Revising Our Operating Model WORK IN PROGRESS FOR CCG CONSULTATION Robert Morton Chief Executive 1 TDA
Current Model Triage Process R1,R2 G1/2 G3/4 CSD/CCORD 4% 81.3% Response 59.28% To Hospital 2
Current Model Current operational model is focused on providing emergency response and transport. Meeting response time targets and keeping ambulances available to respond is expensive. ED common destination for ambulance: contributes to hospital congestion & reduces ambulance availability. Unsustainable model from financial (as well as operational) perspective - rising demand, increasing pensioners and community expectations. Does not support quality patient outcomes at efficient cost. Does not support career opportunities to staff. 3
The Case for Change Five Year Forward View (FYFV) Urgent and Emergency Care Review (UECR) Rising Demand demand growth and ageing patients Health System Changes STP models, ED delays, speciality care pathways Community expectations - reliance on 999 for most crises Workforce - professionalisation, clinical/career progression Resourcing Operations Plans sometimes unfunded Finances - demand diversion reduces revenue, no investment plan 4
Projected Activity 5
Change is Required Treat and Convey (59.28%) See and Treat (35.82%) Hear and Treat (4.90%) Most expensive service Finite resource, long recruitment lead times Patients taken to Hospital EDs (contributes to hospital congestion, reduced EEAST ambulance availability) 6
Urgent and Emergency Care Model 7
Urgent and Emergency Care Model See, Treat & Convey (59.28%) Hear & Treat (20%) Reference: Health Education England See & Treat (35.82%) See & Treat (40%) Hear & Treat 4.9%) See, Treat and Convey (40%) 8
Future Workforce Breakdown Clinical Level Percentage Number* In Post (Nov 15) Gap Est. Cost m** Specialist Paramedic (ECP) 10% 287 Specialist Paramedic (CCP) 2% 57 68 276 14.8 Paramedic 48% 1,378 1,758*** -380-14.4 Associate Practitioner 16% 459 361 98 3.4 Emergency Care Assistant 24% 689 349 340 9.4 Total 2,870 2,536 334 13.3 *Based on ORH: 2,870 WTE figure for 2015/16 (will need to be revised for future years growth) **Based upon average pay costs in November 2015 (excl. overtime) ***Relates to current Establishment, not Registered 9
Key Features 1. Aligns patient s needs with most appropriate clinical service. 2. Supports a system wide perspective, providing integrated care opportunities and reducing conveyance to hospital ED. 3. Enables better use of highly qualified (and expensive) Paramedics for patients with highest medical need. 4. Improves EEAST s operational performance limited resources more available. 5. Aligns demand to the most cost effective service improving EEAST s financial viability. 6. Clear Career Pathway for staff, improving ttraction and Retention. 10
Integration and collaboration with the wider system Retention of skilled workforce Outcomes Reduce 999 callers defaulting into the emergency sector at high cost Mitigate rate of growth for EEAST emergency activities Provide callers with better matched (targeted) care pathways Reducing likelihood of repeat 999 calls and ED presentations Improves EEAST operational and clinical effectiveness at reduced cost of growth Improves responsiveness to most acute patients and supports speciality patient care pathways 11
Safer, Faster, Better Most appropriate service? Hear and Treat Clinical Hub GP Advice Line Specialist Service See and Treat Intermediate Care DSA At Home Clinical Hub Hospital ED Specialist Facility Effective identification of patient acuity Most appropriate location? Most appropriate skill set? Specialist ED Physician Doctor or Nurse Technician Paramedic CCP ECP A more flexible and integrated model 12
PATIENT SAFETY FRAMEWORK Clinically Effective Patient Safety 1. DEVELOP CLINICAL COMPETENCE AND GOVERNANCE IDENTIFY PATIENT NEED Primary Triage Secondary Triage (CSD/GP/HUB) Transition to NHS Pathways 2. IMPROVE TRIAGE CAPABILITY AND CAPACITY IDENTIFY MOST APPROPRIATE DISPOSITION Self Care Hear and Treat Hear and Refer Asset Deployment 3. INCREASE PATIENT PATHWAY AND DISPOSITION OPTIONS Changes Required SELECT APPROPRIATE RESPONSE(S) ECP (Solo) CCP (Solo) RRV (Paramedic/Associate Practitioner) DSA (Paramedic/Associate Practitioner)/ECA) Intermediate Care (Apprentice Practitioner/ECA) 4. IMPROVE SELECTION OF APPROPRIATE RESPONSE AND TRANSPORTATION PLATFORMS 13
Introduce NHS Pathways East of England Ambulance Service Improving our Triage 111 Referral to DoS (CSD/EOC GP) Improved clinical assessment during call Increased volumes signposted to alternative care pathways Hear and Treat increases via Clinical Hub Directory of Services (DoS) to link in with wider health community Allows for more appropriate use of other resources 14
Community Paramedicine (Prevention models) Care Coordination GP Led Multi-disciplinary Clinical Hubs Intelligent Conveyancing Falls Teams East of England Ambulance Service What else can EEAST offer? Supporting Telehealth/Telemedicine Clinical Governance of entire Paramedic workforce (Secondment/Rotational Opportunities across the system to support retention) 15
What can EEAST offer in 2016/2017? Commence development of Specialist Paramedic capacity Continue to stabilise Paramedic workforce Grow capacity through implementation of career pathway/apprenticeship model Care Coordination GP Led Multi-disciplinary Clinical Hubs Intelligent Conveyancing Range of community spoke models tailored to local need i.e. Falls Services/frailty models/care home support etc. Clinical Governance of entire Paramedic workforce (Secondment/Rotational Opportunities) 16
System Benefits Reduced emergency workload targeting frequent users and medically vulnerable Alternate Referral Pathway options Patient needs better managed in home Career opportunities Community engagement 17
Seek CCGs support for the new operating model and strategic direction of EEAST. Ensure the future direction is integrated with and aligned to CCG / System Transformation planning. Working to enhance local partnership, working to enable shared locations and/or services to reduce costs. Develop alternative and appropriate services for patients, utilising NHS Pathways. EEAST to share knowledge and experience to enhance local service delivery to patients and healthcare professionals, evidence based through available data. Working with CCGs 18