The Integrated County Durham & Darlington NHS Foundation Trust:

Developing a Clinical Strategy

Second Stakeholder Event

31 March 2011

Welcome

Stephen Eames

Agenda

• Introduction:– What we have done since the event on 27 January – Purpose of the day

• Workshops – Part one: outlining and testing proposals – Part two: high priorities and quick wins

• Feedback• Next steps

From tomorrow…

• …an acute and community Foundation Trust for County Durham and Darlington

• …more integrated, better co-ordinated care for patients

• …helping the health and social care system work together more effectively

Clinical strategy in the press

Key messages

• There is only one process – and you are part of it!

• This is about hospital and community services, not just hospital services!

• No decisions have been made!• PCT proposal for hyper-acute stroke must

be subject to consultation• However – there are pressures which need

to be addressed

Introduction

Dr Robin Mitchell

27 January – a reminder

Developing vision – an opportunity

“to shift the centre of gravity from hospital to community and develop

fully integrated care pathways”.

What we have done since 27 January

• Summarised stakeholder feedback

• Staff feedback at roadshows

• Internet survey

• Established small workstream teams

• Reviewed design principles based on discussion on 27 January

• Developed proposals for consideration today

You said: 27 January – summary feedbackWhat we need to do

Accessible, efficient and high quality emergency care

More care delivered closer to home / in community

Demonstrable excellence of care for LTC/older people/stroke /EOL

Integrated sustainable womens & childrens services

Improved prevention

Leading edge planned care for CD&D

Clinical services which are fully integrated with local health and social care networks

Joint working to reduce stays / and readmissions

Invest in the infrastructure to make it happen

Needs of ourpopulation

Emerging policyand guidance

lo

Localopportunities

Safe and high quality care Care delivered closer to homeDo more to meet needs of the elderlyImproved influence & Engagement

Focus on Quality, outcomes, safetyDeliver financial sustainability& Commissioning intentionsDevelopment of new consortia

Large flexible workforceAlliances with partners & pathfinders Innovation and ImprovementTcs integration - major pathways in one organisation

Distance between in-patient sitesDecreasing number of medicsIncreasing demographic pressure Reduction in number of hospital beds

Local constraints

You said: revised design principles• Right person, right place, right time

– senior clinician review as early in the pathway as possible where required

• Emphasis on prevention first• Support the reduction of health inequalities• Care closer to home• Integrated pathways designed to deliver flexible, co-

ordinated services’• Making the best use of existing facilities• Services supported by high quality information for patients

and staff• Effective working with care partners• Invest to save

Purpose of today

• Outlining and testing emerging proposals

• Agreeing high priorities and quick wins

• Agreeing next steps

Feedback from the Workstreams

Workshops

Workshops – part one

• Update workshops on work to date

• Describe the emerging proposals

• Use patient scenarios to test proposals against:– Target outcomes– Design principles

Workshops – part two

• High priorities - strategic issues that we need to progress urgently

• Quick wins: issues which we can progress now to improve services

Feedback

Long term conditions - heart• Quick win:• Any priority

issues:• Any concerns:• Level of

support for direction of travel?

• Facilitated discharge – identifying people while in nhosp

• Who will do that role? How will info get out to the community team>

• Fully Suppported by the table and the room

Long term conditions - resp• Quick win:• Any priority

issues:• Any concerns:• Level of

support for direction of travel?

• Urgent pathway to prevent admission rollout to south Durham

• Uniform resp pathway for county and published on map of medicine – led by Alwyn Foden

• Concerns – staff : training existing staff at all levels – IT!

• Onwards and upwards!• Positive impact on A&E

Long term conditions - diab• Quick win:• Any priority

issues:• Any concerns:• Level of

support for direction of travel?

• Good referral guidelines for disease progression, pathway for minor acute events

• Patient education – continue with DAFNE

• Numbers of people with diabetes – IT systems for timely info exchange

• All in agreement – need true integration

Older people (inc. elective medical)• Quick win:• Any priority issues:• Any concerns:• Level of support for

direction of travel?

• Dementia – training of all staff who are in contact with older people through elearning etc; information to signpost patients to services, linked to map of medicine; NED champion

• Priority – single point of access to range of services

• IT – funding boundaries between organisations – electronic info will reduce boundaries

• Concerns – funding; need one pot of money across health and social care

• NB elective work has been drawn into this and will be an enabler

• Specialty based helplines in the community, to direct patients to right services

End of life• Quick win:• Any priority

issues:• Any

concerns:• Level of

support for direction of travel?

• Use of surprise question – 2 way - feeding into GP registers for palliative care

• Engage in advance care planning with these patients• IT – we need timely info, systems which talk to each other;

investment in eg 24/7 palliative care in all localities as “invest to save”; capacity and demand for GP registers, esp non malignant; some need for workforce development

• Stephen Cronin – similar approach required for children• Joan Clancy – 24/7 palliative care would reduce panic

which leads to A&E and admission• Alwyn Foden – map of medicine to support electronic

system re single point of contact• Lot of expertise already exists in primary care – build on GP

and out of hours service.

Women’s and children’s• Quick win:• Any priority

issues:• Any

concerns:• Level of

support for direction of travel?

• Antenatal assessment for vulnerable families• Use of existing facilities – identifying the hubs

and spokes to facilitate integration• Concerns - Skills and training around paed

front of house model; nurse led solutions to doctor shortages; every contact a health imp contact; paed support for maternity; IT systems; need to share family issues and make it 24/7 available across agencies

• Buy in to integ pathway – intrapartum care needs better description

• Joan Clancy: build on existing teams skills

Acute medicine emergency care• Quick win:• Any priority

issues:• Any

concerns:• Level of

support for direction of travel?

• Implement common assessment proces in UCC and A&E; colocation esp at UHND; integrate therapy teams; signage in A&E; implement see and treat; single mgt structure for clinical teams

• Priorities: engage NEAS, esp re 111; engage social care and chs – re LTC, older people to avoid admission; 24/7 services in community and social care to avoid admission OOH; workforce plan; understanding why patients come to A&E; pooling UCC and A&E funding would create flexibility

• Concerns: car parking, lack of 24/7 support; lack of 24/7 UCC in Durham; big public messages; IT, access to systmone;

rs

Surgery• Quick win:• Any priority

issues:• Any concerns:• Level of

support for direction of travel?

• Pre-opp pathway, universal sign up, feed info to GPs, patient questionnaire – use of telehealth or choose and book? Emergency pathway – consultant advice and guidance for GPs; reduce LOS; more bespoke service; use of diagnostics available to GPs; urology – hosp admission unnecessary – quick win re catheter removal

• Concern – impact on district nurses: more capacity to avoid putting service at risk; referral from GPs – to avoid referrals which won’t convert surgery

• Urology pathway quick to implement• Concern – care closer to home will use up existing

community resources which is available to GPs – avoid unintended consequences, eg admission to hospital

General feedback

• Complex picture of needs out of hours and support patients needs

Next steps

• Develop a clinical strategy which looks at how we integrate services into a coherent set of proposals

• Consider enablers – IM&T, finance, estates, workforce

• Consider how we take this forward• Come together again to consider

proposals and options – end of May

Thank you!

Clinical.strategy@cddft.nhs.uk