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TRANSCRIPT
Shaping Sefton
Session 4: Unplanned Care
12 November 2015 with
Prof. David Colin-Thomé
Welcome
Shaping Sefton
Session 4: Unplanned Care
Welcome
Fiona Taylor
Chief Officer, NHS South Sefton CCG/NHS Southport
and Formby CCG
Agenda Time Lead
10.00 Registration
10.20 Welcome Fiona Taylor
Chief Officer, NHS South Sefton CCG
and NHS Southport and Formby CCG
10.25 Setting the Scene Fiona Taylor
10.40 The Art of the Possible – Unplanned Care
inc Q&A
Prof. David Colin-Thomé
Independent Healthcare Consultant
11.20 Coffee break
11.35 What Does it Feel Like Currently?
South Sefton
Angie Smithson
Chief Operating Officer
Aintree University Hospitals NHS Foundation
Trust
11.50 Southport & Formby
Rob Gillies
Executive Medical Director
Southport and Ormskirk Hospital NHS Trust
12.10 What Key Changes are Needed in the System?
What Do You Feel You Can Contribute to These Changes?
Tabletop Session
Fiona Taylor
12.30 Lunch break
13.15 Urgent Care in Sefton Dr Andy Mimnagh
Clinical Lead, Unplanned Care
South Sefton CCG
13.30 Response and Reflections
My Challenge to Sefton
Prof. David Colin-Thomé
13.45 What is the vision for Unplanned Care in Sefton?
Facilitated discussion
Prof. David Colin-Thomé
14.45 Coffee
15.00 Feedback Facilitators
15.20 Summary of the day – Actions and Next Steps Fiona Taylor
15.30 Close and Thank You Fiona Taylor
Setting the Scene
Fiona Taylor
NHS Southport and Formby CCG
NHS South Sefton CCG
Chief Officer
Components
of Care
Shaping Sefton
Our vision for community centred health and care
• Working with the independent King’s Fund across health and
social care
How we will transform services
Blueprint for transforming services
• Begins to describe how we will move our vision of community
centred health and care in our 5 year strategy into a reality
• Focuses on eight health and transformational programmes:
Shaping Sefton Governance Framework
Intermediate Care December 2014
February 2015
Shaping Sefton
Visioning event Frail Elderly
Unplanned Care Urgent Care
Transformation event – early 2016
Our Vision
To create a sustainable healthy community based on health needs, with partners; focused on delivering high quality
and integrated care services to all, to improve the health and wellbeing of our population.
We will deliver our vision through the following five transformation areas:
Primary Care Our aim is to develop a population-based approach to primary care and support them to improve access to primary care and
enhanced quality of service.
Community
Care
Our aim is to achieve services that better link together right across health and social care – from hospital and community and
social services, to GP practices and voluntary, community and faith sector organisations – and where as much care and support
as possible is delivered outside of hospital, making it easier for people to access at the times that are more convenient to them.
Unplanned Care Our aim is to support urgent and unplanned care for our residents focusing on admission prevention by developing quality primary
and community services. Ensure a quality and optimum experience for patients in acute care. Ensure patients are supported to be
in the right place for their care needs.
Intermediate
Care
Our aim is to have ONE point of access, ONE assessment, ONE care planning process. We will do this by commissioning co-
ordinated care for patients via integrated services and be responsive to patients needs.
Mental Health
Our aim is to have improved access to psychological therapies, which offer better recovery rates. We will also work with our
partners in Sefton Council, to implement our joint dementia strategy to ensure services support early identification and meets the
needs of 90% of the population by 2018-2019 to ensure that local people who need mental health care and support will have
simple and easy access to mental health services to assist them in their mental wellbeing.
