Transcript Transformation - Northumberland, Tyne and Wear NHS Trust

Annual Plan 2014 - 2019
Lisa Quinn
Executive Director Performance and
Assurance
Annual Plan requirements
• Major change from last year
• Integrated strategic and operational planning process for 2014
i.e. CCGs, Foundation Trusts, non Foundation Trusts and Local
Government (via Health and Wellbeing Boards)
• Initial guidance issued and a 2 year and 5 year plan is required-but
precise requirements still not clear
• Guidance on precise requirements and content due out week
commencing 16th December
• The Trust’s Plans will continue to reflect IBP (October 2012) and
Transformation of Services
Provisional Timetable-Key Dates
• 10th December 2013-Joint Council of Governors/Board of Directors
• w/c 16th December 2013-Monitor Guidance, Templates and Tools
issued
• 13th January 2014-Initial high level plan submitted to Monitor
• 20th March 2014-Council of Governors Full Meeting (review of draft
2 year plan)
• 26th March 2014-Board of Directors approval of 2 year plan
• 4th April 2014-Submission of final 2 year plan to Monitor
• 15th May 2014-Council of Governors Full Meeting (to sign off 5 year
plan)
• 28th May 2014-Board of Directors approval of 5 year plan
• 20th June 2014-Submission of 5 year plan
• 15th July 2014-Council of Governors Full Meeting (review of
Summary Annual Plan)
• Annual Members Meeting-Circulation of Summary Annual Plan
Annual Plan Working Group
Thank you to all of those that volunteered to be members.
•
Council of Governors Representatives/constituency:
Austen O’Malley-Public
Marion Moore-Service User
Grahame Ellis-Staff
Ann Clark-Carer
•
Meetings-monthly January 2014-June 2014
•
Chair - Steve Brooks, Head of Commercial Support
Questions
Council of Governors
Transforming Services
10 December 2013
Strategic Direction
The environment in which we work:
Quality
Sustainability
•
We have to improve quality for
the patient
•
We have to reduce our overall
cost of doing so by 20%
•
We aim to improve clinical
effectiveness thus reducing
reliance on inpatient beds
We have to create sustainable
services, delivered by
sustainable organisations,
operating in a sustainable
system
-20%
Cost
•
What we are told nationally:
‘The NHS… needs to develop and
implement bold and transformative long
term strategies and plans for their
services, otherwise they will become
financially unsustainable and the safety
and quality of patient care will decline’
Joint letter to the NHS and Local Authorities,
4th November 2013
•
‘Call to Action’ and ‘Closing the
Gap’ reports highlight that the
NHS needs to radically transform
to meet the current quality, safety
and financial challenges
What our partners have told us:
•
We have to get much better at
what we do and how we do it
•
We have to get better at listening
and acting on what people are
telling us
•
We have to be consistently good
across all our services
•
We need to get the patient quickly
into the right services and then
deliver the best outcome possible
What patients and carers have told us:
•
They want high-quality, safe care
close to home
•
They want inpatient services to be
of a high standard
•
They want services designed and
operated around the needs of
patients
•
They want the patient to be truly
‘at the centre’
•
They want to gain and re-gain
independence, as far as possible
Patient
The Service Model
Request for Help
Information & Advice
Initial Response
Initial evaluation regarding nature, risk, complexity and urgency of the problem
More Intensive Packages of Care
Hospital
Signposting to principal service pathway for assessment and formulation
Psychiatric Intensive Care
Treatment Intensity
Low Security
Specialist Ward
Crisis Beds
PICU
Environment
Acute Ward
Intermediate
beds
In the Community
Low Security
Intermediate Facility
Challenging
Crisis Bed
Behaviour
Acute Ward
Mild severe
non psychotic
Very
severe &
complex
nonpsychotic
Psychosis
Dementia
Assessment
Intensive Home
Treatment
At Home
Intensive
Home
Home
Etc.
