[PPT] - Health and Care Working Together in South Yorkshire and Bassetlaw PowerPoint Presentation

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Health and Care Working Together in South Yorkshire and Bassetlaw Review of hospital services

Public event

6 December 2017

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Welcome and introductions

Helen Stevens Associate director of communications, Health and Care Working Together in South Yorkshire and Bassetlaw

10.00 – 10.10

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10.00 – 10.10

Agenda

10.10 Introduction to the Accountable Care System 10.25 The Hospital Services Review 10.45 Questions 11.00 Comfort break 11.15 Urgent and emergency care 11.30 Primary Care and the ACS 11.40 Mental Health and the ACS 11.50 Questions 12.10 Lunch 13.00 Stroke 13.15 Gastroenterology and endoscopy 13.30 Questions 14.00 Maternity 14.15 Care of the acutely ill child 14.30 Questions 14.50 Summary and close Des Breen Alexandra Norrish All Dr Nick Mallaband Dr Andy Hilton Dr Graeme Tosh All Dr Peter Anderton Dr Mo Thoufeeq All Sharon Dickinson Dr Nicola Jay All Alexandra Norrish

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Introduction to the Accountable Care System

Des Breen Medical Director, Health and Care Working Together in South Yorkshire and Bassetlaw

10.10 – 10.25

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10.00 – 10.10

Who are we/what is an Accountable Care System?

We are Health and Care Working Together in South Yorkshire and

Bassetlaw.

We are a partnership of 25 NHS, local authority, voluntary and

independent organisations responsible for looking after the health and care of the 1.5 million people living in Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield.

Through working together, we have been chosen by NHS England

as one of the first areas of the country to become an accountable care system – giving us more freedom to have a local system for local people.

Working together in this way means that we will be able to

better join up GPs and hospitals, physical and mental healthcare, social care and the NHS and give our patients seamless care.

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10.00 – 10.10

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10.00 – 10.10

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10.00 – 10.10

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The Hospital Services Review

Alexandra Norrish Programme director

10.25 – 10.45

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10.00 – 10.10

South Yorkshire and Bassetlaw has some excellent

hospitals and some great care

But healthcare has changed since the NHS was set up, and

the NHS has to change with it

At the same time we are facing challenges we have never

faced before, and we are struggling to provide good care for everyone

We need to look at how we provide care in order to

safeguard the future of the NHS. Why are we reviewing hospital services?

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10.00 – 10.10

The way that the NHS is organised now was designed in 1962. So when the NHS took its current form much of the healthcare of today did not exist We need to change, just as healthcare has changed.

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10.00 – 10.10

At the same time we are facing challenges we’ve never had before;

In 1901 baby boys were expected to live for 45 years and girls for 49 years. In 2012, boys could expect to live for 79 years and girls for 83 years. By 2032, this is expected to increase to 83 years and 87 years respectively*.

King's Fund analysis of Office for National Statistics 2010-based National Population Projections

This is good news – but it means that the number of very elderly and frail people with multiple health needs is growing

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10.00 – 10.10

Demand for care is both growing and changing

The number of older people needing care is predicted to

increase by 25% by 2025.

The greatest increase is predicted to come from an increase in

cases of dementia*.

At the same time, lifestyle-related conditions such as obesity are

increasing.

For patients with dementia, staying in a hospital is often not the best place to be.

Guzman-Castillo et al: Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling study

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10.00 – 10.10

Last year, for example, there was a big

drop in the number of people across the country applying to train as nurses* .

At the moment, we have 180 posts

unfilled just in the 5 services we are including in the Hospital Services

Review. In some services, more than

half the posts are vacant.

Even when we recruit temporary staff,

there are often just not enough trained people to fill the posts.

We need to find ways to keep our workforce and use their skills in the best way. There are shortages of staff across the country in many services

*https://www.ucas.com/file/92646/download?token=FFC9R2rP

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10.00 – 10.10

We’re struggling to meet national targets, which then impacts on care:

Only 2 out of the 7 hospitals covered by the review have

met the target for 62 day waiting times for cancer in the first part of 2016-17.

