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Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
Community Hospitals in Cumbria A Bright Future
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Community Hospitals in Cumbria A Bright Future

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  • 1. Community Hospitals in Cumbria A Bright Future Ross Forbes Director of Corporate Affairs NHS Cumbria
  • 2. Two faces of Cumbria
  • 3.
    • 2,500 sq miles
    • 500,000 people
    • 73 people per km 2
    • Urban/rural split
    • Wide health variations
    • Huge travel times
    • Two ICO pilot areas
    CH H H H H CH CH CH CH CH CH CH CH
  • 4. The Way We Were…
    • Health economy was bust – £36.7m historic debt - £100m deficit projected over 5 years
    • People marching on the streets
    • Efficiencies needed in acute sector
    • Community services fragmented
    • Standards of care inconsistent – systematic approach needed
  • 5. Closer to Home
    • Patient centred care
    • High quality integrated care
    • Broader definition of primary care
    • Active management of long term conditions
    • Radical change to emergency care
    • Right sizing of hospitals
    • Affordable, sustainable
    • New estate
  • 6. Community Hospitals in Cumbria A Bright Future Dr John Howarth GP Cockermouth Clinical Director of Adult Services NHS Cumbria
  • 7. Context – population profile
  • 8. The increasing number of elderly
    • This will result in an estimated 60% increase in hospital admissions over the next 20 years
    • (Teamwork 2007)
  • 9. The increasing number of elderly
    • By 2016 the county council estimate that if nothing changes the numbers supported will increase by 25% equivalent to:
    • 198 more nursing home beds (4 new homes)
    • 459 more residential care beds (9 new homes)
    • 330,000 home care hours a year (130 more full time home carers)
  • 10.  
  • 11. The Past
  • 12.  
  • 13. Cumbria – Where we were in 2006
    • 2 nd worst performing PCT financially - £50 million historic debt with £17 million debt recurring year on year
    • 8 of our 9 community Hospitals ‘must close’
    • Buildings to be sold off
    • ‘No investment in primary care for at least 3 years’
  • 14.  
  • 15.  
  • 16.  
  • 17.  
  • 18. Widespread Support:
    • MPs,
    • Nuclear Agency
    • Unions
    • NFU
    • League of Friends (since 1954)
    • 70,000 signature petition
  • 19. The present
  • 20. Cumbria – Where we are now
    • 9 existing community hospitals saved + 4 new Community Hospitals opening this year
    • £250 million infrastructure programme planned to create community hospitals for the 21 st century
    • Ranked 4 th best nationally for World Class Commissioning
    • Small surplus last 2 years
  • 21. New PCT Leadership Team
    • New strategy of ‘Closer to Home’
    • Community Hospitals a key part of this strategy
    • Centred on clinical leadership
  • 22. Over to you!
    • Improve efficiency
    • Improve clinical and organisational quality
    • Maintain the caring aspects
    • Make these units sustainable
  • 23. Quality
  • 24. Over 30 quality initiatives underway
    • Roll out of saving lives campaign across all community hospitals (focussing on reducing infection)
    • New medical model for each community hospital with clear governance responsibilities, daily ward rounds, dedicated time for GP lead etc.
    • Leadership programme completed for all community sisters. Lead GPs are next
    • Leadership team in each hospital, devolved budgets
  • 25. Over 30 quality initiatives underway
    • Cumbria wide steering group made up of lead GPs and nurses
    • All elements of clinical governance mapped with action plans for each hospital. We have systematically identified our weak areas and have clear written plans to address these.
    • ‘ Lean’ methodology being introduced in all community hospitals – distributed leadership
    • Productive ward programme in all hospitals
  • 26. Primary Care Team Clinical Data Repository Path Lab Radiology Hospital ICO Clinical & Business Support Unit Specialist Teams EMIS Web EMIS Web Pharmacy Connected Community
  • 27. The future
  • 28. The future of Community Hospitals in Cumbria lies within Integrated Care Organisations Part of a whole system designed to treat patients in the community
  • 29. National Integrated Care Pilots
    • 16 Integrated Care Demonstrator Sites
    • 2 years of grant support, 3 years of evaluation
    • DH intention is to build the evidence base around integrated care – case studies
  • 30. Integrated Care Organisation (ICO)
    • Contract from PCT to town or locality based ICO
    • Provider organisation at town or locality level – all staff employed as one team with devolved budget
    • Population approach
    • Lean methods with distributed leadership
  • 31. The Future - Infrastructure
    • £250 million ‘Community Ventures’ bid successful
    • Joint venture with Cumbria Care to rebuild community hospitals, GP premises and Care Homes in Cumbria
  • 32.
    • Case Study – Cockermouth Hospital
  • 33. Cockermouth
    • Three semi rural GP practices will come together (17,000 patients)
    • New premises integrated with the new community hospital (9 beds), virtual ward, enhanced diagnostics, therapy unit, integrated community teams, childrens centre, GP with public health role, NHS dentistry, etc
    • Working closely with social services, mental health and the voluntary sector
    • One team
  • 34. Target LOS Time spent in Hospital has fallen from 39.7 days to 13.8 days in 18 months
  • 35. Cockermouth Hospital – improved efficiency
    • Throughput is up:
    • 110 admissions in 2006/7
    • 198 admissions in 2007/8
    • 306 admissions in 2008/9
  • 36. Cockermouth Hospital – improved efficiency
    • Cost per admission is down:
    • £6559 in 2006/7
    • £3646 in 2007/08
    • £2947 in 2008/9
    • £3612 less per admission x 306 admissions = £ 1,110,000 of improved efficiency!
  • 37.  
  • 38.  
  • 39. Enhanced Diagnostics Primary care diagnostics within primary care
  • 40.  
  • 41. Thank You

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