Plans for urgent care in west Kent: Introduction and background A summary of our draft strategy NHS West Kent Clinical Commissioning Group (CCG) is working to improve urgent care services and we would like to invite you to provide feedback on our draft proposal and strategy. Demand for urgent care services in west Kent continues to increase, and the current system is working too close to its limits. Patients make judgements about how to access care and decide whether something is urgent, based on their understanding of their own health and the local healthcare system. Patients, therefore, need to be assessed at whatever point they access the healthcare system. This is especially important for those with urgent needs. While we have already spoken to and gathered feedback from local patients and the public on a range of urgent and emergency care services, we want to make sure that the urgent care strategy meets the needs of people using the services and we d like to hear from you. We will then review all the feedback and build this into our plans. A summary of our draft strategy 1. NHS West Kent CCG s urgent care strategy sets out and defines the shared vision and aims for urgent care to deliver a safe and sustainable urgent care system by 2020. 2. The purpose of the strategy is to describe the key issues for urgent care services in west Kent, and outline how they will be addressed, working in partnership with health and social care partners. 3. Recognising the need for greater integration, the strategy outlines a new approach to look at the fundamental changes needed to deliver urgent care services which will: a. Put the patient at the centre b. Provide 24/7 access to urgent clinical assessment, advice and treatment c. Deliver improved integration of out- of- hospital care enabling more care to be provided closer to home d. Reduce complexity and evident fragmentation of services. The standards detailed throughout this document are supported by national guidance and have been jointly developed by NHS West Kent CCG, Kent County Council, NHS England and local providers including: GP practices ; Maidstone and Tunbridge Wells NHS Trust; Kent Community Health NHS Foundation Trust; Kent and Medway NHS and Social Care NHS West Kent CCG 1
Partnership Trust. It also takes into account feedback from a wide range of stakeholders and the public. The NHS West Kent CCG Vision for Urgent Care West Kent vision for urgent care To ensure the people of west Kent have access to the right urgent care that is consistently high quality, cohesive and available 24 hours a day, 7 days a week. A key aspiration is to ensure we commission high quality, safe and effective services which meet required standards of care 24/7 and are sustainable. This approach aims to ensure greater focus on helping health and social care providers to work together more effectively. Our three key ambitions are to: 1. Put the patient at the centre through improved integration of primary, community and secondary care. This will enable us to treat patients with the best care in the best place in the fastest time. 2. Ensure efficient patient journeys through hospital by promoting rapid assessment, access to senior decision makers and rapid discharge to the most appropriate place for the patient s recovery. 3. Focus on prevention and self- care and keeping patients out of hospital; while ensuring they receive the most appropriate, high quality care. The impact of the changes and reforms outlined within this strategy will be monitored closely using a robust quality and performance management framework, analysis of local activity, service reviews, evaluations and audits to ensure commissioned services: Are safe, Are of the highest quality, Are clinically effective, Provide a good patient experience and Offer value for money. The tables below provide a summary of the five strategic objectives we wish to deliver by 2020 in order to achieve an urgent care system that delivers the right treatment, in the right place and at the right time. NHS West Kent CCG 2
A Summary of West Kent s Draft Strategic Objectives for Urgent Care 1. Improving access to the urgent care system and improving assessment of patients medical and social care needs Reducing delays to treatment, through shared best decision making, to ensure the right treatment is available at the right place and at the right time so as to facilitate patient recovery. Commission an Integrated Clinical Assessment and Management Service Improve the care of frail older people by increasing access to comprehensive assessments and early assessment by a senior decision maker when they have an acute episode Full roll out of Care Plan Management System (CPMS) which gives those caring for a patient access to specific information from their medical record and online care plan. There will be an equivalent for children with complex special needs or a disability. Single point of access for children and young people s mental health services (CAMHS) and adult mental health services Improved community facilities for people with acute or deteriorating mental health problems. What will good look like? Patients are empowered to manage their own health Patients are helped to navigate the health system and directed to the service that is best able to give them the help they need, as close to home as possible Reduced fragmentation of the urgent care system Improved communication between services Better quality of care and improved health outcomes Reduction in number of Mental Health Act Section 136 assessments / detentions Reduction in number of people being taken to hospital by ambulance NHS West Kent CCG 3
2. Improving patient outcomes in out- of- hospital care Delivering localised primary and community care networks. These networks will be configured to better meet the needs of the communities they serve ensuring patients receive specialist, safe and responsive urgent care treatment closer to home. Expansion of the two current GP in A&E services to become fully integrated Urgent Care Centres Reconfigure community teams to a Primary Care Hub model, based around GP practices. We aim to have fully integrated teams that include, as a minimum, community, mental health and social care provision. Development of children s community nursing service to support early discharge of children and to enable more children with urgent care needs to be cared for at home Redesign community hospitals to provide flexible urgent care including: an intermediate care service (for patients whose needs can be met in a community hospital, rather than acute); slow stream rehab (for patients who are medically fit for discharge from acute care but require longer term rehabilitation) and out- patient provision for frail and older people Commission an integrated therapy service that provides wrap around services for the patient ensuring continuity of care across both community and acute provision. Review of re- enablement and rehabilitation. These are services that help patients to live independently. Roll out a discharge to assess model of care (discharging patients home with appropriate short term support while assessing longer- term care needs) Developing urgent care services provided by GPs and across primary care. 24/7 mental health crisis intervention and home treatment services Commission a community mental health service facility What will good look like? Increase in the number of patients treated at home or closer to home Reduce the number of patients permanently admitted to residential and nursing care homes Increase the number of older people who are still at home 91 days after discharge from hospital into reablement / rehabilitation services Reduction in the number of unnecessary hospital attendances and emergency NHS West Kent CCG 4
