Thames Valley Urgent & Emergency Care Action Summit

Transcription

1 Thames Valley Urgent & Emergency Care Network Thames Valley Urgent & Emergency Care Action Summit Wednesday 1 st March 2017, Holiday Inn, High Wycombe

2 Thames Valley Urgent & Emergency Care Network Introduction A well attended Action Summit consisting of presentations, videos, lively debate and questions was held on 1 st March The Chair, Annet Gamell, introduced the afternoon by reminding delegates that they were all members of the Thames Valley Urgent and Emergency Care Network. This is your Network. Nationally UEC Networks were formed as a requirement of the Keogh review into Urgent and Emergency Care to bring organisations within systems together to collaborate, share best practice and to unblock and tackle issues at scale that individual systems might not be able to. She urged that radical thinking and action is needed to transform the Urgent and Emergency Care System. We cannot just keep aiming to improve the system we have by trying to squeeze out more efficiency and creating more capacity. That only achieves slightly wider bottle necks! She encouraged the approximately 40 delegates to be energetic and interactive during the afternoon. The focus of the workshop would be on collaboration across the system, new models of care, Integrated Urgent Care and collectively learning from the recent winter pressures.

3 Thames Valley Urgent & Emergency Care Network Action summit workshop Wednesday 1 st March Redgrave Suite, The Holiday Inn, Handy Cross, High Wycombe, Bucks, HP11 1TL pm Agenda Time Item Speaker Welcome and Introduction Dr Annet Gamell Thames Valley Urgent & Emergency Care Network Session 1: Collaboration with the Ambulance Service Presentation Development opportunities Presentation Falls prevention Table work Mark Ainsworth Spencer Winch Session 2: Integrated Urgent Care Presentation IUC development Presentation Community Hubs Presentation Channel Shift Table work Matthew Staples David Cahill Rachel Wakefield Coffee Break Session 3: Learning from Winter Presentations Locality feedback Presentation Patient tracking Presentation Ambulatory Care Table work Locality leads Christy Chan Dan Lasserson Question and Answer Session Speaker Panel Closing remarks Dr Annet Gamell

4 Thames Valley Urgent & Emergency Care Network TVUECN Action Summit Aims Progress Network work on the Urgent and Emergency care review and IUC development across TV. Focus on sharing best practice and collaboration.

5 TVUECN Action Summit Thames Valley Urgent & Emergency Care Network Make sense of the confusion for patients public and professionals

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7 Session 2: Thames Valley 111 Integrated Urgent Care service Matthew Staples Thames Valley IUC Procurement Programme Manager

8 Code 8NHS8

9 THE PATIENT OFFER FOR 2020 A single number NHS 111 for all your urgent health needs. Be able to speak to a clinician if needed. That your health records are always available to clinicians treating you wherever you are (111, 999, community, hospital). To be booked into right service for you when convenient to you. Care close to home (at home) unless need a specialist service. Provide specialist decision support and care through a network.

10 Key features A single front door enabling patients to access care 24/7, NHS 111 working together with in hours, OOHs, primary care services and ambulance services Special Patient Notes including End-of-Life Care Plans, will be available when required in the patient pathway Access to a multi-disciplinary Clinical Hub with a wide range of MDT presence, including MH, pharmacy and GP A range of calls will automatically be streamed to the Hub including ED dispositions, Green ambulance, under 5s and over 85s Direct booking into a range of services including (over the life of the contract) in-hours primary care Improved Directory of Services, including availability to clinicians in the community to support decision making face to face with patients

11 IUC Timeline March 2017 Co-production completed (service model and development plan milestones agreed) March 2017 CCG and NHS England Assurance of procurement April 2017 CCG Governing Body contract award decision May 2017 Contract signed Mobilisation begins September 17 Go-Live assurance (NHSE and commissioners) September 17 Service Launch September 17 SDP milestones introduced as planned March 18 Programme Support transfers to BAU

12 Berkshire Healthcare NHS Foundation Trust Integrated Hub

13 Objectives of the Hub To provide a single point of access for referrers, patients and carers of Berkshire; to provide the best use of all system resources- (now including social care and 3 rd sector) promote admission avoidance, enhance timely discharges from hospital, Prevent patients being bounced around the system by coordination of care and resources

14 Integrated Urgent Care Click, Call, Come In Right advice or treatment first time enhanced NHS111 the smart call to make: Improve patient information for call responders (ESCR, care plan) Comprehensive Directory of Services (mobile application) Greater levels of clinical input (mental health, dental heath, paramedic, pharmacist, GP) decision support hub Booking systems GP Connect GPs, UCCs, dentists, pharmacy 59