Only 1 of our 7 hospitals met targets for A&E waiting times

in the first part of 2016-17.

Only 4 of our 7 hospitals met targets for 18 weeks’ wait for

elective (planned) care in the first part of 2016-17.

This means that patients in different parts of the region are receiving different standards of care.

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10.00 – 10.10

The review of hospital services has been set up to look at ways to make healthcare in South Yorkshire and Bassetlaw sustainable.

The review is independent and has been commissioned by all the partner organisations. It will develop recommendations, with engagement from the public and patients, about how healthcare might be improved – for now and the future.

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Questions?

10.45 – 11.00

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Break

11.00 – 11.15

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Urgent and Emergency Care

Dr Nick Mallaband

11.15-11.30

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Urgent and Emergency Care

Dr Nick Mallaband

11.15-11.30

All of our hospitals accept patients all day.
But not all our sites accept all patients.
At the moment, in South Yorkshire and Bassetlaw, if you have a

heart attack, or if your child is badly burned, the ambulance may well drive past your nearest hospital – to get to the hospital where you will get the most specialised care. As healthcare can do more and more, we need ways of making sure patients can get to the best place for their care. Urgent and emergency services help people get to the best place for their care

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Urgent and Emergency Care

Dr Nick Mallaband

11.15-11.30

We do not have enough staff to provide full cover at 7 A&Es,

around the clock.

Sometimes, our specially trained staff are not used in the

best way, particularly for minor injuries or illnesses that could be treated elsewhere.

We staff all of our emergency departments overnight, but

some A&Es have hardly any patients overnight. We need to find ways to better work with the staff we have to provide care. Current struggles in Urgent and Emergency Care:

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11.15-11.30

We’ve been looking at what other places are doing:

For example,

In Cambridge and Peterborough, a new community-based mental health crisis first response service was introduced for people to access urgent mental health support 24 hours a day, seven days a week. The service is open 24/7 for people of all ages throughout Cambridgeshire and Peterborough. There was a 34% average weekly reduction in trips to A&E across the four hospitals and a 20% reduction in admissions because people were getting the care they needed, faster, in a different way.

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13.15-13.30

Please add any ideas to the flipcharts on the wall at the end of the session We want to hear your ideas on how we might solve some of the issues we have talked about today.

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Primary Care services

Dr Andy Hilton

11.30 – 11.40

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11.30 – 11.40

The Accountable Care Transformation Agenda

Supporting “population health” through prevention and

promotion of community wellbeing.

Developing sustainable patient centred services for the future.
Greater integration of services - physical and mental health,

primary and secondary care, health and social care and statutory and voluntary sector.

Tackling inequality.

Improving primary and community care can reduce the need for treatments in hospitals.

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11.30 – 11.40

As GPs we are asking how we,

Are just as involved as other colleagues when influencing

changes

Ensure General Practice and primary care;
Are well resourced
Has an appropriately skilled workforce
Are well led
Are consistent in the offer to patients across the city/region
Are integrated with wider system
Are responsive to our patients?

We want our patient groups to help shape ACS developments – how do we do this?

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11.30 – 11.40

Primary Care and the ACS

Developing General Practice within wider

primary care

Engaging primary care in each ACS

workstream

Developing ‘Primary Care Networks’ as

integrated, multi-organisational teams with on the ground clinical leadership

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11.30 – 11.40

The General Practice and Primary Care strategy:

National policy: the General Practice Forward View
General practice both regionally and locally available
Improved consistency, reduced variation and available locally
Workforce development and diversity
Developing access to services over 7 days
Protecting core values
General practice should be at the heart of the primary care

team to manage care differently, closer to home How we work better together with other services and our communities is central to our work.

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11.30 – 11.40

Primary Care Networks/Neighbourhoods/Primary Care Homes

Groups of practices coming together to share functions and work with wider services including community nursing, social care, voluntary groups for the benefit of patients and populations. Based around 4 key Principles: 1. Scale 30-50,000 populations 2. Understanding the local population 3. Multi-skilled and multi-organisational workforce 4. Aligned clinically and financially Developing Neighbourhoods is a key priority.

