Agenda item

Chris Holt, Chief Operating Officer, Rotherham Foundation Trust

Chris Holt, Chief Operating Officer, Rotherham Foundation Trust, gave the following presentation about Transforming Unscheduled Health Care:-

 

-          Community Transformation launched in April 2014;

 

-          Focus on five priorities

·                     A Better Community Nursing Service

Reconfigured around locality teams

Better leadership, clinical supervision and governance

Additional nurses (14 whole time equivalent posts) against the 2014/15 establishment

New ICT equipment, full connectivity

 

·                     Integrating Services in Health and Social Care (for issues such as falls, respiratory and neurological cases)

Developed new Integrated Rapid Response (merging Fast Response, Advanced Nurse Practitioners)

Respiratory Care Pathway agreed

Investment in Integrated Falls and Bone Health Care Pathway

New Service model for Neuro Rehabilitation

 

·                     An Enhanced Care Co-ordination Centre

Resourced to provide 24 hours’, s7 days per week cover

Hub for new supported Discharge and Admit Prevent Pathways

Develop single point of access for Community Nursing referrals

 

·                     Utilisation of alternative levels of care

Agreed model for Community Unit to target frail/elderly

Discharge to Assess beds commissioned at Waterside Grange

Three supported Discharge and Admission Prevention Pathways

 

·                     Better Governance and Performance Management

Performance Framework established across all Community Teams

Reporting mechanisms and indicators agreed with Teams

Bi-monthly meetings held between Clinical Commissioning Group and Community Teams

 

-          ‘Input’ and milestone focus

 

-          Secured successfully – need stage 2, as the initial programme had concluded in March 2015

 

-          Acute was delivering but had struggled during the Winter

 

Current Situation – an Opportunity

-          Provider of Acute and Community Services

-          Community Transformation enablers

-          A focus to improve within Acute

-          Take a 2 to 3 year view

-          Address other key enablers (Emergency Centre, 7/7 Services)

-          Outcome and performance driven

 

Origins of the Programme

-          Five Year Forward View

-          Future Hospital Commission – Future hospital: caring for medical patients

 

A Future Model of Care

-          Generalist Inpatient Pathways

The Medical Division: unified clinical, operational and financial management

7 days per week by trained doctors using Standard Operating Procedures

-          Specialist Inpatient Pathways

Specialist procedures, clinics, ambulatory care and community support, specialist education, training and research

 

The Ambition

-          Strengthened acute take and ambulatory care

-          Ward reconfiguration and reduced bed base

-          7-day assessment of appropriate patients

-          Community physician support for localities

-          Reduction in acute length of stay

-          Length of stay at home/Usual Point of Residence to be main indicators

-          Primary, secondary and community partnerships

 

Five Key Priorities

-          Emergency access and admissions

-          Structured and systematic management of in-patient beds (acute and intermediate)

-          Embedding Admission Prevention and Supported Discharge Pathways

-          Integration of Acute and Community Care Pathways

-          Partnerships with social care, mental health, voluntary sector partners

 

The presentation and subsequent discussion highlighted the following issues:-

 

: B1 Ward (at the Rotherham hospital) – reorganisation;

 

: the role of the Carats nurses (Community Assessment, Rehabilitation and Treatment Scheme);  the multi-disciplinary team and the co-ordination of care; the multi-disciplinary teams review care plans daily for patients and telephone the Care Co-ordination Centre for advice and to arrange further care/support;

 

: ‘key enablers’ – examples being the Emergency Centre; providing around-the-clock services; Health Service working alongside the Adult Social Care Teams;

 

: staffing and national shortages, having an appropriate mix of skills for the changes and the use of agency staff in appropriate positions;

 

: staff morale and being able to “take people with you” when making changes;

 

: the national call for more hospital beds (to care for the ageing population) and the increasing pressures on community care; the availability of medical specialists and consultants to provide care in the community;

 

: reducing delayed transfers of care (DTOC) as the longer that people remain in acute wards, the more difficult it becomes for them to return home;

 

: services for people who have learning disabilities; ensuring that care providers understood the nature of learning disabilities;

 

: care in the community (and the use of individual care plans) being sufficient to ensure that patients do not have to return to hospital;

 

: reassurance for the general public that the allocation of hospital care, or of care in the community were dependent upon medical decisions and were not to be ‘target-driven’; it was noted that outcome measures were useful in terms of ensuring quality of service;

 

: the strategic health care changes being made were consistent with changes being made elsewhere in the country; communication between the various NHS Trusts; ensuring the consistency of quality standards; triangulation of performance data; the availability of specialist care;

 

: being an integrated Trust for Acute and Community Services was advantageous in controlling patient pathways and ensuring people were only admitted to hospital when they needed to be;

 

: the future model would result in more of the specialists going to the patient rather than patients being moved round the hospital or being in a specialist bed when they did not  need to be;

 

: the challenge of 7 days’ per week services and the involvement of staff in developing services; appropriate use of therapists instead of other medical specialists; use of multi-disciplinary teams in patient care;

 

: the 3 pathways : integrated rapid response (IRR) pathway; community bed base; intermediate care (therapeutic care).

 

Resolved:- (1) That the information now presented about Transforming Unscheduled Health Care be noted.

 

(2) That a further report be submitted to a future meeting of the Health Select Commission as part of its work programme on health and social care integration.