Thames Valley Urgent & Emergency Care Network

Thames Valley Urgent & Emergency Care Action

Summit

Wednesday 1st March 2017, Holiday Inn, High Wycombe

Thames Valley Urgent & Emergency Care Network

Introduction A well – attended Action Summit consisting of presentations, videos, lively debate and questions was held on 1st March 2017. The Chair, Annet Gamell, introduced the afternoon by reminding delegates that they were all members of the Thames Valley Urgent and Emergency Care Network. This is ‘your’ Network. Nationally UEC Networks were formed as a requirement of the Keogh review into Urgent and Emergency Care to bring organisations within systems together to collaborate, share best practice and to unblock and tackle issues at scale that individual systems might not be able to. She urged that radical thinking and action is needed to transform the Urgent and Emergency Care System. We cannot just keep aiming to improve the system we have by trying to squeeze out more efficiency and creating more capacity. That only achieves slightly wider ‘bottle necks’! She encouraged the approximately 40 delegates to be energetic and interactive during the afternoon. The focus of the workshop would be on collaboration across the system, new models of care, Integrated Urgent Care and collectively learning from the recent winter pressures.

Thames Valley Urgent & Emergency Care Network

Time Item Speaker 1300 – 1305 Welcome and Introduction

Dr Annet Gamell

1305 – 1350

Session 1: Collaboration with the Ambulance Service Presentation – Development opportunities Presentation – Falls prevention Table work

Mark Ainsworth Spencer Winch

1350 – 1435

Session 2: Integrated Urgent Care Presentation – IUC development Presentation – Community Hubs Presentation – Channel Shift Table work

Matthew Staples David Cahill

Rachel Wakefield

1435 – 1450 Coffee Break

1450 – 1535

Session 3: Learning from Winter Presentations – Locality feedback Presentation – Patient tracking Presentation – Ambulatory Care Table work

Locality leads Christy Chan

Dan Lasserson

1535 – 1555 Question and Answer Session

Speaker Panel

1555 – 1600 Closing remarks

Dr Annet Gamell

Thames Valley Urgent & Emergency Care Network Action summit workshop

Wednesday 1st March 2017. Redgrave Suite, The Holiday Inn, Handy Cross, High Wycombe, Bucks, HP11 1TL

13.00 – 16.00pm

Agenda

TVUECN Action Summit Aims

Progress Network work on the Urgent and Emergency care review

and IUC development across TV.

Focus on sharing best practice and

collaboration.

Thames Valley Urgent & Emergency Care Network

TVUECN Action Summit

Make sense of the confusion for patients public and professionals

https://www.youtube.com/watch?v=l6iKZ_SOKCY

Thames Valley Urgent & Emergency Care Network

Session 2: Thames Valley 111 Integrated Urgent Care service

Matthew Staples Thames Valley IUC Procurement Programme

Manager

https://vimeo.com/181090441

Code 8NHS8

THE PATIENT OFFER FOR 2020 • A single number – NHS

111 – for all your urgent health needs.

• Be able to speak to a clinician if needed.

• That your health records are always available to clinicians treating you wherever you are (111, 999, community, hospital).

• To be booked into right service for you when convenient to you.

• Care close to home (at home) unless need a specialist service.

• Provide specialist decision support and care through a network.

Key features • A single “front door” enabling patients to access care 24/7, NHS

111 working together with in hours, OOHs, primary care services and ambulance services

• Special Patient Notes including End-of-Life Care Plans, will be available when required in the patient pathway

• Access to a multi-disciplinary Clinical Hub with a wide range of MDT presence, including MH, pharmacy and GP

• A range of calls will automatically be streamed to the Hub including ED dispositions, ‘Green’ ambulance, under 5s and over 85s

• Direct booking into a range of services including (over the life of the contract) in-hours primary care

• Improved Directory of Services, including availability to clinicians in the community to support decision making face to face with patients

IUC Timeline • March 2017 Co-production completed (service model and

development plan milestones agreed)

• March 2017 CCG and NHS England Assurance of procurement

• April 2017 CCG Governing Body contract award decision

• May 2017 Contract signed – Mobilisation begins

• September 17 Go-Live assurance (NHSE and commissioners)

• September 17 Service Launch

• September 17 SDP milestones introduced as planned

• March 18 Programme Support transfers to BAU

Berkshire Healthcare NHS Foundation Trust

Integrated Hub

Objectives of the Hub

To provide a single point of access for referrers, patients and carers of Berkshire;

•

• • •

to provide the best use of all system resources- (now including social care and 3rd

sector) promote admission avoidance, enhance timely discharges from hospital, Prevent patients being ‘bounced’ around the system by coordination of care and resources

Integrated Urgent Care

• Right advice or treatment first time enhanced NHS111 the “smart call” to make:

• Improve patient information for call responders (ESCR, care plan)

• Comprehensive Directory of Services (mobile application)

• Greater levels of clinical input • (mental health, dental heath,

paramedic, pharmacist, GP) • ‘decision support hub’ • Booking systems ‘GP Connect’ • GPs, UCCs, dentists, pharmacy

