Moving to 7 Days Services in
Dudley
Paul Maubach
Chief Accountable Officer
Dudley CCG
Local Dudley
Service Provider
‘Our caring, compassionate and highly
experienced staff are available 24 hours a
day where y...
Deaths by Day in
Dudley - 2012
Weekday Deaths Day Count
Average
Deaths per
Day
Sunday 400 53 7.547
Monday 411 53 7.755
Tue...
Strategic Priority
 Privileging Population Health and Wellbeing
• Autonomous individuals
– Preventing / resolving depende...
Dudley CCG: context
 CCG registered population = 312,000
 48 practices
 10 single handed practices
 Mixture of wards i...
Dudley Health and Social
Care Economy – The
Opportunity
 Unnecessary emergency admissions
 Excessive service usage by ov...
7 day services:
variation in delivery
-15
-10
-5
0
5
10
15
20
Mon Tue Wed Thu Fri Sat Sun
Average Net flow of Patients (ad...
 Post weekend peaks in admissions
 Postponement of discharges due to absence
of support services – therapy, pharmacy etc...
Person
GP
Practice
Community
Clinical
Commissioning
Group
Registered Member
Based in a Locality
Part of a System
Aligned, ...
Integration and Better
Care Fund 7 day services
Community
Rapid
Response
Team
OD:
Leadership
programme
Prevention
agenda a...
 Dudley was successful in applying to be one of
the National Early Adopters
 Cross health economy working group set up
...
Community Mental
Health Teams: adults
and older people
Palliative
care team
Heart failure-
joint pathway
with acute
OT
Phy...
1. Patient experience
2. Integrated team review
3. Information and communication
4. Diagnostics
5. Speed of access and ass...
Evidence base:-
 19,500+ over 65 arrived at ED
 14,500 admissions over 65
 10,000+ over 75
 6,500 admitted for 2 days ...
 Team of 9 Advanced Nurse Practitioners
 Integrated with social care assistants and care
home nurse practitioners
 ANPs...
Community Rapid Response Team for Older
People with Frailty
Integrated with Care Home Nurse Practitioners
and Social Care ...
Practice integrated teams
 To consist of GP, pharmacists,
community nurses, named
social and mental heath
workers. To rev...
 Over 2,200 residents in nursing and residential
homes registered with a Dudley GP
 High number of urgent care admission...
 Community nursing and therapy services have
a single point of access
 Social services have a single point of access
 B...
 Develop self care programmes
 Develop remote monitoring tools (tele-health)
 Increase utilisation of voluntary sector
...
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
Numberofadmissions/attendancesinfollowing
year
ACG Probabilityof Future ...
 Imperative that community practitioners have
access to pertinent information and
particularly for a 7 day service when p...
 Representative approach:
 Patient perspectives a standard item on the integrated
working group
 Aim is to capture the ...
The Overall Purpose is:
 Improve patient experience, and their health and well being outcomes
 Improve patient engagemen...
Strategic Priority
 Privileging Population Health and Wellbeing
• Autonomous individuals
– Preventing / resolving depende...
Questions?
Moving to seven days services in Dudley
Moving to seven days services in Dudley
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Moving to seven days services in Dudley

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Paul Maubach, Chief Accountable Officer
Dudley CCG. Paul's slides from the presentation at the West Midlands 7 Day Services Event on 11th June, 2014

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Moving to seven days services in Dudley

