Integrated care services

Ealing Community Partners

Six month update

Jan 2020

Dr Christopher Hilton – Clinical Director

Outline• Integrated Care service line within West London NHS Trust, and Ealing Community Partners

• Contractual transformation milestones as at January 2020 and impact

– Ealing community referral hub and 24/7 nursing service

– Chronic pain service

– Primary care network reconfiguration

• Additional points to update the Board

– Senior management team

– Estates

– Engagement with Ealing’s Integrated Care Partnership

– Adult autism assessment pilot

– Contract end: One You Ealing service, transition of Child Weight Management to CLCH and continuation of

TB education service

• Service information

– Headline financial performance

– Operational performance

– Clinical governance and patient experience

– Workforce

Integrated Care Service Line

On 01 April 2019 a new “service line” was established within West London NHS Trust’s Local Services Clinical Service Unit to host the Trust’s portfolio of community and public health services. Dr Christopher Hilton was appointed as Clinical Director overseeing the services.

During 2019-20 the service line comprised:

• One You Ealing (contract ended 30 Sep 2019 and Child Weight Management transferred to CLCH to align with school nursing services)

• Home ward Ealing (contract ended 30 June 2019 and the service was absorbed within the new Ealing Community Partners 10 year contract.)

• Hammersmith and Fulham Community Independence Service (lead provider is CNWL for 3-borough service)

• North West London Telemedicine Initiative (Alliance lead is London Central and West Unscheduled Care Collaborative)

• Integrated lifestyles practitioners (providing public health interventions across WLT, funded internally)

• TB Outreach and Education service (commissioned 01 Oct 2020 by Ealing Council Public Health)

• Ealing Community Partners (commenced 01 July 2019)– Ealing community team for adults with learning disabilities

– Locality services (district/community nursing, TVN, bladder and bowel, diabetes and education, care coordination)

– Ealing community referral hub

– Enhanced primary care in care homes

– Intermediate care and Clayponds Hospital (rapid response, home first, step-up beds, rehabilitation beds, end of life care)

– Maximising independence (MSK, adult and neurological rehabilitation, nutrition and dietetics, SLT, podiatry)

– Integrated children’s services (Looked after children, specialist community nursing including special schools nursing, SLT, OT, PT, audiology; mainstream schools buy-in additional services)

– Mental health and psychology services hosted within other West London NHS Trust service lines (primary care mental health, dementia support services and link worker service, clinical health psychology and liaison psychiatry to intermediate care and nursing homes).

Contract milestones

Launch of Ealing Community Referral Hub and Advice Line –November 2019

0300 12345 44Contractual requirement to do this during November

Combines and co-locates multiple existing referral routes in planned and unplanned care teams:- Intermediate care (Home ward) SPA

- District Nursing SPA

- Twilight DN SPA

- MSK Central Bookings

Single call centre supported 24/7 by administrative and clinical staff

Second phase of work will align additional adult services (eg: podiatry, diabetes) and develop pathways for children’s services

Ealing Community Referral HubTotal calls received in hub

Month Total calls Unplanned Planned

November 2019 12725 28.1% 71.9%

December 2019 11867 29.1% 70.9%

Calls answered: within 1 minute

Month Total calls Unplanned Planned

November 2019 70.1% 91.6% 61.0%

December 2019 73.7% 93.5% 65.2%

Urgent referrals into 2h response teams – received

Month Hospital LAS GP Other

November 2019 286 60 114 24

December 2019 299 70 112 72

% accepted 81% 69% 77% 83%

Contract milestones

Launch of 24h Community Nursing November 2019

Contractual requirement to do this during November

Reconfigures and integrates:- Intermediate care core offer 8am - 8pm including new Home First pathway

- Redefines planned community nursing offer between 8am – 8pm

- Removes separate “Twilight team”

- New overnight nursing service providing rapid response (2h) to both community nursing and intermediate care patient groups

- Works alongside existing overnight Marie Curie EOLC Rapid Response service

- Supports SPA and Clayponds Hospital

Most planned care now offered by planned community nursing team with limited adverse impact