Reduce readmissions to hospital
Reduce number of unplanned or emergency admissions
Increase percentage of people dying in their usual place
of residence
Programme areas and Objectives
Pri
ma
ry C
are
Co
mm
un
ity C
are
Un
pla
nn
ed
Care
Inte
rme
dia
te C
are
Me
nta
l H
ea
lth
7 Day Working
IT and Infrastructure
Key
En
ab
lers
Reduce bed days (length of stay)
Provide care closer to home
Ensure that people have a positive experience of care
Health & Wellbeing Board Priorities CCG Strategic Priorities
Build capacity and resilience to empower and strengthen
communities
System Alignment
Ensure all children have a positive start in life
Support people early to prevent and treat avoidable illnesses and
reduce inequalities in health
Seek to address the wider social, environmental and economic issues that contribute to poor health and
wellbeing
Promote positive mental health and wellbeing
Support older people and those with long term conditions and
disabilities to remain independent and in their own homes
IN H
ospital
OU
T H
osp
ita
l
Cardiovascular
Respiratory
Diabetes
Cancer
End of Life
Mental Health &
Dementia
Children's Health
Neurology
Liver Disease
Kidney Disease
CCG Programmes
Se
fto
n S
tra
teg
ic N
ee
ds A
sse
ssm
en
t
Integration
Schemes
Care Closer to Home/Virtual
Ward
Intermediate Care &
Reenablement Self Care, Wellbeing &
Prevention
Transforming
Primary Care
Transforming
Primary Care
Transforming
Primary Care Frail Elderly
Transforming
Primary Care
Unplanned
Care
System Resilience in Unplanned Care Southport and Formby
Sefton Council NHS Services - Private Sector
Funding CVS Cross organisation KEY
T:\Workstreams\presentations\system resilience in unplanned care.pptx
Winter Pressures
ICO - CERT Community Emergency
Response Team
ICO Locality community development
Public Information Campaigns: stay well
and examine your options
Proactive care
GP - increased primary care capacity
GP – care home support ICO - chronic care
ICO - intermediate care step up
ICO – specialist community teams
ICO – additional equipment
NWAS Pathfinder ICO / GP urgent care – decision to admit
NWAS – ambulance nurse
Trust A&E See and Treat Trust A&E rapid
assessment (senior clinician)
Trust A&E front end support (HALT and mental
health)
Trust – Frail Elderly Assessment Unit (FESSU)
Trust - wards
Working towards 7 day working
Additional social work capacity
(BCF)
Linking hospital and social care discharge teams
(BCF)
Trust – expected day of discharge
Planned
Admission
Trust – Ambulatory Emergency Care (AEC)
CVS – additional 1:2:1 support
Pre- admission
Planned
Incr
eas
ing
urg
en
cy /
d
ire
ctio
n o
f fl
ow
Incr
eas
ing
urg
en
cy
/ d
ire
ctio
n o
f fl
ow
Senior medic model (Locality money)
Self-care (BCF, CC2H strategy)
GP Assessment Unit (GPAU)
Discharge Planning
Delayed Transfer of care (DTOC)
Flow Coordinator
Unplanned Care Initiatives Southport and Formby
End of Life
Speedy diagnostic and access to treatment to negate the need for transfer to a secondary care setting
Acute hospital to attain GSF accreditation and undertake national TRANSFORM programme
Appropriate and timely discharge
Ambulatory Care Sensitive (ACS) Conditions
CVD
Heart failure – possible reconfiguration of acute heart failure team to work alongside consultant in AED based on Aintree
model
Stroke – link with Cheshire and Merseyside networks to explore the possibility of 3 hyper Acute Stroke Units across
Cheshire and Merseyside to address and improve inconsistences of the quality of care
NWAS CERT pathfinder
Self care/management
easily accessible support for the self management of conditions delivered as part of the virtual ward and health and
wellbeing board via the better care fund
Patient education
Development of the Community Voluntary Sector (CVS) - Bids from CVS to focus on urgent care to support patients to avoid
admission
Engagement of GPs within Primary Care - Develop Primary Care dashboard to support practices to manage patients via
extended/integrated primary care teams within localities
111 Programme implementation
Proactive case management
Proactive case finding
Community Geriatrician
System Resilience in Unplanned care South Sefton CCG
Sefton Council NHS Services - Private Sector
Funding CVS
LCH Locality community development
Cross organisation KEY
Public Information Campaign
Proactive care
GP - increased primary care capacity
care home support Community Geriatrician NWAS Pathfinder
Integrated urgent care team
