Improving health outcomes across England by providing improvement and change expertise

Seven Day Services …. Our Journey …

Chorley, South Ribble and Preston whole health economy

Improving health outcomes across England by providing improvement and change expertise

Christina Lawrenson :General Manager, Emergency Medicine, Lancashire Teaching Hospital NHS Foundation Trust.

Jane Kitchen:Transformation Manager Chorley, South Ribble and Greater Preston Clinical Commissioning Groups.

Kate Burgess:Locality Commissioning Manager, Lancashire County Council.

Deborah HoweAdult Community Services , Lancashire Care Foundation Trust

Seven Day Services

Improving health outcomes across England by providing improvement and change expertise

…The Context & Journey. ..

Improving health outcomes across England by providing improvement and change expertise

Urgent Care Transformation Programme

Improving health outcomes across England by providing improvement and change expertise

1. Streamlining Access Ability to flex the model More effective use of the contractsRemoval of multiple handoffs Improve communication and coordination Test the step up/down business case Therapy to Therapy direct referrals

2. Care Coordinator Clinical leadershipCritical friend to the acute Coordinator between the acute and the community servicesAbility to test the discharge model as step up/step down and Intensive Home SupportOwnership of issues and mitigation Challenge on ‘medically unfit’ to be discharged decisions

3.Winter Schemes that offered 7 day cover

Pop up clinic in Preston town centre weekendsGP Visiting Scheme linked to NWAS call outs 7 days 24hrsNWAS Ambulance Liaison Officer in A&E 7 daysEnhanced social work provision 7 daysGPs in A&E at Chorley Weekends and BH’sLTH Support: Geriatrician, Extended Nutrition Team, 7/7 Therapy, Transfer Team, 7 Day Treatment RoomsAdditional Step Down beds including Intermediate care when neededLongridge acceptance of out of area patientsIncreased provision of Rapid ResponseEmergency Medicine Decisions UnitConsultant ward rounds at weekends in medicineDischarge Lounge at RPH and CDH

4. Weekly Operational Meeting Weekly dashboard – to include community services and LoSUnderstanding of system wide capacity and demand Ownership of the model Community pharmacy and take home medicine Relationships across the health economy

5. Culture Change Discharge to assessTrusting professional judgement Common understanding of a visionDifferent approach to Bed meetings Changing culture on ‘we need more nursing beds’ mentality Aligning with the core principles of the urgent care programme Utilising all services such as Domiciliary Rehab

6. Care Home Effective Support Service Support MAU ward rounds In-reach into the hospital Support the discharge process Mobilisation of intensive home support Identification of people on INT case loads Advance practitioner level driving operations

7. Intensive Home SupportUnderstanding of what service available Trust has been built in the community offer Care coordinator targeting community matrons Understanding the capacity and availability More targeted approach to step up

1. Streamlining Access

2. Care Coordinator

3. Winter Planning

4. Weekly Operational Meeting & Relationships

5. Culture Change

6. CHESS

7. IHS

Perfect Month

Perfect Month

Improving health outcomes across England by providing improvement and change expertise

……Some of our biggest wins cost us nothing….. • Ethos of Everyone's has a bed and it is in their own home• Better patient experience • Discharge to assess principle , not assess to discharge• Direct therapy to therapy referrals• Achievement of the four hour target• Inception of seven day services …• No blame culture• Collective responsibility “its our target”• Action focused weekly operational meetings

Key Learning &Outputs

Improving health outcomes across England by providing improvement and change expertise

• Keep our patients at the heart of what we do , involve them in the shaping of our services

• Build on the achievements and learning from Perfect Month

• The Urgent Care Transformation program and 7 day services are interdependent to achieve success

• It is a long Journey … but we are all committed to the same direction utilising opportunities along the way..

..Next Steps

Improving health outcomes across England by providing improvement and change expertise

…and finally

Improving health outcomes across England by providing improvement and change expertise

ANY QUESTIONS ?