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So what does it mean for patients?

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11.30 – 11.40

7 day access to GPs

Service co-designed with patients.
Started 1 October 2015.
Urgent evening and weekend GP appointments, routine appts

for practice nurses and physios.

Four Hubs across city in existing GP practices.
Open weekday evenings 6pm-10pm and weekends 10am-

6pm.

Staffed by Sheffield GPs, practice nurses, physios and

Healthcare Assistants.

Appointments booked through registered GP or 111 if out of

hours. These services have been co-designed with patients.

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11.30 – 11.40

Responsive extended access

In 24 months, we delivered 60,000 additional appointments

for GPs, nurses, physios.

93% of practices are now involved.
90% positive rating from patients.
Improved access for areas in the most need
Reduced A&E usage
CQC good with areas of outstanding

The benefits for patients have been significant.

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11.30 – 11.40

Community pharmacists in General Practice

Offer of support to all 86 city practices
1 session per week from local

community pharmacist (2 in larger practices)

Funding to enable this to happen via

Primary Care Sheffield from the GP Access Fund

Range of tasks from medication

review to hospital discharge support

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11.30 – 11.40

Benefits of pharmacy scheme

18,000 interventions by pharmacists
Strengthened working relationships between pharmacists

and GPs & practice staff

96% of work would otherwise been done by GP
Only 5% of work needed to be referred to a GP
3,000 hours of GP time freed up
Improved patient experience and patient safety
Reduced waste

Significant benefits both for GPs and for patients.

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Mental Health services

Dr Graeme Tosh, RDaSH

11.40 – 11.50

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Rotherham, Doncaster and South Humber NHS Foundation Trust

Provides mental health services across the region
Local Care Groups
Representing the Rotherham Care Group
Work closely with local GP’s, Physical Health Trusts, Social

Services and the Voluntary Sector

Moving toward integrated working with a number of

interesting projects

11.40 – 11.50

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11.40 – 11.50

Three examples

Liaison Services – CORE 24
The Ferns
Perinatal Services

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11.40 – 11.50

Liaison Services

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11.40 – 11.50

Liaison is becoming Core 24

Additional Funding
National Initiative
Aimed at 500 bed hospitals
24/7 care
1hr A&E response
4hr ward Response
Exciting plans for immediate response services for

community patients – still in development

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11.40 – 11.50

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11.40 – 11.50

Award Winning Integrated Care Ward

True integrated model
Difficult to establish
Physical Health input from TRFT
On Site at TRFT
Mental Health Input from RDASH
Better for Patients
Excellent Feedback and Outcomes

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11.40 – 11.50

https://www.youtube.com/watch?v=LxE3VQXNuTQ&t=54s

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11.40 – 11.50

Perinatal Services

Embryonic
Locally funded by CCG
1 Full time Nurse
1 Part time Nurse 40%
1 Consultant 10% (me)
Works collaboratively with maternity services, GP’s, social

services, labour ward, midwives, health visitors

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Delivery Perinatal mental health Development of a shared community service across three CCG areas Children and young people’s mental health Improvement and standardisation of crisis care across the ACS Integrated IAPT Increasing access and improving resilience Liaison mental health Core 24 in over 50% of hospitals and appropriate provision in others Adult ASD & ADHD Development of a shared service across the ACS Out of area placements No longer happening in 3 out of 4 providers in the area Employment Development of individual placement support for serious mental illness as part of a comprehensive employment strategy Dementia Improvement of complex care working closely with SYB UEC workstream

Mental Health and Learning Disabilities Workstream priorities

Oversight Social prescribing Building on existing work in Rotherham to improve access for people with serious mental illness Transforming Care Partnerships Delivered by specific project groups ACS key measures Including early intervention, physical health, eating disorder access and dementia diagnosis

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Questions

11.50-12.10

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Lunch

Flipchart exercise

12.10 – 13.00

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Stroke Services

Dr Peter Anderton

13.00-13.15

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13.00-13.15

On 15 November, it was agreed that Hyper Acute Stroke Services will change and will now be provided

n two (three including Chesterfield) sites in South

Yorkshire and Bassetlaw

There is a lot of evidence that shows

you are more likely to survive a stroke, and have less disabilities, if you are taken immediately to a specialist stroke unit, and looked after there for the first 72 hours.