See and Treat A&E Reconfiguration Rapid assessment (senior clinician)
Acute Frailty Unit Trust - wards
Working towards 7 day working
Review Acute Frailty Unit
Linking hospital and social care discharge teams
Expected day of discharge
Increased package of care
Intermediate/transitional care step down
Patient transport vehicles
Re-enablement
Planned
Admission
Discharge Trust – patient choice of discharge destination
policy review
Out of hospital care
Planned
Planned
Incr
easi
ng
urg
ency
/
dir
ecti
on
of
flo
w
Incr
easi
ng
urg
ency
/
dir
ecti
on
of
flo
w
Dec
reas
ing
urg
ency
/
dir
ecti
on
of
flo
w
Increased Primary Care resource
Self-care
Discharge Planning
Acute Visiting Scheme Walk-in Centre /
Urgent Care Centre
Recruitment of 3 WTE Community Geriatricians
Crisis care packages to prevent admission
Specialist community teams
Additional equipment Intermediate care -
step up additional community beds
Front End A&E support (LCH and mental health)
Delayed Transfer of care (DTOC)
Additional social work capacity in Emergency
floor
Ambulatory care sensitive conditions
Integrated Discharge support team including
LCH Community equipment
Community intermediate care
beds
Unplanned Care Initiatives South Sefton
Acute Visiting Scheme
Ambulatory Care Sensitive (ACS) Conditions
CVD Heart failure – reconfiguration of acute heart failure team to work alongside consultant in AED
Respiratory – in reach of Community team
NWAS pathfinder acute visiting scheme
Explore ambulance transportation requirements to support Walk in Centre as part of new model of care as an alternative to A&E
Integrated Discharge Team
111 programme implementation
Review of Walk in Centre and impact of closure of Darzi practice
Self care/management
easily accessible support for the self management of conditions delivered as part of the virtual ward and health and
wellbeing board via the better care fund
Patient education
Development of the Community Voluntary Sector (CVS) - Bids from CVS to focus on urgent care to support patients to avoid
admission
Engagement of GPs within Primary Care - Develop Primary Care dashboard to support practices to manage patients via
extended/integrated primary care teams within localities
Proactive case management
Proactive case finding
Additional Community Geriatricians
Develop acute oncology to include outpatient clinic access for cancer of unknown primary 2/52 clinic, side effects of treatment
(Cancer)
Care Home Improvement Project
Admission Avoidance and
Transition from Hospital Scheme
(Intermediate Care Gateway)
• ‘Step up’ urgent care/admission avoidance
• ‘Step down’ efficient discharge process
• Discharge to assess –
• delay decisions about longer term needs
• no decisions made in a hospital setting
• Delivered by a fully integrated team
• Healthcare
• Adult social care
• Mental health
• Reablement
• Advocacy
• CVF sector links and signposting
Sefton Integrated Care Pathway
Professor David Colin-Thomé, Independent Healthcare consultant
Former GP Runcorn and National Clinical Director for
Primary Care
Currently Chair London GP OOH Forum
Recent Chair, Urgent Care Commission 2015
Shaping Sefton
Session 4 – Unplanned Care
The NHS financial & service challenge will only be met
by radically changing how care is provided:
– New localism;
– Using current & future technologies;
– Streamlining care & removing inefficiencies;
– Integration of care across organisational boundaries.
• The innovation of GP Provider Companies / Federations
are key to realising the above.
Local Priorities
• Caring for our older and vulnerable residents
In particular, the system is failing to provide co-ordinated and integrated care
for frail elderly and patients with complex needs
• Unplanned care
Prevention and early treatment services are often inadequate, allowing patients
to continue ‘cycling’ around the system until their issue become acute
A&E is the easiest part of the system for patients to access, hence receives the
largest flows. Queues build up in A&E as a result of difficulties with flow
management
• Primary care
• and in particular care delivered by general practitioners and practice nurses,
has been the cornerstone of the healthcare system since the inception of
the National Health Service (NHS) in 1948.
• Need to address issues of workload, workforce and reduced funding of
primary care
• We will develop a population-based approach to primary care and
support them to improve access to primary care and enhanced quality
of service.
