Cardiff and Vale UHB Developing our Clinical Services Model for the Future Cardiff Public Services Board 20 th November 2018
Context
Resident Population The total population of Cardiff and Vale is almost 500,000 predicted to grow to 555,000 by 2028 and 592,000 by 2026. The population in Cardiff is rapidly growing, faster than any other city in the UK except London, predicted to increase by 10% between 2017-2027.. Cardiff is also the only part of Wales where there is predicted to be an increase in children under 4 through to 2025 The population age structure of the Vale of Glamorgan is very similar to the Wales average, except for a slightly lower number of young adults (20-24yrs). The population of the Vale will increase modestly over the next 10 years, by around 1% or 1,200 people; however, there will be significant growth in the over-65 and over-85 categories Our Catchment Population 3
Cardiff and Vale UHB Shaping Our Future Wellbeing Strategy into Action Overarching future model of care WELLBEING COORDINATOR Empower the person Outcomes that matter to people Independence and Wellbeing First Point of Contact Stable Non-Complex Care Intensive and/or Enhanced Long Term, Stable Complex Care Speciali st Home first No avoidable harm, waste or variation 4
An Integrated Network of Hospital & Community Care and Well-being Care at Home and in the Community Enhanced Local Within each of the three Localities (Cardiff North & West / Cardiff South & East / Vale of Glamorgan) we are developing a Health and Well-being Centre. Within each of the nine clusters/neighbourhoods we are creating Well-being Hubs with partners. 5
Learning from Canterbury, NZ Vision consistent and compelling vision Clinical engagement and empowerment Culture permissive and accountable Patient/Citizen centred system wide It should be seamless for the person...they have no sense of having been passed from one organisational structure to another...the services are just organised around them.
The Voice of Our Citizens Sam -Age 11 Experienced an Adverse Childhood Experience (ACE) as a result of divorcing parents following incidents of domestic abuse within the home Identified as being dyslexic Demonstrating anxiety and low mood as a result of bullying Underachieving at school Lack of physical activity Computer whizz Cerys Age 44 Overweight/Inactive Low income due to part time employment Recently divorced Relationship difficulties with her 2 children due to behavioural problems Suffering stress Heart disease (Hypertension) Regularly drinks alone Loves gardening Caring for an elderly parent Wynn -Age 77 Lives alone and feels socially isolated Reduced mobility and at risk of falling Low mood Poor diet and loss of appetite Struggling to manage diabetes Financial concerns Former smoker -respiratory condition (COPD) Retired history teacher 7
Delivering in a future state Admission to hospital in an unplanned event = system failure? Pathway
What Will be Delivered Where? NEW UNIVERSITY HOSPITAL OF WALES high level overview Services Proposed for UHW Major Trauma Centre services Emergency Department (A&E) Unselected acute medical intake for Cardiff & Vale catchment Full 24/7 diagnostics including x-ray, MRI (inclcardiac), CT, ultrasound and dopplerimaging, interventional radiology, full regional pathology laboratory services, radio-pharmacy, endoscopy and cardiac catheter laboratory services All levels of critical care All acute emergency care and inpatient beds for all specialty emergencies acute medicine, surgical specialties, acute oncology, cardiology, respiratory, acute stroke, acute gerontology, gastrointestinal & Acute Medical Unit 24/7 emergency theatre capacity incl dedicated major trauma Future Configuration of Services Clinical Approach for UHW Site for acutely ill and complex surgical patients Site provides tertiary services for South Wales It delivers acute services that are dependant on co-location with critical care (L3) People supported back to the appropriate care location at point of no longer requiring high intensity/specialist care e.g. step-down or community Complex elective surgery including cancers, spinal, max facs, vascular, robotic surgery The Noah s Ark Children s Hospital for Wales and all paediatric emergency, intensive care (PICU) and inpatient services A co-located consultant & midwifery led birthing centre Neonatal Intensive Care all levels Specialist tertiary services including cardiac and neuro surgery, blood and marrow transplant, renal surgery, genomics service 9
What Will be Delivered Where? UNIVERSITY HOSPITAL OF LLANDOUGH high level overview Future Configuration of Services Clinical Approach for UHL Site for ill but stable individuals (post acute/step down, rehabilitation) The site provides cold, planned care services The site accommodates specialist services that are not dependant on critical care or 24/7 on-site acute medical admissions Services Proposed for UHL General rehabilitation and ongoing medical inpatient care stepped down from UHW or local residents repatriated from other regional acute hospitals Mental Health inpatient services Hafan y Coed Specialist Neuro and Spinal rehabilitation (Rookwood re-provision) Surgical Centre for elective, high volume but low risk, short stay routine surgery mostly Orthopaedics, General Surgery, ENT PACU/anaesthetic/higher acute care daytime service Hot Pathology daytime service Daytime service imaging services x-ray, CT Ambulatory Care Assessment (including ECAS, Day Hospital functions, Frailty Assessment) Routine endoscopy screening, planned and follow up Partnership palliative care model 10
What Will be Delivered Where? HEALTH & WELLBEING CENTRES high level overview Clinical Approach for H&WBCs Support for unwell but stable individuals Diagnosis of unclear symptoms where no red flag Ambulatory Pathways Outpatient services One facility in each Locality (CRI, Barry and Whitchurch) Future Configuration of Services Core Services Proposed for Each H&WBC Ambulatory care for rapid assessment of patients with specific conditions without the need for emergency admission Range of point of care testing services and plain film x-ray Enhanced enablement services Range of outpatient services Community Mental Health Teams Community Childrens Services There will be a range of additional services that will be developed with locality leads and stakeholder to provide tailored service model to respond to individual locality needs or enhance/develop existing regional service e.g. SARC (at CRI) Younger Onset Dementia Centre (Barry) 11
What Will be Delivered Where? WELLBEING HUBS high level overview Future Configuration of Services Clinical Approach for Wellbeing Hubs Focussed on social model of health Delivered in partnership with local authority and third sector Community developed and led GMS services At least one hub in each cluster (may be hosted in UHB or other partners facilities or in the case of new hubs as part of an integrated partnership model Core Services Proposed for Each Wellbeing Hub GP services Community midwifery services Health Visiting Primary Mental Health Services Community Children s services Some specific outpatient services to meet cluster health priorities There will be a range of additional services that will be developed with cluster leads and stakeholder to provide tailored service model to respond to individual cluster needs 12
So What? Next steps Engagement: Clinicians Communities Stakeholders Community Health Council 13