Improving access to seven day services - Taunton 4th March 2015
The first of the regional events for the south took place in Taunton on 4 March. Over 100 delegates from local health and social care organisations came together with patient, public and voluntary sector representatives to hear about the expectations, opportunities and challenges of delivering seven day services and to review and further develop plans for their local communities.
Interactions between the delegates in their local health and social care communities, supported by the NHS Improving Quality team, made this a vibrant event with everyone contributing to the table discussions during the day.
Key themes emerging during the day included:
• The need for system resilience group members to fully understand the skills and “offer” that each of them can bring to the table to improve health and social care seven days a week. This was highlighted in discussions around clinical standard 9, which many groups focussed on as their top priority.
• The need to have an effective system of information sharing between all parts of the health and social care system.
• The huge role that patients and public groups have to play in planning services.
3.4 - Workforce and developing multi-disciplinary teams in primary careNHS England
The importance of the workforce needs in Beds, Luton and Milton Keynes, what does it mean to the people on the ground and how are they going to be affected. How will it improve their working lives?
Tips to engage stakeholders in 7 day servicesNHS England
NHS England’s Sustainable Improvement team are hosting a series of free sharing and learning webinars to support organisations implement seven day services (7DS).
The next in the series focuses on stakeholder engagement, as feedback from the service has indicated that good stakeholder engagement is a key factor in successfully implementing 7DS.
This webinar will showcase practical tried and tested approaches supported by Trust examples. There will be opportunities for peer to peer connections, learning and for participants to share their own practice.
During this session you will hear about examples from:
University Hospital Southampton NHS Foundation Trust: Whole System: Engaging commissioners, clinicians and Patients for 7DS with Dr Juliane Kause, Care Group Lead Emergency Care, Lead Consultant Out of Hours Care and Seven Day Services.
Oxford University Hospitals NHS Foundation Trust: Spreading the word and resources to help clinicians: Portal for Oxford 7DS Guide with Belinda Boulton, Director of Transformation and Ruth McNamara, Integrated Care Projects Lead.
Maidstone and Tunbridge Wells NHS Trust: Getting it right from the start: engaging internal stakeholders for 7DS clinical leadership and planning with Lynne Sheridan, Head of Delivery Development
Improving access to seven day services - Taunton 4th March 2015
The first of the regional events for the south took place in Taunton on 4 March. Over 100 delegates from local health and social care organisations came together with patient, public and voluntary sector representatives to hear about the expectations, opportunities and challenges of delivering seven day services and to review and further develop plans for their local communities.
Interactions between the delegates in their local health and social care communities, supported by the NHS Improving Quality team, made this a vibrant event with everyone contributing to the table discussions during the day.
Key themes emerging during the day included:
• The need for system resilience group members to fully understand the skills and “offer” that each of them can bring to the table to improve health and social care seven days a week. This was highlighted in discussions around clinical standard 9, which many groups focussed on as their top priority.
• The need to have an effective system of information sharing between all parts of the health and social care system.
• The huge role that patients and public groups have to play in planning services.
3.4 - Workforce and developing multi-disciplinary teams in primary careNHS England
The importance of the workforce needs in Beds, Luton and Milton Keynes, what does it mean to the people on the ground and how are they going to be affected. How will it improve their working lives?
Tips to engage stakeholders in 7 day servicesNHS England
NHS England’s Sustainable Improvement team are hosting a series of free sharing and learning webinars to support organisations implement seven day services (7DS).
The next in the series focuses on stakeholder engagement, as feedback from the service has indicated that good stakeholder engagement is a key factor in successfully implementing 7DS.
This webinar will showcase practical tried and tested approaches supported by Trust examples. There will be opportunities for peer to peer connections, learning and for participants to share their own practice.
During this session you will hear about examples from:
University Hospital Southampton NHS Foundation Trust: Whole System: Engaging commissioners, clinicians and Patients for 7DS with Dr Juliane Kause, Care Group Lead Emergency Care, Lead Consultant Out of Hours Care and Seven Day Services.