•
UEC Review Vision
For those people with urgent but non-
life threatening needs:
•We must provide highly responsive,
effective and personalised services
outside of hospital, and
•Deliver care in or as close to
people’s homes as possible,
minimising disruption and
inconvenience for patients and their
families
Current provision of urgent and emergency care
services
2
2
>100 million calls or visits to urgent and emergency services annually:
• 438 million health-related visits to pharmacies (2008/09) Self-care and self
management
• 24 million calls to NHS
• urgent and emergency care telephone services Telephone care
• 300 million consultations in general practice (20010/11) NOW 340 million
Face to face care
• 7 million emergency ambulance journeys 999 services
• 16 million attendances at major / specialty A&E
• 5 million attendances at Minor Injury Units, Walk in Centres etc. A&E departments
• 5.4 million emergency admissions to England’s hospitals Emergency admissions
• Surge in demand exacerbated the problems in a system we knew was already under strain
• In hospitals the surge “problem” is emergency admissions
• Strong upward trend in all contacts especially to NHS111
• Resilience, and availability, of community-based services and the important relationship with social care services compounds difficulties in the acute hospital sector – leading to unnecessary admissions and delayed discharges
What does the experience and data
from recent winters tell us?
All hours General Practice
Access
• a 1% increase in the population that failed to access a GP within 2
days predicts a 0.7% increase in self-referred A&E visits.
• 1 in 4 people state they would use A&E for a recognised non-
urgent problem if couldn’t access their GP
• 1 in 4 people have not heard of Out-of-Hours GPs
• 75% of those who had intended to go to A&E, but phoned NHS111,
were managed without needing to go; and 30% who would have
dialled 999; but 7 fold increase in 2 years
• Urban 15% and deprived 42% populations higher A&E use
• Accessible GP have fewer ED visits per registered patient 1
• Patients self-refer to ED when unable to see GP within 2 weekdays 2
• A 1% increase in the proportion of patients able to access their GP
is associated with a £20K annual cost saving per average practice 3
• £30 per head of registered population to deliver a ‘never full practice’
– approx 1.5% shift in current NHS funding in England 4
Six Functions of General Practice
• First point of contact care
• Continuous person and family focussed care
• Care for all common health needs
• Management of long term conditions
• Referral and coordination of specialist care
• Care of the health of the population as well as the individual
Chambers and Colin-Thomé (Doctors Managing in Primary Care – International
Focus 2008)
• And
• Managing Paradoxes;
To be ‘small and big’,
Population and individual focus,
Provider and commissioner
• The centrality of the practice.
Five Year Forward View
• The foundation of NHS care will remain list-based primary care.
Given the pressures they are under, we need a ‘new deal’ for GPs.
Over the next five years the NHS will invest more in primary care,
while stabilising core funding for general practice nationally over the
next two years.
• GP-led Clinical Commissioning Groups will have the option of more
control over the wider NHS budget, enabling a shift in investment
from acute to primary and community services.
• The number of GPs in training needs to be increased as fast as
possible, with new options to encourage retention.
• In order to support these changes, the national leadership of the
NHS will need to act coherently together, and provide
meaningful local flexibility in the way payment rules, regulatory
requirements and other mechanisms are applied
General Practice service delivery options
• Analysis of workload to assess practice clinical skill mix
• Partnership model – GPs, practice nurses, practice manager,
Pharmacists
• ‘Joint Ventures’ to deliver care for population groups- CHS, Social
Care, hospital staff
• Role of GP ‘meso organisation’ in supporting above at practice level
and providing services for practices and winning contracts for
services that no longer need to be provided by hospitals
• MultiSpeciaity Community Providers eg ‘Primary Care Home’
• Horizontal or Vertical Integration = PACS
The Primary Care ‘Home’
• Population based primary care is where the needs of the individual and of the community can be met
• Home for all PC providers (Pharmacists, Dentists, Optometrists), CHS and Social Care
• And potentially many currently working in hospitals
• Delivering on;
• Improved service quality and responsiveness to patients’ individual requirements
• Integrated Long Term Conditions care
• Care closer to the patient’s home
• The ‘home’ for extended skills and services
• An alternative to hospital; centricity
• Holding a population budget
• Where bio-clinical focus and addressing the social determinants of health can be the responsibility of one provider organisation
• Importance of relationship with local government and third sector
So how to develop an unscheduled care system?
out-of-hours GP, dispelling myths?
