East Midlands High Impact Change Model (HICM) Event 4 October 2018, 09:30-13:00 Yew Lodge Hotel, Kegworth
Purpose of the Event • To discuss and share innovative practice in implementing the model • To explore some of the opportunities and barriers to using various aspects of the model • To contribute towards a refresh of the model for 19/20
Local Context / East Midlands Journey Ruth Lake - Regional Admissions Avoidance and Discharge Network Chair, ADASS East Midlands
East Midlands Regional Overview Ruth Lake Admissions Avoidance and Discharge Network Chair
East Midlands Journey HICM Engaged Improving Home First Progress Being able to tell our story
Delayed Transfers Average Daily DTOC Bed Days / 100 000 National 16 14 12 10 8 6 4 2 0 All Jul 17 All Jul 18 ASC Jul 18
High Impact Change Progress HICM * * * * * HF / D2A TA Not yet started Plans in place Established Fully Mature * Exemplary but not fully established
Regional AA&D Priorities • Reducing avoidable admissions to hospital and long term care • Maximising the impact of social work at the acute front door • Maintaining / improving DTOC • Progress on HICM • Supporting best practice • Meeting national expectations (LOS, BCF) • Being prepared for winter • IPC • Care Homes
MC1 National Overview of DTOC/Patient flow Liz Sargeant - Clinical Lead, Emergency Care Intensive Support Team
Slide 9 MC1 LOGOS MacGregor, Calum, 12/09/2018
A ‘delayed transfer of care’ occurs when a patient is ready to leave a hospital or similar care provider but is still occupying a bed. Behind every Delayed Transfer of Care, there is a person, in the wrong place at the wrong time
DTOC – the story so far DTOC has been a persistent problem over many years (national reports into DTOC since early 2000s) More recently…. National Audit Office Report (2015) - Discharging older patients from hospital • – 5% muscle strength that older people can lose per day of treatment in a hospital bed – £820m gross cost to the NHS of older patients in hospital beds who are no longer in need of acute treatment. • National Strategy to address DTOC Care Act (2014) – • Legislation outlining LAs duty in relation to assessing people’s needs and their eligibility for publicly funded care and support BCF National Conditions (New condition 4 (2017) – • Requirement for Social Care to work with NHS to implement High Impact Change Model to manage delays in transfer of care (expectations published) • iBCF monies NHS Five Year Forward View Next Steps – • Mandate for NHS to work with Social Care to reduce DTOC CQC Local System Reviews (interface of Health and Care) – – Increased collaboration centrally between national partners • Delayed Discharge Programme Board - Strategic (DHSC, NHSE/I, LGA, ADASS, MHCLG, CQC, BCST • Discharge Steering Group - Operations (NHSE/I, DHSC, LGA ADASS, BCST, MHCLG)
DTOC – the story so far • There has been significant improvement in DTOC over the past 18 months in the face of persisting challenges (workforce, finances/austerity, commissioning – complexity) • By far, the most critical and important work has come from YOU (frontline colleagues) Joint 7,000 6.0% Social Care NHS 6,000 % of occupied consultant-ld beds 5.0% Total Ambition Number of delayed days 5,000 4.0% 4,000 3.0% 3,000 2.0% 2,000 1.0% 1,000 0 0.0% Underpinning the data are numerous examples nation-wide, of health and care colleagues going above and beyond the call of duty, working together to ensure patients are not delayed unnecessarily in hospital – THANK YOU!
