Frimley Park Hospital NHS Foundation Trust’s

Acquisition of Heatherwood and Wexham Park Hospital

Clinical Vision Development

3rd April 2014, 9am to 1:30pm

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Agenda•Introduction

•Setting the scene

•Commissioners’ emerging 5yr strategy

• Joint view

• Individual key messages

•The enlarged Trust emerging clinical strategy

•Breakout groups

• Emergency care

• Care of the elderly

• Planned care

• Quality at FPH and HWPH

• Feedback and next steps

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Setting the Scene

Acquisition of Heatherwood & Wexham Park

Why do this?

•HWP catchment population. Bolster the continuation of hyper acute services at Frimley e.g. vascular and heart attack

•Adds weight to the enlarged organisation becoming one of 40-70 super A&Es

•Avoids a third party based at Heatherwood running elective services

•Provides additional space for development of services

Map of enlarged trust (Showing 30 min drive time and 90% of GP referrals)

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New catchment population estimated as over 800 thousand people

Acquisition Heatherwood & Wexham Park

• FPH to submit FBC May 2014 subject to agreeing terms with DoH/NHS England on:

• Capex

• Deficit support

• Transitional funding

• Revenue support

• OFT case submitted - March 2014

• Transaction date 1 August, subject to FPH Board, CoG and Monitor approval

Key principles

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All three sites, Frimley Park, Wexham Park and Heatherwood Hospital will be maintained

There will be a single, Trust-wide, executive team

The Board will be of the minimum size necessary to effectively manage the Trust and to maintain rapid and flexible decision making

Integrated management structure across all 3 sites

The corporate centre will be of the minimum size necessary to effectively manage the Trust and with responsibilities devolved to local business units where possible

Effective clinical leadership will be at the core of the design, to deliver upper quartile performance outcomes and excellence in patient care

There will be single, Trust-wide, policies, systems and processes

There will be clear and harmonised roles, responsibilities and accountabilities across the enlarged Trust

We will not over-burden reporting and line management responsibilities

Maximum efficiency will be created through removing duplication, centralisation and using economies of scale

Acquisition Heatherwood & Wexham Park

Key opportunities:

• Stroke and possibly pPCI on both acute sites• Cancer services aligned, IOG compliant, single cancer

centre for WP• Radiotherapy on WP site• New elective centre at Heatherwood• Improved vertical integration of services

• Consultant-delivered 7 day services across all sites

• Improved care standards/performance for HWP patients

• Improved standards at Frimley

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Commissioners’ 5 yr strategy

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The enlarged Trust clinical strategy

Map of enlarged trust (Showing 30 min drive time and 90% of GP referrals)

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New catchment population estimated as over 800 thousand people

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Key Services

•A and E

•Cardiology

•Vascular

•Stroke

•Spinal

•Orthopaedics and Plastics

•Cancer Services

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Heatherwood

Possible services on-site:

•Orthopaedics

•Day Case

•Endoscopy

•Ophthalmology

•Breast

•Private

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Breakout Groups

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Breakout Groups

•Emergency care – Helen Coe

•Care of the elderly – Tim Ho

•Planned care – Daryl Gasson

•Quality at FPH and HWPH – Andrew Morris

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Emergency Care

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The Vision for Emergency CareThe whole of the enlarged catchment will benefit from:

•Excellent quality care (in all 5 quality indicators)

•Streamlined patient flows

•24/7 Consultant-delivered care

•A ‘Major Emergency Centre’ within The Trust

•‘Decide to Admit’ system

•The best training experience in the country

•Closer integration with the community:

Shared IT

Ambulatory care pathways

Admission avoidance

Combined performance dashboard

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Emergency Care at Wexham Park

Issues at HWPH Improvement Opportunities

Poor performance metrics Robust clinical governance

Patient flows Pathway redesign

Internal specialty referrals System-wide approach

Staffing mix Investment in training and up-skilling

Quality of accommodation / space Investment in the department

Consultant cover Consultant-delivered service

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Elderly Care

The Vision:

To work with local health providers to take a greater responsibility for the whole of the older adult journey

Become a National Centre of Excellence for the treatment of older people, in line with the latest guidance from the King’s Fund, as we have done with the management of acute stroke

To champion new models of holistic and integrated care to support older adults to live longer and better in their own homes

To deliver high quality secondary care in the community to prevent hospital admissions, as we have done with our Outpatient Parenteral Antibiotic Therapy (OPAT) Service

Specific interventions:

1.Proactive management of higher risk patients, with risk based assessment

2.Front-door Care of the Elderly Physicians, with a 7-day “discharge to assess model”

3.Improved Hospital Care, with treatment pathways specifically for older adults

4.Early Supported Discharge with community team support

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Clinical Model for Care of the Elderly

2. Front-door Care of the Elderly Physicians7-day ‘discharge to assess’ model supports hospital at home models of care (incl virtual wards and day attendances).

Dedicated elderly care assessment beds.

Holistic and appropriate care plans initiated from the start

Out of hospital rehabilitation therapy support

3. Improving Hospital Care‘Decide to admit’ refers patients to the right team 1st time

Standardised treatment pathways ensure consistent high quality care.

Proactive discharge planning, higher frequency ward rounds and more specialty geriatricians.

Team-based care for older patients with minimised ward transfers.

4. Early Supported Discharge‘Wraparound’ community care team gives intensive MDT support.

Robust protocols monitor and identify failing discharges.

Named ‘interface’ geriatricians maintain links with community and continuity of care on discharge.

1. Proactive management of higher risk patientsGP-led risk-based assessment identifies frail patients at risk.

Integrated care services team provides support and advice, led by community geriatricians – early access to geriatrician expertise

Patients are proactively managed, preventing admissions.

Out of hospital rehabilitation therapy support

Reduced Bed Days

Enablers to realise the strategic vision:•IT link with primary care providers.•Collaboration and closer communications with GPs, including specialty consultant-held advice telephones.

• Short term and flexible social care packages.

Reduced Admissions Accelerated Hospital Care+ =

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Planned Care

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The Vision for Planned Care

The whole of the enlarged catchment will benefit from:

•Improved patient choice

•Streamlined patient experience

•Enhanced communications with Primary Care

•Local access

•Heatherwood elective centre

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Planned Care: New Ways of Working

•Pathway approach – MSK, eyes, pain, derm, etc

•1-stop shops

•Demand management, efficiency and performance management

•Use of technology and specialty advice for GPs

•Collaboration with Commissioners

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Breakout Discussions•Mixture of commissioners and provider on each table

•Choose 1-2 topics to discuss

•Agree shared vision

•Capture key points

•Provide feedback of top-3 areas for each topic

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Feedback

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Next Steps•Future meetings