  1. 1. Moving to 7 Days Services in Dudley Paul Maubach Chief Accountable Officer Dudley CCG
  2. 2. Local Dudley Service Provider ‘Our caring, compassionate and highly experienced staff are available 24 hours a day where you can be guaranteed of a personal service from the first call. If you can't get to us don't worry, we will be happy to visit you in the comfort of your own home’
  3. 3. Deaths by Day in Dudley - 2012 Weekday Deaths Day Count Average Deaths per Day Sunday 400 53 7.547 Monday 411 53 7.755 Tuesday 396 52 7.615 Wednesday 396 52 7.615 Thursday 420 52 8.077 Friday 436 52 8.385 Saturday 398 51 7.804 Grand Total 2857 365 7.827
  4. 4. Strategic Priority  Privileging Population Health and Wellbeing • Autonomous individuals – Preventing / resolving dependency • Registered population – Aligned, networked service delivery • Mutual responsibility – Understanding the value of what we do – Sharing our social capital as a community
  5. 5. Dudley CCG: context  CCG registered population = 312,000  48 practices  10 single handed practices  Mixture of wards including some in the lowest 20% for most deprived across the country and some in the top 20% of most affluent.
  6. 6. Dudley Health and Social Care Economy – The Opportunity  Unnecessary emergency admissions  Excessive service usage by over 80s  Too many admissions to nursing and residential care  Recognition by partners of the need for a step change in service delivery  Commitment to redesign urgent care  Evidence that 5 day working creates dysfunctional service pressures
  7. 7. 7 day services: variation in delivery -15 -10 -5 0 5 10 15 20 Mon Tue Wed Thu Fri Sat Sun Average Net flow of Patients (admissions vs discharges)
  8. 8.  Post weekend peaks in admissions  Postponement of discharges due to absence of support services – therapy, pharmacy etc..  Unnecessary admissions due to absence of more appropriate primary and community health services  Inconsistency of patient experience and response, 7 days per week 7 Day Response To Avoid…..
  9. 9. Person GP Practice Community Clinical Commissioning Group Registered Member Based in a Locality Part of a System Aligned, Networked Population Health and Wellbeing Services
  10. 10. Integration and Better Care Fund 7 day services Community Rapid Response Team OD: Leadership programme Prevention agenda and tele-health Risk stratification Single point of access Dudley Care Home programme Integrated teams
  11. 11.  Dudley was successful in applying to be one of the National Early Adopters  Cross health economy working group set up  Working with NHS Improving Quality Team Three main areas of focus  Mapping of services  Developing community standards  Sharing best practice with other early adopters 7 day services
  12. 12. Community Mental Health Teams: adults and older people Palliative care team Heart failure- joint pathway with acute OT Physio Care home nurse practitioners Stroke Neurology Social service teams SLT Current 7 day working From July 2014 Potential to move to 7 days in 2014 MH Crisis Resolution Community Rapid Response Team Tele-care services Dementia Gateways District Nurses Current 7 day working Intermediate Care Community Respiratory Team Virtual ward (Case Managers) Care home provision
  13. 13. 1. Patient experience 2. Integrated team review 3. Information and communication 4. Diagnostics 5. Speed of access and assessment in the community 6. Mental Health 7. Quality Improvement 8. Palliative and End of Life Community Standards
  14. 14. Evidence base:-  19,500+ over 65 arrived at ED  14,500 admissions over 65  10,000+ over 75  6,500 admitted for 2 days or less  85% arrived by ambulance Community Rapid Response Team
  15. 15.  Team of 9 Advanced Nurse Practitioners  Integrated with social care assistants and care home nurse practitioners  ANPs take a referral or intercept 999 green code call  Assess, diagnose, initiate treatment, instigate social care package if required and step down to integrated teams Community Rapid Response Team
  16. 16. Community Rapid Response Team for Older People with Frailty Integrated with Care Home Nurse Practitioners and Social Care Assistants PATIENTS WMAS NHS 111 GP Out of Hours Community Nursing Teams Assessment by ANP or Care Home Nurse Practitioner Within one hour Step down to Locality Integrated Teams Single Point of Access for Advanced Nurse Practitioner Based at WMAS Admit to EAU - Initiate treatment → - Initiate care package → up to 7 days (then review) - Initiate care plan
  17. 17. Practice integrated teams  To consist of GP, pharmacists, community nurses, named social and mental heath workers. To review risk stratification tools and agree a Care Coordinator for complex cases Locality MDT teams  GP Leadership posts in each locality. Remit of reviewing collective outcomes of all teams in their locality and ensuring pathways to locality to borough wide services function effectively Service Integration
  18. 18.  Over 2,200 residents in nursing and residential homes registered with a Dudley GP  High number of urgent care admissions  Dudley Care Home LES operates to provide proactive care and initiate advanced care plans.  Team of 6 care home nurse practitioners to double in size to be integrated with rapid response team and become a 7 day service. Dudley Care Home Programme
  19. 19.  Community nursing and therapy services have a single point of access  Social services have a single point of access  Both in the same building!  Moving to joining together and include mental health Single point of access
  20. 20.  Develop self care programmes  Develop remote monitoring tools (tele-health)  Increase utilisation of voluntary sector (community link workers)  Social prescribing Prevention agenda
  21. 21. 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 Numberofadmissions/attendancesinfollowing year ACG Probabilityof Future High Cost ActualAvg no FHS ActualAvg no OPAs ActualAvg no AE Attendences Risk Stratification  Identification of risk using ACG tool  MDT Care Planning  Care gap
  22. 22.  Imperative that community practitioners have access to pertinent information and particularly for a 7 day service when practices are closed.  All practices now on EMIS web  Piloting tablet using ‘Inchware’ technology to access medical information remotely including the ANPs Mobile technology
  23. 23.  Representative approach:  Patient perspectives a standard item on the integrated working group  Aim is to capture the actions and improvement that need to be implemented.  Feedback given to the patient, carer or advocate that provided the story/experience.  Participative approach:  Development of systematic tool (PSIAMS) to record the patient experience of care  Enables patient to chart their progress against outcome goals Learning from patient experiences
  24. 24. The Overall Purpose is:  Improve patient experience, and their health and well being outcomes  Improve patient engagement, to increase their autonomy to take control over their own care.  Develop collaborative relationships between patients & integrated teams.  To improve collaboration and cross-boundary working between organisations.  To work towards a culture change, that demands values based care, and a can-do attitude. The Specific task is:  To address the issues of complex cases demanding multi-agency approaches Mutual Networked Leadership, shared population, shared outcomes Leadership programme
  25. 25. Strategic Priority  Privileging Population Health and Wellbeing • Autonomous individuals – Preventing / resolving dependency • Registered population – Aligned, networked service delivery • Mutual responsibility – Understanding the value of what we do – Sharing our social capital as a community
  26. 26. Questions?

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