Programme for Health Service Improvement Emerging Clinical Service Framework CARDIFF AND VALE NHS...
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Transcript of Programme for Health Service Improvement Emerging Clinical Service Framework CARDIFF AND VALE NHS...
Programme for Health Service Improvement
Emerging Clinical Service Framework
CARDIFF AND VALE NHS TRUSTYMDDIRIEDOLAETH GIG CAERDYDD A’R
FRO
Aims & Objective
To establish whether there is a broad clinical consensus on the emerging direction of travel within the health care community
To debate emerging issues To create clinical champions To agree next steps
Programme for Health Service Improvement in Cardiff and the Vale of Glamorgan
- Joint programme with our two local LHBs (with LA and HCW involvement)
- New approach to service planning- Strategic Outline Plan by November
- Single strategic document- Describes our model of care for the future- Describes our capital requirements for next 3
– 5 years
- Recognised need for regional dimension
CARDIFF AND VALE NHS TRUSTYMDDIRIEDOLAETH GIG CAERDYDD A’R
FRO
Designed For Life (1)
Improved Performance
Reducing Inequalitie
s Clinical Excellence
Sustainability
Designed for Life - Creating World
Class Health and Social Care
Clinical Networks
Strong Commissioning
Research & Development
Workforce redesign
IM&T
Community involvemen
t
Designed For Life (2)Levels of Care
Local acute services
Services provided at home & in the community
Specialist and Critical Care Centres
Tertiary and highly specialist services
Determinants of Health
Effectiveness Best PracticeLocal Needs
Policy Development
Card
iff a
nd
V
ale
NH
S T
rust
Bro
M
org
an
nw
g
NH
S T
rust
Why change?
Ageing population Clinical standards are rising New targets – Access 2009…. Resources are finite New technologies Working hours Teaching and research Stronger commissioning….. Etc.,
Where we have come from
Change is not new to this health community Emergency services Maternity services Children’s services Mental health services Etc.,
Resource Context
Resource Context
Financial Levels of growth expected to decrease
with associated funding shortfalls increasing
Each organisation is in recovery (£51.5m in 2006/07 including HCW) , and traditional means of efficient savings are being exhausted.
Two local authorities experiencing significant financial pressures
Resource Context
Staffing - Contractual changes impacting on all staff
Agenda for Change Modernising Medical Careers European Working Times Directive – 48 hour
working week by August 2009 Consultant contract GMS and primary care contracts Feminisation of workforce Age profile (46% nurses and 34% Trust
doctors and 70% principal GPs aged 40 – 60 years)
Multiple job holding
Resource Context
Estates and IM&T Much of Trust estate no longer fit for
purpose e.g. Rookwood, West Wing, surgical services for children, Llandough, health centres etc., etc.,
Potential planning blight re. IM&T subject to clarity around scope of Informing Health Care
Opportunities through use of new technologies need to be seized
Clinical Services Strategy
Key Assumptions….
Our users will: Be more confident in using information
and technology Expect responsive, personal and high
quality integrated services Want to receive more care at home, or
as close to home as possible
Clinical Services Strategy Workstreams
Primary & Community Services including Long term condition management Unscheduled care Rehabilitation & intermediate care
Acute and emergency care Tertiary and Specialist (including Cancer
& children’s services) Mental Health Clinical support
Primary and Community Services – emerging model
Network of high quality primary care practices working within defined localities (4 in Cardiff, 3 in Vale)
7 localities as basis for managing access to core community based services managed through resource centres (real or virtual) aimed at enabling individuals to maintain their health and independence
Cardiff Localities
91,693
(18 practices)
93,902
(12 practices)
82,640
(13 practices)
81,700
(11 practices)
Vale Localities
Western Vale 26,678(3 practices
East Vale 38,003(7 practices)
Central Vale 54,974(7 practices)
Resource Centres
Supporting networks of local practices
Basis for locality focused services Virtual or real Tesco Extra/Tesco Express model Health and social care (including
links with independent sector)
Key Issues…
Creating capacity within primary and community services to accommodate presssures of demographic change, service change etc.,
Creating confidence in new ways of working and mechanisms to measure impact of change
Location of resource centres and commitment to locality model (primary care and Trust)
Locality management models
Long Term Condition Management Model – Emerging model
Key Themes Increased support for self care Strengthening and supporting primary care Ensuring access to responsive specialist care Managing the most vulnerable individuals by anticipating their needs
Achieved by: The use of information systems to identifying and support individuals
with long term condition Stratifying individuals by risk Involving patients, and their carers where appropriate, in their own
care A well equipped and educated multi disciplinary workforce Co-ordinating care in line with agreed pathways and protocols Integrating care across organisational boundaries Aiming to minimise unnecessary visits and admissions Providing care in the least intensive setting, including the home
Long Term Condition Management Model
70-80% population with long term condition
High risk patientsCare Management
Highly complexpatients
Case Management
Health Promotion
Level 3
Case manager actively managing and joining up care
Level 2
Multi-disciplinary teams, proactively managing in line with agreed protocols and pathways for managing specific conditions
Level 1
Individuals supported to actively managing their own care
Key Issues…
Case management model who has the lead – primary care? Trust? Joint?
Workforce development – who are our case managers?