Positive feedback from patients (“didn’t have to go to hospital”) and London Ambulance Service about Alternative Care Pathway simplification

Intermediate careAlongside development of hub and 24/7 nursing model, we have been working with Ealing CCG and London Ambulance Service also to promote use of alternative care pathways

- 45% increase in LAS to RR pathway in November (62 referrals vs average of 34 (Apr – Oct) – admission avoidance

- New live pathway from 111 to RR supported by the Directory of Services - 10-12 referrals per month now using this route with ongoing PDSA work

- Launch of new LAS Clinical Hub to RR pathway –conveyance avoidance

0

10

20

30

40

50

60

70

Ealing Homeward Hounslow ICRS CIS - H&F CIS - West London CIS - Central London Brent STARRS Harrow Hillingdon

LAS Referrals Breakdown Nov 19

Accepted F2F Referrals Adivice given to prevent ED admission Inappropriate patient to ED Rejected/No Capacity

Chub Accepted Chub Rejected Rejected other i.e. Out of Area, no info.

Intermediate care

8

72

6067 64

60 63

48

185 187 185

0

20

40

60

80

100

120

140

160

180

200

April May June July Aug Sept Oct Nov Dec Jan

Supported discharge / “Home First” activity (NB Jan 2020 is part month data)

Contract milestones

Chronic pain service

• 6m delay in commencement of this new pathway (due 31 July

2019) due to failed recruitment (single senior psychologist) and

lack of suitable interim clinicians

• CCG will recoup funds from 31 July 2019 to pathway launch date

• New round of recruitment underway led by WLT Consultant

Neuropsychologist

• Other new clinical health psychology activity has commenced with

further work planned to integrate IAPT-LTC offer with psychological

support for LTC in ECP

Contract milestones – PCN alignment

• We are now in a position to share with CDs our named workers for each PCN:

– Community matrons

– District nurse team managers

– Diabetes specialist nurses

– Primary Care Mental Health nurses

– Dementia link workers

– Care coordinators

– Tissue viability

• Additional work ongoing to further refine full locality team configuration according to historical caseload activity versus population health information

• We’re scoping the opportunity to align some rehabilitation services according to PCN or Locality geographies

Additional service developments

since July 2019

Senior Management Team

• Fully recruited

• Senior management restructure consultation concluded Jan 2020 to align inherited structures to bid model / Trustwide norms

Estates

• Planned alignment of referral staff in refurbished office space at St Bernard’s –longer term intent to co-locate with mental health SPA and WLT contact centre in new facility

• Planned alignment of rapid response and pharmacy teams in ClaypondsHospital supporting integrated intermediate care model

• Vacated office space in Mattock Lane at request of LNWUH who intend to use the site for a community sexual health hub

• Integration of children’s nursing services with ESCAN at Carmelita House, and refurbishment of office spaces

• Deployment of new mobile ICT equipment and new HSCN connectivity across all community sites, due to be fully online in Q4

Additional service developments

since July 2019

Estates

• ECP continues to occupy community premises owned by LNWUH on the basis of short term arrangements negotiated prior to contract commencement

• WLT and our advisors believe the terms of occupancy and rates of charge proposed by LNWUH for long term lease represent poor value for money for local health economy, with unexplained unbadged costs. Several capital schemes (eg boiler replacement at Clayponds Hospital) are overdue and not a priority for the freeholder

• LNWUH Executive team has not responded to correspondence from WLT seeking resolution dating back to 30 Sep 2019

• The premises transferred with the community services to LNWUH’s predecessor organisation following the dissolution of Ealing PCT in 2012 and the terms of property transfer indicated that in the event of loss of contract, the premises could transfer to new provider. WLT believes transfer of property for the duration of this contract would support improved integration of care and investment in local community services

Additional service developments

since July 2019

Ealing Integrated Care Partnership

• West London NHS Trust (as lead provider of ECP and local mental health services) is engaging with Ealing’s emerging Integrated Care Partnership to define an integrated primary, community and mental health model of health and social care for local residents.

• Discussions are underway between WLT, Ealing CCG and Council Officers to agree future partnership arrangements for jointly commissioned, co-located, and integrated services.