Oxford University Hospitals NHS Foundation Trust: Spreading the word and resources to help clinicians: Portal for Oxford 7DS Guide with Belinda Boulton, Director of Transformation and Ruth McNamara, Integrated Care Projects Lead.
Maidstone and Tunbridge Wells NHS Trust: Getting it right from the start: engaging internal stakeholders for 7DS clinical leadership and planning with Lynne Sheridan, Head of Delivery Development
NICE Master Class final presentation 25 11 14 (including workshops)NEQOS
Collaborating for Better Care Partnership Master Class with NICE: 'Putting Evidence into Practice' - complete ppt slide pack including the workshop ppts and web links.
Enabling self-management: more than smart phones and digital widgetsNHS Improving Quality
Guest speakers: Ian Briggs, Associate Director Business Development and Jeannie Hardy - County Durham and Darlington NHS Foundation Trust
Hosted by: Beverly Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:
• Introduction to self-management - driven by lifestyle choice and access - underpinned by digital capability / enablers
• Health call Case studies - INR and/or nutrition
• Importance of lifestyle training and clinical empowerment of patient
Dr Alisha Davies explores evaluation of the 'Better access, better care, better lives' scheme in Barking, Dagenham, Redbridge and Havering as part of the Prime Minister's Challenge Fund.
“#CWPZeroHarm”
Cheshire and Wirral Partnership NHS Foundation Trust (CWP) – a provider of mental health and community physical health services – has responded proactively with an initiative to tackle the patient safety challenge posed by Hard Truths. Its #CWPZeroHarm ‘Stop, Think, Listen’ campaign, underpinned by the 6Cs, aims to drive cultural change to deliver improvements in safe care and provide better outcomes. The case study describes how CWP has invested in a number of plans to tackle unwarranted variations in health care by helping staff to deliver continuous improvement. The campaign has already started to make a positive difference – CWP achieved the highest score in the country for ‘overall experience of services’ in the CQC survey of users of its mental health community services.
Anticipatory Care Planning: Time To Make It Happen - Early Intervention Using The Life curve Dr Sarah Mitchell (Programme Manager - AHP National Delivery Plan)
A service improvement focused on frailty using an R&D approach, pop up uni, 3...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
NICE Master Class final presentation 25 11 14 (including workshops)NEQOS
Collaborating for Better Care Partnership Master Class with NICE: 'Putting Evidence into Practice' - complete ppt slide pack including the workshop ppts and web links.
Enabling self-management: more than smart phones and digital widgetsNHS Improving Quality
Guest speakers: Ian Briggs, Associate Director Business Development and Jeannie Hardy - County Durham and Darlington NHS Foundation Trust
Hosted by: Beverly Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:
• Introduction to self-management - driven by lifestyle choice and access - underpinned by digital capability / enablers
• Health call Case studies - INR and/or nutrition
• Importance of lifestyle training and clinical empowerment of patient
Dr Alisha Davies explores evaluation of the 'Better access, better care, better lives' scheme in Barking, Dagenham, Redbridge and Havering as part of the Prime Minister's Challenge Fund.
“#CWPZeroHarm”
Cheshire and Wirral Partnership NHS Foundation Trust (CWP) – a provider of mental health and community physical health services – has responded proactively with an initiative to tackle the patient safety challenge posed by Hard Truths. Its #CWPZeroHarm ‘Stop, Think, Listen’ campaign, underpinned by the 6Cs, aims to drive cultural change to deliver improvements in safe care and provide better outcomes. The case study describes how CWP has invested in a number of plans to tackle unwarranted variations in health care by helping staff to deliver continuous improvement. The campaign has already started to make a positive difference – CWP achieved the highest score in the country for ‘overall experience of services’ in the CQC survey of users of its mental health community services.
Anticipatory Care Planning: Time To Make It Happen - Early Intervention Using The Life curve Dr Sarah Mitchell (Programme Manager - AHP National Delivery Plan)
A service improvement focused on frailty using an R&D approach, pop up uni, 3...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
LTC year of care commissioning early implementer sites workshop held on 1 December 2014. Featuring Dr Martin McShane, Rob Meaker and Renata Drinkwater.
