Transcript Slide 1

South Warwickshire Health and
Care Economy
Urgent Care Plan Update, July 2013
Urgent Care on a Page
Long
Medium
Short
Timescale
Focus
Defined at the period Q1 and Q2 the focus of the South Warwickshire Urgent Care Board
has been to:
a) A&E Performance to consistently be above 95%
b) Understand activity patterns and how existing QIPP programmes address the issues
c) to embed grip and pace into the projects that were scheduled for Q2/Q3
implementation
d) Reviewing surge plan and planning for Winter 2013/14
e) Identifying and evaluating options for the long term
Medium term actions focus on Winter 2013/14. The key aspects are:
a) Ensuring projects due to deliver at the start of Q3. This is supported by a whole system
risk register held be the urgent care board
b) Implement new QIPP programmes such as ABA that have identified through analysis
c) Working with partners such as WMAS, OoH in order to improve system working
d) Engage with local population to mobilise their contribution to the urgent care system
e) New roles for primary care during the in-hours
In addition to the focused actions on the short and medium term we have started work on
the long term sustainable model for urgent care. This is reflected in our pioneer bid
a) We have defined the urgent care system as the following components –
prevention/self management; improving the management of LTC and people with
complex needs; admission avoidance; hospital flow and discharge
b) Engagement events are scheduled over the summer months on future state of
community urgent response (inc OoH) and routine management of LTCs.
c) Development of contingency capacity
Impact to date
Deliverables
First Draft Winter Plan
Revised Surge
plan
GP focus on
Urgent Care
Nursing
Homes
D2A Live 18 extra beds
in the system
Loneliness
Campaign
Hand washing campaign
ABA
EOL
40 D2A beds
Increased
Psychiatric
Liaison
Improved availability of primary
care
Service specification for urgent
community response & OOH
Service
specification
for LTC’s
New type of
contract
Engaged &
responsible
community
A&E @
96.2% in
June
A&E
Attendances
5% down
against plan
1% down
YTD
compared to
2012/13
Pioneer Bid
Hand
washing
campaign
kicked-off
18 extra
beds in the
system
Positive
engagement
with primary
care on new
models
2
Long Term (Actions to
deliver sustainability in
2015/16 and beyond)
Medium Term (Actions to
deliver 95% in Q3, Q$ and
2014/15)
Short Term (Actions to
deliver 95% in Q1 and
Q2 )
Timeline
July 2013
Aug 2013
Sep 2013
Oct 2013
Nov 2013
Dec 2013
Jan 2014
Feb 2014
Mar 2014
Further analysis
into the over 85
yrs reason for
surgical admission
Ongoing
implementation of
SWFT internal
project plan
Urgent Care
board receive
first cross
system risk
register for
urgent care
projects
Discharge
Themed Review
Finalise Surge
Plan and Winter
Plan
Engagement on
Urgent Care
commissioning
Intentions
Urgent Care
Board approve
surge plan
Prioritise
spend in Winter
plan
Commence
testing phase of
surge plan
Continue
testing of Surge
Plan
Revise surge
and winter plan
Commissioning
Intentions
published
Winter
Plan goes
live
Monitor
and review
impact of
surge and
winter plans
and take
appropriate
corrective
actions
Monitor
and review
impact of
surge and
winter plans
and take
appropriate
corrective
actions
Monitor
and review
impact of
surge and
winter plans
and take
appropriate
corrective
actions
Monitor
and review
impact of
surge and
winter plans
and take
appropriate
corrective
actions
Monitor
and review
impact of
surge and
winter
plans and
take
appropriate
corrective
actions
Develop
detailed plan
for the long
term approach
Approval for
approach for
long term plan at
Urgent Care
Board
Commenc
e Long Term
delivery
plan
Urgent Care
Board
Monitor and
review
progress
Urgent
Care Board
Monitor and
review
progress
Urgent Care
Board
Monitor and
review
progress
Urgent Care
Board
Monitor and
review
progress
Urgent
Care Board
Monitor
and review
progress
3
Section One
SHORT TERM ACTIVITIES AND SUCCESS
Short Term Activities and Success
Urgent Care Board
Urgent Care Board Established

The South Warwickshire Urgent Care Board has been established.
Its relationship with the rest of the system is illustrated in figure
one