Adult autism assessment pilot

• Commissioned through ECP for one year and commenced seeing patients in October 2019 –providing an adult assessment service in-borough for the first time (previously assessments were purchased out of area).

Public health services

• Since last update to the Board, the One You Ealing integrated lifestyles service contract led by WLT has come to an end. WLT supported staff from the childhood weight management team to TUPE transfer to Central London Community Healthcare NHS Trust to align with the Universal School Nursing team. A new TB education service was commissioned from WLT. Other staff from Smoke Free, Health Training and Health Check teams were redeployed locally.

Service line leadership team

Service information

Financial position at M9

• The main Ealing Community Partners contract is reporting an overspend at M9 of £526k (+2.2%)

• This relates primarily to:– non-recurrent mobilisation costs (infrastructure and management prior to contract

commencement) including payments to LNWUH for transfer of equipment and transitional ICT arrangements

– pay continues to underspend due to vacant posts not fully filled with temporary staff

• We are forecasting a year-end position of £87k overspend (+0.25%) whilst seeking to bring this to a fully balanced position.

• Budget setting for 2020-21 is under way including:– realignment of budgets to new PCN team configurations

– improved management of non-pay costs in light of actual expenditure from 2019-20 (vs tender assumptions)

– growth / efficiency requirements contained within the contract

Service information

Operational performance

• Full rebuild of all reporting using new definitions and development

of live dashboards for services to monitor performance and data

quality.

• Areas of focus:

– Intermediate care (winter pressures)

– Rapid (2 hour response) services

– PR (vacancies now filled)

– MSK interface referrals (RFS closure)

– KPI waiting times (vs 18ww PTL)

2h

response

Oct Nov Dec Q3 Total

RR/24hD

N/HF268 500 532

1300

EOLC RR 34 40 48 122

NH GP

(NonF2F)

95 73 116 284

NH GP

(F2F)

1 3 10 14

398 616 706 1720

Service information

Integrated Care Services (including ECP) workforce update at M9

• Budgeted FTE (WLT, THH, CNWL): 820

• Substantive FTE 615

• Whole service vacancy rate 25%

• Temporary staffing FTE approsx (bank/agency) 127

• Effective fill rate 91%

* NB ongoing refinement of team structures has continued throughout the first six months of

the contract taking into account inherited TUPE staff vs planned bid establishment as well as

formal staff consultations and this makes month-on-month comparison not fully reliable

Service information

Integrated Care Services (including ECP) workforce update at M9

• All partners have ongoing recruitment campaigns for key posts:– Successful recruitment to all new Community Matron posts and new Marie Curie Nursing

Home Link Worker posts

– Reduction in vacancies in EBAB, TVN, DSN, PR and Paediatric Nursing

• Developmental roles created to attract and retain staff to Ealing– Split / rotational posts across CNWL boroughs / ECP / WLT services

– Nursing apprenticeship Band 4 roles

– Funding approved for advanced practitioner / non-medical prescribing training

– New posts eg First Contact Physiotherapists

– Overseas recruitment campaigns

– Temp to perm

• Ongoing advertising – as of 20 Jan 2020 – 22 open adverts for posts from Band 2 to Consultant

– Flexible opportunities to join bank

Quality and patient experience

• Procured and implemented new Datix incident management system

• Positive improvement in rates of incident reporting

• 5 Serious Incidents and 4 Local Team Reviews

• Recorded 21 complaints and 29 PALS

• FFT feedback

120

153

121

164

212227

0

50

100

150

200

250

Jul 2019 Aug2019

Sep2019

Oct 2019 Nov2019

Dec2019

Incident Reporting Trend

Q4 2019-20

• CQC routine inspection of WLT services

• Engagement with NWL ICS Core Community Services work, LNWUH Recovery Board and Ealing ICP

• Progression of PCN alignment work and joint working with those PCNs who wish to engage with WLT for new roles

• Maximising independence review and pathway integration

• Planning for children’s services improvements in 2020-21

• Conclusion of SLA with LNWUH for shared services