It is estimated that 96 lives are saved

every year in London as a direct result

f consolidating their Hyper Acute

Stroke Units*.

*Morris et al, Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis. British Medical Journal 2014

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We are looking at how we best provide the

ther

elements of care that a stroke patient might need:

Acute

Stroke Services (less specialist hospital care dedicated to stroke patients)

Inpatient rehabilitation (help with areas like speech or

movement for someone who is not yet well enough to go home)

Community rehabilitation (help with returning to daily life,
ften in people’s own homes)

Stroke patients can need months of therapy and support to help them live as well as they can.

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At the moment each of our local places
ffer a different package of support – from

3 months of rehabilitation in Sheffield to 12 months in Bassetlaw.

Some places do not have enough social

workers to provide support as people are moving back home.

Some hospitals do not have enough trained

stroke staff to provide dedicated stroke support services. We need to make care more consistent so that people in South Yorkshire and Bassetlaw have the same chance of recovering fully from a stroke. Problems with stroke services:

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We have been looking at what happens in other places Bassetlaw Bassetlaw has a community stroke rehabilitation team which is integrated with the stroke provision at the hospital. The community rehab team provide up to 12 months of personalised support for stroke patients after they leave hospital. Greater Manchester Having already consolidated their hyper acute stroke services, Greater Manchester are working to improve community rehabilitation by a having consistent, standardised way of delivering these services across the area. Building on successes of Early Supported Discharge, as well as evidence and guidelines, the aim is to ensure all stroke patients, regardless of their disability, who are discharged from hospital are seen in a timely way by a multi-skilled team working together better.

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13.15-13.30

Please add any ideas to the flipcharts on the wall at the end of the session We want to hear your ideas on how we might solve some of the issues we have talked about today.

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Gastroenterology and Endoscopy services

Dr Mo Thoufeeq

13.15-13.30

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13.15-13.30

Gastroenterology

deals with intestinal disorders. The main area we are looking at is Gastro Intestinal bleeding, which describes internal bleeding in the gut. Treatment can be needed very urgently.

Endoscopy

is a diagnostic service by which doctors use a probe to look into the stomach or intestines. This is used to diagnose many different conditions including some cancers. Most endoscopies are planned in advance rather than emergencies. These two services are often carried out by the same staff and we need to find ways of making both of them work well.

What do we do?

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13.15-13.30

Why are we struggling with these services?

We do not have enough staff to provide full cover at 7

hospitals, 24 hours a day. This means that some patients find themselves having to wait until the next morning before they are diagnosed and treated.

Because we don’t have enough staff, an emergency GI bleed

can mean some planned endoscopies get cancelled.

At the same time, more and more people are being referred

for endoscopies.

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13.15-13.30

We’ve been looking at what other places are doing: Endoscopies Screening services

In some countries, specially trained nurses carry out endoscopies with support from doctors in their teams. Improvements in screening technology mean that we can reduce the numbers of unnecessary tests for patients.

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13.15-13.30

Please add any ideas to the flipcharts on the wall at the end of the session We want to hear your ideas on how we might solve some of the issues we have talked about today.

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Questions

11.50-12.10

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Maternity services

Sharon Dickinson, Head of Midwifery

14.00-14.15

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11.50-12.10

Consultant-led services (obstetric units) can provide pain relief (eg epidurals), surgery (e.g. Caesarean sections) and other services in the case of a medical emergency. Midwifery led services (Midwifery-led units and home births) are appropriate for women who are “low-risk” and are not likely to need medical services. These two services can either be in the same place or separate. What are the different kinds of maternity services?

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11.50-12.10

The Better Birth national guidelines were developed with

women from across the country. At the moment South Yorkshire and Bassetlaw does not meet them all.

