Katrina Percy: Working with partners to deliver high quality health and social care services

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Katrina Percy, Chief Executive of Southern Health NHS Foundation Trust, talks about the health system in Hampshire and the key elements of Southern Health’s integrated care strategy.

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Katrina Percy: Working with partners to deliver high quality health and social care services

  1. 1. Transforming community services inHampshire – developing an integratedcare systemKatrina Percy, Chief Executive
  2. 2. Community and mental health services for HampshireSouthern Health NHS FTformed on 1 April 2011 Improving thethrough merger of experience patients, and their familiesHampshire Community have of our servicesHealth Care & HampshirePartnership NHS FT Reducing the Improving costs of our clinical£330m budget, 8000 staff services, delivering more outcomes for patients and for less their familiesDelivering the welldeveloped vision and Our goalsstrategy for integrated care
  3. 3. Delivering improvement through redesign, integration and growth OUR OVERALL AIM improving the health, wellbeing and independence of the patients we serve INTERNAL REDESIGN INTEGRATION GROWTHDoing everything we can Working with our partners Growing our businessinternally to redesign our to develop an integrated where this means we canservices to provide better health and social care deliver better outcomes,quality & better value for system better patient experience money or be more efficient
  4. 4. A long standing vision and strategy to develop integrated care in HampshireCommunity Primary services Care With primary care we are developing a new, integrated workforce which Social care assesses & proactively plans to meet Acuteelderly care the needs of vulnerable patients OPMH With acute providers we are creating integrated acute & community elderly care services to reduce emergency admissions and length of stay Integrated Care Our staff have direct access to a menu of social care services System
  5. 5. Creating a focus on supporting frail elderly people in the community Single Community Care District Twilight Team Team (CCT) based aroundNursing Team general practice, serving a population of approx Rapid Response Community 30,000 people rehab team Team  24/7 service  ⅔ of activity in clinics, Patient ⅓ intensive home support Therapy TeamSupport Team  Locality based virtual wards and Rapid Assessment Units
  6. 6. Integrated primary and community caremanaging the needs of their population Integrated Primary Primary Care Health Care Team GP GP GP GP GP GP GP GP GP GP Practice Specialist Counsellor Nurse Nurse Health Paed Diabetes Visitor nurse nurse COPD Physio HCSW nurse Creating a Community Services single team based OT Practice CCT Nurse Health Paed Diabetes around a Visitor nurse nurse practice Menu of social care COPD population Community Nurse services Physio OT nurse Menu of social care Single admin team? Community Nurse services Single set of patient notes?
  7. 7. Our partnerships with acute providersPiloting an approach where we create a single,integrated multi-professional older people’s service– The Older Persons’ PartnershipOne team, with one aim and one vision, deliveringa single model with integrated leadershipCCG involved from the beginning to create a ‘pullnot push’ model with rapid access to diagnosticsand appropriate specialist expertiseNo money changing hands – overcomingorganisational boundaries without changingcontracting arrangements
  8. 8. Working in partnership with acute trusts Geriatricians working 8am-8pm 7 days per week in Medical Admissions Units and A&E, instead of delivering outpatient clinics New, local, integrated community and acute care Rapid Assessment Units Integrated health and social care community led front door and back door to hospital Investment in team and leadership development to build trust and change behaviours Dedicated leadership team and clear focus on developing the workforce, in partnership
  9. 9. Is it working?Medical Admission Unit discharges Changing how we work together in MAU on 31 26 per day October led to a step change in discharges 22 per day 31 October
  10. 10. Is it having any impact? Commissioning information tells us… +4.7% overall emergency admissions compared to 2010/11 -7.9% emergency admissions for frail elderly and LTCs – conditions we can influence through more integrated servicesMarch June October2011 2011 2011
  11. 11. When we are in contact with the frail elderly, we are able to help keep them out of hospitalOnly 12% of patients on our virtual wards are admitted within 30 days of beingplaced on a Virtual Ward; Southern Health support 88% of patients to avoidAdmissions when on the Virtual Ward
  12. 12. How do we achieve this? Responding to patients in crisis
  13. 13. We support end of life patients to die intheir preferred location – avoiding dying during an acute admission Virtual Wards commenced
  14. 14. But many vulnerable patients are not known to our servicesSo a key challenge for us and the system is to identify earlier thosepatients at highest risk of admission – and in doing so we know we canbegin to address the issues they face. This is a key element of ourwork with primary care
  15. 15. Summary and learningWe are aiming to make a step change – not playing aroundthe edgesCreating and developing leadership capability throughoutthe organisation and system. A leap of faith of the leadersinvolved to ‘just do it’ and refine as we goMaking sure that exchange of money/contracting issuesdon’t stop us doing the right thingThe challenge to focus all our people on the task we face – totransform services – despite uncertaintyEveryone needs to come to work each day thinking how theycan improve outcomes and customer service within theresources we have – providing better care in later lifeIts behaviour we need to change – of our people, partnersand patients

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