Katrina Percy: Our plans to transform health care delivery in Hampshire


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Katrina Percy: Our plans to transform health care delivery in Hampshire

  1. 1. Our plans to transform health care delivery in Hampshire our integrated care model November 2009
  2. 2.  Katrina Percy – CEO, Hampshire Community Health Care Chris Gordon – Medical Director, Winchester and Eastleigh Healthcare Trust John Hughes – Medical Director, Hampshire Community Health Care Sue Harriman – Director of Clinical Excellence and Delivery, Hampshire Community Health Care
  3. 3. Hampshire Community Health Care has responsibility for delivering Our Profilecommunity and out of hospital services across Hampshire Our service portfolio and size Our CommunityHCHC has an annual turnover of £135m andemploys 2300wte (3000 headcount) Serving a Our service lines Which include these services population Rapid Response, Patient of 1.2 million Adult Unscheduled Care Support Teams, community people in 16 beds, etc Health visiting, school localities Child & Family Services nursing, child & adolescent across mental health services, etc Hampshire. Orthopaedic Choice, Scheduled Care diagnostics, outpatient services Dental Services Community dental service Population expected to grow by 50,000 over next Smoking cessation & other Smoking cessation, sexual 5 years, with most growth in 65+ age bands health promotion health service, etc Mix of very rural districts and urban conurbations; mix of very deprived wards and some of the most healthy & wealthy areas in England. Particular need to focus on the growing needs of those with long term conditions and providing support to older people & their carers to remain healthy and independent 3
  4. 4. Our StrategyOur strategy to transform service delivery for people in Hampshire An integrated health and social care system keeping people in Hampshire as healthy and ‘Doing what we independent as possible in do better – and their community proving it’ An organisation leading and working with partners to deliver very high quality integrated health and social care services, with transformational improvements in quality, productivity & patient experience A healthcare provider demonstrably delivering high quality, effective community services that meet patient’s needs and make a significant contribution towards the desired ‘Working with outcomes of the health system others to make a step change’ A healthcare provider with a contract to deliver a range of community services to patients in Hampshire
  5. 5. Our strategyOur strategy to transform services and transform our organisation Our strategy to transform service We measure improvement using delivery 10 Key Outcome Measures Reducing unnecessary hospital Our services will offer consistently available credible alternatives to acute admission & admissions are be responsive to the needs of patients Reducing acute hospital length of stay Rapid response to crisis (1 hour) Leg ulcer management (heal rates) 15% better outcomes, 15% less cost through a new model of care and delivering End of life care (place of choice of productivity improvements death) Access to Care for planned services 40% reduction in acute bed days for older Smoking cessation target people and better outcomes through Sexual Health (Chlamydia screening integrated care partnerships rates) Children and family services delivery of national programme Patient experience measure
  6. 6. Implementing Service TransformationThe bigger prize delivered through wider system change Our aim In order to do this Our aim is to integrate the delivery of care for In order to do this quickly, and in time to reap patients across primary, community, acute and the rewards, we plan to develop an Integrated social care in order to: Care system with federated groups of primary care, community care, social care and elderly acute care, as this will provide for us  Generate cash-releasing efficiency gains in the order of 30% by increasing productivity, reducing cost and removing  A clinically led, patient centred model duplication in community services  A single focussed leadership accountable  Reduce elderly admissions to acute for delivery of these objectives (rather hospitals by up to 40% - improving the than a series of partnerships which rely quality and clinical outcomes of the care we deliver by changing the way we deliver on goodwill to deliver change) services (eg moving hospitalised elderly  Clinical alignment around a single aim care patients into community based virtual  Elimination of the interfaces which wards). Drive reduction in paediatric attendances and admissions to acute currently prevent organisations working together and which result in patients  Improve the experience patients have falling between organisations of the NHS in Hampshire, by providing better co-ordinated care with fewer hand-  The appropriate incentives we need to offs between providers drive change in the system
  7. 7. Implementing Service TransformationBringing organisations together to deliver integrated care Re-ablement services Social Care services Locality based systems of Integrated Care Geographically based Primary Care services Older people’s In- & out- of-hours primary care federated General Practice integrated with community Integrated Care Model services, social care, older Community Services Adult community services people’s medicine and parts Serving population 1m – 2m of older peoples mental health serving approx 100,000 people Adult Mental health services Local clinical leadership, operational management and budgetary control Hospital services - older people’s services, some LTC services, discharge teams, some urgent/unscheduled/front door services - community paediatrics Key: Community based older people’s Forms part of Integrated Care Delivery Model services Remains in existing organisations
  8. 8. Implementing Service TransformationIntegrated Care System formed from local primary & community care services, plusthe relevant components of acute elderly, mental health & social care Community Integrated Care Primary Care services budget budget and staff System and staff primary, community, mental health, social care, and relevant Social care acute care staff work together in Acute budget and staff the Integrated Care System to elderly budget deliver better care for patients and staff Mental health budget and staff Integrated Care System launched with budgets from each organisation and five year trajectory to reduce that funding We need to find a simple way to make the money move round the system – that incentivises the behaviours we want and shares risk appropriately
  9. 9. Implementing Service TransformationFor our patients this will mean significantly better quality of care – in terms ofoutcomes, safety and experience Scenario Current pathway Redesigned pathway Referral to community based Rapid Assessment Unit via Out of Hours Lady aged 92 in an primary care service. Overnight support from Rapid Response Team acutely confused or family. Full assessment next day with diagnostic support. Care Referral to A&E, patient admitted to state, with offensive acute hospital provision in place next day – so admission avoided. Worst case urine, on a Sunday scenario requires short stay in community hospital bed with specialist support and rehabilitation. Confusion settles over 3-5 days; home evening based rehabilitation to enable full functional recovery Assessment at community based Rapid Assessment Unit. Patient fast Lady aged 72 with tracked for specialist diagnostics and Speech & Language Therapy Referral to A&E or Emergency Medical assessment. Home based rehab organised with specialist review by weakness in left Assessment Unit at Acute Hospital Community stroke rehab team. arm If patient does need to be admitted to hospital, the community support team facilitate her discharge home after only 2-3 days Complex case of Early intervention with support to manage patient’s long term older person, Disjointed care, delivered only once condition through a programme supporting exercise, disease patient’s mobility affected and after management and other lifestyle issues. Multi-agency co-ordinated currently managed they are severely impacted by their approach with one care manager. Early pro-active intervention through multiple health and social issues ensures prolonged period of healthiness, independence and self agencies at home confidence
  10. 10. Implementing Service TransformationIntegrated Care System formed from local primary & community care services, plusthe relevant components of acute elderly, mental health & social care Future model: Federated GP practices and hub for primary & Current model: community 24/7 services, rapid assessment of Individual GP practices acute conditions and A&E minors, and community paediatrics GP GP GP GP practice practice practice practice GP GP GP practice practice practice GP GP practice practice GP GP GP practice practice practice Community hub: Rapid Assessment, Beds, GP GP GP Diagnostics practice practice practice GP GP practice practice