Transcript Slide 1

PAST HEALTH CARE SYSTEM
PATIENT
Slide 1
GENERAL HOSPITAL
Residential home
home
A&E
Ambulance
999
GP
gatekeeper
Cottage hospital
Community
nursing services
Mental health
Rest of Acute Trust Services
consultants
Medical Centre
Nursing home
outpatients
critical care
surgery
Diagnostic’s
Wards / bed
rehabilitation
sub teams
? Under
discharge
who’s
care
Local Authority
Social Services
pharmacy
Rehabilitation Team
Home care packages
Voluntary Sector
opticians
1
THE PAST
Slide 2
• Scoop and run ambulances
• Admit to assess need and treatment
• Large uncontrolled demand which is unscheduled and
urgent
• Inappropriate use of A&E – patients with alcohol, drug and
mental health issues which cannot be dealt within the
hospital environment
• Overcrowded, understaffed, under-resourced “casualty”
departments
• Trolleys
• Sickest patients seen by most junior doctors
• Patchy primary care
• FRAGMENTATION
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The Future Vision – 2008 HEALTH CARE SYSTEM
Ambulance Trust
General Hospital
No A&E
Slide 3
A&E
999
ECP
NHS Direct
Complex surgery
Community Hospital
Super GP Surgeries
Urgent Care Centres
Urgent Care Unit
WIC
ESS
PATIENT
EMS
Minor Surgery
HOME
Diagnostic Tests
Acute Alcohol Team
Rapid Response Team
MIC
ECP
Acute Substance Abuse Team
Outpatient Clinics
PCC
Well Being Clinics
ISTC
Local Authority
Rehabilitation Team
Long Term Conditions Clinics
Low Vision Services
Voluntary Sector
pharmacy
opticians
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Slide 4
KEY TO FUTURE VISION OF HEALTH AND SOCIAL CARE SYSTEM 2008
•
•
•
•
•
•
•
WIC
MIC
ESS
EMS
ECP
ISTC
PCC
Walk in Centres
Minor Injuries Centres
Emergency Social Services Team
Emergency Mental Health Team
Emergency Care Practitioner
Independent Sector Treatment Centres
Primary Care Centre
Patient self referral
Practitioner referral
Dashed box indicates service sits in community and is colocated with other services in one site. This depends on model
adopted by PCT
Increase in the type and access to urgent care services in the community
Principle is to assess need before admission. Treat in the field nearer to
home. Reflecting the closure in A&E Departments.
More choice, easier to access, more convenient, improved quality of care,
faster care. Services are centred around the patient.
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THE SERVICE IN 2008
Slide 5
•
PATIENT FOCUSED
•
Community centred
•
Care close to home – where possible
•
Simple access
•
“Seamless” pathways
•
High quality
•
CONTROLLED DEMAND, planned surgery and admission to
Independent Treatment Centres or Super Sugeries
•
Offers choice
•
Encouraging all health partners to work together in a system-wide
approach to developing urgent care services
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Slide 6
The Future Vision 2008: Introduction of New Models of Service Delivery
New Health Surgeries
Increased investment into GP Practices giving rise to new
Health Centres, Polyclinics, Super Surgeries, or Primary
Care Centres.
 125 such centres to open by December 2006, outside general
hospitals, by 2008 the total will be 750 units
 Offering a wide range of services under one roof. The services
provided will reflect the needs of the locality. This should be
achieved through the PCT’s understanding the needs of their
population through research evidence and consultation with
service users about want they want.
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Slide 7
 GP’s with specialist interests and Consultants e.g.
ophthalmology,
community nurse, district nurses, midwifery, dentistry,
physiotherapy, pharmacy, optometry, podiatry.
 Management of long term conditions such as Diabetes,
Heart
Disease, Elderly Care, Asthma, Well being clinics,
Outpatient
Clinics and wide range of diagnostic tests.
