Type keywords in the text box above.
 

Health Village Pilot results in fewer hospital admissions

12 Oct 2017 10:16:21


The Rotherham Health Village pilot has resulted in fewer admissions to hospital compared with the Borough average.

The pilot began in July 2016 and is located at the Health Village which is the base for Clifton Medical Centre and St Ann’s Practice. The team consists of GPs, the community matron service, district nurses, therapists, a social worker, a community physician, social prescribing brokers and a community link worker. There is also dedicated mental health support and further links are being explored with the fire service, police, pharmacies and wider voluntary services.

The approach was developed to ensure that Rotherham health and social care services are able to continue to meet the needs of an ageing population with multiple health needs in a joined up way by working together.

The team proactively manages the care of their locality population by providing coordinated care closer to home, improving the experience of patients and their families and carers, helping to avoid hospital admissions, increasing independence, where possible, and aiming to improve mental health and well-being.

New technology solutions are critical to support the work. The Rotherham Health Record (RHR) allows them to track their patients’ journey through health services and plan their care accordingly. In the future social care and primary care colleagues will also have access to the Rotherham Health Record as well as their data being available within the system.

The key functions of the integrated pilot are:
• Early identification and prevention
• Reablement and rehabilitation
• Community engagement and development
• Case management and integrated assessment of need
• Parity of esteem; equal value given to mental health and physical health

Members of the team were asked what they believe are the main benefits of integrated working for them as team members:

‘Working alongside members from other services,’ ‘Knowing the patient if they come back around the system, ‘Link up with GP and LTC nurses,’ ‘information sharing,’ ‘joint visits,’ and ‘I have mostly valued the Community Link Worker role.’

The pilot is beginning to make links with the Integrated Rapid Response and Care Co-ordination Centre transformation initiatives and an external evaluation has just got underway. It is envisaged that the learning and next steps will be explored in early 2018.
 

Latest News

Our latest news.

 

Our Twitter Feed

@RotherhamNHS_FT
We've tweeted 4979 times so far!
@RotherhamNHS_FT
We've tweeted 4979 times so far!
  • Click here to see the full list of our 2017 Proud Award winners! #TRFTProud therotherhamft.nhs.uk/ProudWinners20… And we will be sharing each of their stories in the new year!
    Wed Dec 13 13:49:27
  • Phil McCarvill @Phil_McCarvill  Fantastic to see @ChrisHoltNHS & @LouiseNHS @RotherhamNHS_FT & to hear about the great work the Trust is doing to harness the power of digital technology & thanks for sharing with other @NHSConfed members at last night's parliamentary event.
    Wed Dec 13 09:41:07
  • NHS Confederation @nhsconfed  Chris Holt @RotherhamNHS_FT discusses the positive impact of innovative data sharing for patients, staff and the wider health service
    Tue Dec 12 19:55:59
  • TRFT Charity @TRFT_Charity  If you're thinking about how you can really make a difference by fundraising for a local charity in 2018, we have some great ideas online here: https://t.co/O841UtgBww #charitytuesday #rotherhamiswonderful
    Tue Dec 12 15:04:25
  • Rotherham Council @RMBCPress  There's a chance of #uksnow this weekend. Don't forget, you can get information on any affected services at our Winter webpages - https://t.co/5tJAsjTibL
    Fri Dec 08 11:10:07