• NAO 2014
• We estimate that out-of-hours GP services cost less now, in real
terms, than they did in 2005-06, but the introduction of NHS 111 has
made comparisons difficult.
• The number of cases being handled by out-of-hours GP services
has fallen significantly to currently 5.8 million contacts
• Most patients are positive about their experience of out-of-hours GP
services.
• Out-of-hours service providers are generally responsive, measured
against the specified time frames
• CQC 2014
• Overall, we found that the majority of services were safe, effective,
caring, responsive and well-led. We identified many examples of
good practice, which we think should be shared so that others are
able to learn from them, and some of these examples are included
throughout this report.
The Kings Fund Urgent and emergency care
myth busters January 2015
• Myth one: A&E waiting times have risen dramatically
• Myth two: The number of people going to A&E is
increasing
• Myth three: Increases in A&E attendances are mainly a
result of reduced access to GPs
• Myth four: A&E pressures are due to an inadequate
number/mix of staff
• Myth five: Delays discharging patients from hospital are
increasing because of problems with social care
Aims
• We will support urgent and unplanned care for our residents,
focusing on admission prevention by developing quality primary and
community services. We will ensure a quality and optimum
experience for patients in acute care whilst also ensuring patients
are supported to be in the right place for their care needs.
• Our aim is to have ONE point of access, ONE assessment, ONE
care planning process. We will do this by commissioning co-
ordinated care for patients via integrated services and be responsive
to patients needs.
• General Principles;
• Whole system transformation with collective ownership and
culture change of all partners
• Patient pathways rather than organisational structures
• Clinical and patient led
4 biggest challenges
• Payment system reform.
• Information sharing. E.g, knowledge of me as a person and
knowledge of relevant clinical condition. So require digital platform
for a system that recognises and then knows what the clinical
condition and care needs are
• System measures e.g, integration-multi channel entry (access-
‘click, call or come in.), structured initial assessment (access and
advice), multidiscipline clinical hub (further assessment, advice,
treatment, referral), face to face care. So for instance need whole
system for demand surges. Contracts must ensure interdependency,
governance, value, safety
• Workforce and skill shift. Care needs to be personalised,
integrated (coordinated) with a single trusted point of contact. Able
to speak to a clinician with clinical decision support from hospital
specialists 24/7
Urgent Care Commission
PHASE 1: Urgent and Important –
The Future for Urgent Care in a 24/7 NHS
PHASE 2: Urgent and Important –
Principles for a Network Approach to Urgent Care
Creating an integrated urgent care
pathway
• A set of system-wide quality standards should be developed and
implemented across all urgent care services. These quality
standards must be clinically focused; patient-centred and build on
existing experience gained in the application of the National Quality
Requirements (NQRs).
• In order to ensure absolute clarity of accountability across the
pathway, a single system integrator should be nominated- appoint
a well-qualified lead commissioner to act as the systems integrator
who may devolve leadership responsibility but not accountability to a
provider organisation or individual
• Data sharing requires a national solution- roll out should be
supported by a programme to help patients understand how their
data will be used and by whom.
•
Creating an integrated urgent care
pathway
• Costs should be measured across the complete cycle of care
for the condition/across a unit of time, if a long term condition
• Encompasses a single payment for a full cycle of care, with
mandatory outcome reporting - Incentivise providers to improve
outcomes and lower costs across full care cycle
• Are underpinned by contracts which allow for shared incentives
between providers on achievement of agreed outcomes -Issues-
risk sharing/cohesion/patient flow to most appropriate.
• Programme budget based on a defined population?
• And held by a population based provider?
Creating an integrated urgent care
pathway
• Workforce planning is critical to the long-term sustainability of the
urgent care sector, mitigating the risks posed by ongoing recruitment
challenges.
– A multi-disciplinary approach must be taken to staffing urgent
care services. The spectrum of advanced practitioners available
to deliver services should be expanded to include pharmacists;
nurses; physician associates; and healthcare assistants.
Practitioners should then have the appropriate skills mix,
enabling an out of hours team to call upon paediatric, mental
health and long-term condition expertise at any one time.
