Hillingdon Summary of progress under Shaping a healthier future

Transcription

1 Hillingdn Summary f prgress under Shaping a healthier future February

2 SHAPING A HEALTHIER FUTURE Shaping a Healthier Future (SaHF) will transfrm fr 2 millin peple acrss Nrth West Lndn Why the system needs t change We have a grwing ageing ppulatin with mre lng-term cnditins One in fur patients find it difficult t see a GP when they need t many end up in A&E We have mre A&E departments per persn than ther parts f the cuntry There are t few specialists in hspitals t prvide high-quality rund-the-clck We are wrking frm inadequate NHS facilities We are wrking within an increasingly tight budget. Nrth West Lndn s five year plan Design a system which better supprts patients gives them mre cntrl input ver their wn Prevent peple frm dying prematurely Enhance quality f life fr peple with lng-term cnditins Help peple t recver frm episdes f ill health r fllwing injury Ensure that peple have a psitive experience f Treat fr peple in a safe envirnment prtecting them frm avidable harm Five year plan t date DRAFT Cnsultatin decisin making Year 1 f implementatin Mental health wellbeing Imprving mental physical health thrugh integrated. Transfrmatin f t be respnsive t patients needs easy t access navigate. Care prvisin as clse t hme as pssible, with GPs at the heart f, where when it is needed. Imprves the lives f users s, prmting recvery delivering excellent health scial utcmes, including emplyment, husing educatin. Whle systems integrated Crdinating acrss cmmissining bdies prviders Peple will be empwered t direct their supprt t receive the they need in their r lcal cmmunity. GPs will be at the centre f rganising crdinating peple s. Our systems prcesses will enable nt hinder the prvisin f GP, cmmunity scial delivered in patients Patient navigatin using 111 Patient triage respnse within 4 hurs GP, cmmunity scial delivered in patients integrated Patient navigatin. using 111 GP cnsultatins Patient triage lng term respnse cnditin within management 4 hurs GP, cmmunity GP, cmmunity Health prmtin scial scial delivery f delivered delivered preventative in patients in patients GP cnsultatins lng term cnditin management Patient navigatin using 111 Patient triage Health respnse prmtin within 4 hurs delivery f preventative Patient triage respnse within 4 hurs GP, Delivery cmmunity f multi-disciplinary scial delivered in patients GP, Access cmmunity t diagnstic scial therapy delivered in patients GP cnsultatins Patient GP, cmmunity lng scial term cnditin management delivered in patients navigatin using 111 GP cnsultatins lng term cnditin management Health Patient prmtin triage navigatin Delivery delivery respnse using f multi-disciplinary 111 f within preventative 4 hurs Health Patient prmtin navigatin triage Access delivery using respnse t diagnstic 111 f preventative within 4 hurs therapy Patient triage respnse within 4 hurs GP ecnmy cnsultatins Access t GP, mre therapy, lng term quickly. rehabilitatin cnditin management diagnstic Health GP cnsultatins Access prmtin t specialist delivery lng term GP f preventative cnditin management Delivery Health f multi-disciplinary prmtin GP cnsultatins Access t delivery lng GP, term therapy, f preventative cnditin rehabilitatin management diagnstic Delivery f multi-disciplinary Access Health t diagnstic prmtin Access t therapy delivery specialist f preventative GP Access t diagnstic therapy Delivery Urgent f multi-disciplinary Care Centres Delivery f multi-disciplinary Access Outpatients t diagnstic diagnstics therapy Access t diagnstic Urgent Care Centres therapy Additinal n sme lcal hspital sites, including Access Delivery deliver t GP, f therapy, multi-disciplinary Outpatients rehabilitatin diagnstic Access t specialist GP, therapy,, the required diagnstics rehabilitatin utpatient rehabilitatin estates diagnstic changes specialist f need. Additinal sme lcal hspital sites, including Access Access t specialist t diagnstic GP therapy specialist, utpatient rehabilitatin specialist Access Access Access t specialist t t GP, GP, therapy, therapy, GP rehabilitatin rehabilitatin