the care debate: an nhs provider perspective dr ros tolcher chief executive, harrogate and district...
TRANSCRIPT
The Care Debate:an NHS provider perspective
Dr Ros Tolcher
Chief Executive,
Harrogate and District NHS Foundation Trust
National Care Association SymposiumThursday 5th March 2015
The context in which health and social care is provided is changing.
What challenges do we face and how is Harrogate NHS Foundation Trust responding to these?
HDFT provides hospital services, and community services….
Hospitals are facing big challenges due to growing
demand and budget constraints….
Each year, the Trust has more than a million contacts with
patients and their families…….
…..for example during last year
Our surgeons performed 27,500 planned operationsThere were 250,000 outpatient appointmentsOur emergency department and minor injuries unit saw
more than 66,300 people There were 17,700 emergency admissions to the hospitalOur district nurses made more than 90,000 visitsOur health visitors completed more than 110,000 contactsOur podiatry service had more than 100,000 contacts across
the countyWe provided care from around 130 sites as well as in
patients’ homes
The population we provide care for is changing
We have a high proportion of older and very old people
70% of over 65s have one or more LTC
The over 65 population is
growing faster than any other
It is now the norm for people to have multiple long term conditions in
later years
The cost of providing health care is rising, but the funding we receive for care is falling….
£ Cost of care
funding
2010 2015
£30 Billion
So we need to provide more for less…...
How are we doing this?
Healthcare provision has been dominated by primary care (GP practices) and
hospital based care…
???
….even though people’s needs often sit between the two and you can’t easily distinguish between a
health need and a care need
We know that many people could remain safe and well at home with the right support
Approx. one in five admissions to the
hospital are clinically avoidable
….and many people remain in hospital longer than they need to.
Nearly 60% of people in hospital beds could have their needs met
in a non-acute environment
In fact, the people who least need to receive care in an acute hospital bed often stay there the longest
A greater proportion of admissions on Saturdays are avoidable, but these patients go on to have a
longer hospital stay
Many people with ‘avoidable admissions’
have a ‘care need’ rather than a healthcare need
In Harrogate and rural district, health and social care providers are
working together to deliver new models of care…..
……designed more closely around the needs of local people, and
offering better value
Our goal is to deliver a comprehensive, integrated care model where….
• Prevention, self-care and independence are the bedrock
• Peoples’ needs take precedence over organisational boundaries
• Our local health and social care system is clinically and financially sustainable
• People and their carers are partners and are involved in planning their goals and care needs
To do this, we will need to….
• Fill the space between the GP surgery and the hospital with a comprehensive, integrated locally based service including nurses, doctors, social workers, therapists, pharmacists, mental health workers
• The voluntary sector has a big role to play• Enhance health care in-put to nursing and care
homes
To do this, we will need to….
• Work with local patients and their families and carers
• Make better use of technology• Agree a single assessment process and a
single, shared patient record• Invest in more staff working in the community• Manage ‘flow’ through the hospital better• Introduce more Extra Care housing
Putting people at the centre
Community HubSingle point of access
for health, social care and voluntary
sector
Health HubIntegrated health
and social care teams
Step up/step down beds
Emergency hospital beds
Thank you for your attention
Questions and discussion