Care homes vanguard

The NHS Five Year Forward View, published in October 2014, sets out a series of new ways of providing care. To help promote these new models of care, NHS England invited organisations and partnerships to become ‘vanguard’ sites. These sites will act as the blueprints for the NHS moving forward and the inspiration to the rest of the country. In March 2015, a total of 29 sites were chosen across the country and Nottingham City was declared a vanguard site for ‘enhanced health in care homes’ – offering older people better, joined-up health, care and rehabilitation services.

For more information click here.

Our care home population

In Nottingham City there are about 1,500 GP-registered care home residents (for older people) in non-specialist care homes. With an ageing population we can expect this number to increase in the future. Care home residents have complex medical needs. The average resident has six diagnoses and takes eight medications. Currently, care homes residents are 0.5% of the city’s population but account for 5% of all admissions to hospital. Many older people are cared for in hospital but best practice evidence indicates that care is most effective when provided at home or in the community.


Our vision is to enable residents living in a care home to be healthier, have a better quality of life and to be treated with dignity and respect, focusing on residents’ capabilities rather than their dependencies. It is our aim that all residents and their families will have a positive experience of care.

Care home residents, commissioners and providers will work together to aim to:

  1. Ensure that care home residents have an improved experience through high quality essential care.
  2. Ensure that all residents have agreed goals of care based on proactive multi-disciplinary review.
  3. Ensure that residents are admitted to secondary (hospital) care only when they have a medical need and are discharged when that need is met.
  4. Ensure that residents have enhanced involvement in decisions about care, place of care and place of dying.
  5. Improve the quality of care for residents through well-co-ordinated, timely care and appropriate use of technology.
  6. Ensure that residents have reliable access to familiar health professionals and are supported by a workforce with the skills to meet their needs.


We will achieve our vanguard vision through a series of inter-linked projects. These include proposals to:

  • Ensure the right urgent care response in a crisis, helping avoid hospital/care admissions, seven days a week.
  • Integrate specialist care homes services including dementia outreach, care homes nursing team and care homes pharmacy.
  • Create a single reablement service for care home residents so they have the opportunity to remain as independent as possible.
  • Use video consultations and expanding telemedicine in care homes.
  • Improve support in the community to allow older people to be discharged earlier from hospital wards.
  • Encourage older people in care homes to take part in activities that maintain or improve their health and well-being.

Benefits for all

Through projects such as these we anticipate realising a number of benefits – for care home residents, for the care home sector and for the health and care system. Residents will experience better quality care, improved support for long-term conditions, reduced risk of falls and injuries, fewer trips to hospital and improved end-of-life care. The care home sector will become a safer environment, working in partnership with clinicians providing better co-ordinated care around the clock. The NHS and local authority will reap the benefits of operating a more efficient system, using resources more effectively and developing a greater skill mix among a more flexible workforce.

pdfDownload a leaflet: An introduction to the enhanced care in care homes Vanguard in Nottingham City


Nottingham City CCG has carried out a programme of engagement in care homes across the city, having commissioned Age UK to obtain views on care from residents, family and carers, staff and future users.

pdfDownload the report here.

Blog posts

pdfIntroduction to our vanguard
pdfOur vanguard focus
pdfVanguard assistive technology
pdfVanguard medicines
pdfVanguard dementia
pdfVanguard engagement