An ongoing conversation. Stakeholder Engagement Part Three

Transcription

1 An ongoing conversation Stakeholder Engagement Part Three

2 Introduction In January 2012, clinicians in North West London officially launched the Shaping a healthier future programme to respond to the challenge of providing high quality healthcare to the two million people who live in the eight boroughs in North West London. Led by the eight clinical commissioning groups (groups of GPs who will plan and buy health services in the future) and other clinicians across NW London, Shaping a healthier future is about working with patients, the public and other clinicians and NHS bodies to identify the challenges facing the NHS here and then develop solutions for a better, healthier future. 2

3 An ongoing conversation On 15 May 2012 over 180 patient and public representatives and local clinicians attended the Sattavis Patidar Centre in Wembley Park for the third major Shaping a healthier future engagement event. Senior clinicians leading the programme explained the process used to develop a medium list of options for improved healthcare and how these will impact on patient pathways. They also gave an overview of the plans for public consultation and sought views on these from attendees. This event was the third in a series of three major pre-consultation engagement events that aimed to inform patient and public representatives and clinicians of programme progress while ensuring feedback and suggestions continuously inform the ongoing proposal development process. Event Engagement Event 1 15 February Read the full report visit our website. Engagement Event 2 23 March Read the full report visit our website. Engagement Event 3 15 May (The focus of this report) Objectives A gathering of patients, public and clinicians to review and discuss the Case for Change, the document which sets out the inconsistencies and failings of the current system and identifies some key objectives for the programme feed into proposed clinical and out of hospital standards inform the development of criteria that will be used to evaluate possible options for change create the opportunity to ask questions of the programme s leaders A gathering of patients, public and clinicians to review progress since last event including how feedback received has been taken into account review and inform the development of each borough s vision and plans for out of hospital care review the process of refining a long list of options for change to a medium length list consider and inform the criteria used to refine the medium length list down to a short list of options for public consultation create the opportunity to ask questions of the programme s leaders review next steps, particularly looking ahead to public consultation A combined gathering of patients and clinicians to collectively review progress since the last event including how feedback received has been taken into account review the content of the public consultation and inform the consultation plan understand how healthcare will be delivered across NWL if the plans proposed by the Shaping a healthier future programme are implemented ensure that Shaping a healthier future s vision for future healthcare is comprehensive and well explained provide an open forum to ask questions of the programme s leaders and provide feedback 3

4 The third event The event on 15 May was held in the evening following feedback from previous event delegates that this was more convenient than a daytime event. During the three hour event, the Programme s clinical leaders and senior representatives presented an update on Shaping a healthier future with opportunities for detailed discussion and written feedback at tables as well as question and answer sessions with the wider group. In attendance were: More than 180 people attended the event including: representatives from six of the eight LINks groups representatives from patient groups such as BME Health Forum, Breathe Easy Brent, West London Citizens, Hanwell Neighbourly Care Scheme and Age UK Councillors and/or officers from six of the eight North West London councils clinical representatives from the Clinical Commissioning Groups in NWL clinical representatives from six acute provider trusts as well as NWL s community and mental healthcare providers GPs from across North West London What we covered Progress review following the last stakeholder event looking at challenges, vision and standards Developing options for change revisiting the evaluation criteria and moving from the long to medium list Presentation and table discussions about patient pathways now and how they could work in future Presentation and table discussions about the plans for public consultation Questions and Answers throughout and a panel session with senior clinicians NB. The agenda was put to a vote on the evening of the event 58% of attendees voted to follow the planned agenda and this decision was honoured albeit with an extended Q&A session at the end. Please see appendices for full agendas and speaker biographies. 4

5 Programme review What we presented Dr Mark Spencer, Lead Medical Director for Shaping a healthier future presented an update on progress to date, including a review of the last event. For a full report on the 23 March engagement event please visit our website or contact the team using the details below. Mark explained: The challenges facing the health system and the need for services to improve to deliver better care for patients in NW London. The three key principles underpinning the vision for care in NW London - localising routine medical services, centralising most specialist services and integrated care. Taking into account feedback from previous events where delegates had asked for more detail on how the out-of-hospital vision will be delivered, Mark highlighted: -- The increased investment in out-of-hospital care of approximately 105 to 130m -- This investment in out-of-hospital care allows for savings in the cost of hospital care, for example by reducing the number of non-elective stays by 55,000 and the number of outpatient appointments by 22 percent -- The work Clinical Commissioning Groups are already doing to improve out-of-hospital care by establishing GP networks and hubs -- How the changes will be supported by patient participation, establishing performance management and incentives frameworks, improved information tools and workforce development Key standards for hospital care and some of the considerations in trying to achieve these standards. 5

