Governing Body Update: Northamptonshire Urgent and Emergency Care (U&EC) Strategy Sylvia Kennedy Director of Urgent & Emergency Care Nene & Corby CCG Tuesday 19 th July 2016
Northamptonshire U&EC Strategy Our Objective To develop a county wide U&EC Strategy, recognising that local differences/factors and populations may require, in some cases, different approaches to delivery. The Strategy will: • Cover the next 5 years • Include physical and mental health, adults and children • Incorporate health and social care needs • Encompass all parts of the patient pathway and care/support in all settings 2
Northamptonshire U&EC Strategy Planning Principles Key local principles Key national • Patient focussed and whole pathway principles driven • Clinically informed, recognises and makes full use of specialist knowledge and expertise across health and social care • Evidence based, reflects recognised best practice in service delivery • Innovative, ambitious but deliverable • Affordable/ Delivers value for money • Set in the context of national developments, East Midlands Urgent & Emergency Care Network (EMU&EC) and the local STP 3
Northamptonshire U&EC Strategy Planning Process 4
Northamptonshire U&EC Strategy Governance Structure 5
National U&EC Strategy Key Drivers for Change – Current Services • Despite a rise in GP consultations and expansion and usage of alternative urgent care services attendances at A&E departments have not reduced • Growth in U&EC is leading to mounting costs and increasing pressure on resources • Overall the system is fragmented and inconsistent service provision means that patients may not be able to access the most appropriate U&EC service to suit their needs, leading to duplication and over- use of the most expensive services, at significant cost to the NHS • The complexity and fragmentation of the current system poses a significant challenge to service integration, even though networking of services is supported by healthcare professionals • Wide variations in the way information is shared between providers is leading to potential duplication within the system causing delay and poor patient experience. 6
National U&EC Strategy Future Offer – Channel Shift Provide care as convenient for the patient as complexity of their illness allows, in the lowest acuity setting that is appropriate, and at the lowest cost for the NHS “CHANNEL SHIFT” 7
National U&EC Review Future Offer – Clinical Advice and Coordination Future ‘ Integrated Urgent Care’ service – ‘channel shifts ’ Patient calls NHS Patient calls More transfers to 111 clinical hub: 999 - Complexity - Streaming 999 Call-handler NHS 111 Call-handler - ‘Speak to GP’ up to 60% Determining skill CLINICAL groups are ADVICE HUB required in the clinical hub GP, mental health nurse, pharmacist, dental nurse etc % % % % % % Ambulance A&E Primary Care Dental/Pharm Other Homecare 8
National U&EC Review Future Offer – No Consult in Isolation 9
National U&EC Review Regional U&EC Network Priorities 2016-2021 10
Northamptonshire U&EC Strategy Local Profile and Key Drivers for Change (Provisional Analysis) Demand and Activity • Year on year increase in demand (attendances and admissions), further growth predicted over the next 10 years in all age groups, but proportionately greater in age 75+ population • CCG A&E attendance rates per 1000 population are overall below the England average • Attendances where outcome is no investigation or significant treatment is 14.9% KGH and 7.5% NGH (some patients arrive by ambulance) • Over the last 14 months NGH has seen an increase in the number of medium (bands 3) and high (bands 1&2) acuity patients attending and a downward trend in low (bands 4 & 5) acuity patients. At KGH there has been a very slight increase in high acuity patients, no change in medium but a more significant rise in low acuity attendances • Both trusts have very high attendance to admission conversation rates which continue to rise • Both trusts have seen significant rises in zero to one day length of stay admissions. 11
Northamptonshire U&EC Strategy Local Profile and Key Drivers for Change (Provisional Analysis) Emergency Department Flow • Almost all U&EC activity at the Trusts goes through A&E, including GP referred patients • Arrival rates outstrip discharge from A&E between 6am and 2pm and then again late afternoon/early evening • Performance for admitted patients is significantly below the standard • A significant proportion of non admitted patients are discharged within 4 hours, but performance is still below 95%. There are between 7 – 12 % non- admitted breaches • The largest proportion of breaches are in the 60+ patient age bands, approximately 50% of these patients are admitted. 12
Northamptonshire U&EC Strategy Local Profile and Key Drivers for Change (Provisional Analysis) Inpatient Flow • Length of stay for non elective medical and surgical patients is longer than would be expected. Significant numbers of patients stay over 7 days and occupy a high proportion of the total acute beds available. The proportion of beds occupied by patients staying over 30 days is high • The local Delayed Transfers of Care rate is approx. 10% against a national target of 2.5% • Overall admission and discharge numbers on a given day are broadly in balance, except at weekends when discharges are less than admissions • Proportion of discharges achieved by 12 o clock for both trusts is low • Suggests length of stay, discharge rate and time are key drivers of performance rather than insufficient bed base. 13
Northamptonshire U&EC Strategy Local Profile and Key Drivers for Change (Provisional Analysis) Community Support • There is a significant reliance on bedded facilities for rehabilitation and re-ablement rather than a focus on whether patient needs could be met at home with support • For domiciliary care the time from referral to package start can be up to 4 weeks. The number of hours of care required by patients on discharge has increased from an average of 1.2 to 1.7 hours per day. Overall • Resource intensive and expensive U&EC system • Sub-optimal patient pathway impacting on quality of care, outcomes and experience. 14
Northamptonshire Strategy U&EC Vision Right Care, Right Time, Right Place • For those people with urgent but non-life threatening physical, mental health or social needs we must provide highly responsive, effective and personalised services outside of hospital, delivered in or as close to peoples homes as possible, thus minimising disruption and inconvenience for patients, their carers and families. • For those with more serious or life threatening emergency physical or mental health needs we will ensure they are treated in centres with the very best expertise, delivering high quality and safe services in order to optimise patient outcomes and enable as many people as possible to safely return to their own homes. • Ensure delivery of the greatest value from every NHS and Social Care pound invested 15
Northamptonshire U&EC Strategy - Strategic Objectives Self care & prevention Rapid access to Enhanced routine care Rapid and coordinated Emergency and acute care and discharge support Primary and urgent care & crisis Community Care in the community response Enable people to remain well for longer and provide better support for people to self care • Promote and support people to make healthier life style choices • People will be supported to look after themselves when appropriate without needing to access urgent care services. Physical and mental health will have parity of esteem. Help people with urgent care needs get the right advice in the right place, 1 ST time. • People will be signposted to the most appropriate service through a locally focussed and responsive single point of access which incorporates clinical triage. They will be able to choose well and the urgent and emergency care system will be simple for people to navigate. Provide highly responsive, effective and personalised service. • This may be delivered in or as close to peoples homes as possible, or in centres which are able to provide the quality of care you need. • People will have equitable and prompt access to services wherever they are and in whichever care setting they enter the system at. More patients will be treated and cared for closer to home. Ensure people with serious or life threatening needs receive treatment in centres with the right facilities & expertise in order to maximise chances of survival & good recovery • Urgent care services will be consistent and geographic variation will not disadvantage patients. Connect urgent & emergency care services so the system becomes more than the sum of its parts • Urgent and emergency services will be integrated around community footprints. • Urgent and emergency care services will deliver maximum value in terms of outcomes, quality and efficiency 16
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