Challenging
Behaviour
Treatment
Assessment Formulation
& Treatment Planning
Crisis Assessment
Discharge
Neuro disability
Learning
Disability
Children &
Young
People
Substance
Misuse
Scaffolding
Medium Security
SMR Principles
•
•
•
•
•
You should reach us, quickly and simply
The earlier the better
To get the right help and care, safely and easily
From our flexible and skilled workforce
In collaboration with you and your carers and partnership
organisations
• So that you can gain / re-gain independence, as far as
possible
• By making smooth and sustainable steps forward
• Reaching us again, simply and quickly
The need to realign and balance resources:
At any time, 3% of patients are consuming 52% of resources
•
•
Inpatient
Services
Community
Services
£92.2M
£84.8M
NTW Whole
costs
NTW Whole
costs
•
•
We spend in inpatient areas to
the detriment of community
services
A few patients consume much
of the resource
Many in-patients perhaps don’t
need to be, but we lack the
necessary community services
to support them out of hospital
We need to balance resources
to maximise quality over cost
Principal Community Pathways
Principal Community Pathways
A programme to design and implement new, evidence-based community
pathways for adults and older people.
Our ambition is high and is matched by the expectations of service users
and carers. The new pathways will:
• Significantly improve quality for the patient
• Double current productive time of community services by redesigning
current systems
• Enhance the skills of our workforce
• Improve ways of working and interfaces with partners
• Reduce reliance on inpatient beds and enable cost savings
This is not achievable in isolation and to be successful we need it to be part
of integrated work with partners
Principal Community Pathways – Timeline
Tranche 1 –
Sunderland & South
Tyneside
Tranche 2 –
Northumberland &
North Tyneside
Design
Test
Implement
Preengagement
Tranche 3 – Newcastle
& Gateshead
Design
Test
Implement
Pre-engagement
1 Dec 13
1 Apr 14
1 July 14
Design
1 Sep 14
1 Dec 14
Test
Implement
1 Apr 15
Principal Community Pathways –
How people have been involved
So far 362 people have attended the 27
clinical and supporting systems workshops,
these have included: GPs, Local Authority
staff, Acute Trust staff, Community and
voluntary sector staff, CCG staff, NTW staff
and most importantly our service users and carers.
• Our Trust-wide Service User and Carer
Reference Group has been involved throughout
• We have presented our plans to various groups
including HealthNet and South Tyneside GP
Education Forum
• We’ve been ‘walking the wall’ with all of our
stakeholders and have so far run sessions for
over 800 people – with more to follow
So what is so
different?
Access
Current State
Multiple points + times of access.
Referral Source + methods vary area to area.
Future State
Single point of access for service users, carers and
referrers, open 24/7
Bouncing.
Service Users and carers are able to self-refer to services
within the scope of Principal Community Pathways
No standardisation of allocation meetings.
Referrals are accepted by telephone, letter, email and fax
Access to clinical advice variable quality + recording
variable
Clear single point for obtaining advice and information,
including clinical advice
Service users are often sent an appointment letter
after the allocation meeting, with no choice of day,
time or venue
Wider hours of operation for community services
Community services operate 9 to 5 in most areas
Most contact with service users is by letter, limited use
of phone calls and text messaging reminders.
Many teams have waiting lists for assessment and for
treatment
Multiple routes for re-engagement into services by
historical service users, no clear route back in
Service User is contacted within 24hrs of referral being
received and offered choice of venue and time for
appointment.
Service User is asked how they would prefer to be
contacted in the future e.g.
letter/phone/email/text/Skype.
There are no waiting lists for patients
Opportunity for easier and more streamlined route back
into services should this be required following discharge
Assessment & Formulation
Current State
First appointment date may be several weeks
after referral being received
Limited choice of appointment
days/times/venues
Service Users often unprepared for the
assessment, giving rise to anxiety and is a cause
of DNAs
Very limited use of reminders of appointments,
often just one appointment letter sent out with
no follow up
Mixed availability of reception services at clinical
venues, and mixed customer service skills
Limited access to physical health check facilities,
many service users not offered this option
Future State
First appointment date is within 7 days of referral being
received (agreed)
Service User offered a choice of appointment
days/times/venues
Service Users given information and invited to tell us a
little about their life using a “introduction to me” before
assessment to feel more prepared
Service User can choose to receive a text message or
phone call to remind them of the appointment
Where clinic appointment is required, Service User is
greeted by front of house staff where demographic
information is checked and an explanation of their visit is
provided
Where required, Service Users will also receive a full
baseline physical health check.
