Wiltshire's Better Care Plan

What is Better Care – in a nutshell?

Health and social care in Wiltshire are working together to change the way that care is provided, especially for frail elderly people. This is happening all around the country. The aim is that people receive integrated care and support across health and social care, with the focus on people being cared for as close to home as possible. It should also mean that people are informed about their care and feel more in control.

What does this mean for you?

Care will be provided as close to home as possible with home always the first option. One of the aims is to avoid hospital admissions and to get people out of hospital as quickly as possible to be cared for closer to home.

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You should be listened to and involved in your care arrangements.

Your care should be coordinated across health and social care so that it is ‘joined up’.

You should have access to the right support 24 hours a day, 7 days a week.

What is Healthwatch Wiltshire’s role in Better Care?

Healthwatch Wiltshire wants to make sure that health and social care services for older people in Wiltshire are working well for them, their unpaid carers and their families. Healthwatch Wiltshire is speaking to people about their experiences of the health and care system.

We are asking people to tell us what is like to use health and care services. This includes whether they, their families and unpaid carers were kept informed and involved as much as they wanted to be in decisions about their care.

What have we done so far?

At the end of 2014, we looked at an individual scheme within Better Care that was working in the South of the county. This scheme, called ‘Discharge to Assess’, was designed to help get people out of hospital once they were medically fit, and into alternative care, either at home or in a residential home.

We produced a report about the experiences of people using the ‘Discharge to Assess’ service from Salisbury Hospital to Camelot Care Home, the residential home involved in this scheme. Click here to view the ‘Discharge to Assess’ report.

From spring 2015 onwards, we have looked at the general experiences of older people receiving care across Wiltshire, from hospital care to care at home.

While many people reported receiving good care, we identified a number of issues that Wiltshire people are experiencing:

Read the report

Wiltshire Better Care Plan – focus on ‘discharge to assess’

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Key Issues highlighted in our Better Care engagement

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Communication

While high numbers of people said they felt listened to, lower numbers said that they knew what was happening next.  Some patients and relatives said they struggled to find out details or were given conflicting information by different members of staff.  People who fund their own care said that they found it particularly challenging to ‘navigate’ the system and find out what they needed when it came to organising their own care (after hospital discharge).

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Discharge from hospital

Many people were very glad to be out of hospital but the process to get home was not always smooth.  Reasons for delays in discharge included:

  • waiting for medications to be issued;
  • waiting for transport;
  • difficulties in obtaining equipment to support being at home;
  • waiting for an assessment and domiciliary care arrangements to be put in place.

Working as a team

Some patients and unpaid carers are experiencing a system that works smoothly with different parts coordinating with each other. However, many others do not perceive the system to be well connected.

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Quality of Care

People reported their concerns about health and care services ‘having enough staff’.  There was a perception that staff are very busy and this could result in slow responses to call bells, delays in getting assistance to go to the toilet and people feeling unable to ‘bother’ staff with questions.

Transport

The availability and affordability of transport is a recurring issue which is reported to HWW through all our work. People tell us about the challenges in accessing health appointments and getting home from hospital because of transport.

Reliance on unpaid carers

Unpaid carers (many are family members) provide a lot of support to older people in Wiltshire. Many are older people themselves. Unpaid carers told us that sometimes they felt that they were relied on to sort out issues including providing transport. Whilst there were high levels of reliance on unpaid carers we found that only half of patients felt that their unpaid carers were involved in discussions and decisions about their care.

Read the update

Better Care Plan Engagement – July to December 2015

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Location of care

People told us that they wanted to be treated close to home, or as close to their family as possible. Given that Wiltshire is a large rural county, travelling between different areas can be difficult especially for older frail people.  Whilst the Better Care Plan aspires to delivering care closer to home, some people said that their preferences (for a local community hospital for example) had not been met.

Domiciliary care

Some people reported very positive experiences.  However, there was enough information to identify issues with domiciliary care as a theme. These included:

  • Lack of confidence in staff (related to training);
  • Availability in some parts of the county;
  • Timing of visits;
  • Challenges for self-funders in arranging care.

Social isolation

Through our engagement with older people, especially in their own homes in more rural areas of Wiltshire, we found that being socially isolated makes people particularly vulnerable. People who don’t have family, friends, or neighbours to advocate for them and to help organise things can feel very alone and anxious.

“This is me”

Arts and Health project

“This is Me” Project

In October 2014 we were successful in our application to the Wiltshire Council Arts and Health Innovation Grant. Our proposal was to commission a piece of art that would illustrate the experiences of older people using health and social care, and their informal carers, in a way which would challenge the commissioners who buy services for these people.

We wanted service users to have a voice in deciding the nature of this project, so we put out a call for applications to deliver this project, and working in partnership with Wiltshire and Swindon Users’ Network, formed a judging panel including service users to choose the design.

Tea parties

The successful application was from Elevate, part of the Art Care department at Salisbury District Hospital. Over the summer of 2015, they used vintage tea parties at community groups and in individual peoples’ homes, with live music, hot drinks and cake (or alternative) and vintage china to make people feel relaxed and able to share their experiences of using health and social care.

These experiences were recorded in a variety of ways – on paper, video, audio recording and being live-tweeted on the @hwwteaparties account.

