Integration in CumbriaI t    ti   i C   biSue Page      gJohn HowarthHugh ReeveRos FallonNHS Cumbria
Welcome to Cumbria                          CH                      H             Cumbria profile            CH           ...
The way we were…   Health    H lth economy was b t – £36 7 hi t i d bt -                          bust £36.7m historic de...
Where are we now?Wh              ?   Debt solved (although pressures still exist!)   Highest score in North West for WCC...
Where does integration take place?               Business Support Services                                       Copelan  ...
Sub locality    Sub locality           Integrated Care relationships           Locality            Locality           Loca...
Welcome to South Lakeland
DGH      DGH
Westmorland P iW t    l d Primary C                   Care C ll b ti                        Collaborative   WPCC is 21 pr...
ProgressProgress   Agreement to form a social enterprise, from April1st, to    both commission and in future provide serv...
The “ i t l” community hTh “virtual”       it hospital                          it l   Step-up step-down unit in Kendal (...
Early discharge and rehabilitationThe “virtual” community hospital: Team responsible for individuals undergoing a        ...
Integrated primary care informationEMIS web   “allows primary secondary and community healthcare            primary,   pra...
Pharmacy                                                                                H                                 ...
Long Term Conditions Cumbria Diabetes
The need   Increasing prevalence of diabetes   Evidence for high quality care in Cumbria      HCC and QoF      But... ...
The Cumbria Diabetes Model of Healthcare:               Primary care               Pi                  (core)             ...
Description of services                 Register                                        Delivers holistic annual review (c...
Description of servicesProvides core careNamed clinical leadIdentify high risk/ use tools   Primary care                  ...
Description of services                                    Primary care                                    Pi             ...
Description of services                   Provides care to individual patients with complex                               ...
Financial resource                    Local authority                                          (Health)                   ...
Progress Challenges of identifying lead p         g             y g       provider Now sitting with Primary Care     WP...
Cockermouth Floods       2009
Cockermouth Floods               17th November 2009   November 2009 was the wettest on record in the    UK (over 8 inches...
Cockermouth Town Centre
Cockermouth Main Street
Collapsed Bridge Workington     PC Bill Barker died
13 whole team meetings to co-ordinate the                          co-       recovery and manage risk                  d  ...
Priorities for the health services:To avoid excess mortality and morbidity                        y             y   Measu...
Reducing risk:   Identified ll t i k l    Id tifi d all at risk vulnerable patients and proactively                      ...
Reducing risk:   Rapidly b ilt    R idl rebuilt GP t l h                        telephone and IT systems                 ...
Longer Term:   Adolescent Health Programme with school and    pupils   Centre for the Third Age – co-locating third    s...
Doing more with less   Cockermouth H    C k        th Hospital - 300% i                       it l       increase i      ...
Policy IssuesP li I   Practice based commissioning has been central    to our approach     Based  on building relationsh...
Sue Page & others: Integration in Cumbria
Sue Page & others: Integration in Cumbria
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Sue Page & others: Integration in Cumbria

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Sue Page & others: Integration in Cumbria

  1. 1. Integration in CumbriaI t ti i C biSue Page gJohn HowarthHugh ReeveRos FallonNHS Cumbria
  2. 2. Welcome to Cumbria CH H Cumbria profile CH CH  2,500 sq miles CH CH CH CH  500,000 people CH H  73 people p km2 p p per  Urban/rural split H  Wide health variations CH  Huge travel times H
  3. 3. The way we were… Health H lth economy was b t – £36 7 hi t i d bt - bust £36.7m historic debt £100m deficit projected over 5 years People marching on the streets Efficiencies needed i acute sector Effi i i d d in t t Co Community se ces fragmented u y services ag e ed Standards of care inconsistent – systematic approach needed
  4. 4. Where are we now?Wh ? Debt solved (although pressures still exist!) Highest score in North West for WCC Closer to Home strategy Clinicians in charge in all 6 localities Devolution of power to ICOsThis is plan A, there is no plan B A
  5. 5. Where does integration take place? Business Support Services Copelan d Allerdal e South Lakelan Furness Cumbria d Central Carlisle Eden