Where appropriate, carers involved throughout the
assessment and formulation process
Service user and carers will leave with a plan and a clear
understanding of what will happen next
Treatment
Current State
Future State
Service Users often only receive a single letter
about an appointment, without options to
receive reminders
Service Users continue to have the choice of text
message or phone call reminders for
appointments
Service Users receive mixed levels of treatment
in the form of clinical interventions and/or
medication, as agreed in their treatment plan
Service Users receive treatment in the form of
clinical interventions and /or medication as agreed
in their treatment plan and in line with NICE
guidance with clear review points to
monitor/change care where appropriate
Service Users have mixed access to community
support to help them with benefits, housing,
social issues
Service Users receive treatment and care in a
range of environments which are not always
the most suitable
Care planning is not always developed
collaboratively with the Service User/carers
Service Users will have access to Peer Support
Workers as well as community workers to help
them with benefits, housing, social issues
Service Users will receive treatment and care in the
most suitable environment
Service Users, Carers and other professionals will
be able to call a review
Care plans will be developed collaboratively with
the patient/carers where appropriate
Discharge
Current State
Future State
Service Users are often ‘discharged’ by one part
of NTW while care continues to be provided by
another part, which is confusing to them, carers
and referrers
The term ‘discharge’ will only be used when the
service user is leaving NTW services in their
entirety – otherwise, the terms ‘transfer’ and
‘transition’ will be used
Discharge planning is not a standardised
approach
Discharge process is part of treatment and the
Service User will feel prepared for the discharge.
Often service users return to NTW because of
unresolved issues in the wider world (social
issues, housing, benefits, welfare), for which they
receive varied levels of support across services
Any disputed issues will be resolved prior to last
meeting.
Service Users do not always have a clear plan of
how to ‘stay well’ and what steps they should
take in the event of a relapse
Carers are not always involved in discharge
planning, and their needs are not always directly
considered
Service User will agree a discharge plan including
how to ‘stay well’ and what steps they should
take in the event of a relapse
Carers will be involved throughout discharge
planning
Mark’s
Story
Mark
Mark is 38yrs old and has struggled with low mood and paranoid thoughts all of his life. He had a
difficult upbringing, his Dad beat him from a young age and would always pick fights and criticise
him. Mark left home at 16 years old. He spent many years on the street, took a lot of drugs and was
in and out of prison for a few years.
He was staying in B&Bs but has recently got a place in a supported living block. He finds it difficult as
he feels paranoid most of the time and thinks people are talking about him. He hears the voice of his
Dad continuously – criticising him and telling him how useless he is. He used to take ODs or get as
smashed as he could to stop the voice, he was always in A+E or being brought in by the police but
nowadays he tends to just withdraw to his room. He smokes a lot of weed which sometimes relaxes
him.
He has seen a psychiatrist in the past and they put him on a tablet. It made him feel blank and tired
and it put weight on him which he hated, so he stopped taking it. He sees his GP quite regularly for
this and that. He’s been referred back to the mental health team a few times but only seen a CPN
once for 20 mins and finds it difficult to get in touch with him. He admits he’s missed a few
appointments. He really wants to stop the voice and improve his mood but he thinks nobody’s
bothered about him because he doesn’t cause trouble anymore.
His doctor asks him to rate his mood on a scale of 1 to 10. It’s 1.
Referral
Process step
Mark is able to ring one
number.
The single point of
access service is
available 24/7
Mark
Mark is contacted
within 24hrs of referral
being received and
offered choice of
venue and time for
appointment.
Mark’s GP is able to
contact the same
number for support or
advice about Mark’s
care
NTW will work in
collaboration with
social care, and 3rd
sector partners to
support Mark
Assessment
Mark is provided with
information about
what to expect from
his visit to NTW
Mark will be sent a
‘introduction to me’
pack where he can
prepare for his first
assessment
If deemed necessary
Mark will also receive
a full baseline
physical health
check.
Mark’s care plan will
be developed
collaboratively with
him
Mark’s discharge
planning commences
at this point
Treatment
Mark will receive
treatment in line with
NICE guidance.
Treatment package
tailored to his needs.
Mark will have access
to Peer Support
Workers and
Recovery College to
help him with
important issues.
Mark can request a
Review at any point.
Mark’s GP will have
access to an advice
line where they can
speak directly to an
NTW psychiatrist or
pharmacy about any
issues in relation to
Mark’s care.
