Community health and social care initiatives

A home monitoring service reduces hospital visits

Norfolk Community Health and Care Trust has reported a reduction in A&E admissions and bed days among a group of high-dependency patients following the introduction of a new remote-monitoring service for people living with heart and lung disease. The service allows users to check their vital signs at home and was designed to improve quality of life for patients and free up hospital beds and surgery time. The technology enables clinicians to monitor trends and intervene if readings move outside individual thresholds. It encourages patients to recognise changing symptoms and promotes self-management of their conditions.

Improving outcomes through reablement

Improving outcomes through reablement at Swindon Borough Council and Great Western Hospital Foundation Trust The Swindon reablement project came from practitioners reviewing a sample of cases for patients discharged from an acute setting over a 6-month period and asking: “was the best outcome for the person achieved?”. Results showed that in 45% of cases where someone was discharged to a residential care setting, they would have achieved a better outcome had they been supported to return home (either directly with domiciliary reablement, or via intermediate residential reablement).

Transforming support to care homes through Skype

Governance documents were developed and clinically led for guidance on how to use video consultations, by way of protocols, privacy impact assessment (PIA), and standard operating procedure (SOP). Practices have been able to adapt these protocols, and are now able to do much of their work in this way, including medication/annual/dementia reviews, check-ups, End of Life (EOL) assessments, and much more.

Over 150 video consultations were carried out in the first month of the wave 2 pilot, not including the hours of support offered by NSCHT to care homes, and participants have since praised the value that this offers to them. Clinicians have been able to see and update patient records in real time, improve patient access to care, become much more time efficient, more digitally enabled and confident, and discover new ways of working that would have otherwise been left unexplored.

The KCC vision is to deliver high quality services which “Help people to improve or maintain their well-being

Promoting wellbeing – supporting and encouraging people to look after their health and well-being to avoid or delay them needing adult social care

Promoting independence – providing short-term support so that people are then able to carry on with their lives as independently as possible

Supporting independence – for people who need ongoing social care support, helping them to live the life they want to live, in their own homes where possible, and do as much for themselves as they can.

The strategy also details what Kent County Council must have in place in order to achieve the vision; effective protection (safeguarding), a flexible workforce, smarter commissioning and improved partnership working

The Activity Academy was an incredible event that united leading care experts and cultural organisations to explore new opportunities to support people living with dementia to lead fuller, happier lives.

Academy of FAB Stuff readers are invited to learn from this event by downloading or streaming an exclusive podcast that shares key insight from the day.  

Warwickshire Fire and Rescue Service Hospital to Home

The service aims to support older and often vulnerable people to remain independent and living in their own home. 
The service is part of the WFRS extended community care designed to reduce risk and improve wellbeing.

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