North East High Impact Change Model (HICM) Event 2 October 2018, 09:30-13:00 The Durham Centre, Durham
Introductions and reflections on the North East journey in respect of HICM Fiona Brown - DASS, Sunderland City Council
MC1 Managing Transfers of Care A National Overview Glasha Frank - Department of Health and Social Care Martha Dalton - Department of Health and Social Care
Slide 3 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 Assessor – Lincolnshire Model and developing an approach to Trusted Assessment Michele Briggs - Lead Care Home Trusted Assessor, Lincolnshire Care Association
Slide 11 MC1 LOGOS MacGregor, Calum, 12/09/2018
Trusted Assessments Michele Briggs Lead Care Home Trusted Assessor Lincolnshire Care Association Developed with John Woods Improvement Manager (Social Care)
Trusted Assessor Trusted Assessment A real world example Agenda Getting Going/ Checklist Myth Busting 13 |
• A person carrying out an assessment on behalf of a third party What is A • A Trusted Assessor completes a bespoke and agreed assessment for a specific purpose. Trusted Assessor? • Using an assessment that was designed for one purpose to serve another. What is Trusted • A Trusted Assessment is completed for one purpose but also used for a second purpose with the agreement of both Assessment? parties. 14 |
• Transfers from hospital to an existing support package. • Transfer of patients to an interim support package e.g reablement or intermediate care. • New admissions to residential care & New packages of Examples domiciliary support. • Care Act Assessments. • Assessments for occupational therapy equipment. • Anywhere else you want to chase delays out of a process 15 |
How we do it in Lincolnshire 16 |
Care Home Trusted Assessor (CHTA) Working together to improve transfers from hospital to care homes
CHTA in Context � Common Problems: � Delayed Discharge � Lack of Trust between acute sector and care providers � Workforce capacity – skills and capacity throughout the system � ONE possible solution – Care Home Trusted Assessor � Care providers as part of the solution not the problem � Simple but effective � Not the only solution � Other trusted assessment � Can be used standalone, or as part of a more compressive solution
Job Description � DOES � Undertake Care Home Pre Admission Assessment � Liaise with Care Home � Record/report to stakeholders � DOES NOT � Complete Statutory Assessments � Choose or influence choice of Care Home
Recruitment � Person Specification � Integrity � Communication � Experience on both sides of the discharge � Methodology � Raise Awareness � Indeed � NHS Jobs � Word of Mouth
Cost vv Benefits � Annual cost for 1 FTE (6+days) approx. £60K including allowance for managing service � Allow for non-productive start (2-4 weeks) trust from care homes is essential � Savings per � Excel Model available
Developing the Care Home Trusted Assessor Role Key factors of our success to date – OWNERSHIP brings TRUST � Assessor is answerable to (ideally employed by) the Care Home Sector � Service is available to all, but not mandatory � Care Home documentation is used where appropriate � CHTA must not place individuals � Independence from all parties – individual care homes can be challenged if appropriate Recognising the importance of the information collected � Granular level information about delays � Trends spotted in a timely manner (end of the week not the quarter)
Statistics per average month – 1.5 FE 66 80 referrals 64 discharges Assessments Completed Total Savings Total days saved 250 £80K (Net)
• You need relationships to build trust • Co-designing with all stakeholders can build the relationships • Agree a set of common/shared objectives for the trusted assessment service The way • Borrow and adapt other peoples’ ideas • Agree forward • What kind of assessment will be included in the service • Competencies and put in place training requirements • How the service will be measured • Find the funding • Start slowly and grow 24 |
What have you Mythbusting heard? 25 |
Questions 26 |
Further Information / Help • MicheleCHTA@linca.org.uk • john.woods2@nhs.net / john.woods.consulting@gmail.com • Rapid Improvement Guide • https://improvement.nhs.uk/resources/rapid-improvement-guide-trusted-assessors/ • Trusted Assessments - Essential Elements • https://improvement.nhs.uk/resources/developing-trusted-assessment-schemes-essential- elements/ • Quick Guides • https://www.nhs.uk/NHSEngland/keogh-review/Pages/quick-guides.aspx • Better Care Exchange • https://future.nhs.uk/connect.ti/system/login?nextURL=%2Fconnect%2Eti%2Fbettercareexch ange%2Fview%3FobjectId%3D9820976#9820976 27 |
Putting arrangements in place for effective Discharge to Assess Gemma Umpleby - Hambleton, Richmondshire and Whitby CCG Cara Nimmo - North Yorkshire County Council
Hambleton, Richmondshire and Whitby Integrated Discharge Pathways
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