ancashire County Council Health Scrutiny Committee r Health Our Care Programme Update esday 3 rd July tacts: ior Responsible Officer: Programme Director: Director of Quality & Performance: TU Director: eraldine Skailes Sarah James Helen Curtis Lee Hay eraldine.Skailes@lthtr.nhs.uk Sarah.james@lthtr.nhs.uk helen.curtis15@nhs.net lee.hay@nhs.net
ntroduction he purpose of the session is to: Set the context for the Our Health Our Care Acute Sustainability Programme Briefly update on each of the workstreams Present the Clinical Case for Change Present the programme timeline Discuss the emerging Model of Care Agree next steps
Our Health Our Care Strategic Objectives: To develop a more person-centred approach to health and • social care, increasingly delivered within community, locality home setting where appropriate. To develop new models of health and social care for our loca • health economy, rebalancing the provision of services to reduce overdependence on acute hospital provision To encourage and enable people to take responsibility for sel • management of their care with support from services to improve their health, wellbeing and quality of life To develop new models of health and care that are clinically • r Health Our Care Workstreams and financially sustainable for the future and able to provide quality services that are safe, accessible, responsive and coordinated. Acute Sustainability (formerly ‘Hospital Care’). To create models of care which will work within an integrated • health and care system , tailored to the needs of our Locality Care (Out of Hospital Care) population and delivered in the right place at the right time. To ensure the process is clinically led and that new models of • Prevention, Early Help and Self Care care are co-designed with the public, patients and partner organisations
Out of Hospital and Prevention A key aim of Our Health Our Care is to ensure patients only have to access in-hospital services when absolutely necessary. The Out of Hospital strategy aims to deliver: • Primary Care at scale • Integrated care teams • An accountable Care System that ensure integration and cohesion across health and social care Delivery of a Prevention and Early Intervention Framework to deliver a system-wide commitment to prevention utilising all resources to enable and maintain physical and mental wellness and build resilience and aid recovery
cute Sustainability ase for Change resents the local picture in terms of population emographics, prevalence of disease and tivity impacts and pressure points. ocusses on key specialty areas: • Urgent & Emergency Care • Acute Medicine • Critical Care • Planned Surgery Performance tablishes the key drivers for change
cute Sustainability Key Drivers for Change ase for Change 1. Changing population demographics resents the local picture in terms of population 2. Health Inequalities emographics, prevalence of disease and 3. Limited workforce tivity impacts and pressure points. 4. Bed occupancy 5. Variation in meeting standards ocusses on key specialty areas: 6. Decrease in planned surgery • Urgent & Emergency Care • Acute Medicine • Critical Care • Planned Surgery Performance tablishes the key drivers for change
cute Sustainability Key Drivers for Change ase for Change 1. Changing population demographics resents the local picture in terms of population 2. Health Inequalities emographics, prevalence of disease and 3. Limited workforce tivity impacts and pressure points. 4. Bed occupancy 5. Variation in meeting standards ocusses on key specialty areas: 6. Decrease in planned surgery • Urgent & Emergency Care Number of people • Acute Medicine • over the age aged 6 • Critical Care set to increase by • Planned Surgery Performance 33,000 by 2037 tablishes the key drivers for change
cute Sustainability Key Drivers for Change ase for Change 1. Changing population demographics resents the local picture in terms of population 2. Health Inequalities emographics, prevalence of disease and 3. Limited workforce tivity impacts and pressure points. 4. Bed occupancy 5. Variation in meeting standards ocusses on key specialty areas: 6. Decrease in planned surgery • Urgent & Emergency Care In Preston 37% of t • Acute Medicine • population live in th • Critical Care 20% most deprived • Planned Surgery Performance areas in England tablishes the key drivers for change
