Janice Horrocks discusses care closer to home. Slides from the impact and celebration event held in Leeds on 3 March 2015.

1. @SONHSTrust
Leading whole system transformation
Care Closer to Home
Janice Horrocks Programme Sponsor
“The right care closer to you”

2. Care Closer to Home (CCtH) partners
• Southport & Ormskirk Hospital
NHS Trust
• Southport & Formby CCG
• West Lancashire CCG
• Sefton Council
• Lancashire County Council
• Liverpool Community Health
• Mersey Care Trust
• Lancashire Care Trust
• North West Ambulance
• West Lancashire Council for
Voluntary Services
• Sefton Council of Voluntary
Services
• Public Health England
• NHS England
• University Hospital Aintree
• Patients and the public
• Southport Nursing Home
Association

3. Case for change
Our population:
•Is ageing – we import people retiring to the area 9,122 or 8.2% of the West Lancashire population
is over the age of 75. By 2022 we expect this will rise to 11.6%.
•Demand for services are rising - Over the last 15 years, short stay (less than two days)‑
admissions have increased by 124%, whereas long-stay (two days or longer) admissions have only
increased by 14%. Bed occupancy rates have been steadily increasing, e.g., 2001/02 = 85% to
2012/13 = 88%, now nationally averaging 89.7% and 1/5 Trusts over 95% (National Audit Office)
•The life expectancy gap between rich and poor is increasing:
– West Lancs: women = 6.3 years; men = 8.7 years
– Southport and Formby: = 7 years for both genders

4. Case for change
National policy drivers:
• Focus on long-term conditions (Dept. of Health 2013)
– In England more than15 million people have a long term condition This figure is set to increase
over the next 10 years, particularly those people with 3 or more conditions at once.
– Long term conditions can affect many parts of a person’s life, from their ability to work and have
relationships to housing and education opportunities. Accounts for 70% of the money we spend
on health and social care in England.
•Simons Stevens ‘5 Year Forward View’ (Oct. ‘14)
– A new relationship with communities = patients and communities gain more control
– Radical upgrade in prevention and public health
– One size doesn’t fit all, so no top down reorganisation, but new detailed care model prototypes
will be developed
– Integrate urgent and emergency care across the system
– Join up care/systems and break down the barriers

5. Hospital is not always the best
place…..
…. to be if you are a frail older person
Research shows evidence of impact of hospital stay on older people:
Amount of time on bed rest = functional decline over 18 months
10 days in hospital = 10 years of muscle aging

6. CCtH is our local integrated
strategy:
• Designed to align the local CCG and Trust strategies with the Sefton and
the Lancashire Health and Wellbeing Board Strategies and Better Care
Fund plans;
• Focused on delivering a set of aims and objectives, which arise from the
strategies stated above; and
• Orientated to lever the maximum benefit from the local health economy
pound, both in ensuring the delivery of effective, safe, high quality services,
designed to deliver better health outcomes and experience of care, but also
through prioritising and investing in activities/projects/services that will
deliver the desired benefits
http://www.southportandormskirk.nhs.uk/downloads/CCtH_strategy_2015final_Feb.pdf

7. To achieve this we will:
Better co-ordinate, plan and deliver more personalised care;
•Develop local community services to offer better access to care and support across the 7 day week;
•Ensure individuals stay in hospital is minimised;
•Design an urgent care system that delivers integrated services outside of hospital for people whose
physical or mental health need for urgent care can be met by responsive advice, support and
treatment closer to home;
•Ensure that end to end integrated care pathways from primary through to specialised care run
smoothly, ensuring evidence based care is consistently and equitably delivered to all individuals and
communities;
•Empower communities and offer greater choice to individuals, by providing transparent information
about the range and quality of health and care services available; and
•Keep Sefton and West Lancashire residents well for longer in our communities, reduce inequalities
and put greater emphasis on prevention of ill health and the mobilisation of community and personal
assets to support self-care

8. To date…
....we have focused on improving services for people living
with long-term health conditions and frail older people
•Integrated Care Pathways
– Cardiology – Heart Failure & Atrial Fibrillation
– End of Life – Advanced Care Planning
– Dementia - Diagnosis
– Frail Elderly – Nursing Home; Crisis & Community
– Respiratory - COPD Diagnosis; COPD Exacerbation & Management of Established COPD
– Diabetes – Foot Attack; Prevention; Primary Care & Acute
•Ambulatory Emergency Care
•Telehealth pilot
•GP acute visiting scheme
•CCtH dashboard

9. System Transformation….
…what are the key issues/challenges?

10. Challenges…
• Managing change and transition at scale, pace and system level
• The £30bn per year gap (by 2020/21)
– Southport & Ormskirk NHS Trust
• Workforce
– Shortage of GPs and need to up skill community and primary care
– Shortage of midwives
– Need to develop new ways of working and workforce roles
• IT – interoperability
– EMIS
• Estate
• Data → intelligence
• Culture

11. How did…
…help us?

12. Our NHSIQ Support Programme
Foundations for
large scale change
Clear, compelling
shared purpose
Driver Diagrams
Narrative
Better decisions
with data
 


 
Measurement
16th
Octobe
r 2013
16th
December
2013
13th
February
2014
9th
April
2014
Culture for
Innovation
More on
Measurement
6th
October
2014
28th
January
2015

15. Nursing home : ‘A’
The home is registered for 65 residents who
comprise of:
34 General elderly
13 Young disabled
18 Elderly Mentally Infirm (EMI)
In April 2014 50 attendances to A&E were recorded
from Nursing Home A. This is a rate of 1.6 patients
on average per day for the month of April.
Considering Manchester House caters for 65
patients, you could in theory say 77% of residents
attended A&E in April. Alternatively, there could be a
high number of re-admissions from Nursing Home A
which is more likely to be the case.
Community Nursing Contacts appear to be showing
a downward trend around the same time as AE
attendances have increased and highlights the
important interventions done by Nursing teams to
prevent patients from attending A&E.

19. Facing the future together
• Integration
• Self-care
• Active case management
• Workforce planning &
development
• Neighbourhood working

20. @SONHSTrust
http://www.southportandormskirk.nhs.uk/downloads/CCtH_strategy_2015final_Feb.pdf