Add BUSINESS CASE FOR LEVEL 2 SPECIALIST NEURO-REHABILITATION BEDS : SLIDE PACK & FINANCIAL MODEL V8 June 2015 1
Add Index • Executive summary Slides 3 - 5 • Business Case on a Page Slide 6 • Model methodology Index/ Summary Slide 7 A. Methodology for calculating DTOC, beds and costs: Slide 8 1. Nos. of Neuro Rehab patients experiencing DTOC Slide 9 2. Nos. of required Neuro Rehab beds Slide 10 3. Cost of Level 2 Neuro Rehab beds Slide 11 • Summary methodology for investment Slide 12 B. Benefits Methodology – Steps: Slide 13 1. Calculate # of Neuro Rehab patients experiencing DTOC per provider Slide 14 2. Calculate average bed days lost per DTOC Slide 15 3. Summary of benefits - Neuro-rehab DTOC Slide 16 Summary of Benefits – ongoing care 4. Slide 17 • Funding Arrangements – Options Appraisal Slide 18 to 31 2
Executive Summary: introduction Add Specialist rehabilitation is the total active care (assessment, treatment and management) of patients with a disabling condition, and their families, by a multi-professional team who have undergone recognised specialist training in rehabilitation, led /supported by a consultant trained and accredited in rehabilitation medicine (RM). (Professor Stokes- Turner 2010). This summary slide sets out the business case and financial modelling for the commissioning of additional capacity for Level 2 Specialist Neuro-Rehabilitation Service (SNRS). The identified capacity resource needed to meet current recognised need is equivalent to a total of 19 SNRS Level 2 beds. The proposed service model will provide a more flexible model of bed based and non-bed based/specialist outreach service to meet the varying needs for specialist neuro-rehabilitation for either bedded or community based interventions – linking both acute and community pathways. The business case has identified that meeting this recognised need will result in immediate clinical and economic outcomes for patients across West London, Central London and Hammersmith and Fulham CCGs, namely: • Provide positive patient experience by substantially reducing unwarranted delay to their next phase of care • Reduce additional cost in the acute hospital costs associated with increased length of stay in hospital • Measurable improvement in patent outcomes due to improved functional gain as a result of timely interventions and reductions avoidable complications; • Quantifiable reduction in long-term (continuing care) costs due to a measurable reduction in the person’s weekly on-going care costs. • Supporting transitions in care back to localities following rehabilitation. 3
Executive summary: demand & capacity Add Currently state: • 10 commissioned SNRS block beds across the Triborough. This is currently being provided at the Albany Unit, Queens Square, London and provided by the University College of London Hospitals Foundation Trust (UCLH). • Significant and increasing Delayed Transfers Of Care (DTOC) in hospitals – 6 to 10 weeks • DTOC not only impacts on patient experiences of care, but also reduces the benefits to be gained from early intervention on reducing dependency levels • Ad hoc out of area spot purchasing , and lost of opportunity in enhancing clinical outcomes and reducing longer term cost for on-going care. Future state: Financial Model quantifies the capacity and investment required to provide a clinical and cost efficient model of care which will significantly reduce: • DTOC pressures and acute bed days lost for this patient cohort by 85% • Reduce dependency levels leading to reductions in on-going care costs by atleast £481 per week per patient . This is a first step in understanding and monitoring demand and capacity required for this cohort of patients. This is due to lack of complete data. However there is sufficient data set on neuro-rehab demand and delays to analyse, extrapolate and to make an informed estimation on current demand. This is explained in slides 7 and 8 onwards. 4
