Care homes in Sunderland now benefit from an added layer of support, thanks to a programme that sees community-based NHS nurses provide specialist assistance to people who live there, and the carers who look after them day-to-day.

Part of All Together Better, the team of community nurses provide visiting-support to care homes across Sunderland.

The nurses – who will visit each of the city’s care homes roughly once a week – are on hand to help staff manage illnesses or injuries effectively, spotting the early signs of health problems and putting in place the right care to treat the person and prevent their condition from worsening.

The service supports people living in residential, nursing and extra care homes, and enhances the support offered by nursing and care staff already working there.  The aim of the service is to prevent people becoming unwell wherever possible, but when they do, to quickly put in place the right intervention to stop them from becoming so unwell they require hospital care.

Debbie Burnicle, deputy chief officer at Sunderland Clinical Commissioning Group (CCG), said: “The new care home nurse support was introduced after we looked at ways of targeting – and proactively supporting – those in the city with some of the most complex health and social care needs. We piloted this approach in the Coalfields area, saw the benefits and learned lessons that we have been able to build into what is now a city wide approach.

“We recognised very quickly that, with that added layer of medical support, we could not only provide greater support during times in which people’s needs become exacerbated, but we could also spot the warning signs and prevent them from becoming unwell in the first place.”

The nurses respond to any changes in the health or behaviour of people living in Sunderland’s care homes, quickly assessing what is wrong and bringing in the right help to get them well again.  By working alongside their area nurse, carers in the city’s homes are better equipped to spot the early signs of problems and to intervene and ensure the condition of the person they are looking after does not escalate.

As part of a multi disciplinary team of professionals, operating in community-based teams, the nurses work alongside care home staff to understand who may need a little extra attention, and then support with medical observations and, where necessary, provide care or medication to get them back to their best.

Working within a Community Integrated Team – five of which have been set up across Sunderland to put health and social care teams on the doorstep of the people they care for – the nurses feed in to a wider group of professionals, ensuring details of any care they provide are shared with those who provide more regular support to the person – their GP or community matron, for example.

The nurses are also able to support residents, their carers and families to put in place emergency healthcare plans (EHP), that can be followed if someone they look after becomes severely ill.  The nurses work to understand the expectations and choices of each person they support, and can also help with end of life planning, to ensure that the wishes of the person can be taken into account when that time comes.

For more information about the care home nurse teams, or the Sunderland vanguard programme, visit; find All Together Better on Facebook and @atbsunderland on Twitter.