Healthy Staffordshire Select Committee Community Hospitals and - - PowerPoint PPT Presentation

North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group 1 North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

Healthy Staffordshire Select Committee Community Hospitals and Discharge to Assess North Staffordshire and Stoke on Trent CCGs 7th August 2017

North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

Why make the changes?

• Increase in the elderly population will continue.
• The current process where hospital discharge is delayed results in progressive harm

to older people with frailty.

• More patients going into 24 hour care as they have not had the opportunity to go

home earlier in their hospital journey.

• Current system configuration conspires to create a sub-optimal clinical experience.
• Delays cause patients to decompensate and in many cases, acute and community

beds have become waiting rooms with unacceptably long waiting times for the right service.

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Benchmarking of Beds

• North Staffordshire and Stoke on Trent historically had three times as many community

beds per capita as the national average, spent three times as much and had three times as many admissions.

• North Staffordshire and Stoke on Trent benchmarked for the population of c.500,000, should

have no more than 128 Intermediate care.

• The area had 244 intermediate care beds in community hospitals, peaking at 362 community

beds in total in 2014/5 with additional beds in care homes.

• There are currently 175 beds commissioned which still leaves Northern Staffordshire as a

significant outlier against national benchmarked levels.

• KPMG analysis of the local system was over reliant upon beds and made recommendations

to close at least two sites in 2014.

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National Clinical Evidence

• ‘It has been estimated that 10 days of bed rest for healthy older people can equate to 10

years of muscle ageing’. National Audit Office – Discharging Older people

from Hospital (2016)

• ‘D2A is a cornerstone of modern care for older, vulnerable people. Time is everything to

people with frailty. People with frailty do not bounce back quickly from illness or accidents. They need time and support in the right place to enable them to recover. The last thing a person with frailty needs is to be kept waiting unnecessarily in hospital for an assessment to get access to care and support’. Professor Martin J Vernon (2016)

• By October 2017 every local health system must have adopted good practice to enable

appropriate patient flow, including better and more timely hand-offs between their A&E clinicians and acute physicians, ‘discharge to assess’, ‘trusted assessor’ arrangements, streamlined continuing healthcare processes, and seven day discharge capabilities’. 5 Year

Forward View (2017)

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National Clinical Evidence

• Local Government Association – High Impact Change model (2017) – Managing Transfers of

Care between hospital and home clearly articulates the benefits to patients through the implementation of D2A.

• ‘…improving support for older people in their homes—either to prevent hospital admission (or

readmission) or making discharge easier when the patient is ready to leave hospital, is crucial to manage patient flows in acute hospitals and ultimately to delivering good patient care’. Public

Accounts committee (2015)– Discharging People from Acute Hospitals

• ‘New figures published since the report was finalised show that the number of patients medically fit

for discharge but stuck in hospital has reached record levels …. it imposes a significant human cost on the patients and families affected. King's Fund response to the PAC report on discharging

• lder people from hospitals (2015)
• Evidence demonstrates that people recover more quickly when they are at home or an appropriate

care home environment as opposed to a hospital ward, with their own clothes and personal items and a sense of independence and if required, rehabilitation, reablement and care packages that support their recovery. ECIP evidence (2016)

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Local Clinical evidence

• Points Prevalence study undertaken within community hospitals demonstrated only

9% of inpatients should have been there and the rest required nursing home or care within their own homes.

• Review of Local Health Economy identified that there was a requirement to markedly

reduce the need for bed based solutions by the prevention of ‘in hospital deconditioning’ in order the release resource to enhance care within patients own

• homes. Dr Ian Sturgess report (2014)
• Individual patient examples identified through MDTs.
• ECIP have worked closely with the Local Health Economy and are fully supportive of

the work undertaken to deliver the new model of care from a clinical and operational perspective.

• Full clinical sign up across the acute, community and mental health trust and support

from general practice.

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Current Position

• 168 community hospital beds temporarily closed to new admission across three hospital sites.
• Plans in place to fully roll out Discharge to Assess across Northern Staffordshire by the 1st

September 2017 resulting in a requirement for fewer beds and increased home based services.

• Investment has been released to support the increase in Home First services on the back of

temporary bed closures.

• Full clinical sign up across the Local Health Economy for the model of care.
• Full support from NHSE and NHSI on the model of care.
• Public consultation and subsequent engagement on My Care, My Way – Home First undertaken

during 2015 and 2016.

