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Bevan Exemplar Cohort 1 Projects

Integrated Health and Social Care Support Worker Project

Rhian Dawson, Linda Williams, Victoria Prendiville, Sian Fox, Sarah Cameron, Gail Jones, Teresa Williams, Linda Morgan, Terri Larkin and Trish Mathias-Lloyd

Hywel Dda University Health Board

This project seeks to transfer healthcare related tasks to social care workers in care homes for older people which historically has been acknowledged to challenge organisational governance and legislation.

The project recognises that its success will be dependent on incremental delivery of small changes to traditional care management in order to ensure prudent health principles such as ‘do no harm’ and ‘only do what you can do’ are adhered to.

The project seeks to deliver quality assured, competency based training to the Health & Social Care workforce in Carmarthenshire. The project has utlised Hywel Dda’s EAGLE (Excellence, Assurance and Governance in a Learning Environment) to provide clinical governance assurance, ensuring the project was developed in a safe and effective way.

The EAGLE Framework provides assurance to all staff, clients/patients and their families that the care is delivered by competent and confident staff. Agored Cymru have accredited the training which has resulted in improved staff morale and team working and critically, client focused care and improved outcomes.

Project Scope:

The scope of the project has not been limited. The Project Board will consider any proposals that meet the overarching aims of this project. Each agreed proposal will be developed into a workstream with appropriate individuals allocated to develop and implement. Each workstream will have its own Risk Log and Progress Plan.

The first phase of the project was to develop transfer of skills around non-complex would care management. This was successfully delivered in one of the residential care homes in Llanelli and evaluated.

The project demonstrated 50% reduction in community nursing interventions in relation to non-complex wound care at the residential care home. The project now has two operational workstreams:

  • Rolling our non-complex wound care management to residential care himes across Carmarthenshire.

Home Enteral Tube Feeding (HETF) via Gastronomy at three disability daycare and respite settings within Carmarthenshire.

Further workstreams have been agreed in 2016/17 in addition to the two above. These are Continence Care & Care to MOve training across our Health and Social Care workforce in residential care.

This Project Supports Prudent Healthcare:

In terms of Prudent Healthcare, the project embodies all the prudent health care principles by its very nature.

  • Achieve health and wellbeing through co-production: Professionals actively participated in the development of workbooks for the training and family and carers were also involved in terms of capturing their wishes in co-producing the individualised training package.
  • Care for those with greatest need first with effective use of resources: A rapid evaluation of the initial Non-complex wound care pilot at Llys y Bryn Care Home demonstrated a 50% reduction in District Nursing interventions within the home. This would also mean a cost saving but better patient outcomes at the same time.
  • Do only what is needed, no more, no less and do no harm: In terms of Non-complex wound care management, being done in a safe environment and at a time that suits the resident as opposed to when the District Nurse was calling.
  • Reduce inappropriate variation through evidence based practice: Competency based care plans are followed and through carers having had training, the carer is able to make a decision as to whether a wound is deteriorating.

Anticipated Benefits:

Patient Safety:

  • Patients are identified by a Health clinician as appropriate. Delegated tasks that are involved within the project continue to be the responsibility of the clinician in line with the 3rd party delegation guidance from the Welsh Health Circular via WG.

Patient Experience:

  • The training was well received by everyone and has led to improved quality of life for the residents in the home which has led to an overall much better experience for the individuals within the Care Home.
  • Care is incorporated into the residents personal care which avoids unnecessary dressing and undressing.
  • Other benefits include improved record keeping, more confidence among staff and better working relationships between Llys y Bryn staff with District Nurses.

Patient Outcomes:

  • There are no new non complex wounds at the Care Home (September) – improved clinical outcomes.
  • Care is planned around the client and not on the availability of professional staff – patient focused care.

Staff Morale:

  • Appetite to undertake further training as its developed.
  • Senior Carers feel empowered and supported in the development of their skills and knowledge – improved staff morale.
  • Senior Carers are not having to constantly contact Community Nurses releasing their capacity to plan care.
  • Good team working between Health and Social Care staff.


  • Reduction in District Nursing interventions.
  • Reduction in GP visits.
  • Reduction of hospital admission.


  • Governance for the project is back to the Integrated H&SC Support Worker Project
  • The training was well received by everyone and has led to improved quality of life for the residents and ultimately, a better experience for all individuals involved.
  • The project utilises the Welsh Health Circular – 3rd Party delegation guidance as a framework for governance for this project.

Motivation for the project – Why this project?

  • It offers an opportunity to start the process of Integration in a clinical setting.
  • Our commitment as organisations and clinical/professional staff to supporting the Integration Agenda.
  • It makes sense.