6 Developing options for change What we presented Mark explained that: Most activity will remain as it is now, for example Specialist Hospitals will remain as they are, and all nine current hospital sites with an A&E will continue to provide Local Hospital services with a local A&E service such as an Urgent Care Centre. In order to meet the quality standards, it is proposed that NW London has five Major Hospitals with 24/7 A&E, consultant-led obstetric units, inpatient paediatrics and associated complex care. Hillingdon Hospital and Northwick Park Hospital are proposed to be Major Hospitals, due mainly to their location and the related effect on patient numbers and travel times. Central Middlesex Hospital is proposed to be developed as an Elective Hospital, as well as providing Local Hospital services including a local A&E service such as an Urgent Care Centre. Of the current hospital sites with an A&E, it is proposed that three should be Major Hospitals and three Local Hospitals (with a local A&E service such as an Urgent Care Centre). Using the evaluation criteria developed by patients and local clinicians and detailed assessment, our Programme Board recommended that Options 5, 6 and 7 were taken forward for further analysis. NB: Since the event the Programme Board, made up of CCG Chairs, Provider CEOs and NHS NW London s Medical Directors, has recommended that these three options be consulted on. The Joint Committee of Primary Care Trusts (JCPCT) will consider this recommendation on 27 June Key 6

7 Shaping a healthier future for North West London Option 5: Major hospitals Hillingdon Northwick Park West Middlesex Chelsea & Westminster St Mary s Local hospitals Charing Cross Hammersmith Ealing Central Middlesex Option 6: Major hospitals Hillingdon Northwick Park West Middlesex Charing Cross St Mary s Local hospitals Chelsea & Westminster Hammersmith Ealing Central Middlesex Option 7: Major hospitals Hillingdon Northwick Park Ealing Chelsea & Westminster St Mary s Local hospitals Charing Cross Hammersmith West Middlesex Central Middlesex 7

8 What you said We sought your feedback on this process. You said: You accepted and understood the challenges being faced by the health service You were concerned that the proposals are driven by the need to make cuts in services You were concerned that Urgent Care Centres (UCCs) will not be able to offer the full range of emergency services that should be provided at a hospital site. Using the example of Ealing Hospital, where A&E admissions have not reduced since its UCC was set up, you said that UCCs should not be seen as a simple replacement of an A&E You highlighted the importance of overcoming the equalities challenges of the proposals. This means making sure that the options do not disproportionately impact on patients from poorer, more deprived and BME backgrounds and older people. In particular you highlighted specific areas of NW London such as Harlesden, Southall and Ealing that need to be closely considered. What we said These proposals are being driven by the need to improve the quality of healthcare across North West London, their primary motive is to improve clinical quality and clinical safety would certainly never be compromised. We will consider your feedback and continue to involve patients, the public and their representatives, local clinicians and health professionals in this process. A key part of the consultation will be to engage with hard-to-reach and under-represented groups and make sure all voices and views are heard. We have also commisioned an Equalities Impact Review which is being carried out by an independant organisation to ensure we understand and consider the impact of proposed changes on those populations with protected characteristics. 8

9 Patient pathways Dr Susan LaBrooy and Dr Tim Spicer, Medical Directors for Shaping a healthier future presented two patient pathways which demonstrated how patients use the current healthcare system and how if we achieve our vision, they will use it in the future. Delegates then had an opportunity to discuss these, along with three other examples, in table groups. The five patient pathways were; major injury, planned care, elderly confusion, asthma attack and mental health. Please see the appendix for the full patient stories. What you said We sought your feedback on these stories. You said: The patient stories have a clear vision in theory but you wanted more detail on how they would work in practice You liked some aspects of the stories and what they might mean for patient care in the future: [It s] good to have physios in GPs, and care for elderly in own home and being checked regularly, and consultant cover on weekends. It is difficult to use representative patient stories given the range of different services with different standards and in some places the future situation is already happening, or the current scenario would not occur You think that the patient stories describing major injury, planned care and an asthma attack are the most feasible. The future scenarios describing care for someone with a mental health issue and for elderly confusion were highlighted as being the most difficult to achieve due to the need to join up primary care with community, mental health and social care services You think that it will be vital to improve the capacity, resources and knowledge of community services and community based professionals in order to make the pathways work In particular if GPs are to be the key link in this, access to GPs needs to be improved, as well as more training and up-skilling of community resources such as community nurses. This has funding implications and you were concerned about where the funding for this would come from GPs are the best placed to know and understand the patient s needs because they have the case history and should be able to monitor and advise. is there enough capacity in primary care to deliver this? There is a need to improve communication in the health service for these patient stories to work in the future as they rely on good joint working You want to see more focus on the holistic nature of health conditions. For example, more explanation about the links between health and other services such as social services, the Local Authority, housing etc. 9