• QIA and EIA completed.

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How will we deliver the shift to home first?

• Track and Triage will replace the assessment functions on the acute site.
• Will track patients from entry to end of D2A and support a pull function once patient is

MFFD.

• Clinical triage will ensure that patients move to the right service based on health and

social care. needs with moves to beds as exceptions – Home First as the first option at all times.

• Will work with patient flow staff to ensure flow and patients moving to the right place

first time.

• A seven day function – will cover the whole of UHNM footprint.

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Investment made

Full roll out of D2A Services commissioned Financial value Capacity Home First Service - Intermediate care, Enablement, Palliative Care and Night support Service £12,300,000 5203 hours a week Bed base Haywood 7,218,007 £ 57 beds Farmhouse 180,700 £ 5 beds Hilton 325,260 £ 9 beds Hilltop 780,000 £ 20 beds Ward 4 model 1,600,000 £ 19 beds Therapy and medical cover 200,000 £ Stadium 1,200,000 £ 33 beds Total invested 23,803,967 £

North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group 10 North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

When did we ask? How did we ask?

• Phase 1 Nov 2015 – March 2016 Consultation on Model of Care –

Home First principle

• Phase 2 Nov 1016 – Dec 2016 – Engagement on Community Beds
• Ongoing dialogue with HOSCs & politicians
• Ongoing dialogue at A&E Delivery Board, D2A Steering Group &

Implementation Group

• Case for change and public briefing documents
• Briefings with local stakeholders, MPs and councils
• Sought the views of public & patients via 2 electronic surveys
• Phase 1 - 24 awareness events to seek the views of local people
• Phase 2 - a further 5 public events independently chaired by Healthwatch
• Meetings with Oversight and Scrutiny committees, patient groups, voluntary sector groups

and primary care localities

• Discussed the plans on local radio to spread awareness and seek responses
• Patient Congress
• Vlog to set the context on social media and website
• Websites featured the proposals and access to the online survey
• Healthwatch conducted own survey engagement

What did They say? Where are we now?

• Patients benefit from being - and prefer to be - at home
• Support for the proposed model of care in principle
• People wanted assurance there is capacity in community services to

support the model

• Uncertainty about the future of community hospitals
• Support for every spouse/family/carer
• Sought reassurance that the new model will be carefully implemented

and patient safety would be a priority

• Wanted to know investment would be in place
• Mythbuster published to dispel some myths and provide reassurance
• All feedback published following independent analysis and questions answered online on

CCGs websites.

• Ongoing dialogue with clinicians, politicians, patients and public
• Secretary of State referrals
• Concern about perceived community hospital ‘closures’
• ‘Save Bradwell Hospital’ and Save ‘Leek Hospital’ campaign groups
• Purdah since February has prevented meaningful dialogue

There is an urgent need to re-engage and move forwards

Engagement So Far

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Benefits for our population?

• Health outcomes improve as more people will be able to live at home for

longer.

• Length of stay in a hospital bed reduces due to longer-term assessments

taking place in a more appropriate situation and place.

• Evidence suggests this should reduce deconditioning caused by long stays in

hospital.

• Reduces duplication and unnecessary time spent by people in the wrong

place.

• Encourages integration of health and social care.
• Improves system flow by enabling patients to access urgent care at the time

they need it.

North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

Where are we now?

• The successful implementation of Discharge to Assess (D2A) is already providing evidence that

the AIRS beds are no longer required

• More people home, far fewer into beds, less beds needed
• There will still be some community beds
• Reduced requirement for social care on discharge from D2A.
• Other community hospital services remain open
• We have clinical and partner support for the model
• This is an opportunity to co-design the provision of local health services
• We desperately want to start consultation: subject to NHS England approval
• 4 New tests
• Clinical Senate has approved the model
• Regional Strategic Sense Check
• National Strategic Sense check

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The questions we want to ask

• What services do the local populations want to see in their locality?
• Are the services in place that you need?
• Are there any essential services missing?
• Are there better ways to deliver services within the locality?
• For more specialist services, could these be delivered from elsewhere?
• How far would you be willing to travel for specialist services?
• Are there any services that you feel that the locality does not need?

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North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

How we want to ask

• Events
• Surveys
• Social media
• Face to face meetings and briefings
• Overview & Scrutiny Committee will be consulted and involved

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