cute Sustainability Key Drivers for Change ase for Change 1. Changing population demographics resents the local picture in terms of population 2. Health Inequalities emographics, prevalence of disease and 3. Limited workforce tivity impacts and pressure points. 4. Bed occupancy 5. Variation in meeting standards ocusses on key specialty areas: 6. Decrease in planned surgery • Urgent & Emergency Care Large gaps in medic • Acute Medicine • staffing within the • Critical Care Emergency • Planned Surgery Performance Department tablishes the key drivers for change
cute Sustainability Key Drivers for Change ase for Change 1. Changing population demographics resents the local picture in terms of population 2. Health Inequalities emographics, prevalence of disease and 3. Limited workforce tivity impacts and pressure points. 4. Bed occupancy 5. Variation in meeting standards ocusses on key specialty areas: 6. Decrease in planned surgery • Urgent & Emergency Care Average bed • Acute Medicine • occupancy above th • Critical Care national average an • Planned Surgery Performance above the recommended rate tablishes the key drivers for change 85%
cute Sustainability Key Drivers for Change ase for Change 1. Changing population demographics resents the local picture in terms of population 2. Health Inequalities emographics, prevalence of disease and 3. Limited workforce tivity impacts and pressure points. 4. Bed occupancy 5. Variation in meeting standards ocusses on key specialty areas: 6. Decrease in planned surgery • Urgent & Emergency Care A&E 4-hour • Acute Medicine • performance at 60% • Critical Care against the standar • Planned Surgery Performance of 95% tablishes the key drivers for change
cute Sustainability Key Drivers for Change ase for Change 1. Changing population demographics resents the local picture in terms of population 2. Health Inequalities emographics, prevalence of disease and 3. Limited workforce tivity impacts and pressure points. 4. Bed occupancy 5. Variation in meeting standards ocusses on key specialty areas: 6. Decrease in planned surgery • Urgent & Emergency Care LTH had the second • Acute Medicine • lowest score in • Critical Care England for patient • Planned Surgery Performance satisfaction with Access and Waiting tablishes the key drivers for change Domain in the 2016/17 A&E surve
cute Sustainability Key Drivers for Change ase for Change 1. Changing population demographics resents the local picture in terms of population 2. Health Inequalities emographics, prevalence of disease and 3. Limited workforce tivity impacts and pressure points. 4. Bed occupancy 5. Variation in meeting standards ocusses on key specialty areas: 6. Decrease in planned surgery • Urgent & Emergency Care High cancellation • Acute Medicine • rates due to lack of • Critical Care critical care bed • Planned Surgery Performance impacting Cancer waiting times tablishes the key drivers for change
cute Sustainability ase for Change Concludes a compelling case for change Based on evidence Supported by clinicians Approved by the system
cute Sustainability Programme Timeline Current Stage: Delivered the Clinical Case for Change • Currently testing and informing the clinically led Model of Care with stakeholders • Baseline modelling • Governance refresh including decision making matrix • Planning for Clinical Senate Visit July 2018 and NHSE Assurance 3 rd July 2018 • Communications and engagement planning •
eveloping the Model of Care Acute Medicine Speciality M Emergency Department Critical Care Surgery Establish Clinical Subgroups Dr Lee Helliwell Dr Somnath Dr Michael Stewart Dr Huw Twamley Tracy Earley •A&E •High volume, •Critical Care •Acute Medical •High acuity impact speci Provisions <72hrs elective provision •Urgent Care Treatment •HDU Workshops 1 & 2 outpatient Centre(s) LOS •Low acuity, high •PACU provision •Ambulatory Care volume elective •Clinical Decision Unit development •High volume, provisions •Signposting of urgent •Medical impact speci Assessment Unit •Outpatient and emergency care inpatient pa needs pathways & •Frailty and flow diagnostic links Assessment Unit Clinical discussion development •Surgical Assessment Unit development Clinical Co-dependencies – Professor Mark Pugh Workshop 3 Initial work to identify: • Scope Further Clinical discussion • Existing service provision • Evidence base, standards and identification of best practice • Plan for workshops & engagement with clinical and managerial staff Workshop 4
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