  6. 6. Sub locality Sub locality Integrated Care relationships Locality Locality Locality Locality Locality Locality Support Headquarters Clinical Senate (Clinical Executive Group) • Developing evidence based clinical pathways and service models • Peer support to localities to improve performance • Collaborating for commissioning and contracting • Working with key public sector partners Business functions HR, Contracting, Finance, Intelligence, Pathway design etc g , y g PCT (System Manager) £800m from DH Ensures public health is protected Contracts with HQ to improve health outcomes Intervenes in the event of whole system failure
  7. 7. Welcome to South Lakeland
  8. 8. DGH DGH
  9. 9. Westmorland P iW t l d Primary C Care C ll b ti Collaborative WPCC is 21 practices (list size 600 – 16,000) and all PCT community health services “Make or Buy” for 110,000 population Key priorities for next 5 years:  Integrating services for older people  L Long t term conditions (i l di supported self mx) diti (including t d lf )  High quality primary care  Access to appropriate urgent care services  Efficient and effective use of elective care services  Working with others to p g promote healthy individuals y and communities
  10. 10. ProgressProgress Agreement to form a social enterprise, from April1st, to both commission and in future provide services Company limited by shares, holding APMS contract with PCT – important for NHS p p pensions etc Leadership from GPs, nurses and therapists across all of primary care Taking on increasing proportion of the PCT budget – approx 50% this coming year A Board including lay members – bringing expertise not token representation Approach to public engagement building on existing structures (mainly non-health) ( y )
  11. 11. The “ i t l” community hTh “virtual” it hospital it l Step-up step-down unit in Kendal (51 beds) p p p ( )  Nearly 50% of admissions are step up  Acute to a community focus - culture challenge  Moving to nurse led with doctor support STINT service  M Manage crises and early supported di h i d l t d discharge  Health and social care input (joint funding)  Nursing home support team Day Hospital  Moving to co-location with wards g  Coordination of physical and mental health services
  12. 12. Early discharge and rehabilitationThe “virtual” community hospital: Team responsible for individuals undergoing a p g g crisis – cared for at home, stepping down to a community bed or supported early discharge Flexible roles – some staff who can work either on the wards or in the community – so can “flex” with pressures i th system in the t Co-location of all + common electronic clinical record
  13. 13. Integrated primary care informationEMIS web “allows primary secondary and community healthcare primary, practitioners to view and contribute to a patients cradle to grave healthcare record”In last 12 months: Installation of superfast local network connecting all health bases across the locality 20 of 21 practices now using EMIS (21st on the way!) All community nursing teams moving to EMIS by mid 2010 and using mobile b db d / netbooks i bil broadband tb k Specialist community teams – transfer almost completed GP OOHs, PCAS and step-up/step-down Unit have access to summary information from the GP record
  14. 14. Pharmacy H os pi ta Radiology Radiology PCAS, GP led wards  lI nf o Report EMIS Web  Hospital and GP OOHs EHR Radiology EHR Report EHR Lab EMIS  EHR EHR Patient Info Patient Results DataReferral Data  R Reports Rx InfoRx Path Lab Repository Guide Specialist Teams  linesData and clinics EMIS Web  Patient Info Data Streaming Data Streaming Reports epo ts Referral between local centres GP and Community Teams Guide and central repository lines Central Support Team
  15. 15. Long Term Conditions Cumbria Diabetes
  16. 16. The need Increasing prevalence of diabetes Evidence for high quality care in Cumbria  HCC and QoF  But... Poor patient education and high drug costs BUT variations in both quality and patient experience across C b i i Cumbria Fragmented and non aligned specialist service
  17. 17. The Cumbria Diabetes Model of Healthcare: Primary care Pi (core) Primary care setting Secondary and Tertiary care setting Primary care y (enhanced) Specialist support for Primary Care Complex care
  18. 18. Description of services Register Delivers holistic annual review (care planning) ( g) for patients with Type 2 diabetes Complete QoF measures Adheres to agreed guidelines Refers to DESMOND Partnership with Cumbria diabetes Primary care Pi Work t W k towards improving quality d i i lit (core) Primary care setting Primary care y Secondary and (enhanced) tertiary care setting Specialist support for Primary Care Complex care
  19. 19. Description of servicesProvides core careNamed clinical leadIdentify high risk/ use tools Primary care Piand interventions (core)Stepped approach to Primary care settingglucose loweringCare planning and on going Primary care y Secondary andmanagement in patients ti ti t tertiary care settingwith Type 1 diabetes (enhanced)Insulin initiation / on going Specialist supportsupport in Type 2 for Primary Care Complex careAddress learning needswith spec support teamRegisters of housebound /high riskCare for house bound /vulnerable groupsSpecific needs of women ofchild bearing ageWork to max’n QOF points