DTOC – the story so far Despite the significant progress… - 4500 patients still in hospital every day (who don’t need to be there) - we have to keep up the work nationally, locally and individually. Nationally - a focus now beyond DTOC to reducing delays through out the entire patient journey • Ambition to reduce DTOC to 4000 beds by the latter part of 2018 • Ambition to reduce extended length of stay • Provide support to local systems
National Support Providing support to systems so that people get the right care, right place and right time and encouraging the development of home first principles Programmes 1. Enhanced – 14 system reviews across 9 areas to really understand why transfers of care remain a challenge 2. Targeted – Tailored Peer Reviews to meet the needs of the system 3. Universal – HICM regional events, Learning from CQC events, Why not home, Hospital Discharge/Home First Practitioner Events Tools (Links included) • Better Care Exchange / Bulletins • LGA Guidance documents • Webinars • DTOC Improvement tool (NHS Improvement) • Quick Guides (NHS Improvement) • HICM (see next slide)
High Impact Change Model • It was developed by national partners in 2015 to promote a new approach to system resilience and year around planning for timely discharge • The model identifies eight system changes which will have the greatest impact of reducing delayed discharge Why refresh the HICM • To take account to new national guidance, address persistent implementation challenges and align guidance to reducing extended length of stay, improving patient flow and early intervention and prevention agenda.
Understanding what works • We are keen to understand and collect an evidence base on what works and why some areas are challenged than others. • We know that local leadership and collaborative working, investment in workforce and investment do have a role to play. • We are also keen to explore whether a combination of national, local and regional support in this area works best
MC1 Trusted Assessment – Overview of national position John Woods - Social Care Lead, NHS Improvement
Slide 17 MC1 LOGOS MacGregor, Calum, 12/09/2018
Trusted Assessments John Woods Improvement Manager (Social Care)
Why Have a Trusted Assessor? Trusted Assessor or Trusted Assessment? Agenda. Do you need a T A? Getting Going / Checklist Myth Busting 19 | Presentation title
Its number 6 in the 8 High Impact Changes. NHS England, NHS Improvement, The Department of Health and Matt say you should. Why have They will count towards performance targets. a Trusted Assessor The lack of them could effect your budget. None of the above – even if they are true. 20 | Presentation title
. 21 | Presentation title
• A person carrying out an assessment on behalf of a third party • A person working for & employed by the Independent Care Sector (ICS) who’s primary role is carrying out assessments to allow for prompt discharge to care and support in the community inc’ at home • A person employed by the Health or Social Care who’s primary role is carrying out What is A assessments to allow for prompt discharge to care and support in the community inc’ at home Trusted • A person employed by Health or Social Care who’s primary role is associated with Assessor managing discharges from hospital and in addition can carry out assessments to allow for prompt discharge to care and support in the community inc’ at home. • A Trusted Assessor completes a bespoke and agreed assessment for a specific purpose. Presentation title 22 |
• Using an assessment that was designed for one purpose to serve another. • A assessment carried out during the course of someone's treatment in hospital that is subsequently accepted and used for a different purpose e.g. • A physiotherapist or Occupational therapist assessment used to support acceptance , upon What is A referral of someone into a discharge support service e.g. discharge to assess Trusted • A ward nurse assessment being used to commission and start a community health package. Assessment • A Dr’s report being used to start an interim support package from Adult Social Care • A Trusted Assessment is completed for one purpose but also used for a second purpose with the agreement of both parties. Presentation title 23 |
• Transfers from hospital to an existing support package. • Transfer of patients to an interim support package e.g reablement or intermediate care. When & • New admissions to residential care & New packages of domiciliary support. Where • Care Act Assessments. • Assessments for occupational therapy equipment. • Anywhere else you want to chase delays out of a process Presentation title 24 |
Do you have delays in getting NO , pat yourself Yes then assessments e.g. on the back and go to next ASC, D2A, HBC carry on doing question. completed. (not what your doing just DTOC) How Do Is it because the process you Know is complicated and drawn out e.g. requires sign offs a TA is Why is there a from managers off site. If delay? so, consider a process redesign workshop what you perhaps using process mapping. need? Is it because the Is it because the assessor’s situation or assessment tool itself is workload is such they cannot carry out cumbersome and the assessment when required. If so, unwieldy? If so hold a then you should consider a trusted redesign workshop. assessment/assessor. 25 | Presentation title
Recommend
More recommend