NHS England and partners have published six Quick Guides to bring clarity on how best to work with the care sector. They can be accessed at www.nhs.uk/quickguides
Want to find out how the care sector can support local systems in the run up to winter? Want to break down barriers between health and care organisations? Want to find out how Leicester has achieved a 60% reduction in care home admission costs? Want to finally break down the myths around sharing patient information and assessments? Want to use other people's ideas and resources?
Webinar outcomes:
Introduction to the care homes quick guides
Two examples of models referenced in the guides:
- Angela Dempsey, Baker Tilly on the Quest4care tool
- Dawn Moody on MDT working and a model implemented in a CCG
Guest Speakers: Nicola Spencer and Emily Carter - NHS England
NHS Quality conference - Lesley GoodburnAlexis May
“Insight and involvement – creating the difference that makes a difference”
How to collate, aggregate and triangulate patient experience, clinical effectiveness and safety data across GP practices, NHS England, CCGs and providers to create themes and trends and make improvements to services based on patient and clinical feedback.
Making Seven Day Services a reality, pop up uni, 2 pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Lesley Strong and Hazel Carpenter: integrating community and social care serv...The King's Fund
Lesley Strong and Hazel Carpenter discuss how Kent County Council, Kent and Medway NHS and Social Care Partnership Trust, Kent Community Health NHS Trust and the clinical commissioning groups have been working together to join up community health and social care services in the county.
Components of integrated care include: a system of risk stratification to determine which high-risk patients the multidisciplinary team are going to work with; co-located, mobile and flexible teams; a single assessment process with assistive technology at the core; and health and social care co-ordinators appointed in some localities.
Transforming End of Life Care in Acute Hospitals PM Workshop 5: How to use th...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals PM Workshop 5: How to use the revised and updated ‘Transform How to Guide’ presented by Maggie Morgan Cooke, Wendy Gray, NHS England
For the Nuffield Trust Health Policy Summit, Stephen Shortt tells the story of a journey from multiple unconnected practices to accountable community based integrated services at scale.
Delayed discharges - A patient flow and safety imperativeAnn Marie O'Grady
Presentation details change project to improve patient flow and safety in Beaumont Hospital, Dublin, for patients whose discharge is delayed awaiting a residential nursing home bed
Stopping over-medication of People with Learning Disabilities
(STOMPLD) 2016.
Reducing Inappropriate Psychotropic Drugs in People with a Learning Disability in General Practice and Hospitals in 2016.
Presentation slides Frailty: building understanding, empathy and the skills t...NHS Improving Quality
Frailty: building understanding, empathy and the skills to support self-care
Guest speaker:Dr Dawn Moody, Director - Fusion48
An opportunity to learn about some innovative approaches to making the health and care workforce 'Fit for Frailty'* (*British Geriatrics Society 2015).
Learning outcomes:
To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty
To hear how Virtual Reality is being used to build empathy for older people living with frailty
To learn about the impact of a county-wide, multi-agency, multi-professional training an toolkit for care professionals working with older people
Resources:www.fusion48.net
Self-management in the community and on the Internet - Presentation 22nd Marc...NHS Improving Quality
LTC Lunch & Learn webinar:- 22nd March 2016
Presenter:- Pete Moore, Educator, Author & Pain Toolkit Trainer
As pain is the most daily health problem reported to a GP-
Developing a national pain strategy- reviews from around the world
Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient C...NHS Improving Quality
Speaker slides from the national conference, 'Electronic Palliative Care Coordination Systems (EPaCCS): Improving Patient Care at End of Life', 17 March 2016
Fire service as an asset: providing telecare support in the community Webinar...NHS Improving Quality
Guest speaker: Steve Vincent - West Midlands Fire Service & Simon Brake from Coventry Council
Hosted by: Bev Matthews, Long Term Conditions Programme Lead, NHS England
Learning Outcomes:-
To better understand the role that the Fire and Rescue service can provide as a community asset to support health needs Enhancing the quality of life for people by supporting them to stay in their own home, even in a crisis
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
Commissioning Integrated models of care
Kent LTC Year of Care Commissioning Early Implementer Site
Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
2. www.cddft.nhs.uk
County Durham & Darlington Profile
• Population base served:
– 610,000 approximately
• 3 Clinical Commissioning Groups
– North Durham, DDES &Darlington
– 82 GP practices
• County Durham and Darlington NHS
Foundation Trust – integrated acute /
community health care provider
– 2 Acute hospitals
– Access to six community hospitals
• Tees, Esk and Wear Valley NHS
Foundation Trust
– Provides inpatient and community
services
• Two local authorities
– Darlington Borough Council
– Durham County Council
• North East Ambulance Service (NEAS)
3. www.cddft.nhs.uk
Approach to 7 Day Services
• Whole economy integrated approach
• Health
• Social Care
• Third Sector
• Patient groups
• Service Transformation
• Integrated governance and planning across all partners
• Align with locality strategies such as ‘Better Care Fund’.
