Local care in west Kent How things are changing
#KMlistens Local care is care not in a main hospital, providing better access to care and support in people’s own communities.
#KMlistens We aim to: • prevent ill health by helping people stay well • deliver excellent care, closer to home, by connecting the care from the NHS, social care, community and voluntary organisations • give local people the right support to look after themselves when diagnosed with a condition • intervene earlier before people need to go to hospital.
What you say you want for local care… • More end of life care and dementia care • More support with healthy lifestyles • Health and social care working together • More services alongside GPs • More services near or in people’s homes • More support for family carers • To see the same person regularly • Faster and easier appointments. 1,925 people 100 people came to responded to listening events in west Kent survey
#KMlistens Your main concerns are • Having to travel further for care • Are there enough staff to go round? • Mental health services and social care • Funding. “Who wouldn’t support better joined up care and more care locally?” To find out what you think, we use: “Good quality social care is so • Listening events important. It has to be equal to the • Online surveys NHS .” • Patient Participation Groups “Expertise will attract expertise • Roadshows and be good for the • Patient and Public Advisory workforce .” Group “The STPs should be screaming for more money .”
Challenges in Kent and Medway Our population is growing About 1.8 million people live in Kent and Medway. By 2031 this number will increase by almost a quarter, + 414,000 compared to 2011 By 2031 More people have long-term conditions like diabetes, lung and heart disease 1 in 4 people in Kent and Medway will have a mental health problem at The number of people some point over the age of 70 will rise by 20% in the next 5 years
Challenges in Kent and Medway As many as four in 10 emergency Evidence shows that every day admissions to hospital around 1,000 people in Kent and could be avoided if Medway are in a hospital bed the right care was when they no longer need to be available in the community We have real challenges recruiting enough GPs and practice nurses Find out more about the challenges we face in our case for change booklet: www.kentandmedway.nhs.uk
Prevention – we will: 8 • Help you to improve your health by providing integrated support that works with you • Use every contact with you to check how you are, training health, care and public sector professionals to give you tailored advice • Help you quit smoking • Help you live well with your health conditions such as diabetes • Help you if your health problem flares up making sure you know what to do • Encourage you to get into the best possible shape before surgery.
8 Everyone has a role to play Self care is: “The ability to live with my condition in my own way , with the best possible support and information , so I can make my own medical and lifestyle choices : my life, in my hands, with the best possible support to help me.”
Our foundation for local care Local care in west Kent has four different levels: General practices Clusters – groupings of GP practices working together Local care hubs West Kent-wide services .
Even better care provided by your GP practice • Strong and resilient general practice at the heart of local care • Working differently through better use of technology • We are already looking at workload and workforce • We are supporting practices to co-operate, collaborate and combine.
Evening and weekend GP appointments By March 2019: • Both pre-booked and same day appointments until 8pm Monday to Friday • Saturday and Sunday opening as needed • We will develop plans with our practices and seek feedback from patients. 54 of our 60 practices currently offer some appointments over and above ‘core hours’
Changing patient care by working together • We have seven GP clusters serving between 46,000 and 82,500 people each – with clinical leadership in place • Each will have a team of health and care professionals - for example, community nurses and therapists, mental health workers, social care, pharmacists • The team’s focus is keeping people with more complex needs well at home and supporting them after a hospital stay.
#KMlistens Mental health Mental health is as important as physical health and we need to do more to join up services. We will: • Deliver rapid access to individuals and their families during their first episode of psychosis • Include more liaison psychiatry in all acute emergency departments • Transform children’s services and improve the transition between children’s and adult services • Improve prevention and early intervention • For women, babies and families , deliver screening, assessment, intervention, training and support during their physical and mental health journey.
Changing social care – joining up with local care – focused on your outcomes Information and Advice Safeguarding Care Navigation There will be more info and People will be safeguarded There will be Promoting guidance about community throughout their journey. Wellbeing Coordinators to help services available to me. connect me to my community Self - Care Pathway for Young People I will be able do my own self The Young Person will remain assessment or access with the same team from 16- support to help do it when I 25 avoiding the current cliff need it edge at 18. Self Management Kent Pathways Service I will be able to use telecare Providing support to achieve and equipment to support the best long term outcomes me in my own home for people and enabling them Staying Well in Your to become more independent Own Home Joined Up Service Delivery “Own Bed Best” I will receive the right level I will have different kinds of If I need support to recover of support at the right time support working well together; I to meet my needs which from a hospital stay I can might need a nurse and a carer have this arranged from my will be enabling and at the same time own home if appropriate outcomes-based
An example: meet Dorothy Dorothy’s care now In the future • Inconsistent and • Consistent and well- overlapped organised • Decided without her • Decided with her involvement • Simple to access • Difficult to access • Focused on her • Focused only on her • Assessed by an health needs expert without • Only assessed by a going to hospital specialist when she visits hospital
Our 8 ambitions for Dorothy and those like her
8 Local care hubs Hubs will be for services that: • don’t need to be in a main hospital • are for a larger population than clusters • need equipment, rooms or staff to be in one place • need to be based with specific other services.
8 What might be in a local hub? • Falls service • Community mental health services • Some outpatient clinics: cardiology, diabetes, medical care for older people • Health improvement services – stop smoking, weight management • Rehabilitation and therapy services – OT, physio • Psychiatry for older people and dementia services • Respiratory services
8 What might be in a local hub? • Patient education classes • Diagnostics – such as X-ray, scans • Pharmacy • Children’s services • Maternity services, such as midwife clinics, antenatal classes • Social services • District council services • Musculoskeletal services – hip and knee pain, osteoarthritis, back pain, pain management
8 Services across west Kent Some services, especially those needed round the clock, are for the west Kent area as a whole. These include: • Beds in the community • for people at risk of going into a main hospital and for rehabilitation and assessment after coming out of hospital • Urgent care services - this will be covered in the next presentation
#KMlistens 8 What will be where? We don’t know yet. To find out we will: Carry out a review of all local NHS buildings , including GP practices, so we understand their condition and suitability for the future Consider: • the needs of our population, growth, what services they require, and what workforce is needed to deliver them • what is safe, cost effective and sustainable Produce possible options based on this information.
8 To deliver local care we need Better use of technology • For you and your family: apps and online information to support you, text messaging reminders, online booking of appointments, prescriptions • By teams: all able to see and update (with consent) patient digital records • By the system: all referrals will be online. So will advice and guidance from hospital doctors to local teams New roles and an integrated approach in general practice and our cluster teams – for example: • Care navigators, paramedic practitioners, clinical pharmacists
8 What does this mean for you? #KMlistens • More self-care thanks to better tools, information and services • Able to get a same-day GP appointment 8am-8pm and at weekends in your local area • Chance to be linked with “what’s out there” – groups, volunteers, services near you • More services locally
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