Solihull CCG, on behalf of Solihull Together, commissioned Age UK Solihull to deliver the Care Navigator Service pilot which is runnig for six months from October 2016 until the 31 March 2017. So far the pilot is proving an invaluable service to GP Practices and patients alike, and is on track to cover 38 sites across Solihull by the end of January.
Care Navigators are based in GP Practices and work with people over the age of 65 in their own homes to ensure they have all the support they require to maintain independence and wellbeing.
Care Navigators focus on prevention and early intervention, working with people through a specific, personalised ‘action plan’ focusing on areas such as health, social care, finances, wellbeing and lifestyle, and using resources within the community where possible. Where appropriate the Care Navigator works with people to ensure they are better equipped to manage their own care into the future.
There are numerous benefits , including improved health and wellbeing, maximised independence, reduced anxiety and loneliness and an improved understanding of their own health and social care options.
The scheme which started on 1st October, recruited four Care Navigators in the first month, and a further eight have joined in the second phase which ran to the end of November. The Care Navigators cover an area of 26 sites across Solihull CCG with a further 6 planned in December. Some sites have required more Care Navigator assistance due to a larger ‘older population. In the first month a total of 36 patients were referred to a Care Navigator.
National evaluations by Age UK of the service have proved huge benefits, with *Age UK Camden having cited several very positive outcomes including reduced hospital admissions, a reduction in GP appointments and improved wellbeing.
All patients referred to the Care Navigator Service receive a Falls Assessment, and simple tips and actions such as seated exercises, more appropriate footwear or small aids and adaptations can be organised to prevent falls.
Care Navigators can also support older people when they are discharged from hospital after an unplanned admission. Once a referral is organised, the patient can be assessed in their home to check they have everything they need when returning from hospital, for example, their heating is on and appropriate support is in place. This is vital in reducing readmissions to hospital.
Age UK Solihull has reported that GPs in Solihull Practices are finding there are massive benefits to both them and their patients. Any medical concerns can be passed from Care Navigator back to the GP and everyone is finding it very positive with Care Navigators also invited to Practice Meetings and really feeling part of the team.
Another beneficiary from the Care Navigator service are the patients’ carers. Once identified as a key carer for a patient, they can be assessed for support including referrals to specialist organisations such as the Carers Centre. National evidence suggests that there are fewer hospital admissions when the carer is supported properly.
*Age UK Camden Care Navigator outcomes can be found here: http://www.ageuk.org.uk/camden/services/care-navigators/