Integrated Care Collaboration between Somerset Care Yeovil District Hospital Oct 2015-present
Outline Introduction YDH/Somerset Care collaboration Care Hotels in NL
Outline Introduction YDH/Somerset Care collaboration Care Hotels in NL
Somerset Care Not-for-Profit Home care, Supported living, Care homes, Training
Somerset Care Not-for-Profit Care homes, Home care, Supported living, Training
Somerset Care Not-for-Profit Home care, Supported living, Care homes, Training 72m turnover, c. 3600 employees 7 domiciliary care bases 5 in Somerset, 1 in Wilts, 1 in Hants/Surrey 16K hours per week, 1000 staff, >2700 customers Income split LA:self-funding 78:22 2 LD bases 5K hours per week supported living Somerset, Dorset, Wilts 28 care homes, 1522 beds, residential, dementia, nursing 27 in Somerset, 1 on IOW Income split LA:self-funding 40:60
Home care YLMS/Realise Specialist care
Vision To lead the market in high quality, evidence-based lifestyle support and care, through research, innovation and outstanding customer focus
Mission To enhance quality of life and promote independence of older and disabled people
Outline Introduction YDH/Somerset Care collaboration Care Hotels in NL
Aims of Collaboration Improve patient flow at YDH Reduce unnecessary length of stay at YDH Enable appropriate reablement Maximise patient clinical outcomes Reduce cost of ongoing care
Criteria for admission Documented confirmation by Consultant of Medically Fit For Discharge status Patient signed up to intensive reablement 10-20 days Discharge destination is usual place of residence Demonstrate ability to actively engage with rehabilitation (physically and mentally) Evidenced potential for rehabilitation
Criteria for admission Holistic therapy requirements identified 18 years Discharge summary completed /medications ready/treatment Escalation Plan in place Ongoing care plans completed for patients with specialist involvement Emergency escalation plan agreed to avoid readmission to YDH
Exclusions Stroke patients Chest pain within last 24 hours Intravenous therapy No fixed abode 72 hours post Myocardial Infarction Medically unstable Dorset GP
Number of admissions 600 admissions 40 35 30 25 20 15 10 5 0 Dec-15 Feb-16 Apr-16 Jun-16 Aug-16 Oct-16 Dec-16 Feb-17 Apr-17 Jun-17 Aug-17 Oct-17
Length of Stay Days Average 11.63
Home First
Length of Stay Days Home First 30.00 25.00 20.00 Average 13.77 15.00 10.00 5.00 0.00 Dec-15 Feb-16 Apr-16 Jun-16 Aug-16 Oct-16 Dec-16 Feb-17 Apr-17 Jun-17 Aug-17 Oct-17
Discharge destination 95% discharged home 35 30 25 20 19 21 26 25 21 23 20 24 21 22 17 18 20 26 27 29 23 15 10 5 0 4 3 3 2 2 2 1 1 1 1 0 0 0 0 0 0 0 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Discharge Home Returned to YDH
Discharge destination 91% discharged home Home First 35 30 25 20 19 21 26 25 21 23 20 24 21 22 17 18 20 26 27 29 23 21 21 21 31 27 30 15 10 11 8 5 0 4 4 3 3 2 2 2 2 1 1 1 1 1 0 0 0 0 0 0 0 0 Dec-15 Feb-16 Apr-16 Jun-16 Aug-16 Oct-16 Dec-16 Feb-17 Apr-17 Jun-17 Aug-17 Oct-17 Discharge Home Returned to YDH
Clinical Outcomes Goal Attainment Scaling (GAS) Scores 30 25 25 23 25 26 21 20 15 18 17 17 15 16 15 19 19 18 19 17 10 5 0 11 10 9 9 7 5 3 1 1 0 12 12 10 10 10 9 9 7 6 6 4 3 3 3 3 3 3 2 2 2 1 1 0 5 2 2 8 8 7 6 6 5 5 4 4 3 3 1 1 1 1 0 0 Dec-15 Feb-16 Apr-16 Jun-16 Aug-16 Oct-16 Dec-16 Feb-17 Apr-17 Jun-17 Aug-17 Oct-17 Overachieved Achieved Underachieved
Clinical Outcomes Goal Attainment Scaling (GAS) Scores Over-achieved Achieved Under-achieved
Costs
Cost of Delays Opportunity cost associated with the time it takes for patients to be assessed and a long term care plan put in place YDH estimates that there is on average a delay of c.20-25 days between a patient being medically fit and having their long term plan of care (POC) confirmed and put in place