Add Executive summary: engagement & recommendation The Business Case for additional capacity has been determined through extensive sector work - coordinated through Imperial College Health Partners (ICHP) – the designated regional clinical and academic science network involving: • Patients and their families/carers, and representative groups e.g. Health Watch • Clinical input from a range of clinicians, practitioners and managers across Acute Hospital Trusts, Clinical Commissioning Groups, Community Health Care providers, • Adult Social Care, and Third Sector (Headway) The following four options were examined in the business case are: • Do nothing and maintain the status quo; • Commission 19 additional SNRS beds resource to provide both a bedded and non-bedded/ Community Outreach model of care within the Triborough CCGs areas; • Commission 19 additional SNRS beds within the Triborough area plus the 10 beds currently at the Albany Rehabilitation Unit; • Undertake a whole service redesign of the full care pathway. This business case recommends option 2 – to commission additional capacity equivalent to 19 SNRS Level 2 beds resource to meet the current and future demand requirements. This will ensure the provision of flexible model of care to meet the varying needs for specialist neuro-rehabilitation . 5
Business Case on a Page – patient flows Add Black arrows show current flows for most patients requiring bedded Neuro-rehab Increased Longer LOS Longer waits in dependency & Reduced outcomes Hospital for limited avoidable Out of Area Level 2 complications provision Long-term care in Independent Hospitals Reduced wait & Timely transfer Local level 2 Specialist Long Acute Transfer to local community based Neuro-Rehab Service Hospital stays Specialist Neuro-Rehab Outreach (SNRS) Beds Service (SNROS) Level 2 Reduced dependency & improved outcomes Home Nursing Home Community Independence Services (CIS) and Community Rehab Teams (CRTs ) Key: Local Communit y Hospita l Existing flows to reduced benefits = costs Neuro Nurs/Res Care New flows to increase benefits = reduce costs CIS/CRTs Rehab 6
Model Methodology – Index / Summary Add Costs Benefits Neuro Rehab Neuro Rehab Neuro Rehab Neuro Rehab 1 DTOC patients DTOC patients DTOC patients DTOC patients (ICHT) (Chelwest) Required Level Average Bed days 2 2 Beds lost per DTOC Cost of Neuro Savings from avoiding a 3 Rehab Level 2 DTOC (DTOC cost Bed reduction) Savings in Long-term care 4 costs (weekly) Financial Summary 7
Methodology for calculating – DTOC, beds & costs Add Calculate the Data sources : number of neuro • ICHT DTOC data (13-14 1 rehabilitation DTOC and 14-15) • National DTOC data patients Commissioner Calculate required Assumptions: number of neuro 2 • Bed occupancy rates rehabilitation beds • LOS Benchmarking Calculate the cost of analysis ARU Contractual a Level 2 neuro 3 • National Tariff value (10 beds) rehabilitation bed • Level 2 Guide base rates • OBD shadow tariff (Putney) 8
1) Calculating the number of Neuro rehabilitation Add DTOC patient numbers *34.6% calculated from comparing total number of Neuro ICHT Neuro Rehab DTOC Data Rehab DTOCs from ChelWest to those from ICHT based on (13/14) 2013/2014 data and methodology. Imperial Chelwest • Imperial Neuro-Rehab DTOC patients 13/14 – 81 81 28 • Chelwest Neuro-Rehab DTOC patients 13/14 - 28 *34.6% • Calculation : 81/28= 0.346 (34,6%) ICHT Neuro Rehab DTOC Estimated ChelWest 14/15 Patients Data (14/15) Neuro Rehab DTOC patients (prorated for full year) Chelwest Imperial 26 77 Extrapolated using monthly averages Total Triborough Estimated ICHT Neuro Rehab DTOC Neuro Rehab DTOC Patients Patients Data (8 months 14/15 in 14/15) Imperial Chelwest Key: Imperial 77 26 Assumption 51 Total: 103 Known Data 9
2) Calculating the number of neuro rehabilitation beds required to reduce DTOC’s Add *LOS and occupancy rate : Standard Occupancy rate assumptions for Level 2 bed unit, based on Albany Unit information – provided by Ray Boateng Neuro Rehabilitation Length of Stay Target bed occupancy Neuro Beds required DTOC (2014/15) rate 103 56 85% 19 (18.6) Calculation: Key: • ((Total neuro rehab DTOC’s* LOS)/ Target Occupancy)/365 Assumption • ((103*56) / 85%)/ 365 Known Data 10
Add 3) Calculate the cost of a Level 2 Neuro-rehab bed Average benchmark analysis - £3,605 per week: • Calculating the average cost of current provision and 14-15 national tariff plus MFF: National tariff (£3,715 per week) • Hospital based Level 2 beds guide base rate (Hillingdon Hospitals – Alderbourne and Mount Vernon units, Albany unit £2,741 per week) • Occupied Bed Day for Independent hospital (Putney) - £4,359 per week The average cost provides basis for market testing. Commissioning envelope - £3715 per week Recommended that the commissioning investment based on conservative scenario to be based National Tariff Plus MFF. Therefore commissioning financial envelope: • 19 beds x £3,715 weekly bed cost x 52 weeks = £3,591,340 • Weekly rate per bed = £531 11
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