diagnstic diagnstic Access t A&E, t Urgent specialist GP Care GP Centres trauma A&E, Urgent Care Centres trauma Urgent Care Centres Urgent Access Care t Obstetrics Centres GP, therapy, rehabilitatin diagnstic Outpatients Urgent Care diagnstics & midwifery unit inpatient paediatrics Outpatients Access t specialist Obstetrics Centres diagnstics GP & midwifery unit inpatient paediatrics Additinal Outpatients n diagnstics sme lcal hspital sites, including Additinal specialist Additinal, utpatient n sme n n sme rehabilitatin lcal hspital lcal hspital sites, specialist including sites, including specialist specialist Elective,, utpatient utpatient rehabilitatin medicine specialist specialist Elective medicine Urgent Care Centres Outpatients Outpatients diagnstics diagnstics A&E, Outpatients A&E, Urgent Urgent Care Care Care Centres diagnstics Centres Centres trauma trauma trauma A&E, Additinal Urgent High Care dependency High dependency Centres n sme trauma lcal hspital sites, including Obstetrics specialist Obstetrics, & midwifery midwifery utpatient unit unit rehabilitatin inpatient paediatrics paediatrics specialist Obstetrics & midwifery unit inpatient paediatrics Obstetrics & midwifery unit inpatient paediatrics Sites delivering highly specialised such as A&E, Elective Sites Urgent delivering Care Centres highly specialised trauma such as Elective cardithracics medicine medicine cancer Elective Outpatients cardithracics diagnstics medicine cancer Outpatients diagnstics Elective High dependency medicine Outpatients High Obstetrics dependency & diagnstics midwifery unit inpatient paediatrics Patient navigatin using 111 Primary cmmunity Transfrming ut-f-hspital imprving access t GPs Prvides mre lcal input int primary cmmissining; imprves access t GPs whilst being able t mve mney arund the health Puts the right supprt in place t nurture grw GP netwrks s they are able t deliver sustainability in the lng term. Develps a primary estates strategy that takes int accunt hub GP estate requirements supprt implementatin f plans t Hspital recnfiguratin Delivers a majr shift in frm within a hspital setting t an ut-fhspital setting s mre peple are treated clser t their. The cncentratin f acute hspital in rder t develp centres f excellence which are able t achieve higher clinical stards prvide a mre ecnmic apprach t the delivery f.

3 INTRODUCTION TO HILLINGDON Hillingdn is the secnd largest f Lndn s 32 brughs, made up f 22 wards it cvers an area f 42 square miles. Ppulatin demgraphics The ppulatin is mst heavily cncentrated in the centre f the brugh. By 2021, the verall ppulatin in Hillingdn is expected t grw by 8.6% t 320,000 This future increase is mainly due t an expected 10% rise in ppulatin under 15 years a 15.4% rise in the ppulatin f thse 75 years ver. Hillingdn is an ethnically diverse brugh with arund 30% f the ppulatin frm black minrity ethnic cmmunities (lwer than the Lndn average 35%). The largest ethnic cmmunity is the Asian cmmunity, with the Indian cmmunity frming 13% f the ttal ppulatin. Hillingdn is a relatively affluent brugh, hwever there are varied levels f deprivatin. The suth the central regins f the brugh have higher deprivatin, with areas falling in the 20% mst deprived quintile natinally, a significant number f areas have children living in pverty. The nrth f the brugh is semi-rural, with large sectins prtected by green-belt regulatin. Care prvisin The Hillingdn Hspitals NHS Fundatin Trust prvides hspital. Central Nrth West Lndn NHS Fundatin Trust prvides cmmunity nursing, therapy mental health. Health challenges 48 GP practices 42 dental practices 63 pharmacies 61 Overview 290,000 Lcal resident ppulatin (mid 2014) 312m Health cmmissining budget 2014/15 14m investment in cmmunity integrated Rates f diabetes, hspital admissins fr alchl-related harm tuberculsis rates are all higher than the Engl average. There is an expected rise in the ver-75 year ld ppulatin ver the next ten years as a cnsequence, it is expected that there will be an increase in rates f cnditins such as dementia. Hayes Harlingtn lcality has the mst significant health challenges.