Membership includes the following organisations:
–
South Warwickshire Clinical Commissioning Group
–
South Warwickshire Foundation Trust
–
Coventry and Warwickshire Partnership Trust
–
West Midlands Ambulance Service
–
Harmoni
–
Warwickshire County Council Social Care
–
Warwickshire Public Health
–
Health watch

The South Warwickshire Urgent Care Board will:
–
Develop an agreed shared understanding and strategic
oversight of the local system/pathways covering Urgent and
Emergency Care, identifying areas for improvement and/or
transformation.
–
To work collaboratively with a common purpose and adopt
the following service delivery principles of:
• Placing the patient at the centre
• Ensuring integration of services across organisations
• Ensuring quality of services and service outcomes
• Improving efficiency
• Improving effectiveness
• Improving productivity
–
With clinical input, to identify and agree priority work
streams for enhancing system flow and improving system
performance within the local health and social care
economy
–
Agree indicators and milestones with realistic timescales to
ensure that work streams delivery the intended outcomes;
i.e. recovery plans where performance is poor; winter
planning; systems development and improvement
–
Collectively monitor and hold each other to account on
delivery of work streams against agreed outcomes.
Figure 1
Integrated System
Board
(Strategy)
CCGs/Providers/LAs
Arden CCGs’ Federation
Commissioning
CCGs
Coventry & Rugby
Urgent Care Board
All Local
Stakeholders
South Warwickshire
Urgent Care Board
All Local
Stakeholders
Warwickshire North
Urgent Care Board
All Local
Stakeholders
Arden Urgent Care Forum: Operational Co-ordination
All Arden Stakeholders


A system wide urgent care project risk register is being developed.
There has been agreement between the organisations that a single
project management approach /toolset will be used to provide
consistency. Each organisation will be responsible for risk rating the
projects that it is leading.
The Urgent Care Board will focus its discussion on those that are
not on track and/or high risk in terms of benefits realisation. This
process will allow each organisation to understand the impact to
other organisations and allow senior input to facilitate interorganisational issues.
5
Short Term Activities and Success
Understanding the Issues
Analysis of Performance

Overseen by the Urgent Care Board there has been a significant amount of
analysis undertaken to understand the issues that need to be addressed.
The analysis can be found in Appendix 1.

There are a number of key issues that have arisen from this analysis and
these have shaped our short, medium and long term approach for urgent
care:
–
When compared to national, west midlands, and Warwickshire
rates per 1,000 population south Warwickshire performs very well
in both A&E attendances and emergency admissions. Therefore,
opportunities to reduce inappropriate admissions are likely to be
less than other areas. We therefore need to have a more radical
approach to managing urgent care demand;
–
Our QIPP programme has targeted the frail population due to the
growing numbers in elderly; whilst the numbers have increased in
the 75-84yrs and 85+yrs length of stay has reduced;
–
Growth in the 85yrs+ has been in surgical specialities and further
work is being undertaken to understand the growth in this area.
Specific focus is being given to falls prevention. This is reflected in
the winter plan and social care are procuring as new falls service;
–
We need to target the 65-74 age group; this will primarily be
tackled this winter through the Assess before Admission (AbA);
–
Consideration needs to be given to the 17-64yrs group as this is
high volume and could deliver quick wins;
–
Opportunities arise from increasing discharges at the weekend;
–
Analysis of breaches shows that only half are related to beds and
therefore more focus needs to be given to other area; however
these factors are inextricably linked.
Themed Review of Discharge

Given the analysis has demonstrated that it is discharge processes rather
than volume of attendances at A&E that are impacting on the ability of
SWFT to deliver the A&E 4 hour standard then a themed review of
discharge processes is being undertaken by the CCG.
GP Review of A&E Attendances

All 36 practices have undertaken analysis of their A&E attendances. Key
findings from this are:
–
The over 65yrs – arriving by ambulance throughout the day but
less so during the night. In the majority of cases they are
presenting with MI, CVA, epilepsy, RTA and therefore
unavoidable;
–
The 16-65yrs – A&E reports insufficiently completed but majority
are self presenting at A&E. Very few are brought in by ambulance
but those that are seem to be mainly trauma, e.g. RTA or sports
injuries.
–
Under 16yrs – analysis shows that these are in the main
appropriate e.g. deteriorating asthma, inhaled foreign bodies,
trauma.