• Programme Methodology for delivery with three priority areas
• Frail elderly
• Urgent Care
• Diagnostics
4. www.cddft.nhs.uk
High Performing 7DS – Some Key Areas
Career Structure
Goal Setting
System
Culture
Disciplinary
System
Stakeholder
engagement &
Communication
Clinical
Governance
Contractual and
competitive
strategy
Pay
Training &
development
LHE and local
Organisation
Structure
Professional
body, Trade
Union
Relationship
Planning
Service ,
investment &
people
Strategic
Decision Making
Information
Systems &
Sharing
Performance
monitoring
&mgt
Job Roles
Local High
Performance
7Ds
5. www.cddft.nhs.uk
A shared vision creates aligned policy?
2014
7 day access
BCF
PMCF
Federated
GP
GP, IT
system
Medical
contracts
Competition
& Cost reduction
DES
2019
Vision &
position
2014
7 day access
DES
BCF
New contracts
Competition
and cost
reduction
“Without a sensible shared vision, a transformation effort can easily dissolve
into a list of confusing and incompatible projects that can take the
organisation in the wrong direction or nowhere at all.”
John P Kotter
6. www.cddft.nhs.uk
Lessons learned from previous programmes of joint work
Lack of clarity about
performance gains
to be delivered in
each org
Rushing to solutions
Change
infrastructure and
plans not in place
No concrete
management
support,
management not
aligned
Resource needs not
recognised
Assumptions &
givens not clarified
and communicated
Visioning just a
paper exercise – not
a real picture of the
future
Change activity &
communications
confined to
‘specialists’
Change
process begins
in the old way –
imposition not
involvement
Key staff issues and
concerns not
addressed
Not enough
information about the
case for change
Once-off
communications no
continuous process
Sheep dip
training/
engagement
Failure to
achieve
tangible
goals
Poor role
modelling
Programme
taking too
long
No redesign – so the new
organisation has the wrong
configuration
Technical system redesign
only – people side short-
changed
Imposed by ‘experts’
Using pilots to
prove/disprove viability
rather than test the design
Inadequate
implementation
planning and
preparation
Resources not available
Performance dip
Training practicalities ignored
Contingent systems changes
not ready
No effective learning
processes
Failure to
evaluate
and review
effectiveness of
the changes
Plateau effect
Leaders stuck in old
ways of working
Reverting to old ways
in times of crisis
Roles not clear
Deliverables not clear
Going too far too fast
Poor role modelling from the
top
7. www.cddft.nhs.uk
Our bespoke change program
B
(1)
A
(2) Local Critical Success
Failure / Factors (5)
Gap
(3)
Change
Priorities (4)
+
Change programme
8. www.cddft.nhs.uk
Programme Methodology
Establish
The
programme
• Agree key 7
day principles
• Define point B
& understand
point A
• 7 day working
gap analysis &
change agenda
• Programme
Plan
• Business case
• Create steering
group, change
support team &
key pathway
teams
• Preparing key
clinicians &
mangers to
lead change
Mobilise
• Establish
the case for
change
• Stakeholde
r analysis &
comms
strategy
• Creating a
shared
7DS vision
• External
visits
benchmark
• Staff input
into 7DS
change
agenda
• Simple
wins
Breakthrough
3 Key pathfinder
areas
• Frail Elderly
• Diagnostics
• Urgent care
• Cascade vision
into pathfinder
areas
• Early Wins
System re-design
• Re-designing work
process and systems
• Social systems
design
• Service configuration
• Governance &
Infrastructure design
• Define capability
needs
• Performance mgt
design
• HRWorkforce
systems design
• Review &
evaluate
pathfinders
• Finalise 7
day working
system &
design
• Consultation
• Develop
phased full
roll-out
business
case & Plan
* Red Text –
Areas of
Progress
9. www.cddft.nhs.uk
Areas of Progress
• County Durham and Darlington Foundation Trust acute
baseline assessment
• Multi-disciplinary team development:
• Acute based
• Community based