15 NHS 111 (Call Handlers using Pathways software) 999 (SCAS) SCAS Clinical advisor whereby onward referral to the clinical hub is deemed inappropriate (e.g. breastfeeding advice, trauma nurse advice) An Outcome and finish in 1st contact New 111 Clinical Hub (Virtual) A&E referral Green re-triage SCAS BHFT (NEW) Clinical Hub SCAS OHFT BHT GP triage Pharmacists Dentists Community Nursing Mental Health Acute specialist consultants LOCAL REFERRAL HUBS (Example BHFT Hub (CPE, GP OOH, Community Physical) Some Social Care GP OOH F2F

16 History of the Hub West Call GP OOH set up circa 20+ years ago (RedDoc) Became part of BHFT 2011 SCAS commenced NHS 111 in May 2013 BHFT used the same model to go live with the local Hub in July 2013 Initially for coordination of referrals/ discharges from Royal Berkshire Hospital A week later switched on GP referrals Integrated H&SC Hub for Wokingham went live in July 2016

17 Berkshire Healthcare F/:kj NHS Found ation Trust Hea rorn he he o f your community

18 What do we do? Process referrals for scheduled and unscheduled community services for Berkshire Single point of telephone contact for Wokingham Borough Council Adult Social Care accessible by service users/patients, carers and professionals for advice and guidance, assessments, equipment and safeguarding. Hub set up to streamline process of referrals going to the correct service first time to avoid bouncing between the different services resulting in patient treatment being delayed Currently the Hub processes approximately referrals and answered 130,000 telephone calls Receive between 450 and 550 referrals per day Answer up to 500 phone calls a day

19 WEST BERKSHIRE HEALTH & SOCIAL CARE SERVICES Adult Speech and Language Parkinsons Children s Centre (pass to service no processing) Chronic Fatigue Syndrome (pass to service no processing) Community Based Neuro-Rehabilitation Community Beds Community Cardiac Rehabilitation (pass to service no processing) Community Matron Continence Advisory Service Community Reablement Team COPD Children & Young Persons Integrated Therapy Diabetic Eye Screen (Adastra only) Diabetic X-pert District Nurse Domiciliary Physio End of Life Falls Heart Failure High-Tech Night Sitting Marie Curie Nutrition & Dietetics MSK Podiatry Rapid Response Rapid Response and Treatment in Care Homes (RRAT) Respiratory Pulmonary Rehabilitation Social Care Start Team Steady Steps (no processing pass to Service) Sue Ryder (no processing pass to Service) Vulnerable Adults (no processing pass to Social Services) WOKINGHAM ADULT SOCIAL CARE Advice and Guidance Assessment Equipment Safeguarding EAST BERKSHIRE HEALTH SERVICES Adult Speech and Language Bridgewell Children & Young Persons Integrated Therapy Community Beds Community Health Clinic (Assessment & Rehabilitation) Community Matron Continence Advisory Service District Nurse Diabetic Eye Screening Domiciliary Physio Falls Prevention Service Frail Elderly Pathway Heart Failure Hi-Tech Intensive Community Rehabilitation Leg Ulcer Clinic MacMillan MSK Multiple Sclerosis Nutrition & Dietetics Parkinsons Post Acute Care Enablement Rapid Access Clinic Tissue Viability Nurse

20 About to be added End of Life West Berkshire- 17 th October 2016 Slough H&SC Hub- April 2017 Reading H&SC Hub- Q Digital Hub- Teleconsultation for Care/ Residential Homes- West of Berkshire- TBC

21 Future Developments & the art of the possible 111 Clinical Hub- use of local clinicians and local hub to get best outcome Other Local Authorities for Social Care integration Full Integration of MH and Physical Health Deeper system integration- having better oversight of all resources to be able to dispatch best resource in most timely way. (example- District Nurse vs Ambulance)

22 What could this model provide? 1.If done at the correct size and scale- county basis ideally- provides economies of scale, best use of local services and knowledge, System resilience Workforce planning and sustainability 2.Potential to use one record to holistically assess and individuals needs Signposting patients/ individuals to the right place (self care or support group or service) avoiding escalation Underpinned by a robust system Directory of Services (not just Acute/ Urgent Care but a DoS for health, social care and 3 rd sector) 1.Ultimately, aims to nudge behaviours through the learned experience of great care/ customer experience

23 Thames Valley Urgent & Emergency Care Network Channel Shift Rachel Wakefield Associate Director Urgent and Emergency Care and Specialist Services East Berkshire CCGs

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25 Channel Shift Inputs Inputs that are system wide: A.Local cost data B. Baseline activity and demographic information C. Population D. Inflation and activity growth assumptions E. Workforce cost assumptions Inputs that are specific to particular UEC interventions F.The quantified opportunity for the intervention to make a difference G.Resource assumptions for the intervention to make a difference H. Data on set up costs I. Activity shift parameters to quantify the effectiveness of an intervention in deflecting activity to an alternative channel

