Vertical Integration: you know it makes sense!

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Vertical Integration: you know it makes sense!

  1. 1. Vertical integration: you know it makes sense! Dr JH Coakley MD FRCP Medical Director and Consultant in Intensive Care Medicine Homerton University Hospital NHS Foundation Trust
  2. 2. Vertical integration: you know it makes sense – well sort of Dr JH Coakley MD FRCP Medical Director and Consultant in Intensive Care Medicine Homerton University Hospital NHS Foundation Trust
  3. 4. Homerton University Hospital <ul><li>University Hospital- approximately 550 beds </li></ul><ul><li>Emergency care predominates (70,000 to >100,000 A+E since 2003, 160,000 OPD, 35,000 IP) </li></ul><ul><li>Relatively young population </li></ul><ul><li>Income approx £140m (give or take PbR tariff fluctuating by10%) </li></ul>
  4. 6. Vertical integration <ul><li>Primary care </li></ul><ul><ul><li>Lack ambition and ability </li></ul></ul><ul><ul><li>Mercenary </li></ul></ul><ul><ul><li>Don’t like hospitals </li></ul></ul><ul><ul><li>Don’t like dealing with difficult patients, so tend to dump them in hospital </li></ul></ul><ul><ul><li>Coffee and golf </li></ul></ul>
  5. 7. Vertical integration <ul><li>… ..so we have a few cross-cultural issues to address before we can get this to work </li></ul><ul><li>Assumes neat distinction between primary, secondary and tertiary care whereas it’s all rather messy </li></ul>
  6. 8. A few myths to dispel <ul><li>Hospitals and their doctors want to keep patients in </li></ul><ul><li>GPs want to keep patients out of hospital </li></ul><ul><li>Patients necessarily want to be out of hospital </li></ul>
  7. 9. A few more myths to dispel <ul><li>Care is cheaper out of hospital </li></ul><ul><li>Stripping out x% of activity will allow removal of x% of income without collapsing emergency rotas and elective work (particularly with EWTD) </li></ul><ul><li>FTs are predatory beasts seeking to admit patients and code them up to maximise profit, hence bankrupting PCTs/PBCs </li></ul>
  8. 10. Vertical integration <ul><li>Our trust runs </li></ul><ul><ul><li>Paediatric hospital-at-home </li></ul></ul><ul><ul><li>Continuing care of the elderly and hospital-at-home </li></ul></ul><ul><ul><li>Community maternity services including home delivery </li></ul></ul><ul><ul><li>Sexual health and community gynaecology </li></ul></ul><ul><ul><li>Community diabetes </li></ul></ul><ul><ul><li>A+E (significant primary care component) </li></ul></ul><ul><ul><li>Locomotor service </li></ul></ul>
  9. 11. Vertical integration <ul><li>In the pipeline </li></ul><ul><ul><li>Paper clinics </li></ul></ul><ul><ul><li>Telephone, e-mail, fax advice clinics </li></ul></ul><ul><ul><li>Rapid access clinics </li></ul></ul><ul><ul><li>Hospital-at-home in other areas </li></ul></ul><ul><ul><li>Cardiology </li></ul></ul><ul><ul><li>COPD </li></ul></ul><ul><ul><li>PUCC </li></ul></ul>
  10. 12. Vertical integration <ul><li>PCT suggests £10m activity out </li></ul><ul><li>We need to increase provision clinically and financially </li></ul><ul><li>Do we have to stay in hospital or should we have real joint commissioning and provision? </li></ul><ul><li>In whose interests is it to reduce hospital attendance? </li></ul><ul><li>How can PCTs or PBCs commission and provide – hospital doctors do not understand this </li></ul>
  11. 13. Vertical integration <ul><li>Finnamore (local) work </li></ul><ul><ul><li>AHA / A&E and sexual health have biggest potential impact </li></ul></ul><ul><ul><li>Less so for minor procedures, ENT, gynaecology, cardiology, diabetes, COPD. </li></ul></ul>
  12. 14. Vertical integration <ul><li>For every change proposed, the principle question must be ‘how will this make it better for the patient, and where is the evidence to support that?’ </li></ul><ul><li>If we try to get it right for patients (individually and as groups) we have an outside chance of making the system work </li></ul><ul><li>If we just argue about money, structures, processes we almost certainly won’t </li></ul><ul><li>This will be difficult with present commissioning conflicts of interest </li></ul><ul><li>We would describe ourselves as a community hospital </li></ul>

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