We also have shortages of obstetricians and midwives which

means that even units with high risk women do not have a consultant present 24/7. We need to find ways to make better use of our workforce and provide more choice to women. We’re not meeting the Better Birth guidelines

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11.50-12.10

North East England

Australia

Mater Mothers’ Hospital in Australia experienced a shortage of midwives in the early 2000s. The hospital developed a “midwifery refresher programme” targeted at midwives who had been out of practice for an extended period and who wanted to return to midwifery. They were then able to recruit enough trained staff for their services. Targeted stop-smoking services were delivered across North East England to reduce smoking rates among pregnant women. Their smoking rates are now falling faster than England rates. This means babies are more likely to have an increased birth weight which is a sign of better health in newborns.

We have been looking at what other places are doing:

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13.15-13.30

Please add any ideas to the flipcharts on the wall at the end of the session We want to hear your ideas on how we might solve some of the issues we have talked about today.

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Care of the Acutely Ill Child (up to 18 years old)

Dr Nicola Jay

14.15-14.30

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14.15-14.30

Children’s illnesses tend to be different from adults’: most

will become ill very quickly, and recover very quickly (often within a few hours).

Whilst some children will obviously be very sick and require

specialist care for longer, most children attending A&E stay in hospital for less than 24 hours. Often they

nly

need

bservation from skilled clinicians and would then be better

cared for at home or by their GP. This means that care for children is different from adults – we need more ability to observe children for short periods of time. How do children’s hospital services work?

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14.15-14.30

Every hospital in South Yorkshire and Bassetlaw, with the

exception of Sheffield Children’s Hospital, has significant staffing problems in at least one area (consultants, nurses, or trainee doctors).

At a national level, paediatrics is one of the specialties where

there is the biggest gap between the number of trainees and the number of staff that are needed. We need to find ways to make better use of our workforce and adjust services to better care for patients. Problems with children’s hospital services

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14.15-14.30

Are we doing it right?

The illnesses that children have, and the main risks that

they face, are changing as lifestyles change. We’re currently not set up to care for this in the best way.

For example more children are now living with chronic

conditions that they might not have survived in the past. We need to be able to care for them at home rather than requiring them to come into hospital every time which can be upsetting for both them and their families. The way we deliver care is becoming out of date with what children need.

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14.15-14.30

One example is that we now have more children living with asthma

Significant numbers of children suffer from asthma
For some children it is so serious, that it can be fatal
But for most children it’s a condition they live with day to day
Our health and care system needs to be flexible enough to

respond to both We need to design services that mean that very ill children can get specialised care when they need it, while those with chronic illnesses are supported out of hospital wherever possible.

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14.15-14.30

What should we do instead?

Any new way of delivering care should meet the needs of

South Yorkshire and Bassetlaw’s current and future children.

We need to work together better across all healthcare types

– primary, community and in hospitals so children have access to high quality care no matter where they live.

Which services should children be taken to first?

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14.15-14.30

Mid Yorkshire Hospitals changed their site-specific service offer

and consolidated all paediatric inpatient beds at one site, complementing with Paediatric Assessment Units at the other sites which are open 12 hours each day. They also implemented transfer protocols to ensure patients flow effectively between sites. This enabled more sustainable rotas and more on-site consultant cover.

What’s working well for others?

Imperial Child Health GP hubs comprise groups of two or three

general practices who work closely with paediatric consultants from a local hospital. The consultants provide training to the GPs as well as a telephone advice line for them when GPs want a second opinion on handling particular issues. This reduces the number of avoidable trips to hospitals.

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13.15-13.30

Please add any ideas to the flipcharts on the wall at the end of the session We want to hear your ideas on how we might solve some of the issues we have talked about today.

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Questions

14.30-14.50

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Summary of next steps and close

Alexandra Norrish, Programme Director

14.50-15.00

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14.50-15.00

We would like your continued input throughout December: we will be getting more ideas from patients and the public, along with looking at the ideas that our clinical working groups have come up with. January - April: we will be working to develop the ideas that have been put forward by the public and clinicians, and will engage with the public as we do this. End April: we will publish the Hospital Services Review report.

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13.15-13.30

Please do add any ideas to the flipcharts on the wall at the end of the session We want to hear your ideas

n how we might solve the

problems we have talked about today.

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