59

“Click, Call, Come In”

GP OOH F2F

SCAS

Some Social Care

NHS 111 (Call Handlers using ‘Pathways’ software)

An Outcome and finish in 1st contact

LOCAL REFERRAL HUBS

(Example BHFT Hub (CPE, GP OOH, Community Physical)

A&E referral

999 (SCAS)

Green re-triage

SCAS Clinical advisor whereby onward referral to the clinical hub is deemed

inappropriate (e.g. breastfeeding advice, trauma nurse advice) New 111 Clinical Hub (Virtual)

BHFT (NEW) Clinical Hub SCAS

OHFT BHT

GP triage Pharmacists Dentists Community Nursing Mental Health Acute specialist

consultants

History of the Hub

• West Call GP OOH set up circa 20+ years ago (RedDoc)

• Became part of BHFT 2011

• SCAS commenced NHS 111 in May 2013

• BHFT used the same model to ‘go live’ with the local Hub in July 2013

Initially for coordination of referrals/ discharges from Royal Berkshire Hospital

A week later switched on GP referrals

• Integrated H&SC Hub for Wokingham went live in July 2016

Berkshire Healthcare F /:kj NHS Found ation Trust

Hea rorn he he o f - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

your community

What do we do?

• Process referrals for scheduled and unscheduled community services for Berkshire

• Single point of telephone contact for Wokingham Borough Council Adult Social Care accessible by service users/patients, carers and professionals for advice and guidance, assessments, equipment and safeguarding.

• Hub set up to streamline process of referrals going to the correct service first time –

to avoid ‘bouncing’ between the different services resulting in patient treatment being delayed

• Currently the Hub processes approximately 160000 referrals and answered 130,000

telephone calls

• Receive between 450 and 550 referrals per day

• Answer up to 500 phone calls a day

WEST BERKSHIRE HEALTH & SOCIAL CARE SERVICES Adult Speech and Language Parkinsons

Children’s Centre (pass to service – no processing)

Podiatry

Chronic Fatigue Syndrome (pass to service – no processing)

Rapid Response

Community Based Neuro-Rehabilitation Rapid Response and Treatment in Care Homes (RRAT)

Community Beds Respiratory – Pulmonary Rehabilitation

Community Cardiac Rehabilitation (pass to service – no processing)

Social Care

Community Matron Start Team

Continence Advisory Service Steady Steps (no processing – pass to Service)

Community Reablement Team Sue Ryder (no processing – pass to Service)

COPD Children & Young Persons Integrated Therapy

Vulnerable Adults (no processing – pass to Social Services)

Diabetic Eye Screen (Adastra only) WOKINGHAM ADULT SOCIAL CARE

Diabetic X-pert Advice and Guidance District Nurse Assessment Domiciliary Physio Equipment End of Life Safeguarding Falls Heart Failure High-Tech Night Sitting Marie Curie Nutrition & Dietetics MSK

EAST BERKSHIRE HEALTH SERVICES Adult Speech and Language

Bridgewell Children & Young Persons Integrated Therapy

Community Beds Community Health Clinic (Assessment & Rehabilitation)

Community Matron

Continence Advisory Service District Nurse Diabetic Eye Screening Domiciliary Physio

Falls Prevention Service Frail Elderly Pathway Heart Failure Hi-Tech Intensive Community Rehabilitation Leg Ulcer Clinic MacMillan MSK Multiple Sclerosis Nutrition & Dietetics Parkinsons Post Acute Care Enablement Rapid Access Clinic Tissue Viability Nurse

About to be added

• End of Life West Berkshire- 17th October 2016 • Slough H&SC Hub- April 2017 • Reading H&SC Hub- Q1 2017 • Digital Hub- Teleconsultation for Care/ Residential

Homes- West of Berkshire- TBC

Future Developments & the ‘art of the possible’

• 111 Clinical Hub- use of local clinicians and local hub to get best outcome

• Other Local Authorities for Social Care

integration

• Full Integration of MH and Physical Health

• Deeper system integration- having better oversight of all resources to be able to dispatch best resource in most timely way. (example- District Nurse vs Ambulance)

What could this model provide?

1.If done at the correct size and scale- county basis ideally- – provides economies of scale, – best use of local services and knowledge, – System resilience – Workforce planning and sustainability

2.Potential to use one record to holistically assess and individuals needs

– Signposting patients/ individuals to the right place (self care or support group or service)

– avoiding escalation – Underpinned by a robust system Directory of Services (not just Acute/

Urgent Care but a DoS for health, social care and 3rd sector)

1.Ultimately, aims to ‘nudge’ behaviours through the learned experience of great care/ customer experience

Channel Shift

Rachel Wakefield Associate Director – Urgent and

Emergency Care and Specialist Services East Berkshire CCGs

Thames Valley Urgent & Emergency Care Network

Channel Shift Inputs

Inputs that are system wide: A.Local cost data B. Baseline activity and demographic information C. Population D. Inflation and activity growth assumptions E. Workforce cost assumptions