 To facilitate this budget control has been transferred from national
control to local level.
 5% of the NHS budget has been transferred from the Acute Trust
(general hospital) to the PCT’s. This means PCT’s and GP hold the
purse strings to commission or provide services, they deem
appropriate.
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New Community Hospitals
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Will offer patients wide range of access to health and social care which
will be co-located on the same site. They will complement the specialist
general hospital, providing speedy access to key medical tests, day case
and outpatient surgery. They will be integrated with Social Service
Departments.
•
providing care closer to home in six specialities –
ear, nose
and throat, trauma and orthopaedics, dermatology, urology, gynaecology
and general surgery.
•
£700 million into new buildings through NHS LIFT, by the end of 2005, 54
new buildings were opened and in 2006, a new LIFT building is expected
to open every week.
•
Purpose-built facilities, where GP services are on the same site as
pharmacies and social services, The centres are more convenient for
patients, particularly older patients and those with long-term conditions,
as they offer more care closer to home.
some models of community hospitals will provide Urgent Care Units
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Examples of Community Hospital Developments
Slide 9
Reference to CISP, 2006 Developing Community – Hospitals – Models of
ownership [1] pdf, gives cases of community developments of hospitals.
Recommended referencing to the Funding Team as it explains how
voluntary organisations can fund services from the NHS.
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Services which may be provided in Community Hospitals
Slide
10
Long term conditions Clinics
a resource Base for management of LTC with Specialist GP
interest and Consultants for chronic disease management in the
community.
Older people
Multidisciplinary Assessment Centre, for falls / mobility and
complex needs. Integrating intermediate, social, urgent care and
mental health.
• step- up / down intermediate care
• In / out patient clinics for comprehensive assessment for long
term packages of care.
Children and Young Peoples Centres
Focusing on the Family and preventive health. Based on
integrated and co-ordinated care across wide selection of
agencies. Plan is for 3,500 Children’s Centres by 2010.
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Service which may be provided in Community Hospitals
Slide 11
Self Care and Self Management
The following facilities will be provided to enable self care of own health
• Education Rooms for Action on Personal Health
• terminals for personalised support packages for lifestyle changes,
• rooms to meet with health trainers and personal advisors
• gym equipment, yoga, dance, drama and music facilities
• kitchen facilities for cooking and learning new skills
• Facilities fpr Self Assessment
• enabling an individual to complete own health check
• enable to check own blood testing, borrow, learn and use self
testing equipment.
• Facilities for Information Encompassing
• provision of both general and local information
• enabling individuals to obtain help and learn how to access it and
how to personalise it.
• Sign posting
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Service which may be provided in Community Hospitals
Mental Health Facilities
Slide 12
The principles of Self care and self management extends to Mental
Health Services.
Priorities focus on the development of community Well-being
Resource Centres providing services and access to agencies in
community locations e.g. Employment Advisers
• increased uptake of Direct Payments and advance directives, will
enable service users to receive services in more local facilities
• more culturally specific services, contact points and information
services and
• better use of community facilities to provide information
signposting on mental health and mental health services.
Our health, our care, our community: investing in the future of
community hospitals and services, 2006) p 40
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Slide 13
Super surgeries
The NHS Plan (2000) describes a vision of the new GP surgery as,
“ many of the GP’s will be working in teams from modern multipurpose premises along side nurses, pharmacists, dentists,
therapists, midwives and social care staff. Nurses will have new
opportunities and some GP’s will tend to specialises in treating
different conditions. An increasing number of consultants will take
outpatient sessions in local primary care centres.”
PCT’s are being encouraged to set up one-stop health centres which
bring services, such as GP. Health visitors, dentists, pharmacy, a
cardiology clinic, x ray facilities, optometry services, Sure Start and
healthy living café under one roof. Work on about 50 centres is
underway. (The NHS in the UK 2006/07)
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Slide 14
An acute hospital admission is
a failure of the Health System.