10 Patient Stories Patient story 1 Major injury You wanted to see more detail about how the decision making process in this situation would work in future including how the patient would be assessed on the severity of the injury and what this means for where she would be taken by ambulance services. This may also have an impact on travel times and access to a major A&E in the case of a major injury. How do patients know if they have to go to (a) minor injury unit or if their condition will only be treated in the major A and E? You questioned the workforce implications of this story and the role of junior doctors and the feasibility of consultants working additional evening or weekend shifts. Patient story 2 Planned care In this scenario you felt it was not clear how patients would access the specialist they needed any differently if care was based out-of-hospital as opposed to in hospital. You also had questions about the role of GPs in this scenario and the capacity of a GP network to be able to cover all specialisms and geographical areas adequately, as well as where singlehanded practices exist. GP buy-in for these proposals will be crucial in making these successful. You felt that this scenario shows clear cost savings in the future so it may be more feasible to implement. Patient story 3 Elderly confusion You felt this could be a feasible pathway for the future and that it does bring GPs and hospitals closer together for better outcomes for the patient. You had concerns about having the money for community services and the capacity to support this in the community, eg. not having enough community nurses. Patient Story 4 Asthma attack You saw this as an improvement on the current patient experience and questioned why this was not already happening. This scenario will require expertise, funding and interested community GPs to work together with someone with specialist knowledge at the UCC. For this to work, the IT systems of different providers will need to work seamlessly together. 10

11 Patient Story 5 Mental health You said that the role of community services is crucial in making this work and to join services in the community up - Care navigators urgently needed. You felt there was an assumption in this scenario that there will be an available team of carers in the community on tap. You wanted more clarity about the role of the GP in this scenario. Developing future pathways You highlighted a number of other scenarios that you wanted to see included in future patient stories such as paediatrics, maternity, outbreak/pandemics, learning disability, drink-related disorders, diabetes, home care etc. You also wanted to understand the patient experience when there are comorbidities. You wanted to see more detail about the facts and figures of current patient experience such as the percentages of current patients experiencing the system as described, and who would be affected in the future. Also, more data about the cost savings as a result of these changes. You suggested that patients should be involved in producing the pathways and these should be formalised so that patients and clinicians are aware of them. 11

12 Consultation plan What we presented Kai Rudat, Director at the Office for Public Management (OPM), presented the consultation plan and activities. OPM is providing support for key public and patient engagement elements of the Shaping a healthier future public consultation. He explained: The importance of consultation with the public and patients to ensure views are heard and inform the proposals. The aims of the consultation process in being transparent, wide-ranging and encouraging as many responses as possible. The key activities as part of the consultation plan including distributing the consultation document and analysing responses, carrying out events in communities and with clinicians and using a range of media including online methods to get responses. Kai highlighted how you could get involved in the consultation by spreading the word, letting us know how we can reach your organisation or community, or if there are specific parts of the community you think may be particularly affected by the proposals. What you said We sought your feedback on our plans for consultation. You said: Principles and approach You wanted the consultation approach to be focussed on listening to all parts of the community and involve patients upfront, for example in developing the consultation questions and designing other materials. This should be wider than just consultation with the Programme s Patient and Public Advisory Group (PPAG) Key messages about the case for change and the motivation behind the programme should be strengthened and simplified Public will respond much better if you re honest about context of making savings not just improving quality of care. People will respect that. You reinforced the consultation aims as being important, such as the need for plain English, an Easy Read version of the consultation, use of different languages for different community groups. 12

