North Staffordshire Clinical Commissioning Group North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group Healthy Staffordshire Select Committee Community Hospitals and Discharge to Assess North Staffordshire and Stoke on Trent CCGs 7 th August 2017 1
North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group Why make the changes? • Increase in the elderly population will continue. • The current process where hospital discharge is delayed results in progressive harm to older people with frailty. • More patients going into 24 hour care as they have not had the opportunity to go home earlier in their hospital journey. • Current system configuration conspires to create a sub-optimal clinical experience. • Delays cause patients to decompensate and in many cases, acute and community beds have become waiting rooms with unacceptably long waiting times for the right service.
Benchmarking of Beds North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group • North Staffordshire and Stoke on Trent historically had three times as many community beds per capita as the national average , spent three times as much and had three times as many admissions. • North Staffordshire and Stoke on Trent benchmarked for the population of c.500,000, should have no more than 128 Intermediate care. • The area had 244 intermediate care beds in community hospitals, peaking at 362 community beds in total in 2014/5 with additional beds in care homes. • There are currently 175 beds commissioned which still leaves Northern Staffordshire as a significant outlier against national benchmarked levels. • KPMG analysis of the local system was over reliant upon beds and made recommendations to close at least two sites in 2014.
National Clinical Evidence North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group • ‘It has been estimated that 10 days of bed rest for healthy older people can equate to 10 years of muscle ageing’. National Audit Office – Discharging Older people from Hospital (2016) • ‘D2A is a cornerstone of modern care for older, vulnerable people. Time is everything to people with frailty. People with frailty do not bounce back quickly from illness or accidents. They need time and support in the right place to enable them to recover. The last thing a person with frailty needs is to be kept waiting unnecessarily in hospital for an assessment to get access to care and support’. Professor Martin J Vernon (2016) • By October 2017 every local health system must have adopted good practice to enable appropriate patient flow, including better and more timely hand-offs between their A&E clinicians and acute physicians, ‘discharge to assess’, ‘trusted assessor’ arrangements, streamlined continuing healthcare processes, and seven day discharge capabilities’. 5 Year Forward View (2017)
North Staffordshire Clinical Commissioning Group National Clinical Evidence Stoke-on-Trent Clinical Commissioning Group • Local Government Association – High Impact Change model (2017) – Managing Transfers of Care between hospital and home clearly articulates the benefits to patients through the implementation of D2A. • ‘…improving support for older people in their homes—either to prevent hospital admission (or readmission) or making discharge easier when the patient is ready to leave hospital, is crucial to manage patient flows in acute hospitals and ultimately to delivering good patient care’. Public Accounts committee (2015)– Discharging People from Acute Hospitals • ‘New figures published since the report was finalised show that the number of patients medically fit for discharge but stuck in hospital has reached record levels …. it imposes a significant human cost on the patients and families affected. King's Fund response to the PAC report on discharging older people from hospitals (2015) • Evidence demonstrates that people recover more quickly when they are at home or an appropriate care home environment as opposed to a hospital ward, with their own clothes and personal items and a sense of independence and if required, rehabilitation, reablement and care packages that support their recovery. ECIP evidence (2016)
North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group Local Clinical evidence • Points Prevalence study undertaken within community hospitals demonstrated only 9% of inpatients should have been there and the rest required nursing home or care within their own homes. • Review of Local Health Economy identified that there was a requirement to markedly reduce the need for bed based solutions by the prevention of ‘in hospital deconditioning’ in order the release resource to enhance care within patients own homes. Dr Ian Sturgess report (2014) • Individual patient examples identified through MDTs. • ECIP have worked closely with the Local Health Economy and are fully supportive of the work undertaken to deliver the new model of care from a clinical and operational perspective. • Full clinical sign up across the acute, community and mental health trust and support from general practice.
North Staffordshire Clinical Commissioning Group Current Position Stoke-on-Trent Clinical Commissioning Group • 168 community hospital beds temporarily closed to new admission across three hospital sites. • Plans in place to fully roll out Discharge to Assess across Northern Staffordshire by the 1 st September 2017 resulting in a requirement for fewer beds and increased home based services. • Investment has been released to support the increase in Home First services on the back of temporary bed closures. • Full clinical sign up across the Local Health Economy for the model of care. • Full support from NHSE and NHSI on the model of care. • Public consultation and subsequent engagement on My Care, My Way – Home First undertaken during 2015 and 2016. • QIA and EIA completed.
North Staffordshire Clinical Commissioning Group How will we deliver the shift Stoke-on-Trent Clinical Commissioning Group to home first? • Track and Triage will replace the assessment functions on the acute site. • Will track patients from entry to end of D2A and support a pull function once patient is MFFD. • Clinical triage will ensure that patients move to the right service based on health and social care. needs with moves to beds as exceptions – Home First as the first option at all times. • Will work with patient flow staff to ensure flow and patients moving to the right place first time. • A seven day function – will cover the whole of UHNM footprint.
North Staffordshire Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group Investment made Full roll out of D2A Services commissioned Financial value Capacity Home First Service - Intermediate care, Enablement, Palliative Care and Night support Service £12,300,000 5203 hours a week Bed base Haywood £ 7,218,007 57 beds Farmhouse £ 180,700 5 beds Hilton £ 325,260 9 beds Hilltop £ 780,000 20 beds Ward 4 model £ 1,600,000 19 beds Therapy and medical cover £ 200,000 Stadium £ 1,200,000 33 beds Total invested £ 23,803,967
North Staffordshire Clinical Commissioning Group North Staffordshire Clinical Commissioning Group Engagement So Far Stoke-on-Trent Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group When did we ask? How did we ask? • Phase 1 Nov 2015 – March 2016 Consultation on Model of Care – • Case for change and public briefing documents • Briefings with local stakeholders, MPs and councils Home First principle • Sought the views of public & patients via 2 electronic surveys • Phase 2 Nov 1016 – Dec 2016 – Engagement on Community Beds • Phase 1 - 24 awareness events to seek the views of local people • Ongoing dialogue with HOSCs & politicians • Phase 2 - a further 5 public events independently chaired by Healthwatch • Ongoing dialogue at A&E Delivery Board, D2A Steering Group & • Meetings with Oversight and Scrutiny committees, patient groups, voluntary sector groups Implementation Group and primary care localities • Discussed the plans on local radio to spread awareness and seek responses • Patient Congress • Vlog to set the context on social media and website • Websites featured the proposals and access to the online survey • Healthwatch conducted own survey engagement What did They say? Where are we now? • Patients benefit from being - and prefer to be - at home • Mythbuster published to dispel some myths and provide reassurance • All feedback published following independent analysis and questions answered online on • Support for the proposed model of care in principle CCGs websites. • People wanted assurance there is capacity in community services to • Ongoing dialogue with clinicians, politicians, patients and public support the model • Secretary of State referrals • Uncertainty about the future of community hospitals • Concern about perceived community hospital ‘closures’ • Support for every spouse/family/carer • ‘Save Bradwell Hospital’ and Save ‘Leek Hospital’ campaign groups • Purdah since February has prevented meaningful dialogue • Sought reassurance that the new model will be carefully implemented and patient safety would be a priority There is an urgent need to re-engage and move forwards • Wanted to know investment would be in place 10
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