• Analysis of key barriers to change
• Integrated planning documentation including vision,
principles and service blueprints
• Information sharing Agreements (ISA)
• Template and populated ISAs
• Case study on information sharing
10. www.cddft.nhs.uk
Standard 3 - Multi-disciplinary Team (MDT)
review
“All emergency inpatients must be assessed for complex or on-going needs
within 14 hours by a multi-professional team, overseen by a competent
decision-maker, unless deemed unnecessary by the responsible consultant. An
integrated management plan with estimated discharge date and physiological
and functional criteria for discharge must be in place along with completed
medicines reconciliation within 24 hours.”
Supporting information:
• The MDT will vary by specialty but as a minimum will include
Nursing, Medicine, Pharmacy, Physiotherapy and for medical patients,
Occupational Therapy.
• Other professionals that may be required include but are not limited
to: dieticians, podiatrists, speech and language therapy and
psychologists and consultants in other specialist areas such as
geriatrics.
• Reviews should be informed by patients existing primary and
community
• Appropriate staff must be available for the treatment/management
plan to be carried out
11. www.cddft.nhs.uk
Achievements
7 DAY MDT
Average Discharge
Increase by 7%
Reduction in LOS
5%
Medical Boarders
Per Day
Reduction of 67%
AM discharges
Increase by 13%
Non acute tfr of
patients per week
Increase by 27%
ED Activity
Increase by 5%
Falls per week
Reduced by 25%
12. www.cddft.nhs.uk
Further 7 day Projects Which Have Stemmed
From The Implementation Of Standard 3…
There are 4 key issues which are blocking medically fit patients from leaving the ward…
On average the information centres across the six wards are typically seeing 30 patients
per week who are now medically fit for discharge but are “blocked” in the system due to
problems which are being addressed.
Just over one
third of the
patients ready to
move on are
under the Trust’s
control
By making problems visible on information centres, the teams have highlighted 4 key areas
of focus: CHC assessments, Nursing Home discharges, Diagnostics and community
hospitals.
14. www.cddft.nhs.uk
What We Are Trying To Achieve
• Improve patient experience
• More effective care planning and packages centred on
individual needs
• Care in the community or at home where preferred option
• Increase in self-management
• Increased involvement of Voluntary Care sector
• Prevent unnecessary acute admission/re-admission
• Reduce length of stay (e.g. through ‘in-reach’)
• Reduce number of patients transferred to long term care
15. www.cddft.nhs.uk
Stakeholders Involved
• Darlington CCG & Associated Practices
• County Durham and Darlington FT
• Darlington Borough Council
• Tees, Esk and Wear Valley FT
• Voluntary Sector
• Care Home Sector
• Healthwatch
• NEAS
• North of England Commissioning Support
16. www.cddft.nhs.uk
Progress since March 2014 –
Primary Care
• Practice MDT’s take place monthly in place with attendance from
Social Workers, Community matrons and Voluntary Sector brokers
• Advanced care plans being developed for 2% of population at
highest risk of emergency admission
• Monthly meetings to discuss those who have had emergency
admission in previous month & agree how care plan/support
package needs to be amended to prevent re-occurrence
• Voluntary sector broker liaises with other VS organisations as
appropriate
• Referrals made to other teams as appropriate e.g. mental health
• Evolutionary development
17. www.cddft.nhs.uk
Progress since March 2014 – Care Homes and initial
feedback
• Community Matrons now working 9am – 5pm; 7 days a week
– linked to Top 10 Care Homes
• District Nurses pick up any referrals overnight
• Community Matrons attending all GP practices monthly MDT’s
• EHCP/Advanced Care Plans starting to be put in place for all
patients in care homes.