Discharge
Upon discharge Mark
will agree a discharge
plan including how to
‘stay well’
Mark’s discharge plan
will also include what
steps he should take in
the event of a relapse
Mark’s GP will also
receive a copy of this
plan along with any
early warning signs
and initial
management plan
Augmenting Services
Total beds per 100,000 of population within the Mental
Health Care Packages & Pathways consortium
What does this mean for inpatient
services?
Our aim for in-patient services is to ensure that when
service users need to be in hospital, they are looked after
in
• an appropriate environment,
• which is properly staffed, and
• delivers effective interventions which are focussed on
recovery
• supporting people to step down out of hospital, as soon
as their needs allow
Northgate
Bed Model Current State
(42 Wards April 2013)
St Georges
U
R
G
E
N
T
Male Acute
Female Acute
PICU
LD
OPS (func.)
P
L
A
N
N
E
D
Stepped Care
OP Organic
The Grange
St Nicholas
Rose Lodge
S Tyneside DH
CAV
Monkwearmouth
QE
Cherry Knowle
Elm House
Brooke
House
What does this mean for inpatient
services?
• Overall, across the Trust we are looking to
reduce in-patient provision for adults and older
people’s services from the current level of 723
beds to around 425.
A group of senior clinicians suggested that the following suite of
wards, with the appropriate enablers in place, could be a starting
point for a discussion about the future of NTW inpatient services
Ward Grouping Count
Assessment
8
PICU
1 or 2
Organic
6
Stepped Care
5
LD
1
Complex Care
2
Frail Group
2
Key
Ward Type
Male Assessment
Female Assessment
PICU
LD
Functional Frail
Male HDU
Female HDU
Moving On
Organic
Complex Care
Senior NTW clinical staff agree the co-location
of certain “ward types” makes clinical sense
Key
Functional /
Complex Services
Male Assessment
Female Assessment
PICU
LD
Functional Frail
Male HDU
Female HDU
Moving On
Functional Frail /
Organic
Organic
Complex Care
Option W
(26 Wards)
St Georges
Male Assessment
Male HDU
Female Assessment
Female HDU
PICU
Moving On
LD
Organic
Functional Frail
Complex Care
Rose Lodge
St Nicholas
Monkwearmouth
Hopewood Park
Option X
(26 Wards)
St Georges
Male Assessment
Male HDU
Female Assessment
Female HDU
PICU
Moving On
LD
Organic
Functional Frail
Complex Care
Rose Lodge
St Nicholas
Monkwearmouth
Hopewood Park
Option Y
(26 Wards)
St Georges
Male Assessment
Male HDU
Female Assessment
Female HDU
PICU
Moving On
LD
Organic
Functional Frail
Complex Care
Rose Lodge
St Nicholas
Monkwearmouth
Hopewood Park
Option Z
(26 Wards)
St Georges
Male Assessment
Male HDU
Female Assessment
Female HDU
PICU
Moving On
LD
Organic
Functional Frail
Complex Care
Rose Lodge
Monkwearmouth
Hopewood Park
The travel issue…
• Across NTW it is not unusual for people to travel to the
right inpatient services.
• Every patient is asked about travel for them and their
carers/family on admission
• Wards have a number of resources available to help
families and patients, including ward cars, access to
information on grants for families etc.
• We are working on ways to ensure local staff can keep in
touch without too much travel
The staff perspective
• NTW does not anticipate making any compulsory
redundancies as a result of this change
• There will be separate staff consultations in due course
• Affected staff will have access to TED – the
Transitional Employment and Development Approach
Proposal for public involvement and
consultation 2014
Phase 1 – FDP delivery schemes for 2014/15
• Newberry closure
• Hebron closure
• Newcastle dementia (castleside)
• Greentrees - Interim
• Rehabilitation South of Tyne (Brooke House and Elm
House)
• Rehabilitation North of Tyne (The Grange and Church
View) Potentially interim
Proposal for public involvement and
consultation 2014
Phase – Inpatient Beds Consultation
• Options W, X, Y, Z
• 6 local authority areas (NB South Tyneside TBC)
• i.e. all adult and older peoples assessment and
treatment beds, dementia and LD
• Exclude rehabilitation beds
Proposal for public involvement and
consultation 2014
Timing
Preparation:
December 2013
Phase 1:
January – March 2014
Phase 2:
Mid May – August 2014
Implement phase 1 from April 2014
Implement phase 2 from April 2015
Questions?