Monitor;
Exploring Acute Care Models 2014
• 1. A greater emphasis on ‘risk tiering’ in paediatric and intrapartum
maternity care, supported by complementary networks of staff and organisations.
For example, Sweden’s Stockholm County has a three-tier network of intrapartum
maternity care, with different units caring for women and babies at different levels of
risk. These risk-tiered systems are facilitated through shared clinical governance and
formal patient transfers and protocols. (1/5 children to ED where no children’s IP
services}
• 2. Increased use of technology. In some systems, technology is used to deliver
complex care remotely. For instance, in the state of Arkansas, USA, specialist
doctors deliver stroke care remotely to patients using video-links. Similarly, in the
USA, spoke sites for intensive care can be supported remotely by an electronic
intensive care unit (eICU) hub site. Technology is also being used to share patient
records efficiently, leading to better integrated care, as seen in the single
comprehensive electronic child health record used across primary and secondary
care settings in Canada.
• 3. Greater use of GPs to deliver out-of-hours urgent care. This approach
was prevalent in the Netherlands, where GPs are often the gatekeepers for
emergency care. A&E attendances in the Netherlands are about 120 a year per 1,000
people, compared with 278 in England. In the Netherlands 39% of patients attending
A&E are referred by GPs, compared with 5% in England
Enhanced NHS 111 - the “smart call” to
make:
• 16m patient contacts over the last year, 1% 111 re
pharmacy, 9% 111 for dental pain- is commonest cause
of analgesic overdose
• Principles- personalised, integrated, digital platform so
system that recognises and then knows what the clinical
condition and care needs are. So click, call, come in as
3 entry opportunities
• Future; up to date patient information ? cloud
technology, comprehensive DOS, clinical input-clinical
decision support from hospital specialists 24/7, booking
system
‘Next to knowing when to seize an opportunity,
the most important thing in life is to know
when to forego an advantage’
• Integration will depend on Health Economy behaviours
• -the interests of patients and citizens trump those of institutions
• -no disputes but ok if disagreements
• -need to choose our leaders for their behavioural attributes not
only knowledge and experience
• We need to focus on relationships underpinned by a contract, not
defined by the contract
• design, develop, test and implement system-wide outcome
measures for which all members are jointly held to account
• A key focus for future commissioners as it is noticeably lacking
currently, is how to commission for individual patients
Conspiracies against the laity
• The only way to get sustainable improvement
is for the NHS to also be held to account by individual patients
• A want is a need. The issue is how we respond
• If a patient perceives it is urgent-it is urgent
• Self care and self management is as much about a partnership with
professionals with much better and easily accessible information
about self-treatment options needs to be made available – patient
and specialist groups, NHS Choices, pharmacies
•
Coffee
11.20 – 11.35
What does it feel like currently?
South Sefton
Angie Smithson
Chief Operating Officer
Aintree University Hospitals NHS Foundation Trust
Urgent Care
Angie Smithson
Chief Operating Officer, AUHFT
12 November 2015
Patient Experience & Outcomes
• A&E FFT improving – 87% Sept (88%
Merseyside/NHSE)
• Major trauma outcomes – 2nd best in country
• Mortality indices all improving
Performance
• Length of stay improving but still higher than peers
• 4 hour waiting time standard improved up to August, now declining
• Ambulance handover times declining
• Improved zero length of stay (particularly frail elderly)
• Improved access – direct admissions
• “Ready for discharge” numbers higher than required
Changes made to Urgent Care Pathway
• Staffing – A&E and Acute Medicine
• Development of AMU model
• Introduction of GP hotline
• Introduction of AEC
• Focus on use of EDD and board rounds
• Move into first phase of UCAT
• Development of Discharge to Assess Model (D2A)
Work with Partners
• NWAS – ALO
• Merseycare – escalation process, breach
reviews
• LCH – Matron in A&E, DPT, weekly meetings,
daily capacity meetings
• LAs – weekly meeting, escalation
Work in Progress/to do • Improve time to see first clinician in A&E
• Recruitment to ED & acute medicine Consultants
• Continued focus on board rounds, ward rounds for earlier discharges and implementation of Medworxx
• Work with partners to reducing RFD list
• Frailty model
• Work with GPs re variability
• Final phase of major trauma
• Revision to Rotas and implementation of Major Trauma Lead rota
• Second phase UCAT
Summary
• Work in progress
• Embedding changes a key challenge
• System wide focus needs to continue
What does it feel like currently?
