7 day services is only part of a whole system transformation
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7 day services is only part of a whole system transformation



Birmingham, Sandwell and Solihull Collaborative's presentation for the 7 Day services event in the West Midlands on the 11th June 2014.

Birmingham, Sandwell and Solihull Collaborative's presentation for the 7 Day services event in the West Midlands on the 11th June 2014.



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7 day services is only part of a whole system transformation Presentation Transcript

  • 1. Seven Day Services Improvement Programme Birmingham, Sandwell and Solihull Collaborative 7 Day Services Presentation ‘7 day services is only part of a whole system transformation’ 11 June 2014
  • 2. Stage 1 : Providing the same level of health and social care services seven days a week across Birmingham to achieve consistent outcomes.  Stage 2 : With the integrated stage one platform in place the aim is “Level up”, quality and effectiveness across the breadth of the interfaces between acute health, community based health including primary care and social care services.  Locally recognise that 7 day working is part of a much larger requirement for whole system change and aware this could require fundamental changes to commissioning models and provider networks. 2 Vision
  • 3. System Chronology • June 2013 – Joint programme looking at integration for older adults – identified 7 day services as a key enabler for system wide transformation • October 2013 - Created collaborative response to NHS IQ 7 days services early adopter – including HeFT Acute, Community and Mental health along with social care • December 2013 – Winter pressure activity focused around 7 day services and expanded the scope to include UHB and Sandwell and West Birmingham acute’s. • April 2104 – Key scheme within Birmingham Better Care Programme • Now – Fundamental enabler for wider unplanned care transformation
  • 4. Delivery & Governance •CEO Forum operating at unit of planning level inc Sandwell and Solihull •HWB – accountable for Birmingham BCF •Birmingham Better Care Board – CEO and Clinical Exec leads level set up from April 14 •Programme Group includes PM’s and business change managers will report into Integration Board •Scheme project groups – multi- organisational •Executive Sponsors – commissioner and provider for each scheme
  • 5. Birmingham Better Care Themes Place Based Integration Care In A Crisis System wide enablers Outcomes for People
  • 6. The Care in a Crisis Transformation Challenge •Modelling a 7 day LOS for unplanned care in Birmingham hospitals and applying a 80:20 rule identifies an opportunity of 800 beds •Acute clinical leaders are broadly comfortable that a 7 day LOS target is appropriate •Confirmed by Oak Group acuity reviews – local and national data •Improved case finding for step up/down, discharge planning and new clinical philosophies •7 day access to appropriate community services •Philosophy of short term re-ablement/rehabilitation - return home should be common aspiration •Integration between specialist, primary and social care including mental health •New partnerships & new models of care to meet new challenges specifically dementia
  • 7. The Place Based Integration Challenge •Long term support – proactive and preventative care •Interdisciplinary teams established around primary care •Accountable Community Professional •Including the broader voluntary sector and other organisations within community •Integrating specialist/ primary and social care including community organisations •Case management informed by risk stratification •Philosophy of early identification of changing need/ enablement •Targeting the groups which will benefit most from intervention
  • 8. System enablers Whole transformation programme underpinned by • Need for shared understanding on activity and financial scale of challenges – case for change medium and long term • Creation of campaign – the “Birmingham Conversation” , citizens, patients and staff • Recognised need for crucial system wide enablers ; • 7 day services • Data – NHS number as unique identifiers, Central Care Record • Integration dashboard – being developed with CSU • System wide acuity decision support tool
  • 9. Birmingham BCF – Schemes • Scheme BCF01 – Developing and agreeing the case for change • Scheme BCF02 – Creating the impetus for change • Scheme BCF03 – Accountable community professional • Scheme BCF04 – Defining new Primary Care service delivery models • Scheme BCF05 – Discharge from acute setting and step up/ down care • Scheme BCF06 – Instigate 7 day health and social care services • Scheme BCF07– Establish Combined point of access • Scheme BCF08 – Improve data sharing between health and social care
  • 10. Scheme BCF01 – Developing and agreeing the case for change Sponsor – Barbara King, Mark Newbold Deliverables : • Unit of Planning - Collate respective financial and activity challenges – based on output develop system wide options (Plan, A,B,C) •‘As Is’ system diagnosis – by provider, commissioner, sub economy and system including quality, spend, activity, performance, resource utilisation and savings challenge – system level savings challenge – demographic impact • Opportunities for improvement across productivity and efficiency, achieving best in class - beyond best in class – include outcome metrics • High impact areas and populations to focus efforts on and the quantum resource needed to shift, investments and savings • Viability assessment of system wide and sub economy achievability and associated options • Proposed response and contracting options for potential 15/16 delivery. Including steps to achieve sign off within provider organisations. • Commissioning intentions for 15/16 10