• NEAS aware of new ways of working and ring Matrons prior to
patients conveyance to hospital
18. www.cddft.nhs.uk
Outcomes So Far:
Emergency Admissions from Care Homes –
April to November 2014
Local
authority Location Name Apr-14
May-
14
Jun-
14 Jul-14
Aug-
14
Sep-
14
Oct-
14
Nov-
14
Curren
t Total
Darlington
Darlington Manor Care
Home 6 4 6 3 4 1 24
Darlington Eastbourne Care Home 6 8 1 8 6 8 4 2 43
Darlington Eden Cottage Care Home 6 8 1 8 6 8 4 2 43
Darlington
Grosvenor Park Care
Home 8 7 9 8 5 9 6 52
Darlington Rydal Care Home 3 2 2 4 2 10 2 25
Darlington
St Georges Hall and
Lodge 4 5 6 4 7 4 2 32
Darlington The Gardens Care Home 9 5 8 8 6 7 5 2 50
Darlington The Grange 8 17 16 5 7 6 6 2 67
Darlington Ventress Hall Care Home 4 5 7 11 8 4 4 2 45
Darlington Willow Green Care Home 14 9 8 7 5 3 3 1 50
Monthly total 68 65 63 68 49 66 38 14 431
19. www.cddft.nhs.uk
Issues – Or Challenges
And Opportunities
• Multi organisation working
• Aligning national strategies against challenging
timelines
• Information sharing
• IM & T
• Communication
20. www.cddft.nhs.uk
Future direction and next
steps
• Community Rapid Assessment Service - Front of House
• Geriatrician telephone advice line 12:00 – 14:00 Monday to
Friday
• Hospital to Home
• Additional matrons/assistant practitioners to support
remaining care homes
• Identification of areas for future development/investment
21. www.cddft.nhs.uk
Overcoming the IG ‘Barriers’
• It’s not ‘we can’t share’ – its ‘how can we share’
• An Information Sharing Agreement (ISA) is a document
for all parties to agree :
• Assist compliance with information rights law and
practice.
• Set’s out standards and consistency that have to be met
by all signatories.
• Ensure patient consent is achieved in process
23. www.cddft.nhs.uk
Arriving at a GP practice at 2pm on a Saturday, we note that
• The practice is open and offering both emergency appointments and
clinical sessions to patients who have booked there appointment
through the multi-agency SPA.
• A mixture of local point of testing, locality based x ray and digital health
care systems providing a local integrated diagnostic support system.
• We note the GPs working on the Saturday sessions are from a range of
local practices, the local GP federation providing a locality based
approach to 7 day working and medical cover.
• A frail elderly MDT meeting is in progress with a local specialist GPwSI,
Social worker, a NA&S collaborative nurse , a community diabetic
specialist nurse and CPN are holding a video conference with a
community geriatrician who is linked in from the local community
hospital where she is helping on assessments of patients to move back
to home based settings.
• The MDT are all using TPP Systmone as the core single record and
basis of the case mgt of both high risk patients and those who are being
discharged from hospital. The social and community staff linking in
through their mobile working laptop system, all patients on the MDT
system having agreed to share their information
• Leaving the practice we note that a program of LTC support sessions
are planned for Monday, at these sessions consultants and specialist
nurses are booked to provide integrated support sessions to frail elderly
patients with multiple conditions - diabetes, vascular and supporting
podiatry and retinal screening sessions being carefully planned to allow
access to clients until 7pm
24. www.cddft.nhs.uk
Travelling to a local care home on Sunday we note
• A NA&S collaborative nurse is undertaking a review of 6 patients, 3 identified
in a local MDT meeting from risk stratification process as having a risk of
escalation and 3 recent arrivals from a planned discharge process 2 from a
community hospital and one from a DGH.