Inputs that are specific to particular UEC interventions F.The quantified opportunity for the intervention to make a difference G.Resource assumptions for the intervention to make a difference H. Data on set up costs I. Activity shift parameters to quantify the effectiveness of an intervention in deflecting activity to an alternative channel

Date Version 26/01/2017

Urgent and Emergency pathway interventions model FINAL DRAFT

Local base data input cost data

baseline activity

population

inflation and growth assumptions

staff costs

Results control sheet and graphical results

intervention data outputs by channel

projection calculations

Navigation To:

Interventions Model Description and evidence base Additional cost info

Decreasing Ambulance conveyances: Hear and Treat Decreasing Ambulance conveyances: See and Treat

M

M

E

E

C

C

Integrated clinical hubs - Increasing Clinical advisor consultations Integrated clinical hubs - Integration of 111 and OOH hubs

M

M

E

E

C

C

Ambulatory Emergency Care M E C

Personalised care planning M E C

Co-location of UCC M E C

GP extended hours M E C

Community pharmacy: PGD minor ailments service Community pharmacy: Emergency medication supply

M

M

E

E

C

C

Summary care record: Use for IP drug reconciliation Summary care record: Use in ED

M

M

E

E

C

C

Improved Referral processes - In Ambulance Service M E C

Improved Referral processes - In ED M E C

Improved Referral processes - In Care Homes M E C

Discharge to Assess M E C

Discharge Planning M E C

Rapid Response Services M E C

Care homes: Falls response training M E C

Care Home educators M E C

Early Warning Score in Care homes M E C

Template for input of locally defined intervention M

Intervention lm act on activify c annel .Annual

tmer enc1 a aa1s tD attenas

tDMinor attenas ucc attenas

OOH clinic ts

OOH nome ts

111 calls (call nanaler)

111 calls (clinical aavisor)

Communi armac1 attenas

Amoulance • Amoulance· Amoulance· see ana conve1 Communi near ana treat See ana treat totD contacts

lntermeaiate Social services care aaa1s oomicilia care GP attenas GPvi ts

100,000

80,000 n,m

00,000

40,000 jj,m 1,,m

10,000 14,llo

1,m 1,m 4 8,0 0 - - - ,-- )00 -88 -J,m

-10,000

1111 -8,001 - ,,,1 -B,m

-40I 000

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AxiiTitle -fJJOI OO

Discussion - IUC

Thames Valley Urgent & Emergency Care Network

www.england.nhs.uk 76

A&E

Key: Dark red fill represents high number of attendances

Weekly A&E 4hr performance for SC Acute Trusts -Unvalidated data Week Ending

w-e 04 Dec 16

w-e 11 Dec 16

w-e 18 Dec 16

w-e 25 Dec 16

w-e 01 Jan 17

w-e 08 Jan 17

w-e 15 Jan 17

w-e 22 Jan 17

w-e 29 Jan 17

Trend

OUH 95.17% 89.49% 87.95% 96.26% 88.45% 81.70% 81.50% 90.38% 85.62%

BHT 87.80% 85.56% 87.79% 90.82% 85.29% 86.72% 90.12% 86.13% 90.01%

RBH 95.87% 89.89% 87.99% 95.69% 88.02% 81.02% 90.08% 93.39% 93.54%

HWP 88.81% 80.37% 81.99% 91.82% 80.23% 78.88% 88.13% 89.56% 79.00%

RUH 84.08% 82.84% 85.75% 88.32% 86.33% 70.63% 74.39% 76.27% 72.44%

GWH 77.08% 72.01% 78.68% 86.51% 78.46% 73.37% 82.26% 82.48% 79.55%

SFT 93.74% 88.76% 87.41% 85.71% 81.77% 83.03% 81.17% 90.05% 84.96%

GHT 80.97% 67.40% 66.89% 82.82% 77.43% 67.51% 75.59% 80.19% 77.61%

Key 95% or over Between 90% and 95% Below 90%

Weekly A&E attendances for SC Acute Trusts -Unvalidated data Week Ending

w-e 04 Dec 16

w-e 11 Dec 16

w-e 18 Dec 16

w-e 25 Dec 16

w-e 01 Jan 17

w-e 08 Jan 17

w-e 15 Jan 17

w-e 22 Jan 17

w-e 29 Jan 17

Trend

OUH 2,818 2,989 2,871 2,514 2,745 2,738 2,729 2,610 2,761 BHT 2,755 2,756 2,760 2,461 2,624 2,666 3,554 2,495 2,532

RBH 2,396 2,492 2,381 2,229 2,362 2,361 2,237 2,253 2,444

HWP 2,333 2,425 2,460 2,187 2,271 2,296 2,208 2,194 2,343

RUH 1,577 1,643 1,705 1,259 1,668 1,515 1,480 1,496 1,553

GWH 2,251 2,315 2,167 1,935 2,140 2,193 2,046 2,061 2,196

SFT 831 881 866 756 883 866 733 754 811 GHT 2,512 2,509 2,383 2,328 2,592 2,533 2,253 2,256 2,439