4 OUT OF HOSPITAL CARE Hillingdn CCG has invested 14m 1 in 13/14 14/15 n increasing the number f cmmunity jining up health scial. Whle systems integrated Integrated Care Planning: Giving patients with lng term cnditins a plan GP, cmmunity that cnsidered scial all their health delivered in patients scial needs; keeping peple healthier fr GP, lnger cmmunity reducing scial the need delivered fr in hspital patients. Unmanaged lng-term cnditins Patient navigatin using 111 are a majr cause f emergency admissins t hspital; s better supprt thrugh Patient GP, GP, cmmunity triage navigatin cmmunity respnse using scial 111 scial within 4 hurs delivered delivered in patients in patients plans is an essential part f reducing pressure n hspital. We have Patient triage respnse within 4 hurs Patient s Patient far navigatin supprted using using 111 nearly ,000 patients with plans. Patient Patient triage triage respnse within within 4 hurs 4 hurs GP cnsultatins lng term cnditin management Health GP New cnsultatins prmtin Health delivery lng term Scial f cnditin preventative Care management Crdinatrs Primary Care Navigatrs help Health GP deliver prmtin plans delivery f fr preventative peple with lng term cnditins signpst patients t cnsultatins GP cnsultatins lng lng term term cnditin cnditin management health in Hillingdn. Health Health prmtin prmtin delivery delivery f preventative f preventative Delivery Hme f multi-disciplinary Safe - A jint team with staff frm the hspital, cmmunity nursing Age Delivery f multi-disciplinary Access UK t diagnstic t help peple therapy regain their independence after a serius illness r accident Access Delivery t f diagnstic multi-disciplinary therapy helping Delivery f speed multi-disciplinary up discharge frm hspital. Access t diagnstic therapy Access t diagnstic therapy Access Access t t GP, GP, therapy, therapy, rehabilitatin rehabilitatin diagnstic diagnstic Access t t specialist GP, therapy, GP rehabilitatin diagnstic Access Access t specialist t GP, therapy, GP rehabilitatin diagnstic Access t specialist GP Access t specialist GP Cmmunity Out f Hspital We have redesigned implemented 7 planned pathways acrss musculskeletal, ear nse & thrat, gynaeclgy urlgy. This has lead t a reductin f apprximately 2774 first utpatient appintments Urgent Care Centres Urgent Care Centres Outpatients diagnstics Outpatients Urgent Care diagnstics Centres Additinal n n sme lcal hspital sites, including Additinal Outpatients n diagnstics sme lcal hspital sites, including specialist specialist, Additinal, utpatient utpatient rehabilitatin n sme rehabilitatin lcal hspital specialist sites, specialist including apprximately 7397 fllw up appintments. specialist, utpatient rehabilitatin specialist A&E, Urgent Care Centres trauma A&E, Urgent Care Centres trauma A&E, Urgent Care Centres trauma Obstetrics midwifery unit inpatient paediatrics Obstetrics & & midwifery midwifery unit unit inpatient inpatient paediatrics paediatrics Obstetrics & midwifery unit inpatient paediatrics Cmmunity dermatlgy service: a new cnsultant led service running frm three lcatins acrss the brugh, giving patients faster access mre chice f lcatins cnvenient fr them. Opthalmlgy is als nw perating as a cmmunity based service. Elective medicine Elective medicine Outpatients diagnstics Elective medicine Outpatients High dependency diagnstics High dependency Outpatients diagnstics High dependency Rapid Respnse service: receives referrals frm A&E, GPs, Lndn Ambulance Service Care Hmes is currently supprts 5 peple a day t avid unplanned admissin via A&E. Sites delivering highly specialised such such as as cardithracics cancer cancer Sites delivering highly specialised such as Sites delivering highly specialised such as cardithracics cancer cardithracics cancer C-rdinate My Care: A tl fr patients with terminal illnesses that allws them t share decisins wishes abut their with all health supprting them. The tl supprts patient chice, helps avid hspital admissins supprts peple t have a cmfrtable death. The tl is nw available acrss Hillingdn. Additinal ne ff investments Infrmatin Technlgy imprvements: all Hillingdn GPs nw use the same IT system making it easier t implement changes acrss all practices. Practice Cmmissining Imprvement (PCI) prgramme: Mentring Caching prgramme t help underperfrming practices imprve. Mental health wellbeing Psychiatric liaisn service hme treatment service fr adults lder adults. Rapid Respnse service fr patients with urgent mental health needs. The team supprts patients by prviding mental physical health, therapeutic in cmmunity settings. Integrating Mental Health. shifting t ensure peple receive the mst apprpriate, clser t hme. 125 patients nw receiving supprt frm general practice (excluding Child & Adlescent Mental Health Services, Mther & Baby cmmunity, specialist teams memry ). Additinal investment in Child & Adlescent Mental Health Services, Perinatal IAPT (imprving access t psychlgical therapies). GP, GP, cmmunity scial delivered in in patients GP, cmmunity scial delivered in patients Patient navigatin using Primary Patient navigatin using transfrmatin 111 Patient triage respnse within 4 hurs (including OOH hubs) Patient triage respnse within 4 hurs Patient triage respnse within 4 hurs Cnvenient access t GPs - 96% f practices ffer electrnic prescriptin. 