Southport and Formby
Rob Gillies
Executive Medical Director
Southport and Ormskirk Hospitals NHS Trust
An integrated care organisation
UNPLANNED CARE
Trust Performance: The number of patients spending more
than four hours in A&E departments from arrival to discharge,
transfer or admission is below the 95% target, at 93.9%, YTD
(up to 10/11/2015).
This is mainly due to poor performance at Southport A&E
department, which is at 85.3% YTD (up to 10/11/2015).
An integrated care organisation
Southport A&E Department
Performance against the four hour measure
The following tables show performance at Southport A&E department.
2015/16 compared to 2014/15 performance:
Quarterly:
Previous six weeks:
An integrated care organisation
The Trust is taking a number of actions focussing efforts in managing
demand in A&E over the winter period. This is with engagement with
commissioners.
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Southport A&E Performance against 4 hour
measure
2014/15 2015/16
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Southport A&E Number of Attendances
2014/15 2015/16
What Key Changes are Needed in
the System?
What Do You Feel You Can
Contribute to These Changes?
Tabletop Session
Lunch
12.30 – 13.15
Unplanned Care in Sefton
Dr Andrew Mimnagh
Clinical Lead
Unplanned Care
Pre-Hospital Hospital Discharge/
Patient Flow
Patient Flow
Groups Involved
CCGs LAs
Aintree
University
Hospital
CVS LCH Primary Care
Pre-Hospital
LCH Locality
Community
Development
Community
Intermediate Care
Team with Step Up
Facilities Urgent Care/
Decision to Admit
Community
Geriatrician
Pro-active
care
Specialist
Community
Teams
Community
Urgent
Care Team
Public
Information
Campaign
Pathfinder
NWAS
Acute Visiting
Scheme
Walk-in Centre
Care Home
Innovation
Programme
{CHIP} Increased
Primary Care
Capacity
including LQC
Pre-Hospital Support
‘Crisis’ care
packages to
prevent
admission
Discharge to Primary Care for
CDM
Secondary Care Aintree/Alder Hey
NWAS
Closed episode of care
Walk-in Centre
Patient
Other MDT
Discharge
Urgent care community
Drugs & Alcohol
Alder Hey Support
HCT Mental Health
Aintree Support
Community Care
Therapy
GP Hotline
See & Treat
Improved Utilisation of Walk-in Centre
Aintree AFU Dedicated Discharge/ Frailty Co-ordinators
Potential Frail Elderly Pathway
?Direct Admissions via Community
Geriatrician (LLCG & SSCCG)
Intermediate Care
?Future Direct GP Referrals
Intermediate Care
ERT (Liverpool) if
required
Home with Support
Urgent Care Team (Sefton)
if required
Admissions via A&E
Role to Liaise with Community Services
& LAs
Hospital
See
and Treat Front End A&E
Support including
LCH/Mental
Health
A&E
Reconfiguration
7-day
working
Linking Hospital
and LCH
Discharge Teams
Rapid
Assessment by
Senior Clinician
Acute Frailty
Unit
Additional Social
Work Capacity in
Emergency Floor
Acute Trust
Discharge
Patient Flow
Discharge
Increased
package of
care
Discharge
Support Team
including LCH Expected Date
of Discharge
Re-enablement
Change in
Practice
Patient Choice
Review
Intermediate
Care Step Down
Community
Equipment Additional
patient transfer
vehicles in and
out of hours
Response and Reflections
My Challenge to Sefton
Prof. David Colin-Thomé
What is the vision for Unplanned Care
in Sefton?
Prof. David Colin-Thomé
Facilitated discussion
Coffee
14.45 – 15.00
Feedback
Facilitators
Summary
Actions
Next Steps
Fiona Taylor
Thank you
Date for your diary:
** Shaping Sefton 5: Transforming Sefton**
Early 2016
Contact: