NWL Neuro-Rehabilitation Programme Jess Henderson, Davina Richardson, Susan Brown May 2016
Who we are We are a partnership organisation bringing together the academic and health science communities across North West London. We are also the designated Academic Health Science Network (AHSN) for the same area. We re here to deliver demonstrable improvements in health and wealth for the people of North West London and beyond through collaboration and innovation.
Our partners in North West London
Our three strategic priorities We re focused on: enabling discovery of new ideas and innovations, and then facilitating the adoption and diffusion of these across the NHS reducing variation and spreading best practice across healthcare strengthening synergy between the NHS and industry for the benefit of patients and to create wealth for the local population, the NHS and the UK.
Neuro-rehabilitation the problem
Complex pathway
Staff gave an average score of just over 2/5 about how well the referral pathway worked Too many variables in forms when units surely all need to know the same information Poor feedback from accepting and declining units Reliance on paper based communication when email would be much quicker Variable service, often no acknowledgement of referral, info on likely assessment date or likely wait for bed. At least level 1 units have single form. It would be nice if all bedded units had single form Not a clear process. Each unit has their own criteria/method of assessment and it is only because our therapists have so much experience that we can navigate through the process/ A lot of paperwork and chasing
A proposed pilot
What is Badgernet? A North West London pilot which aimed to: Improve the neuro-rehabilitation referral pathway Collect information to improve the quality of services and enable commissioners to commission smartly The pilot started in September, and has included: 8 L1 neuro-rehabilitation units 7 L2b/ 3 neuro-rehabilitation units 8 referring hospitals
8 referring hospitals 15 neuro-rehab services were involved in the pilot Referrers Imperial College Healthcare Trust Charing Cross Hospital Hammersmith Hospital St Mary s Hospital London North West Healthcare NHS Trust Ealing Hospital Northwick Park Hospital Central Middlesex Hospital Chelsea and Westminster NHS Foundation Trust Chelsea and Westminster Hospital West Middlesex Hospital Providers Hillingdon Neuro-Rehabilitation Services: Alderbourne Unit Daniel Unit Royal Free Neurological Rehabilitation Service Robertson Neurological Rehabilitation Service Charing Cross Neuro-Rehabilitation Unit Clayponds Hospital Central London Community Health: Athlone Unit 8 x L1 Neuro-Rehabilitation Services across London (not directly involved)
We agreed some new standards to work towards to accompany the pilot Consolidation of paperwork to two referral forms: One for L2b/3 units Adherence to the L1 Consortium Form Referral to assessment time for L2b/3 units of 7 days. Baseline of 8.04 days (UKROC data) Referral to admission time for L2b/3 units of 14 days (inc weekend). Baseline of 17.37 days (UKROC data) Saving of 741 per patient
What have we learned about our provision of neuro-rehabilitation in NWL?
So what has been achieved? For our 8 North West London CCGs we have recorded in the period 1 st September- 31 st March: Referrals: 155 referrals made into L2b/L3 units 122 accepted 23 declined 10 open referrals Admissions 72 L2b admissions 55 L3 admissions Active waiting list 3 on the L1 active waiting list 12 on the L2b/3 active waiting list
We are also getting an understanding of patient needs and whether services are sufficiently responsive Referral Reasons in NWL 1% 7% 4% 4% 52% 2% 30% Multiple reasons Primarily complex physical Primarily cognitive behavioral Assessment of low awareness state 120 Advice for appropriate placement 100 Other Not recorded 80 Average wait by referral reason One outlier of 206 days, and another with an 81 day wait 60 40 20 0 Number of Patients Average wait
The system allows for identification of savings 20 18 16 Average Referral to Admission by CCG The overall average wait is 11.4 days, a reduction from 17.4 days for 127 patients. This represents a saving of 168k in 7 months (using 220 cost for average bed day) 14 12 10 8 6 4 2 We can see variation across our CCGs, and it may give an indication of a need to review process or capacity to understand the drivers for this. The sample size remains small so the data is easily skewed by one outlier 0 NHS Brent CCG NHS Ealing CCG NHS Harrow CCG NHS West London CCG NHS Central London CCG NHS Hammersmith and Fulham CCG NHS HounslowNHS Hillingdon CCG CCG *The data does not include a small amount of forwarded referrals as they do not highlight actual service performance
How are our providers performing? Neuro-Rehab Units - Volumes and Waits 50 45 40 35 30 25 20 15 10 5 0 Charing Cross Neuro- Rehabilitation Unit (L2b) Hillingdon Rehabilitation Service (L2b) RNRU Homerton (L2b) Robertson Neurological Rehabilitation Unit (L2b) Royal Free Neurological Athlone Rehabilitation Unit Clayponds Hospital (L3) Rehabilitation Centre (L2b) (L3) NR Unit 1 (L2b) NR Unit 2 (L2b) NR Unit 3 (L2b) NR Unit 4 (L2b) NR Unit 5 (L2b) NR Unit 6 (L3) NR Unit 7 (L3) Number of patients Average referral to admission time
Staff have reported an improvement As a system, there are still some user training issues, but the overall process for referring is quicker and we don't have to wrestle with fax machines. General feedback is that that providers need to complete their sections better. Glitches have been addressed on an ongoing basis. There would be a benefit in having this available pan London
Overall Benefits Patients: Supporting faster access to neuro-rehabilitation services to accelerate recovery Better communication between services ensuring patients are accessing the right care, in the right location at the right time Allows for review of local services to ensure they are optimised Clinical Staff: More transparency through the referral process, this means less time chasing paperwork and more time available to spend with patients An audit trail of actions taken regarding patients and referrals Education around available services for patients Beds are freed up in acute trusts for patients who need them Commissioners: Access to non-identifiable data which was previously unavailable, allowing for greater visibility of provider and acute performance to enable smarter investment in services Savings generated through efficiencies
Neuro-Navigator Service 19
What patients told us Lack of engagement with patients and families Delays in accessing appropriate care Feeling lost and abandoned on discharge from rehab Don t know what help they can get access to, and who to ask 20
So how have I helped? Close working with clinical teams in acute - attendance at therapy MDTs allows earlier referral, advising on most appropriate referral, changing pathway in response to changing needs of patients Liaison with consultants /therapists from specialist rehabilitation units - they get up-to-date information on patients and priorities for admission - allows me to get information on local capacity Family support as early as possible and through the pathway - Link in transition between services - Consistent point of contact 21
Benefits To patients Getting people in the right place to meet their needs, at the right time To clinical staff Upskilling/ education about specialist and local rehab services Sustains good practice in appropriate referral Time can chase referrals and save clinical time To the health system Appropriate use of specialist resource - through reduced inappropriate referrals Days saved in acute estimate in first 8 months 165-180=GBP 45,000-50,000 22
Future challenges and developments Continue to collect acute days saved /DToC data Qualitative feedback from service users clinicians and patients Feedback information on use of services / gap analysis 23
Questions?