13 Methods used during consultation The spread of channels and approaches for the consultation felt fairly comprehensive to delegates A number of different routes of accessing patient and public views were highlighted by including GP practice meetings, supermarket, schools/colleges, Twitter and Facebook, outpatient clinics, children s centres, youth parliaments, colleges, local festivals, pensioners forums, faith groups, charity organisations for particular groups (eg. homelessness, drugs, alcohol), young mothers groups, pharmacies, carers groups, housing associations You suggested the use of key roles in the community to act as champions and advocates for the consultation process, such as GPs and pharmacists, community group leaders, community ambassadors and culturally recognised leaders Another key role is frontline NHS staff being involved in the consultation to give the insider view on the proposals Delegates liked the idea of the consultation roadshows, and wanted more local meetings as well as larger public meetings specifically focussed on options 5, 6 and 7 You wanted the consultation to use social media and technology creatively, for example an interactive aspect to the website as well as an introductory video that local groups and charities could show their members and users to encourage responses, or a viral video for the internet. Ensuring the consultation is wide ranging You want to see a robust consultation process that ensures good representation across the general public and hard to reach groups There should be specific and extra consideration of the equalities impact of the changes, especially in relation to deprived parts of different boroughs and those that already find it difficult to access services You wanted to see more public, patient and voluntary sector involvement in the delivery of consultation activities and in developing materials and making decisions, in particular BME groups, faith groups and young people, who may be under-represented in the consultation responses Delegates suggested greater and more random sampling of the public s views on the proposals The consultation also needs to involve the Royal Colleges and explore the views of the teaching hospitals. 13

14 Information to be included as part of consultation. Some of you felt the decision making process used to get to the medium list was unclear and you wanted more information about how future decisions will be made. In particular, you wanted to understand how results will be analysed given the different responses from people in different parts of NW London, as well as how the consultation responses affect the final decision by the JCPCT The JCPCT will make the final decisions what if they do not like the result of the public consultation? You wanted to have a greater understanding of how needs and incidence of disease across the boroughs link to the level and location of where services are or should be through, for example, population and needs maps You would like more analysis and explanation of what services will be needed in the community after changes are made and how to ensure they are adequately resourced and trained. Detailed business plans and cost analysis would be helpful Delegates wanted to have a clearer picture of the amount of consultation already undertaken and planned to be carried out Delegates wanted to hear more about the role of the focus groups and how they fit in with consultation responses You wanted more information about how each local area will be specifically affected by the proposals, and even having localised equalities Impact Assessments. All of this will be considered as part of the consultation process. 14

15 Next steps This event was the final of three major engagement events held during this pre-consultation period. There will be a wide range of activities during consultation. In the meantime, the programme s leaders will continue to build your feedback into their plans, specifically: Working with local clinicians to further develop the three recommended options for consultation Working with local clinicians, local authorities and others across the eight NW London boroughs to refine the local visions for out-of-hospital care Working with clinicians to develop more detailed patient pathways Holding ongoing discussions with local patient representatives on our Patient and Public Advisory Group (PPAG) - which has representatives on each of our working groups Running more engagement events to give a wider body of local patient representatives and local clinicians the opportunity to hear about the programme and influence it Further developing our consultation plans and refining this with the North West London JHOSC and PPAG Producing newsletters and other communications for local stakeholders and maintaining a programme website, free telephone line and address. Closer to the launch of the public consultation, events and activities will be promoted locally, as well as via programme newslettters and online. Please do let us know if you or others you know would like to be added to our contact listor if you know any local groups or organisations who would like to be involved. Contact us To register for the event or for further information please contact the Shaping a healthier future team: Telephone: communications@nw.london.nhs.uk You can also visit us at our Shaping a Healthier Future website where further materials are also available for download. 15

16 Appendix A: Q&A Here are some of the questions you asked during the event. There are more questions and answers available on our website. If your question has not been answered here please contact the Shaping a healthier future team using the contact details above. Q: Improving care in the community will only work if social and health care are more integrated. An integrated care plan will be vital. Is this included in your plans? A: We recognise that integrated care is currently lacking and our work is trying to address this. In Hammersmith and Fulham there is an effective model which integrates health and social care and we want to use this model across North West London. Q: I have respiratory illness and the hospital care for this is non existent an out-ofhospital service has been established but it has not been properly resourced and staffed. My community nurse lacks the clinical knowledge to care for me, in fact I know more about my condition than she does. A: We intend to improve respiratory care as part of the proposals patients need to be able to access the necessary support. That said, we also want to encourage and support patients to become more knowledgeable and able to self-care where appropriate. We also recognise that primary and secondary care are linked, you need to look at the whole picture and invest in both to achieve real improvements. Q: Many existing Urgent Care Centres are not equipped to deal with a whole range of conditions. For example, in Ealing the UCC needs to be able to refer to the A&E department in order to meet patient s needs. A: We accept that currently there is variability in terms of what UCCs can provide and we have set up an Urgent Care Clinical Implementation Group to look at their development. We want to ensure that urgent care sites consistently meet an agreed set of standards. We will not change A&E services until we are sure that UCCs are up to standard. Q: UCCs are in fact not fit for purpose unless they are connected to A&E units will your proposals factor this in? A: We would not make any proposals if they did not meet the criteria for safe and high quality care. Not all UCCs necessarily have to be linked with an A&E service, in the current system some are performing well separately. 16

