Transcript Document
RIGHT CARE RIGHT TIME RIGHT PLACE
Developing Integrated Services in Trafford
Dr Nigel Guest GP Chief Clinical Officer Trafford CCG www.traffordccg.nhs.uk
The original case for change
• Services needed to change in Trafford to ensure patients experience accessible, high-quality and sustainable services www.traffordccg.nhs.uk
The original case for change
1. Clinical – Safety – National and regional guidance 2. Financial – £19m per annum recurring deficit www.traffordccg.nhs.uk
Development of the Clinical Model
• • • • • Clinical Congress December 2011 Leading specialist clinicians Public representation Developed new model of care New Health Deal proposal www.traffordccg.nhs.uk
Trafford Integrated Care
• Supporting New Health Deal • Commenced 2008 • Services in place • Improving / expanding www.traffordccg.nhs.uk
What we said we would do
• Care for more people that have unscheduled care requirements in the community rather than the hospitals • Proactively manage patients before they get into crisis • Ensure services offer good access and are easy to navigate to • Encourage the clinician community to work together to make the best possible pathways for the patients www.traffordccg.nhs.uk
Care Co-ordination
Data Sharing Diagnostic Equipment Patient Experience Risk Stratification Map of Medicine Ascot House Discharge Co ordinator Community Matrons IV Therapy GP Education Training Development Community Geriatrician Practice Nurse Development
Care Co-ordination
Integrated Services in Trafford
• Community geriatricians – Consultant in the North, South and GPSI • Community matrons • Discharge co-ordinators • 72 hour rapid response team • 10 bed intermediate care at Ascot House • 5 virtual intermediate care beds in the community • IV therapy team www.traffordccg.nhs.uk
Integrated Services in Trafford cont.
• Additional equipment for one stop resource centre • Diagnostic equipment in primary care • Health checks in nursing homes • Palliative care re-designed model of care (EPAC) • Data sharing • Risk stratification • Map of medicine • Peer review www.traffordccg.nhs.uk
What are we doing next
• Focus on respiratory • Development of the care co-ordination centre • Work on planned care to reduce the numbers of people requiring out-patients • More service in the community • Improve the community estates • Introduction of technology – Tele health/telecare • Development of Integrated of Health and Social Care Teams in the Community www.traffordccg.nhs.uk
RIGHT CARE RIGHT TIME RIGHT PLACE
Integrated Care in Trafford
Dr Scott Pearson www.traffordccg.nhs.uk
Scott Pearson – GP with interest in Older people • Complex and Palliative care • Advanced Planning • Integrate Care by information sharing across agencies including out of hours and NWAS.
• Proactive Nursing Home Reviews • Referrals from UHSM • Referral from the Community • GPs • Community Matrons • Care Homes www.traffordccg.nhs.uk
Case Example
• 88 Year old lady – nursing home resident, bed bound. Lacks capacity to make decisions.
• Admitted to UHSM with biliary sepsis and blocked biliary stent.
• Tagged for follow up by UHSM • Discharged and reviewed by myself in community.
• Best interest meeting arranged. Discussion with next of kin, nursing staff and myself.
• Terrible time in hospital. Failed endoscopy. Severe distress.
• Best interest decision to keep patient in nursing home if further infection. Other agencies updated including out of hours service and copy of best interest meeting sent to home.
• Lived happily for several months and then developed a further infection.
• Treated in home but deteriorated suddenly, home called ambulance in panic but also called myself. I attended and ambulance cancelled, patient died with peacefully with family around her in nursing home 2 days later.
www.traffordccg.nhs.uk
RIGHT CARE RIGHT TIME RIGHT PLACE
Integrated Care in Trafford
Gill Eccles Pennine Care www.traffordccg.nhs.uk
Case Example Our Aim:
To keep patients as well as possible, for as long as possible, and as independent as possible within their own homes.
What We Do:
Manage patients with long term conditions Work in conjunction with other health and social care professionals and the voluntary sector Provide advice, support and education on an individual patient level
Where We Fit Into An Integrated Service:
Relationships with GPs Relationships with District Nurses, Specialist Nurses and Allied Health Care Professionals Relationships with community geriatricians Relationships with Social Care Relationships with secondary care (hospitals)
All centred on individual patients and their needs
www.traffordccg.nhs.uk
Mr Delamere
85 years old 3 falls in one week GP referred to District Nurses for dressing to head laceration GP found low blood pressure – reduced medication Wound bleeding +++ Sent to hospital Head sutured and sent home DN monitored BP 90/50 sitting, 60/40 standing DN referred to Community Matron Seen by Community Matron same day. BP very low Community Matron reviewed medication and made changes Urgent referral to Occupational Therapist Zimmer Frame and extra stair rail supplied Blood tests and ECG taken – diagnosed with atrial fibrillation Weekly monitoring by Community Matron Review by Community Geriatrician in Virtual Clinic
Outcome
No further falls BP within normal limits Monitoring by Community Matron and Geriatrician to maintain stability
Changing hospital services in Trafford
October 2013
Ground to be covered….
