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Hertfordshire County Council

The Better Care Fund is being used to create projects that support personalised care given to people in their home and communities.


 

The integrated Rapid Response teams

Our Rapid Response teams are able to quickly respond to people needing immediate care.

Nurses, social workers, mental health staff, physiotherapists and occupational therapists respond to older people who are at risk of being admitted to hospital in the near future.

When the team gets a referral from the GP they contact the patient within one hour and arrange a visit. During the home visit a holistic assessment is carried out to identify, plan and address the patient’s needs. This means more people are being cared for in their own home and unnecessary hospital admissions are avoided, which frees up beds.

The St Albans and Harpenden Rapid Response team was shortlisted for a national Health Service Journal Value in Healthcare Award 2017.

Multi-Specialty Team approach

This initiative in West Hertfordshire brings core teams from health and social care together to coordinate the care planning of complex patients who have multiple needs.

They have a weekly multi-agency meeting to discuss referrals from GPs and other frontline staff. Those who attend include community nurses, social workers, therapists and mental health teams. They work together to consider what the patients' needs are and how they can work together to give people the best care.

Feedback from staff across West Hertfordshire has been very positive. Staff have reported:

  • quicker referrals and responses
  • improved working relationships and communication between care groups
  • increased ability to address people's multiple needs and give personalised care
  • co-ordinated responses meaning improved outcomes for patients.

Hertfordshire Home Improvement Agency

This new shared service brings together the County Council and local housing authorities to provide a single end-to-end service for home adaptations that support independent living.

It aims to provide a more resilient and efficient service whilst reducing waiting times, making maximum use of Disabled Facilities Grant funding and improving customer satisfaction.

The service helps older, disabled and vulnerable residents to apply for Disabled Facilities Grant and other funding, appoint contractors to carry out home adaptations (such as improving access, making the bathroom safer and installing stair-lifts), as well as providing support, advice and guidance throughout the process.

You can get in touch with the Hertfordshire Home Improvement Agency via their web page.


 

Impartial Assessors

Impartial Assessors are trained nurses employed by Hertfordshire Care Providers Association to speed up admissions into care homes and reduce delayed discharges.

The Impartial Assessor carries out a comprehensive assessment of the needs of older people in hospital to assess if they’re well enough to return to their care home. They then work with the older person, hospital discharge team and care home staff to make sure they get back to their care home as soon as possible.

This project initially started as a pilot in August 2016 at the Lister Hospital in Stevenage. Following the success of the pilot, two Impartial Assessors now work at the Lister Hospital (providing a service six days a week) and the initiative has also rolled out to the Princess Alexandra Hospital in Harlow and Watford General Hospital.

 

 

Using technology to give better care

We’re working to enable and improve data sharing between health and social care organisations to avoid people having to tell their story more than once. We’re also making use of advances in technology to better understand the health needs of Hertfordshire residents.

For example, we’re rolling out a risk stratification tool to GPs, which uses several data sources to identify patients in a GP practice most at risk of an emergency admission. By using this data the GP can target interventions more precisely and prevent people needing to be admitted to hospital and remain independent at home.

 

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