84% f practices ffer nline appintment bking. 76% f practices ffer cnsultatins via telephne with 84% f practices using telephne triage by clinicians. 9 practices ffer early mrning late evening appintments ranging frm 7.30am t 8.30pm.12 lcal practices are nw pen n Saturdays. GP GP cnsultatins lng lng term term cnditin management GP cnsultatins lng term cnditin management Health prmtin delivery f f preventative Health prmtin delivery f preventative Delivery f f multi-disciplinary Delivery f multi-disciplinary Access t t diagnstic therapy Access t diagnstic therapy Urgent Care Centre pened in Oct 2013, prviding a 24-hur GP led service fr minr illnesses injuries. Since then, 100,932 patients (Oct 13 Dec 14) have used the service. The service sees apprx 60% f peple walking int A&E. Access t t GP, GP, therapy, rehabilitatin diagnstic Access t GP, therapy, rehabilitatin diagnstic Access t t specialist GP GP Access t specialist GP GP netwrks are develping t ffer a wider range f frm general practice. Prgrammes are being develped t ffer 24 hur bld pressure mnitring, respiratry reviews, diabetic, wellness prgrammes targeted fr thse currently using A&E Urgent Care Centres (t prvide alternative Urgent Care Centres Urgent Care Centres Outpatients diagnstics Outpatients diagnstics Additinal n n sme lcal hspital sites, including Additinal specialist, utpatient n sme rehabilitatin lcal hspital sites, specialist including specialist thrugh, GPs). utpatient rehabilitatin specialist Imprved estates - Hillingdn is investing in the buildings needed t deliver mre in an ut f hspital setting clser t hme. A&E, Urgent Care Centres trauma A&E, Urgent Care Centres trauma Obstetrics && midwifery unit unit inpatient paediatrics Obstetrics & midwifery unit inpatient paediatrics Prductive Practice - GP netwrks participating in a prgramme designed t create capacity in general practice thrugh mre efficient wrking. Elective medicine Elective medicine Outpatients diagnstics Outpatients diagnstics High dependency High dependency Investment nte: Additinal expenditure n ut f hspital infrastructure, spent since the start f SaHF. This Sites is delivering expenditure highly n specialised primary such cmmunity as as, prvided utside f acute, intended t Sites cardithracics delivering highly cancer specialised such as reduce dem n the acute sectr, i.e. t reduce nn-elective r elective admissins, in-hspital utpatient cardithracics cancer appintments, A&E attendances. Als includes investment in supprting infrastructure. Prject csts are excluded.

5 FUTURE OUT OF HOSPITAL PLANS Whle systems integrated Imprve integrated case management f Lng Term Cnditins thrugh key cmpnents f the Integrated Care Prgramme (ICP). LTC related A&E attendances are believed t accunt fr apprximately 50% f all A& E attendance. Develping integrated pathways t supprt LTC management is expected t reduce emergency admissins by 300 a year, first utpatient appintments by 750 fllw up appintments by Enhanced risk assessment, including health scial risk stratificatin tl, practive early identificatin f peple with susceptibility t falls, dementia scial islatin. Extend planning t all peple with cmplex health needs; include peple with medium risk wh will benefit frm planning intrductin f self- pathways. Multi-disciplinary teams regularly meeting at a lcal level including: nursing, pharmacy, scial, mental health, third sectr with General Practice at the centre. Care-crdinatrs as a first pint f cntact fr patients rs with the rle f crdinating all patients activities. Develp an pen access IT platfrm t share real-time infrmatin enabling jined up fr patients receiving help frm several. Exp Rapid Respnse service, including embedding scial, perating ver 7 days, creating a single intermediate team which will include dementia, reablement, cmmunity rehabilitatin, equipment, tele hme. Exp the Early Supprted Discharge service (Hme Safe) t specialty wards fr lder peple in additin t the Acute Medical Unit f THH. Establishing a service that perates at scale fr patients acrss the brugh. GP, cmmunity scial delivered in patients GP, GP, cmmunity scial delivered in in patients Patient navigatin using 111 Patient navigatin using 111 Patient triage