The need to target the 16-65ys correlates with the in depth analysis that
has been undertaken
Emergency Care Intensive Support Team (ECIST) Review

ECIST undertook a follow-up visit at SWFT to review progress since the last
visit. Good progress was noted in ward processes, 7 day working, care of
the elderly and CERT teams.

There is a 10 point action plan ; each work stream has a clinical and
managerial lead (This plan is described in summary on the next page)
6
Short Term Activities and Success
SWFT Internal Action Plan
Aim
Outcome
Measures
Assessment
Unit
Right Care, Right Time by the Right person with the
Right Skills in the Right Place -bring the Clinicians to
the front door and pull patients through the
system
Improving Patient Flow, Discharge,
transfer to ambulatory pathways, free
up A&E .
Percentage of patients for whom the A&E 4
hour Standard is deliver; number of outliers;
% of GP admitted patients that go directly to a
ward rather than via A&E; admission rate per
1,000 population; patient satisfaction; number
of ambulance handovers completed within
required timeframe
Escalation
Plan
To develop an internal Trust document,
understood and adhered to by all, including
external stakeholders, which describes clearly the
escalation policy of the trust when all unscheduled
care beds are full
A fully agreed escalation policy to
improve patient flow and improve
patient care to ensure that our care is
Safe, Effective, Compassionate and
Trusted.
Percentage of patients for whom the A&E 4
hour Standard is deliver; number of outliers;
% of GP admitted patients that go directly to a
ward rather than via A&E; admission rate per
1,000 population; patient satisfaction; number
of ambulance handovers completed within
required timeframe; Number of cancelled
operations; RTT position
A&E Staffing
Redesign
To manage variation, improving patient
experience.
To meet demand real time at front door
Reduced mortality, increased transfer
of patients to ambulatory pathways,
Senior clinicians at the beginning of the
patient journey, no ambulance
handover breaches.
Mortality rates, A&E to admission conversion
rate; patient satisfaction (friends and family
test ) number of complaints; staff satisfaction
Assess Before
Admission
(ABA)
To Develop a model of care for adult patients who
require urgent assessment and possible
intervention, which facilitates rapid assessment
and decision making at the appropriate stage in the
patient journey, rather than defaulting to an
emergency admission
Enhanced Patient Experience, Seamless
pathways which avoid hospital
admission
Percentage of patients for whom the A&E 4
hour Standard is deliver; number of outliers;
% of GP admitted patients that go directly to a
ward rather than via A&E; admission rate per
1,000 population; patient satisfaction; number
of ambulance handovers completed within
required timeframe; number of patients on
ambulatory pathways
TTO Process
Review
To achieve a TTO process that is proactive and
assists in the patient’s discharge
TTO’s are available when the patient is
discharged or processes are developed
to ensure that TTO availability does not
hold up discharge.
Number of patients discharged before lunch
7
Short Term Activities and Success
SWFT Internal Action Plan
Aim
Outcome
Measures
Test the
Quality of
Ward
Processes
Assess capabilities of ward clinical teams to deliver
the standards we have set and develop a workforce
development plan
All clinical staff adhere to the agreed
standards and a workforce plan is
developed and implemented. Ensure
patients are discharged effectively at
the weekends
Percentage of patients for whom the A&E 4
hour Standard is deliver; number of outliers;
% of GP admitted patients that go directly to a
ward rather than via A&E; admission rate per
1,000 population; patient satisfaction; number
of ambulance handovers completed within
required timeframe
Develop a
Workforce
plan
Develop a workforce development plan which
addresses the present and future workforce needs.
Ward based clinical workforce if fit for
purpose , has appropriate capacity,
skills and training
Staff satisfaction; agency costs; mortality rate;
patient satisfaction; sickness and absence
rates
Increase
Emergency
Ambulatory
Pathways
Introduce further emergency ambulatory pathways
designed to avoid admission
Improving Patient Flow, Discharge,
transfer to ambulatory pathways, free
up A&E .
Percentage of patients for whom the A&E 4
hour Standard is deliver; number of outliers;
% of GP admitted patients that go directly to a
ward rather than via A&E; admission rate per
1,000 population; patient satisfaction; number
of ambulance handovers completed within
required timeframe
Review of
Internally
Delivered
Services
Review all support services provided internally to
ensure that delivery is supporting effective patient
pathways and doing today’s work today (including
diagnostics, pathology, pharmacy, therapies and
hotel services).
Improving Patient Flow, Discharge, free
up A&E . Improve the services provided
as part of Assess before admission
Percentage of patients for whom the A&E 4
hour Standard is deliver; number of outliers;
% of GP admitted patients that go directly to a
ward rather than via A&E; admission rate per
1,000 population; patient satisfaction; number
of ambulance handovers completed within
required timeframe
Review of
Adult Mental
Health
Services
Review the Arden Mental Health Liaison Service in
order to provide a gap analysis and plan for 7 day
cover. Establish a referral flow chart with Mental
Health Provider in order to ensure that mental
health emergency out of hours response meets
patient need
Improving Patient Flow, Discharge,
transfer to ambulatory pathways, free
up A&E .
Percentage of patients for whom the A&E 4
hour Standard is deliver; number of outliers;
% of GP admitted patients that go directly to a
ward rather than via A&E; admission rate per
1,000 population; patient satisfaction; number
of ambulance handovers completed within
required timeframe
8
Short Term Activities and Success
Changes Made
Revised Surge Plan