• Background • Services that are not changing • Changes to planned care services • Changes to urgent care services • Clinical service model interdependencies • Summary
Background
• Clinical risks in maintaining small services, seeing comparatively limited numbers of complex patients • Difficulties in recruiting and retaining high quality staff • Difficulties in maintaining staff skills and competencies • Clinical service model developed through close joint working between clinicians in primary and secondary care • Clinical model supported by National Clinical Advisory Team (NCAT)
Services that are not changing
• Children’s Resource Centre – services will remain unchanged • Outpatients – all existing services will be maintained, and new services are being developed • Diagnostics – a comprehensive range of services will be maintained at Trafford General • Day case surgical and medical services – existing services maintained and capacity expanded
Changes to planned care services
• An Elective Orthopaedic Centre will be established on the Trafford General site, bringing together the elective Orthopaedic services from MRI and Trafford • Inpatient care for other surgical specialties (General Surgery, ENT, Gynaecology) will transfer to MRI/St Mary’s • Pre- and post-operative services (outpatient clinics, therapy appointments) will be provided locally • Day case surgical services will be expanded on the Trafford site
Changes to urgent care services (1)
• The A&E service will be re-designated as an Urgent Care Centre and will reduce its hours to 8am – midnight • The ambulance service will take the sickest patients to A&E services with the full support of teaching hospital facilities • The Trafford Urgent Care Centre will be staffed by a full team of Accident and Emergency doctors and nurses • The Medical Assessment Unit (and medical wards) will continue to admit patients 24/7, either from the Urgent Care Centre or from GPs
Changes to urgent care services (2)
• Patients requiring complex intensive care will be treated in the specialist unit at MRI; a high dependency unit will continue on the Trafford site.
• A Gynaecology Assessment Unit will provide urgent assessment for pregnant women between 9am and 4pm • The Paediatric Observation and Assessment Unit will be discontinued • The existing Walk In Centre functions at Trafford General and Altrincham Hospitals will be maintained
Clinical service model interdependencies
Emergency Access Centre Out Patients Adult Medical Assessment Intermediate Care Daycase Unit OP clinics and direct access radiology and tests
Common infrastructure HDU Crash team Radiology Pathology
Elective Orthopaedic Centre Day case surgery, day case medicine and endoscopy Inpatient and daycase elective orthopaedic surgery
Summary
• Service model developed by local clinicians (doctors, nurses and therapists from primary and secondary care) • Validated by independent national team (NCAT) • Reviewed in light of consultation comments • Re-tested in the development of multi-agency implementation plans • Continues to be judged as clinically safe and deliverable
Greater Manchester Area Team Joint Health Overview & Scrutiny Committee 22 October 2013
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Performance Report to Operations Executive- 30 May 2013
Four Assurances Set Out in Letter • Alternative services proposed by the local NHS to be in place ahead of changes being made to what are existing services. Progress will be assessed and evaluated
throughout the transition
by NHS England in conjunction with Overview & Scrutiny Committee.
• The NHS has arrangements in place to ensure patient safety is not compromised during the transition to new services.
• Unequivocal assurances have been given by a provider’s board or chief executive that their organisation can safely receive additional patients and activity, however small.
• NHS England is satisfied that the three neighbouring A&Es that will need to treat additional patients are consistently meeting their waiting time standards.
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JHOSC - 22 October 2013
Services In Place Safety During Transition Assurance From Neighbouring Trusts
Trafford Strategic Programme Board Correspondence From Trusts
X X X X
A&E Performance
A&E Performance X X
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JHOSC - 22 October 2013
Accident & Emergency Monthly Performance - Retrospective 100% 90% 80% 70% 60% 50% CMFT Salford UHSM Target
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JHOSC - 22 October 2013
Accident & Emergency Quarterly Performance - Retrospective 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% Q1 2012/13 Q2 2012/13 Q3 2012/13 Q4 2012/13 Q1 2013/14 Q2 2013/14 CMFT Salford UHSM Target
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JHOSC - 22 October 2013
Accident & Emergency Performance Q1 2012/13 Q2 2012/13 Q3 2012/13 Q4 2012/13 Q1 2013/14 Q2 2013/14
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JHOSC - 22 October 2013
CMFT
96.16% 95.51% 95.37% 95.22% 95.30% 95.10%
Salford
95.48% 96.14% 94.60% 95.54% 95.01% 97.60%
UHSM
95.19% 94.95% 91.52% 86.94% 95.49% 96.20%
Accident & Emergency Performance - Prospective • Previous 18 months • Stability of services • 4 hour breaches – reasons • More complex cases • Capacity vs. flow • Winter plans 13/14 • Opportunity cost of £5.5m
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JHOSC - 22 October 2013
Summary
Services In Place Safety During Transition Assurance From Neighbouring Trusts
Trafford Strategic Programme Board
√ √ √
Correspondence From Trusts
√
A&E Performance
A&E Performance √ √
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JHOSC - 22 October 2013
Process • Trafford Strategic Programme Board – 16 th October 2013 • JHOSC – 22 nd October 2013 • Regional Director Meeting – 23 rd October 2013 • JHOSC – December 2013 /January 2014 • JHOSC – April 2014
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JHOSC - 22 October 2013