  • 11. Scheme BCF02 – Creating the impetus for change Sponsor – Peter Hay / Andrew Coward / Viv Tsesmelis Description – To develop and implement a public and staff facing cross organisational communication and engagement programme including shared tools to support the conversation, which engages people in the challenge, listens to and builds upon their ideas to meet our objectives and empowers them to change. Deliverables : The Birmingham Conversation Leadership Development for Integrated Working Frontline Workforce development Engaging people in becoming active co-producers of health 11
  • 12. Scheme BCF03 – Accountable community professional Sponsor – Tracy Taylor / Sue Hartley / Nick Harding Description – Put in place the appropriate activities to ensure role is recognised and embedded across the city including required process and assessment and plan documentation Deliverables – The role definition and supporting training and supervision infrastructure. The supporting agreements, documentation, systems and processes to underpin the role and enable integrated care without duplication. Capacity requirements for the role Joint and trusted processes, assessments and plans, training requirements and associated rollout across the identified workforce Co-ordination of community MDT visits 12
  • 13. Scheme BCF4– Defining new Primary Care service delivery models and associated roles and infrastructure Sponsor – Andrew Coward / Andrew Wakeman Description – 1)Agree approaches to General Practice development, including NHS England where appropriate, per CCG. 2)Develop interdisciplinary working between statutory services including social care, mental and physical health, and evaluation of current IMPACT, Falls, EOL and support to care homes initiatives. 3)Review current community support/development initiatives and voluntary sector services currently commissioned across the whole system. Deliverables GP development plans * 3 Develop new service delivery models and associated commissioning plans for interdisciplinary teams Agreement on approach to community support/development initiatives and particularly the commissioning of the voluntary sector Agreed protocol for management of patient in a crisis (BCF05) Proposal for number and geography of places 13
  • 14. Scheme BCF05 – Discharge from acute setting and step up/ down care RAG STATUS Sponsor – Barbara King / Andrew Catto Description – Develop single trusted assessment and plans and the service delivery model e.g. Co-ordination hub to ensure effective admissions avoidance and discharge into lower levels of care. To include mental health services e.g. RAID, EOL care. Procure clinical decision making support tool / Clinical Utilisation Review e.g. Oak Group. Improving early discharge planning in hospitals Develop Commissioning plan for Step up / down to ensure appropriate capacity and delivery models across the city Deliverables Joint and trusted processes, assessments and plans, training requirements and associated rollout across the identified workforce Proposed service delivery model associated Business case Procurement and implementation plan for support tool Step up / down commissioning plan Agreed protocol and management of patient at end of episode of care (BCF04) Approach in shift in professional activity from acute to community setting e.g. Social Workers 14
  • 15. Scheme BCF07– Establish Combined point of access Sponsor – Tracy Taylor / Andy Williams Project Manager - TBC 0.5 – plus solution architect role initially – options appraisal , art of the possible Description – As part of the city’s offer to all citizens, to enhance and expand a city wide combined point of access to support self assessment and management, early identification of need and proactive care. Enhance and expand the city wide single point of access to support and align service response times to Community alternatives for urgent care and links with 111. Including wider elements of community health, mental health e.g. RAID, social care, EOL care and the third sector. Utilise the single trusted assessment, to manage real time capacity and flow info with aligned response KPIS across the system Care in the crisis co-ordination hub 15
  • 16. Scheme BCF08 – Improve data sharing between health and social care Sponsor – Gavin Ralston for CCR and Adrian Phillips BCC lead for overall uptake on NHS on number in social care Description – Ensure the NHS number is used consistently across the system as a common identifier and routinely reported. Ensure the effective roll out of the Midlands Central care record Procure the Pi dashboard to support integrated care at an individual, provider and commissioning level. Deliverables NHS Number being used as the primary identifier for all correspondence across health and social care NHS Number used as early as possible in the clinical process/care pathway Real-time retrieval, or if batch tracing that there are clear processes in place for ensuring that it is retrieved in a timely manner, for example, not after a week of the patient being discharged. All systems able to handle the NHS Number API in place between all relevant systems 16
  • 17. Scheme BCF06 – Instigate 7 day health and social care services across the economy Sponsor – Nick Harding / Andrew McKirgan Description – To develop 7 day services at the interface between hospitals and out of hospital alternatives as per our City wide pioneer application. To ensure all services required are in place to enable a timely admission avoidance or discharge into lower levels of care 7 days a week. Deliverables Co-ordination of action plans for all organisations, using the NHS IQ seven day services toolkit to baseline activity, by end June. Continue engagement with NHS IQ and peer organisations as early adopter. Common dashboard 17