17 Q: Given the nature of the populations it would be vital to conduct an Equality Impact Assessment (EIA) on the proposals. Are there plans to do this? A: An Equalities Impact Review (EIR) has been commissioned and is due to report in mid June and a full Equalities Impact Assessment (EIA) will be undertaken before any final decisions are taken. We agree that this is vital - tackling health inequalities (for example reducing variations in life expectancy across boroughs) is one of the core goals set out in the proposals. The EIR will highlight those equality groups who may have a high demand for services in NWL or who would be particularly impacted by the proposed changes. There will then be further direct engagement and consultation with the communities highlighted (eg. newly arrived/refugee communities, BME women, SE Asian communities). Q: Access to GP s appointments in many parts of NW London is currently very difficult. Is this a priority? A: We recognise the difficulties with access to GPs, and we are aware that this problem leads to a rise in hospital admissions. We know that there needs to be an investment in GP and out-of-hours services if we are to improve community health. We want to implement clear standards relating to access, and are forming GP networks which will increase access to suitable skilled professionals. The health service in London will be overseen by a National Commissioning Board that will hold GPs to account for the standards of care they provide. They will be looking at the performance of GPs across a range of standards. In terms of long-term conditions we need to achieve the right level of care and need to be challenged to do so. Q: The consultation process and decision making process needs to be transparent and explicit in terms of how the final decisions are reached. If there is overwhelming democratic opposition to the changes will this have an impact on the outcome? A: An independent body will analyse and weigh up the responses received during public consultation and the report of their findings will be available publicly. Once the feedback has been reviewed a recommendation will be submitted to the JCPCT for approval at a public meeting. 17

18 Appendix B: Agenda Time Content Presenter 5:30-6:00pm Registration and refreshments 6:00-6:10pm Welcome and introduction Dr Anne Rainsberry 6:10-6:45pm :45pm 7:45-8:00pm 8:00-8;45pm Progress review Short video from 23 March event Where we are now Interactive voting Patient pathways now and how they could work in the future Short video on out-of-hospital care Small group discussions and plenary feedback Break Consultation plan Small group discussions and plenary feedback Chief Executive, NHS NWL Kai Rudat Facilitator and Director at the Office for Public Management Dr Mark Spencer Medical Director, Shaping a healthier future Dr Susan La Brooy Medical Director, The Hillingdon Hospital Dr Tim Spicer Interactive voting 8:45-9:00pm Q&A session Dr Mark Spencer Medical Director, Shaping a healthier future Kai Rudat Facilitator and Director at the Office for Public Management Dr Susan La Brooy Dr Tim Spicer 9:00pm Close contacts and next steps Dr Anne Rainsberry 18