The real challenge to the NHS
is how to manage chronic
disease better
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Slide 15
URGENT CARE is all unscheduled, urgent and emergency
care, i.e. anything which is not a programmed activity
Current Admissions - 70% elderly, Majority with long term
conditions of which 50% are unnecessary.
The 20% of Patients who need 80% of the Care
•`Older People
• Decreased Functional Ability
•Mobility, sight loss, daily living skills
• Revolving Door Admissions
• COPD & Heart Failure
• End of Life
• Psychological & Social Support
• Packages of care tailored to the individual
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Slide 16
Urgent care Services
Our health, our care, our community: investing in the future of
community hospitals and services, 2006) p 40 states,
• Community Hospitals have a future major role in Urgent and
Unscheduled care.
• It anticipates an increase in this type of provision which will be set
out in future government Urgent Care Strategy.
• Minor injury units (MIU) and NHS Walk in Centres (WIVs) are
providing much urgent / unscheduled care in the community.
• A network of Urgent Care Centres are planned which will be nurse
led and co-located with out of hours GP’s, emergency social
services team and emergency mental health teams, ambulance
base with Emergency Care Practitioners (ECP)
• Central will be Diagnostic Facilities, X-Rays for example will prevent
unnecessary attendances to acute general hospitals.
• Urgent Care Centre will additionally act ( in some models of
practice) as a resource for management of chronic disease.
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Slide 17
The Urgent Care Strategy
• The new focal point for integrated unscheduled/ urgent
care
URGENT CARE PLUS
• The link to Long Term Conditions (LTC)
• Base for community matrons
• LTC diagnostics
• LTC review clinics
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our health, our care, our community: investigating in the future
of community hospitals and services (DOH, 2006)
Slide 18
A new generation of community hospitals and services
The White paper defines what a “community hospitals and services” are
as covering the following
• The broad range of services that are sited in defined local
communities with small populations rising to about
100,000
• Any clinical or social care functions that can be provided safely
and appropriately away from large specialist centres and those
services and functions that benefit from close links to other local
services, for example intermediate care services aimed at enabling an
older person to regain independence in their own home .
• Will not undertake complex surgery requiring general anaesthetic nor
provide fully fledged accident and emergency.
• It means that some larger hospitals will concentrate on specialist
services and some will merge or close
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Individual and Community
Oriented Preventative Action for
Health
Slide 19
Individually
oriented
preventative
action
Health
Hazards
Community
oriented
preventative
action
poverty
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Intersectoral action for Health. WHO. 1986
Delivering Choosing Health (DOH 2004)
Slide 20
Key messages:
• Making healthy choices easy choices
• Interventions for the disadvantaged
• Health policy to inform and support
Principles:
• Informed choice
• Personalisation: supporting people to make healthy choices,
especially deprived groups and communities
• Working together through effective
Choosing Health’ priorities
• Reducing health inequalities
• Reducing smoking, obesity, alcohol consumption,
• Tacking hypertension, poor dietary intakes, lack of exercise,
• Improving mental health and well being
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Slide 21
21
Slide 22
Level 3
Case management
Disease
management
& equally
shared care
Patients with highly
complex needs and
co-morbidities
Level 2
High risk patients
Level 1
Largely
self
care
70-80%
population
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Future Health Care Trends – an overview
• There are many powerful forces for change in our population’s
health and the way we deliver health care.
• The population is ageing. The balance between young and old
is shifting. Life expectancy is increasing, as premature
mortality rates fall. The average family size of 1.77 (2004) sits
below the replacement level of 2.1. The number of single
person and single parent households is growing. The number
over 60 are expected to grow by nearly a third by 2021, while
the numbers of young people under 16 will fall. The ethnic
population is also ageing. However, there is significant
uncertainty about the net impact of the ageing population on
health care demand.
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• The workforce is changing and ageing. The national and
international competition for skilled staff will grow. The
workforce is demanding a better work/life balance.
