Governing Body Update: Northamptonshire Urgent and Emergency Care - - PowerPoint PPT Presentation
Governing Body Update: Northamptonshire Urgent and Emergency Care (U&EC) Strategy Sylvia Kennedy Director of Urgent & Emergency Care Nene & Corby CCG Tuesday 19 th July 2016 Northamptonshire U&EC Strategy Our Objective To
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driven
makes full use of specialist knowledge and expertise across health and social care
best practice in service delivery
developments, East Midlands Urgent & Emergency Care Network (EMU&EC) and the local STP
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Provide care as convenient for the patient as complexity of their illness allows, in the lowest acuity setting that is appropriate, and at the lowest cost for the NHS
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NHS 111 Call-handler CLINICAL ADVICE HUB up to 60%
%
Ambulance
%
A&E
%
Primary Care
%
Dental/Pharm
%
Other
%
Homecare Determining skill groups are required in the clinical hub GP, mental health nurse, pharmacist, dental nurse etc More transfers to clinical hub:
999 Call-handler
Future ‘Integrated Urgent Care’ service – ‘channel shifts’
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growth predicted over the next 10 years in all age groups, but proportionately greater in age 75+ population
England average
14.9% KGH and 7.5% NGH (some patients arrive by ambulance)
medium (bands 3) and high (bands 1&2) acuity patients attending and a downward trend in low (bands 4 & 5) acuity patients. At KGH there has been a very slight increase in high acuity patients, no change in medium but a more significant rise in low acuity attendances
which continue to rise
admissions. 11
Emergency Department Flow
referred patients
again late afternoon/early evening
hours, but performance is still below 95%. There are between 7 – 12 % non- admitted breaches
approximately 50% of these patients are admitted. 12
Inpatient Flow
would be expected. Significant numbers of patients stay over 7 days and
beds occupied by patients staying over 30 days is high
target of 2.5%
balance, except at weekends when discharges are less than admissions
performance rather than insufficient bed base. 13
Community Support
re-ablement rather than a focus on whether patient needs could be met at home with support
increased from an average of 1.2 to 1.7 hours per day. Overall
experience. 14
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health or social needs we must provide highly responsive, effective and personalised services outside of hospital, delivered in or as close to peoples homes as possible, thus minimising disruption and inconvenience for patients, their carers and families.
mental health needs we will ensure they are treated in centres with the very best expertise, delivering high quality and safe services in order to
safely return to their own homes.
pound invested
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Rapid and coordinated urgent care & crisis response Emergency and acute care Self care & prevention Rapid access to Primary and Community Care
Enable people to remain well for longer and provide better support for people to self care
Help people with urgent care needs get the right advice in the right place, 1ST time.
point of access which incorporates clinical triage. They will be able to choose well and the urgent and emergency care system will be simple for people to navigate. Provide highly responsive, effective and personalised service.
quality of care you need.
enter the system at. More patients will be treated and cared for closer to home. Ensure people with serious or life threatening needs receive treatment in centres with the right facilities & expertise in order to maximise chances of survival & good recovery
Connect urgent & emergency care services so the system becomes more than the sum of its parts
Enhanced routine care and discharge support in the community
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As providers and commissioners in the local health and social care economy we will work to achieve the following outcomes:
and information sharing between organisations.
are supported close to home where possible.
the 4 hour ED target which we commit to owning as a system.
and access alternative urgent care services when appropriate.
manner.
Rapid and coordinated urgent care & crisis response Emergency and acute care Self care & prevention Rapid access to Primary and Community Care Enhanced routine care and discharge support in the community
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People will easily engage with advice, support and information services. People will use this support to self manage their care needs People will be able to access these services without a referral. People will have the ability to choose well. Patients are guaranteed immediate response to time critical, serious and life threatening need. Patients can rely on a mobile response through 999 and have a care decision made in under 4 hours. Patients will access intensive input to treat & care for episodes of crisis.
