other organisations and I certainly didn’t know the other care home managers, owners or staff. Life before the vanguard was very much Crossways on its own, we felt isolated and not part of a wider system. The work that changed all of this began in 2014 when I was invited to the first Care Home Managers Forum. I attended with some nervousness as I didn’t know what to expect but was told to come with an open mind. I needn’t have worried, as we immediately got the sense that senior people in the NHS and local authority wanted to hear our opinions and work together to solve problems. This joint work and collaboration is evident in everything we have achieved in the programme, all innovations and ideas have come from “us” the “front-line”.
The care home manager’s forums are a real success story of the vanguard and they have now evolved to include other communities of practice such as a carers forum and care champions forum. They are a place where managers or carers get together in an informal setting to share opinions and problems about how to improve care for residents. The collaborative approach to caring for our residents is helped by the attendance of wider NHS and public body colleagues, for example: community and acute services, London Ambulance, London Borough of Sutton and voluntary and community organisations. This open approach to sharing ideas has helped us realise many of our ambitions and it has been such a refreshing and welcome approach.
One of our first successes was the development of the “concerned about a resident poster” The poster was developed by staff in all of the care homes and we were consulted on all aspects, whereas previously we would be given the finished product with little involvement. The poster has resulted in fewer ambulance call outs to care homes using it and it has now been adapted by the Healthy London Partnership for use across the region. From a personal perspective my staff and I are now more knowledgeable about which community services to call for residents whenever their conditions deteriorate.
There have been many other highlights of the programme, but the three that really come to mind are: the Sutton Red Bag, the health and wellbeing rounds and the broad training programmes that have fostered great working relationships across health and social care that didn’t previously exist. I recall an early forum when the concept of the red bag was being debated and some people did not think it would work as we discussed the barriers and problems of transferring patients to hospital. Ultimately we were able to create solutions for the problems and develop a pathway that has benefitted the residents and really supported the staff in working better for patients. It is such a huge highlight for me to have been part of the process and to say, I am part of the birth of the red bag!
One of the most tangible benefits of the programme has been meeting people from across health and social care and building relationships. It’s so important to feel like I or any of my staff can now just pick up the phone and seek help. It’s now so easy to make a referral and seek support for a patient. Previously it was all very formal and there were a lot of myths about what we could and could not access. Now so many more colleagues just visit the home and relationships have been made with multi-disciplinary professionals, e.g. the dieticians, speech and language therapists, link nurses, occupational therapists, podiatrists and district nurses. They just pop in, sometimes unannounced and we work together to support residents have happy and meaningful lives.
My staff share my enthusiasm for how things have changed. I have witnessed a real difference with staff who were previously introverted and slightly withdrawn. I’ve watched how they’ve grown in confidence how they’re now able to supervise others, share opinions and be more proactive in identifying a residents health or care needs.
Residents have told me that they’ve felt a marked difference in the care that they now receive. They have greater confidence in the health and care system. They feel safer in the home and in being transferred to hospital with confidence they’ll come back safely. Residents also speak highly of the health and wellbeing round. It was so important to them to have a health professional visit and care for them not just because they were unwell but that they were interested in knowing more about the patient’s wellbeing. A direct outcome from all the training for staff was that patients are now being treated for conditions more quickly, they’re health does not deteriorate to the point where it becomes an emergency and they’re able to receive a lot more treatments at home. These treatments range from catheters being unblocked in the home, syringe driver treatments and spotting the signs of nutrition needs through bowel and urine testing. Residents no longer have to wait for treatments, nursing home staff are more able to address residents clinical needs.
I am aware however of challenges on the horizon. I worry about recruitment and retention. Luckily I’ve been able to retain the majority of my staff, but I know that this is an issue nationally. Working in a care home is not seen as high profile as working in an acute ward or A&E department and we need to change that perception. We’ve received such bad press over the years and it is my ambition that this changes.
From a Crossways perspective I know that my own staff are now more skilled and therefore marketable, they could use these new skills elsewhere. It is therefore my responsibility to embed the good practices from the vanguard programme into all areas of the home.
In sharing my experiences I’m hoping that other care home managers lose the suspicious feeling toward external agencies. I know that this is something we all need to work on. There can be a sense that external colleagues will look and dig for things that are wrong. This mentality needs to change. We need to be more transparent, we need to open our doors. I would advise my care home manager colleagues to get out there, get your face known, get your name known and speak up! Build relationships, communicate and trust colleagues. Others want to support the care home to deliver the best care for residents so we need to work in collaboration to achieve this. Since the programme I no longer fear reporting an issue. I am more ready to report problems because I know that the response I get from colleagues will be to support me to improve the situation.
I’m hopeful that through the vanguard programme we can improve the relationships between commissioners and care home providers. We can galvanise the wider system to support care homes deliver the best possible care. My wish is that more colleagues would visit the homes on a more regular basis. But not confine their visits to quality reviews or monitoring meetings. They should see the care homes in action, build relationships with the staff, carers and the residents. The benefits of these interpersonal relationships are so valuable. Staff get such a boost and reward from meeting people from the wider health and care system, they feel connected and part of the bigger picture.
My final hope is that the Sutton team are successful in continuing the good work that they have begun and that we continue to spread all that we’ve learned from the programme.
Sarah Stacey bio
Sarah started her career in a dementia home in Epsom in a junior role, but was identified as a 'Future Manager' and went on to train and then become a deputy manager at that home. She joined Crossways nursing home in 2010 as their Business Manager and has been the registered care home manager since March 2013.