Post on 31-Mar-2015
Welcome to the new acute and community
County Durham and Darlington NHS Foundation Trust
Clinical strategy
FT member events
April 2011
The new Foundation Trust…
• …an acute and community Foundation Trust for County Durham and Darlington
• …more integrated, better co-ordinated care for patients
• …helping the health and social care system work together more effectively
• …opportunities for staff working in new and different ways
Trust governance
Public governors
Staff governors
Governing Council
Stakeholder governors
FoundationTrust Board
Clinical vision – an opportunity
“to shift the centre of gravity from hospital to community and
develop fully integrated care pathways”.
Clinical vision• Premier provider of healthcare in County Durham and
Darlington including:– Prevention and enablement– Community Services– Planned and emergency hospital care
• Major provider of women’s and children’s services in the North East
• Reputation for excellent specialist services• National profile as a pathfinder for new ways of offering
health services in hospital, home and community
Clinical strategy – our aims
• The best health outcomes for patients
• An excellent patient experience
• High quality, low cost services for commissioners
Clinical strategy – key areas
Long term conditions
Care of older people
Women and children
Acute medicine and emergency care
Surgery
End of life care
Case study – long term conditions
Case study – long term conditions
Long term conditions• Quick win: Facilitated discharge, good referral guidelines for
disease progression, pathway for minor acute events, access to specialist support 0900-1700 via bleep and phone line (being set up now),
• Priority issue: Patient education, equity of care, community clinics across the county, decrease LOS in surgical patients (CQUIN), IT - common LTC pathway and paperless clinics with instant transfer of data across primary and secondary care
• Synergy benefits: – Outcomes and experience: reduced admissions through better
accessibility to specialist staff, better screening and management– Workforce: development opportunities working across the pathway
utilising district and community nurses and integrating them with hospital specialist nurses
– Efficiency: Community rather than hospital follow ups; Nurse rather than Consultant follow ups. Working along with other workstreams - old age/ emergency and end of life care pathways to be put in place
Older people• Quick win: Dementia – training of all staff who are in
contact with older people through e-learning etc• Priority issue: single point of access to range of
services• Synergy benefits:
– Outcomes and experience: Early prevention /screening, future care planning
– Workforce: better use of specialist skills through dedicated specialist direct assessment /admission unit
– Efficiency: better use of community hospitals
End of Life• Quick win: Use of DH ‘surprise question’ as a trigger
into advanced care planning in the last year of life• Priority issues: Shared, real time access to information
via IT systems; single point of access in the form of a coordination centre
• Synergy benefits: – Outcomes and experience: patients more likely to
access preferred option/place of care at the end of life– Workforce: developing skills to facilitate patient choice
of preferred place of care at the end of life– Efficiency: reduce number of avoidable admissions to
acute care at the end of life
Acute medicine emergency care• Quick win: integration of protocols between UCC and A&E• Priorities: joined up approach with all stakeholders including
NEAS, social care
• Synergy benefits: – Outcomes and experience: reduced waits by quicker access to
appropriate level of care – Workforce: access to senior experienced clinician opinion at
earliest opportunity in the pathway– Comprehensive directory of supporting services in community and
acute settings – Efficiency: reduced admissions from ED and urgent care
Women’s and children’s• Quick win: Antenatal assessment for vulnerable
families• Priority issues: Middle grade cover in paediatrics
and maternity, training of advanced paediatric nurse practitioners, consultant numbers in paediatrics
• Synergy benefits: – Outcomes and experience: Community care pathways for
women with low risk pregnancies – Workforce: Alignment of community midwives with integrated
children’s teams– Efficiency: integrated Health Visitors and school nursing
children’s teams with social care
Surgery• Quick win: Redesigning pre-operative pathway; changes to
urology pathway• Priority issues: Addressing pressures in vascular surgery• Synergy benefits:
– Outcomes and experience: more accessible service for patients, reducing unnecessary hospital visits ( pre-operative pathway), delivery of care closer to home (Urology pathway).
– Workforce: changes to skill mix to meet pathway requirements, staff have the skills to deliver care in the appropriate setting for the patients
– Efficiency: Reducing emergency admissions to hospital. Offering other services to manage surgical emergency activity, to deliver a better service for patients.
Clinical strategy - discussion
• What services could be offered in the community that are currently offered in hospital?
• Delivering services in hospital– Advantages– Disadvantages
• Delivering services in the community– Advantages– Disadvantages
We are developing a new clinical strategy for the new organisation
Take part in the discussion atwww.cddft.nhs.uk/about-us/clinical-strategy.aspx
Any questions?