Through the Arden Urgent Care Forum we have developed a
revised surge plan that will operate all year;

Escalation triggers and actions have been revised;

Plan being tested and is a ‘live document’;

Training in place across Arden to ensure the escalation levels and
actions are understood across organisations and clinical teams;

The Surge Plan accompanies this Urgent Care Plan.
Discharge to Assess Pilot Started

Additional A&E Staffing

Significant investment has been made in A&E. The business case
recently approved by SWFT Board of Directors will result in 2 extra
consultants, 13 wte nurses and 4 extra administrators
Communication with Primary care

New system implemented in July to ensure faster transfer of A&E
attendance information to GPs to enable them to take appropriate
action with the patient. By August the GPs will receive information
within 24hrs.
18 beds are now available in nursing homes
7 Day Working

In the past 12 months significant moves to 7 day working have
been made with acute physicians, extra consultants and ward
based teams at weekends to supplement the weekend emergency
admission team;

7 day working in radiology from May 2013;

6 day OT and discharge coordinators and pharmacy.
9
Short Term Activities and Success
Impact – A&E 4hr Performance
10
Short Term Activities and Success
Impact – Number of A&E Attendances
To date we have had 1% less A&E attendances than we did last year and 7.4% less than we contracted for in 2013/14
1,400
1,200
Attendances
1,000
800
600
400
200
-
2012/13
2013/14
PAM 13/14
11
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Week 12
Week 13
Week 14
Week 15
Week 16
Week 17
Week 18
Week 19
Week 20
Week 21
Week 22
Week 23
Week 24
Week 25
Week 26
Week 27
Week 28
Week 29
Week 30
Week 31
Week 32
Week 33
Week 34
Week 35
Week 36
Week 37
Week 38
Week 39
Week 40
Week 41
Week 42
Week 43
Week 44
Week 45
Week 46
Week 47
Week 48
Week 49
Week 50
Week 51
Week 52
Admisions
Short Term Activities and Success
Impact – Number of Emergency Admissions
To date we have had 4.3% less admissions than we did last year and 3.3% less than we contracted for in 2013/14
450
400
350
300
250
200
150
100
50
-
2012/13
2013/14
PAM 13/14
12
Section Two
MEDIUM TERM ACTIVITIES
Medium Term Activities
Winter Plan – Mobilising our Communities
Outcomes
Actions
Lead
Communities take an active
approach to care for the most
vulnerable
 Increased number of
volunteers i.e. 4X4 drivers
 Reduced level of
loneliness and anxiety in the
elderly and other members of
our community that are
socially isolated
 Increased use of
alternative health care
provision e.g. pharmacies
 Increased awareness of
prevention and infection
control in the community
 270 Winter Champions
 All schools in
Warwickshire to receive hand
washing material
 Reduced number of
people attending GP
surgeries/ A&E when
displaying signs of norovirus
 Reduction in the number
of children attending A&E with
common childhood illnesses
•
In July review the Feel/Choose Well campaign from 2012/13 to understand impact and opportunities for
improvement.
During August design an Integrated Communication Strategy that gives clear messages in a co-ordinated way.
Launch will be in September and focus on the following themes
–
Flu vaccination
–
Alternatives to A&E
–
How to keep well and what to do if you are ill
–
Think of the vulnerable – neighbourly duties etc
–
Importance of washing hands and how to etc
–
What to do to avoid norovirus and what to do and what not to do if you are displaying symptoms
SWCCG
Get Involved campaign running in south Warwickshire during June to increase the number of Health Champions
aim is to use this group and existing GP Practice PPGs to deploy mobilisation experts in order to create ‘Winter
Champions.’ Plans in development, go live in September
Currently seeking the support the NHS Change Day Team
SWCCG
Hand Washing Campaign: Members of the South Warwickshire Public and Participation Group initiated a hand
washing campaign that we want to support
They want to motivate children, parents, carers and the wider community to embrace and share proper handwashing practices and to take on the role of hand-washing champions. The campaign is seeking to transform
hand-washing with soap from an abstract good idea into an automatic behaviour carried out in homes, schools,
workplaces and communities.
Testing approach in schools in July. Delivery mechanisms being identified and costed during July. Decision on
approach August.
SWCCG
•
Working with the Young Foundation we are seeking to engage with voluntary organisations, patient groups and
our health champions in south Warwickshire to tackle the issue of Loneliness. We want to build on initial ideas
to ‘Prescribe a Friend’ and hold a loneliness summit in September. Aim is to build momentum to coincide with