  • 18.  About developing a sustainable health and social care system  Facing the future in ways that strengthen our common approaches – using Winter funding to test approaches and assumptions to 7 day services focusing on hospital and community interfaces  Building upon already good practice in some areas: Trusted assessor at front and back door of some acutes and integrated discharge hubs, Community Health SPA and rapid response, Mental Health RAID & CERT, therapists and radiology at some acutes  Commitment to take evidence based approach to improve outcomes – developing dashboard starting with improving acute outcomes  Learning from each other – via CQUINs, same CQUIN in each health provider contract, system wide involvement in priorities for each organisation  Working with national programme to develop clinical standards for community and social care services to aid local gap analysis  Developing role of General Practice in seven day services in the Better Care Programme 18 Context - Birmingham , Solihull and Sandwell Collaborative Early Adopter
  • 19. • Objective to provide the same level of health and social care services 7 days a week for across Birmingham • Winter pressures funding Birmingham City Council to provide social workers to work seven days per week • Sandwell & West Birmingham – started 1 November - with the aim of increasing weekend discharges, smoothing variance of flow across the week and avoiding hospital admissions • HEFT – started 16 November - with the aim of smoothing discharge over 7 days and reducing current backlog • UHB – started 21 December – with the aim of smoothing discharge over 7 days • Extended to community hospitals in January • Using experienced social workers from across the service to support 7 day services and appointed a manager to manage the weekend service • Engaged with 125 nursing and residential providers to understand their issues and concerns of which 37 committed to admitting at weekends 19 BCC Winter Activity
  • 20. • 577 Contacts made by BCC social workers to date across all sites • 478 assessments completed by BCC social workers to date across all sites • 74 discharged over weekend / bank holiday (80% with arranged support) • 176 planned to be discharged in first 2 working days post weekend / bank holiday 20 Main support types arranged for those discharged at weekend or within 2 working days % Enablement 37% Home care package 32% Restart of existing package 8% Family support 7% BCC Winter Activity Data as at March 14
  • 21. Winter funding provided to BCHC to increase community capacity to develop and deliver integrated care pathways 7 days a week in support of admission avoidance and early supported discharge from both acute and community bedded units including: • Discharge to Assess – Trusted Assessor Role • Development of Discharge Hubs • Community Consultant Geriatrician in SPA • Additional sub acute and Intermediate care beds • Stroke early supported discharge pathway • Increasing capacity across the community bedded units to enable better system flow 21 Community Health Trust Winter Activity
  • 22. Each acute hospital has taken a slightly different approach : •Utilising primary care – SWBH •Supported Integrated Discharge – HEFT • Supporting Mental Health Services - UHB 22 Acute Trusts- 7 day services:
  • 23. • Whole system approach required to have an impact • Developing relationships is crucial in order to change current behaviours and cultures • Making effective use of home care assessors – we were missing opportunities to discharge into the enablement programme even though it was a 7 day service • Continuous learning to identify areas for improvement and proactively put plan in place to address • Grow social care services that we need to work with – Home care and enablement • Developing service through enhanced assessment beds (now available at weekends) and interim beds – new services commissioned for this winter have 7 day working in their contracts and working with existing services to vary contracts • Engage and listen to views of our stakeholders, such as nursing and residential homes • Understand the overall effect – impact on length of stay as well as admission and discharge 23 Lessons learnt so far
  • 24. • Initiatives judged to be delivering system benefit rolled on for 3 months and then subject to further evaluation and confirmation of future funding via Birmingham Better Care • Assessment of transferability of schemes across whole system and identifying any system gaps • Involve service users, families and the community in co-design 24 Move from winter work to BAU
  • 26. Mortality rates – same by day of week
  • 27. Discharge rates still reduced at weekend 0 2000 4000 6000 8000 10000 12000 14000 Mon Tue Wed Thur Fri Sat Sun Day of Discharge Discharges by day of discharge 0% 5% 10% 15% 20% 25% 242526272829303132333435363738394041424344454647484950515253 1 2 3 4 5 6 7 8 9 101112131415161718192021 % discharged at Weekend - Monday 4th June to Sunday 27th May (Nonelec Only)
  • 28. LOS of stay varies but…… 2.0 2.0 2.1 2.1 2.2 2.2 2.3 2.3 2.4 2.4 2.5 2.5 Mon Tue Wed Thur Fri Sat Sun Day of Admission Average LOS by day of admission
  • 29. Who is available at weekend Consultants - most patients seen every day of the week Junior doctors – ward rounds but after that still reactive service mostly
  • 30. Nursing 24/7 cover Increasing seniority presence Specialist nurse presence variable
  • 31. Therapies Major reconfiguration Physiotherapy OT very limited SLT none
  • 32. Clinical Support Services Imaging  Routine lists at weekend  24/7 urgent  Discharge support Pathology Pharmacy Social Care
  • 33. Non-clinical support Portering Domestic services Ward Clerks
  • 34. Managerial Still an on call system Site Office
  • 35. Key lessons Whole team Not just consultants Developing Dashboard, visible to all Utilising the 7 day standards at directorate level Not a separate project
  • 36.  Same CQUIN across all health provider contracts  Linked to national toolkit  Community providers will use toolkit as basis of their action plans  System partners involved in identifying priorities for organisations 36 Learning from each other – via CQUINs
  • 37.  Engage with other early adopters to develop clinical standards for community services  Apply locally to support gap analysis 37 Clinical Standards for Community and Social Care
  • 38.  Maintain link with LAT and 3 CCGs as they develop approaches to improving access across 7 days to improve the unplanned care system 38 General Practice
  • 39. Questions ?