North Yorkshire Clinical Commissioning Group and Nidderdale Plus

North Yorkshire Clinical Commissioning Group and Nidderdale Plus

Care Home Tablets and Video Calling Devices

Briefly describe the initiative/ project/service; please include your aims and objectives

The wellbeing of residents in care homes is paramount. That means every aspect of wellbeing, from physical to mental. A conversation with a loved one and being able to see their face makes a massive difference to people living in care homes and allowing them to stay connected during the unprecedented times caused by the COVID pandemic is vital. The UK government introduced strict lockdown measures in March to limit the spread of coronavirus, encouraging people to stay at home and only go outside for essential trips such as exercise, food shopping or to collect prescriptions. Delivery of traditional Primary Care Service Models proved to be difficult under COVID with site visits potentially increasing the risk of infection being brought into the care home
Many healthcare services were reconfigured to adhere to these new measures, which meant that most face-to-face appointments were replaced with telephone or online consultations. Under normal circumstances, in-person visits to care homes are always welcome. They provide great comfort and vital clinical support to residents as well as allowing staff to keep in contact with the important people in the lives of the residents themselves. When those visits from loved ones and primary care clinicians were no longer possible it was necessary to use alternative means of keeping those essential contacts going. Maintaining face-to-face contact between residents, their loved ones and clinicians involved in their care:
– Would be possible using remote and virtual applications already available to members of the public, social care workers and primary care clinicians.
– Would require all care homes to have the necessary equipment to access these applications and have the necessary support to staff.
– Would require coordination between local organisations involved in supporting care homes.

In response to this, two complementary initiatives were designed and delivered at pace and scale across the care homes in North Yorkshire. The North Yorkshire Clinical Commissioning Group deployed 202 tablets to North Yorkshire care homes alongside an additional 30 “consumer” video calling devices deployed by North Yorkshire County Council to its own Elderly Persons Homes. Both initiatives were at a time when all parts of the health and care sector were under significant operational pressure resulting from the COVID pandemic. In addition, infection prevention control measures together with essential social distancing meant the delivery and handover of all these devices had to be carefully organised and managed through close working between the CCG and Council digital support teams, and a local community hub (Nidderdale Plus). Sandra Anderson, Director at the Millings Care Home in the North Yorkshire town of Bedale, said: “From our first try we had a really good experience using the device. Residents were really happy with how it worked and we found it to be a really efficient way to contact healthcare professionals”

What are the key achievements?

All the devices were delivered through collaboration between the North Yorkshire CCG and Council digital teams supported by the local voluntary sector organisation Nidderdale Plus. Deliveries were undertaken within strict infection control measures. The deployment of the devices has been followed up by a structured survey and evaluation report commissioned by the North Yorkshire CCG. In addition, regular usage data was analysed to assess the amount of activity taking place through the devices. The devices can also be utilised by staff to access essential training sessions and materials and also to access applications such as self-care apps targeted towards a resident’s particular condition. Feedback from care home staff, residents and primary care clinicians was obtained and fed into the evaluation process.

Some of that feedback is below:

 “Great initiative that we hope will continue after the pandemic restrictions are eased”

“Very useful project to enable increase in use of technology and improve ways of working during current pandemic”

“It’s really wonderful for our residents to be able to see the faces of their loved ones – we’ve had a few happy tears from them.”

“Having the tablets has been invaluable during this crisis when residents can’t see their friends or families when normally, having visits would be the highlight of their day.”

“It means families can have ‘virtual visits’ and it’s been brilliant.”

“It gives everyone reassurance and peace of mind – families know their relatives in the care home are fine and it’s good for the resident’s mental health and stops them feeling isolated and locked in.”

“Only that it is a great support. Much better to be able to see the GP during a consultation for our residents, rather than a telephone call. I have seen residents interacting with the calls and enjoying the experience.”