the Christmas period when people are most susceptible to loneliness. Loneliness is attributable with
inappropriate use of GP and A&E services
SWCCG
•
Expansion of Befriending Services and early intervention delivered by the 3rd Sector
WCC -SC
•
Developing a Parenting Skills Manual to support parents look after common childhood illnesses to avoid
inappropriate use of A&E
SWCCG
•
•
•
•
•
•
14
Medium Term Activities
Winter Plan - Infection Control and Prevention
Outcomes
Actions
 Consistent approach to
infection control across providers in
health and social care
 Reduced number of bed
closures due to norovirus
 Providers recover faster from a
norovirus outbreak
 Reduced antibiotic prescribing
for viruses
 Reduced number of admissions
relating to alcohol
 Reduced number of falls from
homes
 Reduced number of bed days
relating to fracture neck of femur
•
Infection control and norovirus policy – NHS South Warwickshire CCG is working with the other
CCGs in Coventry and Warwickshire to develop a consistent policy for the prevention and
management of infection control and norovirus. Due to be approved in [August]
CRCCG,
WNCCG &
SWCCG
•
Engagement with GP practices and SWFT consultants to ensure that there is appropriate antibiotic
prescribing , particularly in the case of viruses
SWCCG/
SWFT
•
Engagement with Nursing Homes via the nursing home forum on infection control in order to
embed infection control standards
Additional support will be given to care homes via the specialist care home support team
(currently hosted by Arden Commissioning Support) to prevent those with norovirus symptoms
from being admitted to hospital by providing staff within the care homes to support additional
needs.
SWCCG
Alcohol team based in A&E to identify patients attending A&E due to alcohol. GPs are notified of
their attendance and then contact the patient.
Drink awareness campaigns to run during December
GP practices will be screening newly registered patients to identify alcohol related risk and
signposting people to appropriate self help services and referring to specialist services
Falls prevention targeting people in nursing and residential settings in addition to the wider
community
Falls awareness campaigns
WCC –
PH/SWCCG
•
•
•
•
•
•
Lead
WCCSC/SWCCG
15
Medium Term Activities
Winter Plan – Improved Management of LTC s and
those with complex needs
Outcomes
Actions
Lead Agency
 30% reduction in
nursing home admissions
 Improved quality of
care in nursing homes leading
to reduced avoidable harm
 Antipatory/ Advanced
care plans in place for
nursing home and EOL
cohorts
 DNAR transferred
across organiastion and
visible via EPaCCs system to
WMAS
•
Work has been undertaken in nursing homes for the last 12 months to improve the standard of nursing
in care homes. From April 2013 this has been enhanced through the establishment of a specialist
nursing team
From October this will be further enhanced through increased medical input from GPs. Learning from
other areas suggests that enhanced GP input can lead up to 30% reduction in admissions from this
group and 48% reduction in LOS if they are admitted
SWCCG
•
Telemedicine has been used by community service staff for over a year, we are seeking to gain further
benefits through a focus on Heart Failure patients across primary and community care
SWCCG
•
The EOL project aims to improve the identification and management of EOL. The basis of this project
is improved identification of patients at the EOL and utilisation of the palliative care register. To
support the accelerated culture change within the community a practice development team will be
funded.
Each practice will hold a minimum of 10 multidisciplinary team meetings (MDT) per year to discuss
the patients on the EoL register.
The objective of the project is to reduce admissions to hospital by 5% in the EOL group. For all
patients who die in hospital a detailed significant event analysis (SEA) will be conducted by the
practice in order to understand why the admission occurred
SWCCG
•
•
•
16
Medium Term Activities
Winter Plan – Admission Avoidance
Outcomes
Actions
Lead Agency
 Reduction in the need to
admit to access urgent
diagnostics
 Increased telephone triage
 Increased awareness
amongst professionals of services
that are available support
admission avoidance
 Increase in number of
patients diverted from A&E to
OoH
•
Work with NHS England to ensure that patients have access to GP appointments at peak times
in demand, considering additional capacity and looking at the scheduling of primary care
appointments to ease the surge on both ambulance crews and A&E;
Members Council discussions to encourage practices who are not already doing so, to
introduce telephone triage so improving primary care access;
