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Community Hospitals in Cumbria A Bright Future


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Community Hospitals in Cumbria A Bright Future

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