19 Appendix C: Presenter biographies Anne Rainsberry Chief Executive, NHS North West London Dr Anne Rainsberry has worked in health for over 20 years both in general management and in human resources roles. She first became an HR Director in the NHS in 1995 holding a number of Board level positions in London. Anne joined the Department of Health in 2001, working firstly as Director of Workforce Development in the South East Regional Office and latterly the Department of Health and Social Care Sector, with responsibility for leading the delivery of workforce modernisation in the NHS and Social Care across the south east and subsequently the south of England. In 2004, she was appointed as Director of Human Resources for the Department of Health with responsibility for the Department and its agencies and leading HR policy for its 26 arms length bodies. In 2005 she was awarded Doctorate of Business Administration with distinction. In 2006 Anne was appointed to her present role as Director of People and Organisational Development for NHS London and is also the Deputy Chief Executive. Since February 2010 Anne has also been the Cluster Chief Executive for NHS North West London. Mark Spencer Medical Director, NHS North West London Dr Mark Spencer has been a General Practitioner and trainer in a practice in Acton since He is now senior partner and maintains an interest in respiratory disease amongst others. He initially became involved in commissioning with an interest in Evidence Based Medicine via fund-holding, then joined the leadership teams of PCG and Ealing PCT where he was lead Clinical Director and PEC Chair, before moving to give clinical input in NHS North West London. He continues to be involved in Ealing Clinical Commissioning Group. Tim Spicer Chair of the Hammersmith & Fulham Clinical Commissioning Group and Medical Director for Shaping a Healthier Future Dr Tim Spicer is a General Practitioner and Partner at the Richford Gare Medical Centre in Hammersmith and also acts as the Chair of Hammersmith and Fulham Clinical Commissioning Group. Tim entered medicine as a mature student following a successful career in the Arts. He has over 8 years of experience in commissioning and has contributed to a wide range of projects including the North West London Integrated Care Pilot and is currently Co-Chair of Continuity of Care integrating Health and Social Care for the residents of Hammersmith and Fulham. 19

20 Appendix C: Presenter biographies Susan La Brooy Medical Director, The Hillingdon Hospital and Medical Director for Shaping a Healthier Future Dr Susan La Brooy has been Medical Director at The Hillingdon Hospitals Foundation Trust for the last six years. She is also Consultant Physician in Acute Medicine and Care of the Elderly with more than 25 years of experience including four years spent as a Senior Lecturer and Head of Department at the University of Singapore. She has undertaken a range of leadership and change management roles including modernising older people s services in the health community, clinically leading the merger of Mount Vernon and Hillingdon Hospitals, and most recently as clinical quality lead achieving Foundation Trust Status for the Hillingdon Hospitals Foundation Trust. Susan also led a team responsible for improving A&E targets for the Modernisation Agency, and contributed to the London and National Implementation for Older People. As Associate Dean at the London Deanery from she ensured the successful implementation of the controversial Modernising Medical Careers and managed the Trust Liaison Dean Service supporting education and training in Trusts across London. Kai Rudat Independent Facilitator Kai acts as an advisor, facilitator and consultant on the relationship between organisations and their stakeholders. His areas of expertise include customer segmentation and insight, community engagement, evaluation and strategic futures thinking. Working with local partnerships and services, regional bodies and key government departments and sector bodies, Kai has recently completed projects on future approaches to innovation in local government, the future of community empowerment, evaluations of major health service initiatives and local engagement projects with diverse customer and community groups. Prior to joining OPM, Kai was Director of Social Research at MORI where he was responsible for major evaluations and nation studies for government departments. Previous positions include five years of international research with the BBC World Service, dealing with development issues in Latin America and Africa and with political change in Eastern Europe. He has also worked as a youth and community worker in an inner-city area of Birmingham. 20

21 Appendix D: Five Patient Stories The patient s story: #1 Major Injury Here s what happened Amrita, 22, lives in North West London and has recently started using her bicycle to get around her neighbourhood at the weekends One Saturday evening, a car door opens and she is thrown into the road An ambulance is called and because Amrita is shocked and hurting all over she is immediately blue-lighted to the nearest A&E What happens now When she arrives at hospital, Amrita is seen by a junior doctor who establishes that she has no broken bones but is in pain, so some blood tests are conducted She is then admitted to the observation ward in casualty, to be reviewed by the consultant the next morning Four hours later, Amrita suddenly develops a severe pain in her abdomen and has to be transferred to another hospital for surgery What would happen after our changes Amrita would be taken to a major A&E with proper weekend consultant cover, and would be seen by an A&E consultant immediately who would organise x-rays and get her seen by a consultant surgeon The surgeon would confirm the need for abdominal surgery which would then be properly organised in good time, instead of being an urgent case rushed to another hospital. 21

22 Appendix D: Five Patient Stories The patient s story: #2 Planned care Here s what happened Winston, a builder aged 53, lives in North West London One day lifting some rubble he suddenly has a sharp pain in his elbow He goes home early and books an appointment to see the GP the next day What happens now Winston s GP diagnoses tennis elbow and refers him to the orthopaedic team at the nearest district hospital where he is given an outpatients appointment Winston has to wait for his appointment and when he finally attends the clinic, the diagnosis is confirmed The hospital firstly suggests a physiotherapist but this programme of treatment doesn t really help Winston So the hospital then suggests a special injection into his elbow and he is booked in for the procedure ten days later What would happen after our changes Winston would be seen and diagnosed by another local GP who specialises in these conditions The GP also has access to physiotherapy so Winston is seen at the same visit and treatment is started straight away When it emerges the physiotherapy is not working, the same GP can give Winston the necessary injection This all makes the whole procedure much shorter and avoids a visit to hospital altogether 22