Continue engagement with member practices to identify options for new models of supporting
a urgent care response in the community. i.e. GP in ambulance, GP doing home visits for
multiple practices Proposals developed during August with October implementation
SWCCG
Work currently taking place to determine service model, demand and capacity for the ‘Assess
before Admission’ (AbA) model. Current proposal will be tested at a stakeholder event 24th
July.
Purpose of the model is for GPs to refer into an one-stop outpatient appointment with 2448hrs in order for diagnostics and expert opinion
Communication plan to raise awareness with all professionals on what services are available as
an alternative to hospital & how they are accessed.
SWCCG/SWFT
•
Improve interface between OoH and A&E to create a pull system out of A&E and into OoH
SWCCG/SWFT/
Harmoni
•
Expansion of night sitting services from 3-5 days to support people in their own homes
WCC -SC
•
Social Care Emergency Response
WCC
•
•
•
•
•
SWCCG/SWFT/WCC
17
Medium Term Activities
Winter Plan – Hospital Flow
Outcomes
Actions
Lead Agency
 Improved Patient Flow, and discharge
 Increased uptake of ambulatory
pathways,
 A fully agreed escalation policy to
improve patient flow and improve patient
care to ensure that our care is Safe, Effective,
Compassionate and Trusted
Reduced mortality, increased transfer of
patients to ambulatory pathways, Senior
clinicians at the beginning of the patient
journey, no ambulance handover delays
TTO’s are available when the patient is
discharged or processes are developed to
ensure that TTO availability does not hold up
discharge.
Ensure patients are discharged effectively
at the weekends
•
Increase consultant presence in the Assessment Unit to achieve Right Care, Right Time by
the Right person with the Right Skills in the Right Place
Bring the Clinicians to the front door and pull patients through the system
)
To develop an internal Trust document, understood and adhered to by all, including
external stakeholders, which describes clearly the escalation plan of the trust when all
unscheduled care beds are full.
SWFT
Redesign A&E in order to manage variation, improving patient experience and meet
demand real time at front door
A&E extra staffing (Medics, Nursing & Admin) Including 1 A&E Consultant
SWFT
•
Undertake a review of the TTO process in order to achieve a TTO process that is
proactive and assists in the patient’s discharge including Weekend Working for
Pharmacists
SWFT
•
Provide consultant and junior cover on wards at weekend. Consultants and junior cover
X 4 PAs per weekend
Assess capabilities of ward clinical teams to deliver the standards we have set and
develop a workforce development plan
SWFT
•
•
•
•
•
•
SWFT
18
Medium Term Activities
Winter Plan – Discharge
Outcomes
Actions
Lead Agency
Improved system flow
Reduction in delayed
discharges
Improved relationships
across the system
Reduction in ongoing care
needs (D2A)
•
CWPT
•
Review the Arden Mental Health Liaison Service in order to provide a gap analysis and plan for 7 day
cover.
Establish a referral flow chart with Mental Health Provider in order to ensure that mental health
emergency out of hours response meets patient need .
To provide access and response for community and D2A beds
•
Home for lunch will ensure that 40% of discharges occur in the morning in order to support flow
SWFT
•
Increased Reablement capacity available including care home beds and home care provision to
facilitate timely discharge supported by occupational therapists and nurse co-ordinators to ensure
capacity is used effectively.
WCC-SC
•
Age UK support individuals who do not need social care or community services in their discharge
home i.e. take them home, buy food, pop in and see them in days following discharge
SWCCG/
WCC- SC
•
Increase Community Emergency Response Team (CERT) capacity to meet demand on the day every
day.
SWFT
•
Social care scheme to support MH discharges
WCC -SC
•
Increased Reablement Capacity
WCC
•
Discharge to Assess will enable patients ongoing care needs to be assessed in a non-acute
environment therefore freeing up acute beds
WCC –
SC/SWCCG/SWFT
•
Daily conference calls with SWFT, CWPT and WCC to resolve blockages to discharge
•
19
Medium Term Activities
Winter Plan – Surge Actions
Outcomes
Actions
Lead Agency
Proactive system response
when the LHE is under
extreme pressure
Rapid de-escalation
• A Trigger system is being developed so that there is rapid and consistent response to
LHE pressure in relation to accessing additional community capacity (beds & home care
packages) and out of hours capacity that is over an above regular capacity requirements.
SWCCG/Arden
Urgent Care Forum
20
Medium Term Activities
Commissioning Intentions