Capacity and commitment to delivering against agreed care pathways
Integrated Community Based Rehabilitation and Intermediate Care Services – Emerging Model
A multi-disciplinary team based on resource centre populations providing:
- Rapid assessment service- Acute/rapid response- Community based active rehabilitation and Reablement- Maintenance and prevention services
Direct Access to Specialist Support Services working across localities, for example:
- Acute day treatment services - community based inpatient rehabilitation beds- Hospital based diagnostic support services- long term condition management support services- specific condition based expert teams – eg Parkinsons/stroke/continence
Community based rehabilitation and recovery model
Rapid Assessment Service
Maintenance and Prevention Services
Community Based Active Rehab & Reablement
Acute / Rapid Response
Identified lead consultantGPwSIs
Nurse consultants / specialists / rehab nurses / acute nurses /
community nursesTherapists - physio, OT, SLTHome care / social workers
Diagnostic support staffIntermediate care support staff
more specialist services e.g. stroke, continence
acute day treatment services
in-r
ea
ch
ho
sp
ita
l s
erv
ice
s
CD
M s
erv
ice
s
Key Issues…
Commitment to locality based model
Number and location of community inpatient capacity Trust clinical view maximum of 3 ideally linked to resource
centres (2 in Cardiff, one in Vale)
Single in-patient stroke unit
Clear view on spinal and neuro rehabilitation
Ensuring model addresses needs of all adults requiring rehabilitation (not just older people)
Addressing capacity within independent sector to support people with continuing care needs
Mental Health Services – Emerging Model
Provides model for wider programme…. Investment in community based
services to reduce dependence on institutional care
Elderly care assessment on DGH site
Key Issues…
Vale of Glamorgan LHB commissioning intentions re. Western Vale
Links with locality model for other community services (including Resource Centres)
Developing capacity within the independent sector to support continuing care for older people with mental health needs
Unscheduled Care – Emerging Model
Network of core GMS Services / Primary care services in OoH
Extended primary care
including case
management, nursing
home team, expert patient
programme etc.,
(resource centres)
Specialist rapid access clinics incl diagnostics
MAU (UHW/Llan)
SAU (UHW)
Acute rehab
Community based rehab/
reablement
Acute admission with agreed care
plan
Community based inpatient
Community Rehab
Elective Discharge
support
Community nursing
Paramedic / NHSD
Voluntary Sector
Palliative Care
OPD
Extended Primary Care
Intermediate Care
Acute Care
A&E
Mental Health Crisis Team
Emergency social care
Elderly Care Assessment
Service
Rapid/Acute
response team
Acu
te R
esp
on
se
Co
nta
ct C
entr
e
Key Issues…
Opportunities for more integrated out of hours models – how do we take these forward?
Walk in Centres – is there a role for something new?
Ensuring alternatives to admission address issues associated with medical responsibility
Elective and Emergency Care – Emerging Model
Clear separation of emergency and elective workstreams
Clearer separation of local and specialist workstreams
Pathway/Protocol driven care Supports effective teaching and
research Environment fit for purpose
C&V Clinical Strategy Summary of Hospital Profiles
Llandough Acute medical admissions
(Vale and W Cardiff) General Medicine All intermediate surgery CAVOC Midwifery unit EMI assessment Gynae cancer ? Cancer surgical centre…
Supported by appropriate diagnostic & support services including rationalised labs etc.,
UHW A&E Acute medicine (Central &
East Cardiff) General Medicine All emergency surgery All complex surgery Specialist/tertiary services All inpatient paeds Obstetrics/MLU
Key Issues…
Elective surgical model
Ensuring effective locality flows to achieve balance across two sites in relation to medicine
Surgical Cancer services model
Specialist and Tertiary – Emerging models
Effective networks to manage tension of access and excellence
Potential for increased role as specialist centre for South Wales- Surgical cancer- Surgery for children
HCW Reviews Neurosurgery Thoracic ….
Key Issues…
Ability and incentives to make networks work effectively
Lack of robust regional planning, commissioning and delivery mechanisms
Critical mass and VFM
Clinical Support Services
Using technology to support local diagnostic services Near patient testing Pathology rationalisation PACS
Key Issues…
Implications & links to all Wales Diagnostics Strategy work
Ability and commitment to rationalise services across multiple sites
Impact of telecare strategy
Emerging Clinical Strategy Framework….?
Increasingly local care – less care in main acute hospitals
Primary care practices Resource centres and community based services
Acute and emergency hospitals
Intermediate care and
rehabilitation
GP/Nurse led beds
Outpatients
Minor emergencies
Day-therapy services
Day-case surgery – local
anaesthetic
Diagnostics(such as
X-ray)
Patient Education
and support
Local Authority Services
Primary care team
and therapy Services
Minor procedures
Clinics (for example
diabetes and CHD)
Tertiary and specialised services
Elective (non-urgent)
surgery
Inpatient cancer
services
Complex diagnostics
Specialist outpatients
Secondary emergency services
Acute women’s and children’s
services
Major accident and emergencies
Well-men and well-women
clinics
Rehabilitation support
Voluntary sector
services
Community services
Local facilities throughout the
area
Resource centres serving networks of @ 50 – 80,000 populations
University Hospital of Wales, Llandough
Increasingly specialist care – more care in major hospitals
How will we deliver care?
Patient pathway not professional convenience.. Acuity based not “ology” based… multi-disciplinary not medical … Integrated not silo…What’s stopping us?
Patient experience Political environment (external) Professional standards (including teaching & research) Pathway and processes (and clinical linkages) Physical capacity and environment Pounds and pence People
Where will we deliver care?
What, if anything, is an exception to the emerging clinical strategy?
Why? Patient experience Political environment (external) Professional standards (including teaching &
research) Pathway and processes (and clinical linkages) Physical capacity and environment Pounds and pence People
Key Issues for SOP
Resource Centre models for each locality Commitment to locality model
Elective surgical services profile Separation of emergency and elective
Inpatient/community rehabilitation model 3 community inpatient units
Unscheduled care model Scope/commitment to integration
Independent Sector…….
Hazard Warning
We will need to:
Agree some core assumptions
Ensure we build in flexibility
Predicting the future is difficult and we will get
some things wrong