“I feel that the use of technology i.e. video calls would be of great benefit to use going forward when COVID-19 restrictions are lifted. It reduces the amount of people coming into the home. Also one of our residents has attended and enjoyed weekly alcohol and anxiety groups. In the past he has not attended these groups, he says that he is attending due to been in his home environment”

“Reduced need to physically visit means patients are more likely to get a face to face consultation, although virtual. It also frees up clinical time that otherwise would have been spent travelling to and from the care home. More regular review of our patients has been possible.”

“The main difficulty is that for elderly residents with visual or hearing impairment, they struggle to engage with the tablet. It still enables me to see them however. I have found it helpful to examine overall well being, breathing, rashes, to do memory assessments. The obvious benefit it that it has significantly reduced the number of visits in person required. This has 2 benefits: Firstly reduced risk of infection spread, and secondly, it does save time for GPs too.”

“The drawbacks are definitely smaller than I thought. Clearly it’s more difficult to assess someone’s appearance over a video link but actually with a set of obs and a carer who is able to give a good account of how the resident has been doing, if the resident can’t do this for themselves, almost all problems that generally come up during the weekly care home round can be dealt with in this way perfectly well.”

Following completion of the initiatives, the local ITV News programme covered the story as an example of how people were adapting to the COVID-19 lockdown restrictions and brought positive publicity to the work of the CCG and the Council in caring for residents in these settings.

What are the key learning points?

The allocation formulas used to decide how many devices to issue to each care home were devised separately by the CCG and the Council. This resulted in Council Elderly Persons Homes receiving more devices than the non-Council care homes of a similar size. However, the devices have been in such demand across all care homes that further work is now required to identify sources of additional devices. Access to care home settings has been restricted, not just for loved ones and primary care staff, but also to the digital teams and the community hub (Nidderdale Plus) who provided the delivery and handover services. Much of this has been done remotely which has presented challenges for some care home staff who are unfamiliar with the technologies being provided. Communication and support materials have been made available to primary care & care home colleagues via email, but may have benefitted from a more hands on, one to one contact, but owing to resources and sheer demand on all services this wasn’t possible or practicable given the nature of the pandemic response at the time. For example, providing more training and engagement opportunities through webinars would have meant care homes were better prepared for the devices and more aware of the benefits the devices would bring to their services. The initiatives have highlighted some difficulties in care home IT infrastructure and network availability which will be further considered as part of a wider assessment of digital maturity in care homes. The initiatives have highlighted benefits in care homes being overall closer to the patients journey and further support to bring them into the patient record journey should be considered (NHS Mail, online records, completion of the DSPT, SCR-AI etc.)

Additional Comments

Early feedback from care homes indicated additional applications would be useful if deployed onto the devices. As a result, Whatsapp and Skype were made available on all devices. This work has also now been replicated across England through subsequent initiatives to provide tablet devices to all care homes via a national allocation and delivery process.

COVID-19 Response Recognition Award

The wellbeing of residents in care homes is paramount. That means every aspect of wellbeing, from physical to mental. A conversation with a loved one and being able to see their face makes a massive difference to people living in care homes and allowing them to stay connected during the unprecedented times caused by the COVID pandemic is vital. Under normal circumstances, in-person visits to care homes are always welcome. They provide great comfort and vital clinical support to residents as well as allowing staff to keep in contact with the important people in the lives of the residents themselves. When those visits from loved ones and primary care clinicians were no longer possible it was necessary to use alternative means of keeping those essential contacts going.

Maintaining face-to-face contact between residents, their loved ones and clinicians involved in their care:
– Would be possible using remote and virtual applications already available to members of the public, social care workers and primary care clinicians.
– Would require all care homes to have the necessary equipment to access these applications and have the necessary support to staff.
– Would require coordination between local organisations involved in supporting care homes.

Some very powerful and emotional stories have been created through these initiatives including interest from the local ITV News network who broadcast a piece on the work. The devices were in place ahead of the National VE Day celebrations which meant residents were able to take part in those celebrations. Having already provided the devices to all care homes across North Yorkshire means that as we approach another phase of COVID related lockdown measures the remote and virtual visits to residents will continue. With residents, families and friends, staff and clinicians all now aware of the advantages these solutions have brought we can only see an increase in demand for this in the future as care homes continue to operate under challenging circumstances.