Below is a brief description of each of the workstreams in the Happy, healthy, at home programme.
| A new model of care for people with acute needs | We want to make sure that wherever possible people with acute needs are supported in the community so that they don’t have to go into hospital. Where people do need to go into hospital we are trying to reduce avoidable delays so that they can get home as quickly as possible. |
| Integrated Care Team workstream | Enhanced recovery at home service – To help people continue their recovery at home once they’ve left hospital, or to stop our most vulnerable patients from needing to go into hospital, we are trialling a wider service which is delivered in people’s homes. This will give them the support and treatment which they need to make sure their health continues to improve. Community bed review – We are looking at how beds in community hospitals are being used, to make sure that patients are recovering in the right setting. Integrated care – New teams have been set up who are made up of GPs, mental health workers, social workers, nurses and eventually hospital consultants. These teams meet weekly to review the status of their most vulnerable patients and to take proactive action to make sure that they are happy, healthy and at home. |
| Prevention and self-care | Healthy Living Pharmacies is about using pharmacies to help local people by providing proactive health advice, promoting health and delivering more wellbeing services. Recovery College Model – is a programme of courses which focus on living with and living beyond a mental health condition, or chronic physical condition. Carers - we know the importance of carers and are looking at how best to support them, so that they and the people they care for are happy, healthy and at home. |
| Supporting the development of primary care to operate at scale | Developing the way that GP surgeries work together to make best use of resources and to offer additional services in an effective way. |
There are four ‘enabling’ workstreams which support the delivery of the primary workstreams.
Access to electronic records for patients and care professionals
This workstream ensures that all relevant health and social care professionals are able to securely access the information they need, when they need it, in order to make the right decisions about a patient’s care – and with patient consent in place.
Understanding the needs of local people and the outcomes they seek
This workstream ensures that the new models of care being developed and implemented match that the local population needs – giving people the best chance of remaining happy, healthy, at home, and making the best use of public money.
Workforce and organisational development
Focusing on the workforce and ensuring the behavioural changes needed to deliver the new model of care happen.
Engagement and co-production
We are putting engagement and co-production at the heart of the vanguard programme. Citizen leaders will share in collaborative partnerships, and local people will participate in service design and delivery. Staff across the system are fundamental to the success of this workstream, and their input and support is vital.