moving to seven days services in dudley
DESCRIPTION
Paul Maubach, Chief Accountable Officer Dudley CCG. Paul's slides from the presentation at the West Midlands 7 Day Services Event on 11th June, 2014TRANSCRIPT
Moving to 7 Days Services in Dudley
Paul Maubach
Chief Accountable Officer
Dudley CCG
Local Dudley Service Provider
‘Our caring, compassionate and highly experienced staff are available 24 hours a
day where you can be guaranteed of a personal service from the first call. If you
can't get to us don't worry, we will be happy to visit you in the comfort of your
own home’
Deaths by Day in Dudley - 2012
Weekday Deaths Day Count
Average Deaths per
Day
Sunday 400 53 7.547
Monday 411 53 7.755
Tuesday 396 52 7.615
Wednesday 396 52 7.615
Thursday 420 52 8.077
Friday 436 52 8.385
Saturday 398 51 7.804
Grand Total 2857 365 7.827
Strategic Priority
Privileging Population Health and Wellbeing
• Autonomous individuals
– Preventing / resolving dependency
• Registered population
– Aligned, networked service delivery
• Mutual responsibility
– Understanding the value of what we do
– Sharing our social capital as a community
Dudley CCG: context
CCG registered population = 312,000
48 practices
10 single handed practices
Mixture of wards including some in the lowest 20% for most deprived across the country and some in the top 20% of most affluent.
Dudley Health and Social Care Economy – The Opportunity
Unnecessary emergency admissions
Excessive service usage by over 80s
Too many admissions to nursing and residential care
Recognition by partners of the need for a step change in service delivery
Commitment to redesign urgent care
Evidence that 5 day working creates dysfunctional service pressures
7 day services: variation in delivery
-15
-10
-5
0
5
10
15
20
Mon Tue Wed Thu Fri Sat Sun
Average Net flow of Patients (admissions vs discharges)
Post weekend peaks in admissions
Postponement of discharges due to absence of support services – therapy, pharmacy etc..
Unnecessary admissions due to absence of more appropriate primary and community health services
Inconsistency of patient experience and response, 7 days per week
7 Day Response To Avoid…..
Person
GP Practice
Community
Clinical Commissioning
Group
Registered Member
Based in a Locality
Part of a System
Aligned, Networked Population Health and Wellbeing Services
Integration and Better Care Fund
7 day services
Community Rapid
Response Team
OD: Leadership programme
Prevention agenda and tele-health
Risk stratification
Single point of access
Dudley Care Home
programme
Integrated teams
Dudley was successful in applying to be one of the National Early Adopters
Cross health economy working group set up
Working with NHS Improving Quality Team
Three main areas of focus
Mapping of services
Developing community standards
Sharing best practice with other early adopters
7 day services
Community Mental Health Teams: adults
and older people
Palliative care team
Heart failure-joint pathway
with acute
OT
Physio
Care home nurse
practitioners
Stroke
Neurology
Social service teams
SLT
Current 7 day working
From July 2014
Potential to move to 7 days in 2014
MH Crisis Resolution
Community Rapid Response Team
Tele-care services
Dementia Gateways
District Nurses
Current 7 day
working
Intermediate Care
Community Respiratory Team
Virtual ward (Case Managers)
Care home provision
1. Patient experience 2. Integrated team review 3. Information and communication 4. Diagnostics 5. Speed of access and assessment in the
community 6. Mental Health 7. Quality Improvement 8. Palliative and End of Life
Community Standards
Evidence base:-
19,500+ over 65 arrived at ED
14,500 admissions over 65
10,000+ over 75
6,500 admitted for 2 days or less
85% arrived by ambulance
Community Rapid Response Team
Team of 9 Advanced Nurse Practitioners
Integrated with social care assistants and care home nurse practitioners
ANPs take a referral or intercept 999 green code call
Assess, diagnose, initiate treatment, instigate social care package if required and step down to integrated teams
Community Rapid Response Team
Community Rapid Response Team for Older People with Frailty
Integrated with Care Home Nurse Practitioners and Social Care Assistants
PATIENTS
WMAS
NHS 111
GP Out of Hours Community
Nursing Teams
Assessment by ANP or Care Home Nurse Practitioner
Within one hour
Step down to Locality Integrated Teams
Single Point of Access for Advanced Nurse
Practitioner Based at WMAS
Admit to
EAU
- Initiate treatment →
- Initiate care package → up to 7 days (then review)
- Initiate care plan
Practice integrated teams To consist of GP, pharmacists,
community nurses, named social and mental heath workers. To review risk stratification tools and agree a Care Coordinator for complex cases
Locality MDT teams GP Leadership posts in each
locality. Remit of reviewing collective outcomes of all teams in their locality and ensuring pathways to locality to borough wide services function effectively
Service Integration
Over 2,200 residents in nursing and residential homes registered with a Dudley GP
High number of urgent care admissions
Dudley Care Home LES operates to provide proactive care and initiate advanced care plans.
Team of 6 care home nurse practitioners to double in size to be integrated with rapid response team and become a 7 day service.
Dudley Care Home Programme
Community nursing and therapy services have a single point of access
Social services have a single point of access
Both in the same building!
Moving to joining together and include mental health
Single point of access
Develop self care programmes
Develop remote monitoring tools (tele-health)
Increase utilisation of voluntary sector (community link workers)
Social prescribing
Prevention agenda
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f a
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issi
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ACG Probability of Future High Cost
Actual Avg no FHS
Actual Avg no OPAs
Actual Avg no AE Attendences
Risk Stratification
Identification of risk using ACG tool
MDT Care Planning
Care gap
Imperative that community practitioners have access to pertinent information and particularly for a 7 day service when practices are closed.
All practices now on EMIS web
Piloting tablet using ‘Inchware’ technology to access medical information remotely including the ANPs
Mobile technology
Representative approach: Patient perspectives a standard item on the integrated
working group Aim is to capture the actions and improvement that need
to be implemented. Feedback given to the patient, carer or advocate that
provided the story/experience.
Participative approach: Development of systematic tool (PSIAMS) to record the
patient experience of care Enables patient to chart their progress against outcome
goals
Learning from patient experiences
The Overall Purpose is: Improve patient experience, and their health and well being outcomes Improve patient engagement, to increase their autonomy to take control
over their own care. Develop collaborative relationships between patients & integrated teams. To improve collaboration and cross-boundary working between
organisations. To work towards a culture change, that demands values based care, and a
can-do attitude. The Specific task is: To address the issues of complex cases demanding multi-agency
approaches Mutual Networked Leadership, shared population, shared outcomes
Leadership programme
Strategic Priority
Privileging Population Health and Wellbeing
• Autonomous individuals
– Preventing / resolving dependency
• Registered population
– Aligned, networked service delivery
• Mutual responsibility
– Understanding the value of what we do
– Sharing our social capital as a community
Questions?