Commissioning alternatives to
hospital
Dr Seth Rankin
Rob Persey
Structure
• Introduction to the Community Ward in
Wandsworth.
• Platform for other admission diversion
schemes.
• Not just health and social care – everybody’s
responsibility!
What is a Community Ward?
• A new way to structure Community Service.
• Multidisciplinary Platform
for providing integrated health & social care in the
community.
• Towards developing a comprehensive service
designed to deliver acute & chronic healthcare at
home.
An Analogy…
Hospitals
Community Wards
Acute & Chronic Patients
Acute & Chronic Patients
Home-based
A&E, MAU, Inpatient, etc
MDT ‘Ward Rounds’
Paper-based
MDT Ward Rounds
Bedside & Paper
Nurses
Doctors
Social Workers
Pharmacists
MDT input…
Nurses – CMs, ANPs, DNs
Doctors – GPcw, Geriatricians
Social Workers
Pharmacist
MDT input – Mental Health,
Palliative Care,
Specialist Nurses,
Addiction Services,
Age UK, Carers
Why have a Community Ward?
•
•
•
•
•
•
Improve patient’s experience and increase
capacity for home-based healthcare
Reduce unnecessary admissions.
Assist integration, productivity &
responsiveness of community services.
Platform for Integration of Social and Health
Services.
Care often not equitable across an area.
To prevent admissions and facilitate
discharge we need to provide a safe place for
patients to go.
The Basics:
• Daily ‘activity rounds’ with core team
• Weekly MDT ward rounds with ‘everyone’
• Joint visits (GPcw, CM & SW) for ‘chronic’ patients
• ANP or GPcw visits for ‘acute’ patients
• In-reach into hospitals to facilitate early discharge
• Patient information entered directly into GP’s
computer (EMIS) via remote connection
Key elements
MDT
‘Rounds’
GPcw
(Core Team)
• DNs • ICT • Specialist Nurses
• Mental Health • Dementia Addiction
• AgeUK • Palliative
...and more
Geriatricians
Integrated IT
(EMIS, iClip, Framework i)
Patient Pathways:
Community Ward
Primary
Care
Acute
Intervention
Social
Services
Secondary
Care
• ANP
• GPcw
SPoC
Ward Clerk
Chronic
Management
Ambulance
Service
Voluntary
Services
Secondary
Care
(IP or OP)
• Community Matron
• GPcw
• Social Worker
Predictive
Modelling
GP
Lessons Learned:
•
•
•
•
•
•
•
•
Patients prefer to be at home.
Massive duplication of services in the community.
MDT meetings & integration help address this.
Integrating with Social Services is enabled by MDT
meetings.
GPs can be useful.
‘Ward Clerk’ role is vital.
IT integration can be cobbled together.
None of this is easy.
Challenges:
•
•
•
•
•
•
•
•
•
•
Ongoing Funding linked to Evidence of Effectiveness.
Transition from Pilot to Establishment.
Staffing levels difficult to maintain – CMs & GPs.
Line Management Structure & Systems.
Project/Change Management resources.
IT integration – technical difficulties & lack of will.
Predictive Modelling.
Rooms & Estates Issues.
Internal ‘marketing’ – hearts & minds of existing staff.
External ‘marketing’ - GPs, Secondary Care, Social
Services, Ambulance, OOH providers, voluntary sector.
Exploring other admission diversion
schemes
• Developing an integrated assessment and response
service (IARS):
– Improve transition for patients between hospital and
community services
– Reduce acute hospital activity, including unnecessary
admissions
– Maximise independent living to support people ‘to do’
rather than ‘be done to’
– Reduce and delay admissions into residential/nursing
care
– Develop dementia friendly services
IARS – what’s in scope? (list not
exhaustive!)
• Community Ward as platform for other
interventions:
– Reablement and Intermediate Care
– Telecare and telehealth services
– Equipment
– Integrated Falls Service
– Community Therapies
– Out of Hours service
– Specialist Day Services
3 workshop questions ?!?! …
• Practically how do we implement this on the
frontline – can it work as a platform for
integrated health and social care delivery?
• Will we ever realistically see a reduction in
hospital admissions?
• (How) can we facilitate the transfer of resources
from the acute to the community sector?