23 Appendix D: Five Patient Stories The patient s story: #3 Elderly confusion Here s what happened Elizabeth, aged 85, lives on her own and copes well, but in recent years has become increasingly frail and has had a few falls One Sunday she falls in her front garden, and is seen by a neighbour, who calls an ambulance As Elizabeth is confused and shocked by the fall, the ambulance crew take her to hospital where it is discovered she has a urinary tract infection Because hospital staff have no other information about Elizabeth, she is then admitted What happens now While being treated for her infection, Elizabeth also contracts a hospital acquired infection and has to be kept in for even longer This reduces her mobility, making it even more difficult for her to return home Eventually the decision is taken to move Elizabeth into a nursing home instead of returning to her own home What would happen after our changes Elizabeth would be kept under more regular review by a community nurse and would have her own care plan Because Elizabeth has previously fallen, she attended a falls clinic and notes on this incident are recorded in her plan this means that when she falls again she is known to the community team and has been assessed as vulnerable in her plan This plan would be kept somewhere obvious and her neighbour would know about it, in case Elizabeth got into trouble So when Elizabeth falls, the neighbour calls her GP whose number is on the plan The GP calls round, diagnoses a urinary tract infection, and contacts the community team who arrange for a more regular carer to visit Elizabeth at home until she is better The GP also arranges for a hospital bed to be delivered so Elizabeth can be treated at home until she becomes more mobile again She also has visits from the physiotherapist who assists in her mobility Once she is on the mend, the community nurse arranges for her to attend a day care centre three days a week, which helps her to recover even more and keeps her active and meeting new friends. 23

24 Appendix D: Five Patient Stories The patient s story: #4 Asthma Attack Here s what happened Tomasz, 14, lives in North West London with his family He has asthma which he usually keeps under control with an inhaler However he does suffer from bad recurring attacks and, after a game of football after school one day, he has a particularly bad attack What happens now Tomasz s mother is used to taking him to A&E when he has his attacks because they live within half an hour of one by car and, with waiting time targets, he can usually be seen within two hours However because he is being treated at an A&E they have to monitor him for 3 hours after he arrives and, because on this occasion it all happens after school and it is now early evening, by the time he is discharged it is quite late What would happen after our changes Tomasz would not need to spend time in A&E as he would regularly visit a community asthma clinic in his local area and he and his mother would be better taught how to cope with his condition Tomasz could also be given an asthma app for his iphone which helps him to engage more with managing his own condition Through this route a community respiratory nurse would visit Tomasz at home and, with his mother, would manage his condition more effectively so he did not keep having severe attacks and having to liaise with paediatricians at the hospital Even if Tomasz did suffer an attack, he could be seen at an urgent care centre who would know all about his care and be able to liaise with the paediatric team at the hospital themselves, avoiding the need for Tomasz to liaise with them himself. 24

25 Appendix D: Five Patient Stories The patient s story: #5 Mental Health Here s what happened Edwin, 45, lives in North West London and has had a history of depression not helped by his diabetic condition which has been recently diagnosed During one of his depressive episodes, he forgets to take his regular medication and his diabetes gets out of control He collapses one day and is admitted urgently to hospital What happens now In hospital, Edwin s high blood sugar level is rapidly brought down but he needs to stay in to bring his condition under more control The hospital is unaware of his depression which then gets worse and, as a result, Edwin visits the canteen which then makes his diabetes worse because of all the extra food he is eating Eventually Edwin gets so frustrated he discharges himself from hospital and goes home without any ongoing care planned or enough medication A few weeks later Edwin collapses again this time he is even sicker than before What would happen after our changes Edwin s care at home would have a dedicated plan and team of carers He would attend clinics and have more regular help with his diabetes and depression This would avoid his condition deteriorating so badly and, if there were any danger of this, the signs would be spotted earlier on by the care team and measures taken to prevent it getting worse If he does get admitted the community team will support his care and ensure that both his diabetes and depression are treated 25

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