  20. 20. Description of services Primary care Pi (core) Primary care setting Primary care y Secondary and (enhanced) tertiary care setting Specialist support for Primary Care Complex careReviews newly diagnosed Type 1 before referring to Enhance CareProvides a structured Type 1 support serviceProvides staff training both formally and informallyCoordinates/provides patient education and Type 1 post education supportAd hoc specialist advice to other professionalsLocality based individual case discussion with specialist teamContributes to developing clinical g p g guidelinesSupports development with Core Primary Care Practices to become enhanced practicesProvides enhanced services to core practicesCo ordinates the specialist support services for Primary Care eg nutrition, psychology, retinalscreening
  21. 21. Description of services Provides care to individual patients with complex needs Provide/coordinates multi specialty services eg Pregnancy, renal, eyes, vascular, heart and feet Provides transition and young adult services Provides inpatient care Primary care Pi (core) Primary care setting Primary care y Secondary and (enhanced) tertiary care setting Specialist support for Primary Care Complex care
  22. 22. Financial resource Local authority (Health) resource Personalised The population individual care Primary care is the HUB through (healthy, high risk and commissioning, facilitating, undiagnosed) understanding and providing Biomedical Policyintervention determinant s Community s engagement to maximise local assets Self S lf management t Maintaining registers Risk factors Relevant information Routine review Awareness raising Care planning p g Personalised care Social marketing Linking with planning community and Reducing inequalities support services Contact point to NHS Healthy cities, schools, stadia etcHelping to build resourceful Helping to build resourceful individuals communities
  23. 23. Progress Challenges of identifying lead p g y g provider Now sitting with Primary Care  WPCC  Allstaff (incl consultant lead) moving to primary care Cumbria wide education  Daphne, p Desmond and Walking away from g y Diabetes Other long term conditions following  Incl paediatrics, elderly care
  24. 24. Cockermouth Floods 2009
  25. 25. Cockermouth Floods 17th November 2009 November 2009 was the wettest on record in the UK (over 8 inches i th month) ( i h in the th) Over 12 inches fell in 24 hours on the fells above Cockermouth 10 out of 11 bridges damaged or destroyed 880 h houses and 190 b i d businesses fl d d flooded Our health model in action!
  26. 26. Cockermouth Town Centre
  27. 27. Cockermouth Main Street
  28. 28. Collapsed Bridge Workington PC Bill Barker died
  29. 29. 13 whole team meetings to co-ordinate the co- recovery and manage risk d i k
  30. 30. Priorities for the health services:To avoid excess mortality and morbidity y y Measures to avoid diarrhoeal disease Measures to prevent severe respiratory illness M t t i t ill (crowding in church halls and reception centres) Re-establishment Re establishment of normal health services for long term conditions asap especially the re- establishment of pharmacy services and systems Boosting p y g psychological support g pp
  31. 31. Reducing risk: Identified ll t i k l Id tifi d all at risk vulnerable patients and proactively bl ti t d ti l contacted them e.g. Severe COPD, palliative care, frail elderly. Established heightened surveillance for diarrhoea cases – every case was investigated by the seconded infection control nurse Gave public health information/lectures to rescue workers and all staff and displaced at the reception centres on hand hygiene and diarrhoea prevention prevention. Vaccinated 1000+ at risk in reception centres and 350 rescue workers against swine flu and seasonal flu in the first week
  32. 32. Reducing risk: Rapidly b ilt R idl rebuilt GP t l h telephone and IT systems d t (within 24 hours) Re-established pharmacy services ( p y (within 24 hours) Provided extended GP opening 24 hours for first day then 8am-8pm every day for the next 2 weeks including weekends Rapidly established additional counselling services i l di d i including drop i services in i Dug the foundations for a 26 room temporary building within 5 days of the floods g y
  33. 33. Longer Term: Adolescent Health Programme with school and pupils Centre for the Third Age – co-locating third sector, health, social care, memory clinics, dementia expertise etc d i i Harnessing the whole community response to health – cheer up teas street angels etc teas,
  34. 34. Doing more with less Cockermouth H C k th Hospital - 300% i it l increase i in throughput 2006-9 Length of Stay down from 36 days to 11 days £250,000 reduction in annual nurse costs from 2006 to present Nurse wte reduced from 23.4 to 13 Cost per admission reduced by more than half 19% reduction in non elective bed days spent in Acute Trust in 2008-9 2008 9
  35. 35. Policy IssuesP li I Practice based commissioning has been central to our approach  Based on building relationships with GPs more than the li itself th policy it lf  Trusting clinicians and handing over real responsibility (+accountability) has been crucial Transforming Community Services - vertical integration v horizontal integration Social S i l enterprises and pension i i d i issues PBR and Foundation Trusts

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