respnse within 4 hurs Patient navigatin triage using respnse 111 within 4 hurs Primary including hubs Establishing different mdels f fr different grups f patient (e.g. wrking ppulatin, patients with cmplex needs) t make mre tailred t their needs t reduce avidable use f urgent /A&E. GP cnsultatins lng term cnditin management GP GP cnsultatins lng lng term term cnditin management Health prmtin delivery f preventative Health prmtin delivery f f preventative GP master classes training pprtunities fr primary staff t build skills capacity within general practice; supprting the shift t mre supprt available utside f hspitals. Delivery f multi-disciplinary f Delivery Access t f diagnstic multi-disciplinary therapy Access t t diagnstic therapy Exp imprve the prvisin f nline fr patients, including extending nline access t medical recrds the availability f nline Access t GP, therapy, rehabilitatin diagnstic t t GP, GP, therapy, rehabilitatin diagnstic Access t Access t t appintments. specialist GP specialist GP GP Mental health wellbeing Deliver Year 2 f ur Jint Mental Health Strategy with Lndn Brugh f Hillingdn: fr mental health we will redesign invest in the fllwing: Urgent, Child adlescent, Dementia, GP, cmmunity scial delivered in patients GP, cmmunity scial delivered in patients Patient navigatin using Older 111 adults Patient GP, GP, cmmunity cmmunity using scial 111 scial delivered delivered in patients in patients Patient triage respnse Acute within inpatient 4 hurs beds Patient triage respnse within 4 hurs Patient Patient navigatin using using Patient Patient triage triage respnse Learning within within 4 disabilities. hurs 4 hurs GP cnsultatins lng term cnditin management GP cnsultatins lng term cnditin management Health Health prmtin prmtin delivery delivery f f preventative preventative GP cnsultatins GP cnsultatins lng lng term term cnditin cnditin management Health Health prmtin prmtin delivery delivery f preventative f preventative These changes will imprve access fr patients, especially thse in crisis, reduce waiting times imprve early detectin f Dementia s users rs can get the supprt that they need at an early stage. Delivery f f multi-disciplinary Access Delivery t t diagnstic f multi-disciplinary therapy Delivery f multi-disciplinary Access t diagnstic therapy Access t diagnstic therapy Cmmunity Access Access t t GP, GP, therapy, therapy, Out rehabilitatin f Hspital diagnstic Access t t specialist GP, therapy, GP rehabilitatin diagnstic Access Access t specialist t GP, GP therapy, Access t specialist GP rehabilitatin diagnstic Access t specialist GP We are develping three Hubs acrss the brugh. These hubs will prvide a base fr the delivery f Out f Hspital the delivery f integrated. The first hub has been develped in the suth f the brugh at the Hesa Centre; Urgent Care Centres Urgent Care Care Centres Outpatients diagnstics Outpatients Urgent Additinal Care diagnstics Centres n sme lcal hspital sites, including specialist Additinal Outpatients with tw, further utpatient n n diagnstics sme sme hubs rehabilitatin lcal lcal identified. hspital hspital sites, sites, specialist including specialist specialist Additinal,, utpatient utpatient n rehabilitatin sme rehabilitatin lcal hspital specialist sites, specialist including specialist, utpatient rehabilitatin specialist A&E, Urgent Care Centres trauma A&E, Urgent Care Centres trauma A&E, Urgent Care Centres trauma A&E, Urgent Care Centres trauma Obstetrics Obstetrics midwifery unit inpatient paediatrics & midwifery unit inpatient paediatrics netwrks. Obstetrics & midwifery unit inpatient paediatrics Obstetrics & midwifery unit inpatient paediatrics Enhance intermediate prvide seamless cmmunity including review realignment f cmmunity t emerging GP Elective medicine Elective Outpatients Elective diagnstics medicine medicine High dependency Outpatients Outpatients diagnstics diagnstics High dependency High dependency Imprve f peple in nursing, including advanced planning increased clinical supprt skills develpment with the benefits f managing the f residents within the hme preventing unnecessary attendance at r admissin t hspital. Sites delivering highly specialised such such as as cardithracics cancer cancer Sites delivering Sites delivering highly highly specialised specialised such such as as cardithracics cardithracics cancer cancer Extend recently redesigned cmmunity based (MSK, ENT, gynaeclgy urlgy) t be available frm mre sites acrss the brugh. Urgent Care Centres Care Urgent Outpatients Care Centres diagnstics Outpatients Additinal diagnstics n sme lcal hspital sites, including Additinal specialist, utpatient n n sme sme rehabilitatin lcal lcal hspital sites, sites, specialist including specialist, utpatient rehabilitatin specialist