• The patient discharged from hospital, arrived an hour ago, the community led
integrated intermediate care / discharge team planned the discharge from the
hospital with essential medication being provided from the new 7 day pharmacy
service. The script being sent electronically from the hospital
• The patients hospital discharge information pack, included a web generated
nutrition plan, and a digital health monitoring pack. This cheap and flexible
digital health pack, brought by the ISIS HCA in the boot of his car, was
connected and put on line and started taking readings within 10 mins. The
information being cloud based, allows decisions around additional care to be
made by local GPs accessing clinical information. This INR dependant patient
is also utilising the digital monitoring system to dose check as required.
• The care home staff are preparing for a visit from a local care home support
team of GP, a NA&S collaborative nurse and pharmacist who provide focussed
support to help avoid hospital admissions
25. www.cddft.nhs.uk
In a local elderly persons home
• An NA&S nurse practitioner is visiting to check out a
person on the local risk of admission register, the persons
carer has called for help from the SPA as they were
concerned.
• The nurse is using a digital stethoscope to listen and
transmit in real time the heart and lung function to a COPD
consultant operating in ‘the front of house’ team of the
local A&E unit. The conclusion is that a course of IV
antibiotics supported by the local nursing team in the
persons home and an enhanced support package , which
includes a 3rd sector sitting service, organised by the
social worker through the SPA will prevent risk of
admission.
• The carer has on their carer patient portal a contact name
and support person named to discuss their concerns if
required.
• Falls tracker call has been taken by the patient and carer –
this asks simple questions to help triage whether after a
recent fall the falls team need to come out
26. www.cddft.nhs.uk
NA&S wrap around service model
• minor injuries
• Help line
• Emergency
care
• Elective
• LTC
• Self mgt
• Health imp
• dementia
• Care mgt
• Nutrition
• isolation
• maternity
• Obs & Gynae
• childrens
• Poorly child
• Prevention
• Talking
therapies
Women
and
families
Frail
elderly
Urgent
care
Adult
7daydiagnostics&pathlab
MentalhealthMDT–
disruptivelifestyle/
addiction
Specialist teams
consultant /
ANP
Community H&WB /
Outpatient / digital
hub
Self mgt support
digital
monitoring
Palliative
care
Singlepointof
accessSPA
ISIS/Rehab/
Hospitalto
home
Community
Beds
27. www.cddft.nhs.uk
Clinical Programme Board
(Transformation Board)
County Durham and Darlington Strategic Programme
Board
Darlington
Organisational
Leads
Better
Care
Fund
7 Day
Working
Care
Closer To
Home
Unschedul
ed Care
Planned
Care
County Durham
Organisational
Leads
Strategic Enabling Programmes
Informatics, Estates, Workforce, etc
County Durham and Darlington Transformation Hub
Darlington Transformation Hub
PROGRAMME
PORTFOLIO
GOVERNANCE
RESOURCES
Clinical
Advisory
Group
Darlington
Unit of Planning
County Durham
Unit of Planning
PLANNING
Health and Wellbeing Boards
County Durham Transformation Hub
28. www.cddft.nhs.uk
IM&T & Equipment infrastructure
• Shared records based on NHS Number
• Community and primary teams on same system
• Portal technology to link acute /primary/ community/ social
care / tewv/3rd sector and patient / carer
• Mobile working with common communications / Wi-Fi to
allow access at any part of LHE system
• Digital health systems with multi input capability and able to
link to patient record electronically
• All infrastructure (wires / kit / support from common supplier
/ maintenance / helpdesk system )
• All clinical equipment standardised
• Single process for immunisation & vaccinations
management – managed by upgraded child health
approach