Patients will receive proactive and targeted care delivered routinely and as part of a package
short term. Patients will be cared for in a consistent and planned way. People will have access to community based care when needed on the same day, tomorrow or planned in advance.
Patients can access urgent advice, care, treatment or diagnosis 24/7. Patients will receive consistent and rigorous assessment of the urgency of care need. Patients can expect timely assessment and to not have to provide information or be assessed more than once. People will access community health and social care professionals as the first active point of contact in the health and social care system. People will have access to community based care when needed on the same day, tomorrow or planned in advance.
Rapid and coordinated urgent care & crisis response Emergency and acute care Self care & prevention Rapid access to Primary and Community Care Enhanced routine care and discharge support in the community
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I am able to look after my physical and mental well being day to day. I am able to access self-care advice when needed. I know where to get guidance on the resources I can use from the health and social care system. I will be able to access patient education courses I am linked in to the wider voluntary and community support networks in my area. I know who to call if I want more information I will be seen promptly if I need to attend ED. I will have access to senior clinical advice when needed. My onward care decisions will be made quickly. If admission is necessary, I will be transferred to a ward in a timely fashion. I will have comprehensive discharge planning in place upon admission. I will not be in hospital for longer than is necessary. I will be discharged before 12pm on day of discharge and have no delays. I will be returned home as the first and preferred
I am involved in my care and understand my condition. I have a named care worker and a care plan shared across partner agencies. I am supported at home and in the community. I am helped to navigate the system. I can talk with my GP about my care plan. I know who to call if I am worried. I can access short or long term care depending on my needs. I am assessed once and have regular check ups. My care is reviewed regularly with me. I can access the same level of treatment at any UCC facility. I can access crisis response services in a timely way day or night. I can speak to a clinician about my urgent care needs in a timely way. I have rapid access to community services when needed. I understand alternative
Emergency Department. I am seen by trained and competent staff. I can get an appointment on the same day with a member of the community health and social care team who knows what care I have been receiving elsewhere. I am referred promptly to other services when needed. I feel supported to manage my own condition. My mental health needs are given equal priority.
Urgent Care door Rapid and coordinated urgent care & crisis response Emergency and acute care Self care & prevention Rapid access to Primary and Community Care Enhanced routine care and discharge support in the community Front A&E door Admission door Discharge door
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Compliance with the 7 day service clinical standards Configuration of services and models of care to
and efficiency. Optimised patient flow improved via internal patient care and review process/systems GP direct access to advice, diagnostic, ambulatory,
services to avoid A&E attendance All age mental health liaison services will be available 24/7 Optimise use of Ambulatory Care Services to avoid inpatient admission
Same day appointment with Health / social care professional Aligned / integrated OOH service Enhanced primary care mental health pathways Enhanced support to care homes 24/7 SPA via 111 for rapid assessment and advice which will access a range of primary and community services ie. RRT 24/7 Mental health crisis response and intensive home treatment service/crisis house Conveyance avoidance maximised through hear/ see and treat Rapid access community based ambulatory services for key patient groups ie. frail older people and children
MDT approach to assessing , coordinating and meeting complex patient needs in the community Optimising Telehealth and telecare Timely access to community based services for key patient groups e.g. those with eating disorders, mental health and alcohol issues and children and young people with complex needs Single point of access to discharge, reablement and rehab services to significantly reduce delays in transfers of care
Social prescribing & wellbeing navigation Prevention at scale Patient activation (Detail covered in prevention section
Rapid and coordinated urgent care & crisis response Emergency and acute care Self care & prevention Rapid access to Primary and Community Care Enhanced routine care and discharge support in the community
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emergency and crisis response and key enablers.
Case for Change – complete the draft, consult, amend if needed and publish final version Timescales, co-dependencies and alignment of work programmes Delivery Planning – in detail for 2 years and a road map for a further 3 years Impact Assessment – Health and well being, quality and outcomes, equality and finance