The NHS South Warwickshire CCG Integrated Plan 20132016 implicitly describes changes to the urgent care
system;
The focus of year 2 (2014/15) will be on the urgent care
system. We consider the urgent care system to have 5
component parts and are engaging on these as part of
our commissioning intentions process;
The aim is to identify the outcomes that we will
commission for in each of the 5 areas both in the
medium but also the long term;
These 5 areas are:
–
Self management and prevention;
–
Management of long term conditions and those
with complex needs;
–
Admission avoidance;
–
Hospital flow;
–
Supporting Discharge;
We have created the illustration below to describe to
stakeholders the different parts of the urgent care
system, what we are doing at the moment but also
questions about what else needs to be done – this is
central to the engagement we are undertaking during
the development of our commissioning intentions.
21
Section Three
LONG TERM ACTIVITIES
Long Term Activities
Outline of Approach
Outcomes Approach

We want to move away from the current way of commissioning
services and want to move to an outcomes based approach;

We are therefore starting engagement to develop the outcomes
that we would want to the urgent care system to deliver through
the commissioning intentions 2014/15 process
Alternative contract models

We have already undertaken an options analysis with PWC and
identified that a prime contractor model for the over 75s and those
with Long Term Conditions

We are in dialogue with Cambridgeshire and Peterborough CCG;
Oxfordshire CCG to understand the process they undertook to
develop their Capitated Outcome Based Incentivised Contract
(COBIC) approach so that we can effectively plan our approach.
Pioneer Bid

We have submitted an Expression of Interest to become an
Integration Pioneer site. Building on the work that we have already
started we are seeking support
–
To mobilise our communities
–
Development of a new contractual model
–
Workforce Integration
–
IT integration
–
Primary Care Redesign
Developing the plan

During August we will be synthesising all the strands that we have
for a sustainable urgent care system with a view that we start
engaging during the autumn

The two key areas that will provide the initial focus are the
management of long term conditions and admission avoidance

For LTCs we will be focusing on how to deliver the person centred
narrative included within our pioneer bid.

For the admission avoidance we will focus on what is needed for all
of our population in the community to prevent admissions 24/7.
Impact on providers

Both of the above areas will impact significantly on primary care;

We want to optimise the opportunities we have in retendering
IAPT, community services and Out of Hours contracts to deliver
different services therefore both of these areas are likely to lead to
major procurement exercises.
23