admissions More flexible out- of- hospital services Improved quality care and health outcomes Better integration of services 3. Improving the quality and patient experience of acute hospital care We aim to improve patient experience of care in our main hospitals by enhancing the quality of care, ensuring all patient groups receive high quality specialist services reducing health inequalities, and safely reducing treatment times. On arrival at A&E, patients will be assessed quickly by a senior decision maker and started on the most appropriate clinical pathway: emergency care, ambulatory emergency care (AEC), mental health, frailty or primary care. Ambulatory Emergency Care (AEC) is a pathway that enables patients to access diagnostics and treatment, without the need to stay overnight in hospital. Patients within the AEC or primary care pathways should be discharged back to primary or community care within 24 hours. Discharge will be within 48 hours for frailty patients. To ensure patients who require admission can return home as soon as they are medically able to, we aim to manage patient flow better, review our seven day services ensuring the right support services are available and arrange for many more people to be assessed at home rather than in hospital, which prolongs their stay. Ensure all patients attending A&E are assessed early by a senior emergency medicine clinician. This will ensure patients are transferred to the appropriate clinical pathway and reduce inappropriate acute admissions Ensure all children and young people attending in A&E are cared for in a child appropriate environment with dedicated paediatric staffing Improve the assessment of all acute patients by ensuring ambulatory emergency care becomes the default care strategy Commission a 24/7 all age mental health acute liaison service Improved early warning systems for high risk / deteriorating patients Review of the use of Clinical Decision Unit (CDU), Medical Assessment Unit (MAU) NHS West Kent CCG 5
and Paediatric Assessment Units. These are short- stay wards that patients are admitted to from A&E in order to carry out further assessment and diagnostics. Commission a frailty unit at MTW. This is a ward specially designed to meet the needs of frail older people. Review of acute seven day services to ensure the right support services are available both in hospital and in the community to facilitate early discharge Improve the way the acute hospital works with primary care and community services Commission an integrated therapy service that spans secondary and community care Introduction of a Learning Disability Liaison Nurse at MTW What will good look like? 95% of A&E attendances result in the patient being admitted, transferred or discharged within four hours of their arrival at A&E Increased proportion of patients who recover from trauma Increased number of patients on planned ambulatory care pathways Decrease in the length of stay for patients that have had an emergency admission Reduced length of stay in hospital and reduction in delayed transfers of care. (When patients are medically fit to be discharged from hospital but are delayed for other reasons.) Patients living longer in better health Improved patient (parent/carer) satisfaction Reduced re- attendance and readmission rates 4. Focusing on self- care and prevention to reduce acute admissions of care We aim to improve health outcomes, maximise health efficiencies and ensure that people are seen in the right place and the right time with an emphasis where appropriate on self- management of illness. This will involve delivering care closer to home. Roll out of the west Kent frailty pathway. With a focus on self- care and pro- active care at home. If a person does become acutely unwell the care will move from the proactive model to the reactive model of care with timely assessment and care planning. NHS West Kent CCG 6
Development of strategies to enable patients to access information on how to manage minor illness Develop stronger links with pharmacy promoting them as first point of contact Developing ambulatory emergency care pathways in the community Improve the management of long term conditions, including better support and advice for children and young people, their parents and education staff Moving unscheduled care to planned and elective care. What will good look like? Patients are empowered to manage their health Facilitate self- care and community based care where appropriate, enabling A&E services to deal with more complex or appropriate cases Reduced fragmentation across the urgent care system Better quality of care and improved health outcomes Improved patient satisfaction. 5. Delivering a system wide approach to urgent care Urgent care services will be commissioned and delivered across a whole system, developing urgent care networks to manage demand more effectively and reduce fragmentation of services Better management of seasonal pressures Urgent and Emergency Care Networks working towards seamless urgent care provision across Kent and Medway. Develop communication systems that enable best interest discussions around patients who become acutely unwell in the community. Promote more collaborative working between organisations System Resilience Groups: groups where leaders from all sections of health and social care work together to lead services. Workforce development The Better Care Fund and a joint commissioning strategy with Kent County Council for urgent care services, including joint commissioning of services for children and young people. NHS West Kent CCG 7
What will good look like? Patients are helped to navigate the health system and directed to the service that is best able to give them the help they need, as close to home as possible. 95% of A&E attendances result in the patient being admitted, transferred or discharged within four hours of their arrival at an A&E department Patients living longer in better health Reduced fragmentation across the urgent care system Better integration of services Increased knowledge and competencies of local health and social care professionals in delivering urgent care and ensuring it is embedded into all areas of patient care Better quality of care and improved health outcomes NHS West Kent CCG 8