26 Date Version 26/01/2017 Urgent and Emergency pathway interventions model FINAL DRAFT Local base data input cost data baseline activity population inflation and growth assumptions staff costs Results control sheet and graphical results intervention data outputs by channel projection calculations Interventions Model Navigation To: Description and evidence base Additional cost info Decreasing Ambulance conveyances: Hear and Treat M E C Decreasing Ambulance conveyances: See and Treat M E C Integrated clinical hubs - Increasing Clinical advisor consultations M E C Integrated clinical hubs - Integration of 111 and OOH hubs M E C Ambulatory Emergency Care M E C Personalised care planning M E C Co-location of UCC M E C

27 GP extended hours M E C Community pharmacy: PGD minor ailments service M E C Community pharmacy: Emergency medication supply M E C Summary care record: Use for IP drug reconciliation M E C Summary care record: Use in ED M E C Improved Referral processes - In Ambulance Service M E C Improved Referral processes - In ED M E C Improved Referral processes - In Care Homes M E C Discharge to Assess M E C Discharge Planning M E C Rapid Response Services M E C Care homes: Falls response training M E C Care Home educators M E C Early Warning Score in Care homes M E C Template for input of locally defined intervention M

28 Intervention lmact onactivify c annel.annual 100,000 80,000 tmer enc1a aa1s td atenas tdminor atenas ucc atenas OOHclinic ts OOHnome ts 111cals (cal nanaler) 111cals (clinical aavisor) n,m Commu ni armac 1 atenas Amoulance Amoulance Amoulance seeanaconve1 Communi near anatreat Seeanatreat totd contacts lntermeaiate Social services care aaa1s oomicilia care GPatenas GPvi ts 00,000 40,000 jj,m 1,m 14,lo 10,000-1,m - - 1,m 4 8, ,-- ) J,m -10,000-8,001 -,,,1 -B,m -40 I 000 -fjjo I OO -4 1 jjo, -4,m -J,040 AxiTitle

29 Discussion - IUC Thames Valley Urgent & Emergency Care Network

30 A&E Week Ending w-e 04 Dec 16 Weekly A&E 4hr performance for SC Acute Trusts -Unvalidated data w-e 11 Dec 16 w-e 18 Dec 16 w-e 25 Dec 16 w-e 01 Jan 17 w-e 08 Jan 17 w-e 15 Jan 17 w-e 22 Jan 17 w-e 29 Jan 17 OUH 95.17% 89.49% 87.95% 96.26% 88.45% 81.70% 81.50% 90.38% 85.62% BHT 87.80% 85.56% 87.79% 90.82% 85.29% 86.72% 90.12% 86.13% 90.01% RBH 95.87% 89.89% 87.99% 95.69% 88.02% 81.02% 90.08% 93.39% 93.54% HWP 88.81% 80.37% 81.99% 91.82% 80.23% 78.88% 88.13% 89.56% 79.00% RUH 84.08% 82.84% 85.75% 88.32% 86.33% 70.63% 74.39% 76.27% 72.44% GWH 77.08% 72.01% 78.68% 86.51% 78.46% 73.37% 82.26% 82.48% 79.55% SFT 93.74% 88.76% 87.41% 85.71% 81.77% 83.03% 81.17% 90.05% 84.96% GHT 80.97% 67.40% 66.89% 82.82% 77.43% 67.51% 75.59% 80.19% 77.61% Trend Key 95% or over Between 90% and 95% Below 90% Week Ending w-e 04 Dec 16 Weekly A&E attendances for SC Acute Trusts -Unvalidated data w-e 11 Dec 16 w-e 18 Dec 16 w-e 25 Dec 16 w-e 01 Jan 17 w-e 08 Jan 17 w-e 15 Jan 17 w-e 22 Jan 17 w-e 29 Jan 17 OUH 2,818 2,989 2,871 2,514 2,745 2,738 2,729 2,610 2,761 BHT 2,755 2,756 2,760 2,461 2,624 2,666 3,554 2,495 2,532 RBH 2,396 2,492 2,381 2,229 2,362 2,361 2,237 2,253 2,444 HWP 2,333 2,425 2,460 2,187 2,271 2,296 2,208 2,194 2,343 RUH 1,577 1,643 1,705 1,259 1,668 1,515 1,480 1,496 1,553 GWH 2,251 2,315 2,167 1,935 2,140 2,193 2,046 2,061 2,196 SFT GHT 2,512 2,509 2,383 2,328 2,592 2,533 2,253 2,256 2,439 Trend Key: Dark red fill represents high number of attendances 76