Better heart attack and chest pain care - Shaping our local response Dr Doug Skehan Clinical Director Cardio-Respiratory Services, UHL
What are we proposing locally? UHL’s vision is: � To be the number one major provider of emergency and specialist services in England, recognised for quality of care and the strength of our business � In the premier league of clinical and applied research organisations � We have the bold ambition to move from ‘good to great’ How has this shaped our approach locally? UHL already has excellent outcomes for heart attack and chest pain however we know we can do better. There is inherent inequity in the current model of delivery In this context we have applied to be accredited as a Specialist PPCI centre which will offer PPCI 24 hours a day, seven days a week and an Acute Coronary Syndrome Centre, operating out of Glenfield Hospital. Glenfield Hospital hosts a £5.5m research centre for heart disease and is at the forefront of developing and applying best practice To deliver the above we are proposing a world class team model to deliver the best care for the Leicester, Leicestershire and Rutland population (and beyond) predominantly facilitated through a single Coronary Care Unit located at the Glenfield Hospital. Cardiology expertise and input will be maintained at LRI to support multidisciplinary team working particularly in the care of patients with multiple problems
Why change? • Coronary heart disease is a major cause of premature death across the Leicester, Leicestershire and Rutland population • Not all patients who could currently benefit from this service are able to access it in a timely fashion • Often they present to the Emergency Department and may then require cross town transfer causing unnecessary delay in definitive treatment • Time could mean heart muscle - PPCI works best if given quickly - • Concentrating skills and equipment in specialist centres builds experience and gets better results • An increase in PPCI and other minimally invasive treatments may reduce the subsequent need for major open heart surgery
What would this mean for patients locally? On site cardiology expertise maintained as part of multidisciplinary team at LRI
Better stroke care - Shaping our local response Dr Sean Treadwell, Consultant Physician, UHL
What are we proposing locally ? UHL’s vision is: � To be the number one major provider of emergency and specialist services in England, recognised for quality of care and the strength of our business � In the premier league of clinical and applied research organisations � We have the bold ambition to move from ‘good to great’ How has this shaped our approach locally? UHL hosts the Trent Stroke Research Network. UHL already has good outcomes for stroke and provides 24/7 access to thrombolysis and a rapid access TIA service. The health economy currently supports early specialist rehabilitation for County patients, closer to home. We know we can do better for more of our patients as there is inherent inequity in the current model of delivery. In this context we have applied to be accredited as a Specialist Primary Stroke Centre. This will offer access to 24/7 thrombolysis and a rapid access TIA clinic but not neurosurgical intervention. Based on best practice, it is proposed that this operates out of Leicester Royal Infirmary. This will require relocation of the Acute Stroke Unit and TIA clinic from the Leicester General to the Leicester Royal. The model will be complemented by timely access to specialist rehabilitation closer to home where reasonably practicable.
Why change? • Cardio-Vascular disease is a major cause of premature death across the Leicester, Leicestershire and Rutland population • Not all patients who could currently benefit from this service are able to access it in a timely enough fashion because of the point of access. This means there is inherent inequity • Patients may self present or it may not be clear initially that they are having a stroke. Most often in this situation patients present to the Emergency Department • Time is Brain - Time wasted may result in long term disability or death • Concentrating skills and equipment in specialist centres builds experience and gets better results
What does this mean for patients?
Better surgical orthopaedic care - Shaping our local response Mr Andrew Brown, Consultant Trauma and Orthopaedics, UHL
What are we proposing locally? UHL’s vision is: � To be the number one major provider of emergency and specialist services in England, recognised for quality of care and the strength of our business � In the premier league of clinical and applied research organisations � We have the bold ambition to move from ‘good to great’ How has this shaped our approach to service improvement locally? UHL’s orthopaedic service ambition is to be the provider of choice for our local and wider population based on our reputation and clinical outcomes. The service is already recognised nationally for its very competitive length of stay and infection control performance however, based on the level of demand on the service and critical theatre constraints waiting times are longer than the service would like. This makes sustainable achievement of the 18 week Referral to Treatment Time Target extremely challenging In response an increase in elective orthopaedic operating capacity on the Leicester General site is proposed. This is to meet demand and to put capacity resilience into the system for current and future need On December 3 rd 2009 Trust Board approved a Full Business Case for additional theatre capacity at the Leicester General Hospital with a projected project cost of £6.56m. The Anticipated completion date of the project is 31st October 2010
Why change? � With an aging population and increased patient expectations orthopaedic services have seen a sustained rise in referrals � Increase in work up prior to referral or exhaustion of alternative clinical pathways has resulted in a step change in the conversion rate from outpatient attendance to surgery seen by UHL over the last 2 years (from circa 36% to 80%) This has resulted in a critical theatre capacity constraint � Year on year the Musculo-Skeletal Directorate has had to refer £4m worth of activity to the Independent Sector and other providers for treatment despite patients choosing to come to UHL for their care � Pre-assessment for 5,000 patients per annum takes place in inadequate facilities What improvements will the proposal deliver? � Improved quality of care � Improved patient environment � Improved staff retention, recruitment and morale � Improved efficiency (theatre utilisation, reduce premium rate working) � Improved responsiveness
Recap on Proposals The local service improvements outlined today are currently under development and the views of JHOSC on the direction of travel are welcomed. This forms part of a wider on-going engagement strategy. In summary the proposals summarised today have presented a clinical case for change which include: Moving the Cardio-Vascular Unit from the LRI to the Glenfield to form an integral part of an Specialist PPCI and Acute Coronary Syndrome Service for the patients of Leicester, Leicestershire and Rutland and further afield. Cardiology expertise will still form part of the multidisciplinary team model in place at the LRI Moving the Acute Stroke Unit and the TIA clinic from the LGH to be co-located with the Emergency Department at the LRI. This is the basis of LLR’s proposition for a Specialised Primary Stroke Service Increasing theatre capacity for planned orthopeadics on the LGH site together with improvements in pre-assessment facilities
Next steps & draft timeline • Ongoing Public and patient involvement Dec 2009 – March 2010 • Recommendations from regional process Early 2010 Types of services and where they are to be located • Next update to JHOSC March 2010 • Outline timetable for services in place by the end of 2010 subject to approvals
Thank you, any questions?
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