• Current lifestyles present major risks to the future health of the
population. Obesity, sedentary lifestyles, sexually transmitted
disease, and alcohol consumption are growing, especially
amongst the young. This is driving increased incidence in
diabetes, osteoarthritis, heart disease and kidney disease. Over
a quarter of the population still smoke. This creates a
significant burden of respiratory disease and cancer.
• Health inequalities continue to present a challenge. People
from lower socio-economic groups are much more likely to
adopt risk taking lifestyles and yet are frequently handicapped
in accessing health services and taking on board positive
health messages - 40% of those from social classes D&E have
poor literacy skills.
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• The disease profile is changing. Previously fatal acute
conditions such as cancer and heart disease can now be
treated. Ageing related and chronic diseases, such as diabetes,
respiratory illness, renal disease and arthritis, are becoming
much more significant. More people are living with long term
illness, and with multiple conditions.
• Medical advance can improve health outcomes, but will create
budgetary pressures. Significant advances in medicine and
surgery are anticipated, supported by the increasing insight
offered by genetics. The “capacity to treat” is increasing,
especially the older frail. This magnifies the potential demand
of an ageing population.
• The expectations of society are changing. Rising education and
income levels are helping to drive higher public expectations of
health and health care services. The future old are expected to
be much more demanding than their current counterparts.
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•
Advances in information technologies enable improved models of
care. The capacity to share clinical information and expertise between
professionals and patients offer many opportunities for patients to
take a positive and active role in their care and improve the quality of
patient care and outcomes.
•
These forces bring threats and opportunities to the health of the
population and health care services. The impact on health care
demand and our capacity to meet that demand is very difficult to
foretell.
•
There is significant debate about the impact of an ageing population.
The incidence of chronic disease grows markedly in those over 60, but
there is also evidence that the old of today are fitter than the old
twenty years ago, postponing the onset of chronic disease. As
chronic conditions are diagnosed earlier, treatment is likely to be more
effective. One of the greatest uncertainties is that of the impact of
current lifestyles on the population over the next two decades. Will the
young of tomorrow have even greater levels of obesity, sexually
transmitted disease and drug misuse than the young of today, and will
the old be sicker and more dependent? A lot will depend on society’s
attitude and response to risk taking behaviours. We have the
opportunity to live longer and healthier lives than ever. Will society
grasp that opportunity, or will we see health inequalities increase as
some do and some don’t, or perhaps can’t.
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Large growth in the number of older people – what will be the impact on
total health care costs?
Per capita costs are greater for older
people
•Starting from 2006, the
post-war baby boom will
boost the year-on-year
growth rates in the elderly
populations, with growth
rates peaking in 2012.
4500
4000
Hospital and community health service
expenditure by age of recipient
(£ per head, 2002/03)
3500
3000
2500
2000
•The number of people
over 65 is expected to
grow by
– 527,000 - 2010
1500
1000
500
0
All
births
0–4
5–15
16–44
45–64
65–74
75–84
85 and
over
– 1,619,000 – 2015
Source: DH
– 2,390,000 - 2020
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An increased capacity to treat and reduced age discrimination are
raising intervention rates in older people
Demographics and Medical Demand
(% increase, 1990-2000)
No. of people
2.8
75-84
85+
30.1
109
Elective
admissions
Emergency
admissions
CABGs(1)
(1) Coronary Artery Bypass Grafts
Source: DH, ONS
167
28
79
596
525
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New technologies offer a means to bridging the care gap
New
technologies
enable a
different
relationship
with older
service users
•Social Care is developing a
number of new care models
– Extra care housing
– Homeshare
– Adult placement
– Technology-enabled
services
– Connected care centres
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The Planning Framework
It outlines four objectives for the future NHS
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Our health, our care, our
say
People want to keep themselves well, and
take control of their own health. They
wanted more help through:
• Better information
• Advice
• Support
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