Cost of Plan of Care Delays Home First 35,000.00 30,000.00 25,000.00 20,000.00 15,000.00 10,000.00 5,000.00 0.00 Feb-16 Apr-16 Jun-16 Aug-16 Oct-16 Dec-16 Feb-17 Apr-17 Jun-17 Aug-17 Oct-17
Costs Cost of bed in acute hospital 400 per night, 2800 per week Cost of bed in community hospital 285 per night, 2000 per week Cost of bed in brand new purpose built nursing care home 117 per night, 825 per week Nursing care home cost 2-3x lower than hospital Better environment, more intensive rehabilitation, better outcomes
Cost savings 42% of patients required a reduction in their predicted care packages upon discharge from Cookson's Court Downstream saving to the local authority of c. 1.6 million p.a. in home care costs Resulted in reduced elective cancellations, and income protection of an estimated 1.9m in 17/18
Feedback The world is a better place because of people like you Wonderful staff, highly efficient, compassionate and very caring No praise is high enough A total credit to the service Dad returned home with renewed confidence Thank you for the advice and help you have given to us all. We will be able to care for Mum so much better now
Feedback Thank you for your professionalism, friendliness and kindness You deserve a medal for your 100% fantastic service The care and support given to Mum has been amazing So grateful for your service Highly efficient, compassionate and caring therapists Cannot praise therapy staff highly enough and long may the service continue The therapy staff were amazing and nothing was too much trouble The staff were always willing- thank you for everything There are no words to express my gratitude, thank you with all my heart. I ve been born again
Case Study 73 year old lady admitted to YDH 31 st May 2016 Fell from steps, bilateral inversion, unable to weight bear Diagnosis L #5thMT and R #2,3,4 th MT and #distal phalanx of greater hallux Slow progress in mobility and function; mobilising with WZF short distances only, assistance of 2 people for transfers. Unable to complete personal care activities Felt that wasn t being communicated with spoken to PALS, felt that was just thrown into a corner of a bay and left Orthopaedic team felt too unrealistic to mobilise without frame or complete steps therefore aiming home in microenvironment with QDS double up PoC personal care Admitted to CC 16 th June 2016
Case Study Within 3/7 independent with toileting throughout 24hours, independent using shower, independent with 1xWS, independent completing steps Within 4/7 able to carry hot drink whilst mobilising, independent outside with stick, able to complete full flight of stairs Discharged home 21 st June with no PoC Feedback: I did not think I d be able to do this for months I cannot thank the therapists enough for their encouragement and treatment they are a credit to the NHS I feel so privileged to have been able to come here, I just wish I could thank you all personally
Conclusion Collaboration and integration of services does not require a change in organisational form or complex rearrangement of budgets, it depends on relationships between people at different levels in the collaborating organisations
Outline Introduction YDH/Somerset Care collaboration Care Hotels in NL
Care Hotels The Netherlands
Bernhoven hospital
Health and Care Healthcare in NL paid for by insurance 100 euros per adult per month After hospital treatment, patients are moved asap for rehabilition to Care Hotels for up to 44 days Cost of bed in care hotel is ½ that of hospital bed
Udens Duyn, Uden, NL
Care Hotel, Uden 76 beds, 12 for regular guests 4 th floor - highest dependency of need 3 rd floor physiotherapy room and gym 2 nd floor regular guest rooms 1 st floor lowest dependency of need, lounges, dining room, activity room, library, hair-dressing salon
Care Hotel, Uden
Dr Jane Townson Chief Executive, Somerset Care Group www.somersetcare.co.uk @drjanetownson https://www.linkedin.com/in/janetownsonphilpott