 

Arts and Health project findings:

  • People who have had a stay in hospital and then come home told us that often the communication between different services isn’t good enough. This can result in confusion and things not happening as promised.
  • Looking after a relative, spouse, or friend is rewarding but tough work. Unpaid carers provide a hugely valuable service and they need support to carry on with their role.
  • People who fund their own social care can feel ignored and struggle to get the information and support they need to organise and pay for their own care.
  • People who use care at home (domiciliary care) want it to be ‘person centred’. Ideally that means having the same staff coming to care for them and coming at set times which suit the person. Good communication with the Care Agency office is crucial.
  • Transport is a big issue in parts of rural Wiltshire. Getting to hospital and back home can be costly and difficult.
  • It was clear to us how important both reliable social connections and the opportunity to participate in meaningful activities are for older people.

Read the report

This is Me – using the arts to engage with older people

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Intermediate Care

Homefirst

Intermediate Care is a service that supports patients who are being discharged from hospital.  Its purpose is to provide a short period of support and rehabilitation.  For most patients this will take place in their own home.  For some people who cannot return home immediately from hospital, it will be in a nursing home.

People receiving intermediate care may be supported by a range of different professionals, including nurses and nurse assistants, physiotherapists, occupational therapists and therapy assistants, care support workers, social workers and social care staff.

The Intermediate Care Service can include:

Help with personal care (e.g. to wash or bathe, dress/undress, use the toilet).

Help with meal times (eg preparing hot and cold drinks, meals, help to eat).

Help to move about safely (e.g. get in/out of bed or chair, walk about indoors).

Equipment to help people regain or maintain their independence.

We investigated the experiences of people using ‘HomeFirst’, a pilot scheme in the Salisbury area, where this intermediate care was provided at home. Under ‘HomeFirst’, the patient had an initial assessment on the same day that they were discharged to ensure that they got the right level of support to be safe at home. The initial assessment was the starting point to discuss how the Intermediate Care service could help them to become as independent as possible.

Healthwatch Wiltshire spoke to people using ‘Homefirst’ about their experiences. The information we gathered was fed back to the service to help it improve.  The key points that we heard were also written into a report that went to the people who oversee health and social care in Wiltshire and were used in the evaluation of the service.

Read the article

HomeFirst from the Patient and Carer Perspective

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Rapid Response End of Life

Patients who are at the end of their lives often need extra care and support.

Dorothy House Hospice Care and Prospect Hospice have developed a service that aimed to provide extra support to patients and their families at times of greater need. This provided up to 72 hours of additional specialist care to people who were at the end of their lives.

Healthwatch Wiltshire spoke to the families and unpaid carers of people who had used this extra support service to find out how well it worked for them.  We also spoke to the staff involved in delivering the service.

A report explaining what people have told us has been written and shared with the organisations involved with Better Care.

Read the report

Evaluation of the Rapid Response End of Life Service

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Wiltshire End of Life Strategy Public Engagement

Support for people at the end of their lives and their unpaid carers is commissioned (paid for) by NHS Wiltshire Clinical Commissioning Group (CCG) and Wiltshire Council.  They asked Healthwatch Wiltshire to help gather public feedback on the refreshed Wiltshire End of Life Strategy (2017-2020). The strategy sets out the planned priorities and ambitions for End of Life care in the county over the next three years.

Healthwatch Wiltshire spoke to people across the county to gather their thoughts.

A report detailing what people told us has been written and shared with the commissioners and organisations involved in providing care to people at the end of their lives, and with the unpaid carers of those who are at the end of their life.

A response from the CCG saying how they will use the feedback has been received and can be found alongside the report..

Read the report

Public Engagement on the Wiltshire End of Life Care for Adults Strategy 2017-2020

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Read the response

How the CCG will use our feedback

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Transfers of Care

Discharge from hospital is a frequent topic in the news, with concerns about people being discharged from hospital too soon, delays when appropriate care in non-acute settings is unavailable, and discharged without their individual needs and those of their unpaid carers being taken into account.  In Wiltshire and across the country, there in an increasing emphasis on keeping people out of acute hospital if they can safely be cared for in a different setting, such as at home, or in a community hospital or in a nursing home.

Healthwatch Wiltshire was asked to talk to local people to discover more about their experiences of discharge processes and transfers of care for themselves or the person that they care for.  We heard from people whose care had been transferred between different services or settings, and from their unpaid carers, through face to face or telephone interviews, paper or online questionnaires and discussions at community groups.

Our findings are not dissimilar to those found nationally.  They also reflect what we have previously found in our engagement with people about their care under the Better Care Plan.  There is a lot of high quality care in the county that people are happy with, but also delays causing concerns and frustrations, and insufficient communication is at the heart of many of the issues for patients and carers.

Our report has been shared with the organisations who provide and pay for care in Wiltshire, so that they are aware of local peoples’ experiences.  Going forward, we will be producing information to help local people and their unpaid carers learn more about the discharge process, what they can expect and what they can do to help the process work as smoothly as possible.

Read the report

When Care is Transferred

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Read the update

When Care is Transferred – August to December 2016

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Share your experiences with us!

Please talk to us and let us know about your experiences. We want to talk to as many older people as possible to find out whether the new ways of working are making a difference.

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Contact Healthwatch Wiltshire

If you would like any additional information about the Better Care Plan or you have any questions or comments you can get in touch with us via the details on our Contact page.

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