County Durham and Darlington
Local Health and Social Care Economy
Improving health outcomes across England by providing improvement and change expertise
County Durham & Darlington profile
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Population base served –
– @610,000 CD&D
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Patient group engagement
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3 Clinical Commissioning Groups
– North Durham, DDES &Darlington
– 82 GP practices
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County Durham and Darlington NHS
Foundation Trust – integrated acute /
community health care provider
– 2 Acute hospitals
– Access to six community
hospitals
– Cross patch Community Service
portfolio
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Tees, Esk and Wear Valley NHS
Foundation Trust
– Provides inpatient and
community services including
mental health
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Two local authorities
– Darlington Borough Council
– Durham County Council
Key areas of 7 day development
• Urgent care
• Frail elderly / LTC
• Diagnostics
Improving health outcomes across England by providing improvement and change expertise
Baseline assessment
against the Standards
Clinical Standard
Gap Analysis
1. Patient Experience
In 2013 77% of patients felt involved enough in decisions about their care
4. Shift Handovers
Consultant assessment within 14 hours of admission - currently achieving approx
60%
National Early Warning score - currently using EWS
No MDT team in place
Expected date of discharge is not visable on all wards
Medicines reconciliations are not always in place
Primary and Community care records are not available to inform reviews
No Trustwide electronic solution to record handovers
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Current 5 day/limited services include, Bronchoscopy, CT (pilot 7 day at UHND),
Echocardiography, Histopathology, MRI and Ultrasound
Limited Interventional Radiology 7 days a week
7 day service available however within the 1 hour timescale is not delivered
Not every patient is reviewed everyday by a Consultant 7 days a week.
2. Time to first Consultant Review
3. MDT Review
Diagnostics
Intervention/Key services
Mental Health
Ongoing Review
9. Transfer to Community, Primary
and Social Care
HELS, OT, Pharmacy, Physio and social services are not available 7 days
Primary and Community do not always have access to senior clincial expertise eg
via phone call
10. Quality improvement
A system is needed to document all that are involved in patient care participate
in the review of care
Improving health outcomes across England by providing improvement and change expertise
Bridging the Gap……….
Improving health outcomes across England by providing improvement and change expertise
Work commenced to date….
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(Standard 2)
NEWS SCORE – to be implemented by September 14
14hr assessment after admission – Qtr1 audit undertaken
(Standard 3)
MDT Pilot on 1 Acute site – looking at a PWC method
called “Perform” – August 14
IT Portal
(Standard 5)
7 day diagnostics – Pilot over winter
(Standard 9)
Additional Community staff 7 days – Pilot over winter
Improving health outcomes across England by providing improvement and change expertise
Progressing the Baseline Assessment
Support for CD&D initiatives
e.g. Frail Elderly MDTs
1. Inform Resilience Planning
2. Inform 7DS future priorities
CDDFT Assessment
Outcomes
Improving health outcomes across England by providing improvement and change expertise
Drivers for Change
• Frail elderly and over 75s identified as a priority in Darlington and
increasing demographic shift
• Unscheduled care pressures
• Better Care Fund
• Prime Ministers Challenge Fund
• ‘Avoidable Admissions DES’ in Primary Care
• CCGs to identify £5 per head of population transform care/invest
in additional services and prevent unplanned admissions
Improving health outcomes across England by providing improvement and change expertise
MDT development
• Mandate to proceed from all organisations (health, social
care and voluntary sector)
• A detailed process flow is being developed
• Identifying links to ‘Primary Care Enhanced Service –
Avoiding Unplanned Admissions’
– Ensure MDT is complimentary
• Developing ‘enabling’ functions (estates, IM&T, information
governance, workforce)
Improving health outcomes across England by providing improvement and change expertise
All in locality and managed by primary / community care
Co-ordinator – Community Matron
111, NEAS , A&E
Practice MDT
(phase 1)
GP
Practice Nurses
Community Nurses
Social worker
Specialist Nurses
Third Sector
(Monthly)
Rapid Access Clinic
- 7day Diagnostics
- Front of House
Escalation MDT
(Phase 2)
Geriatrician
RIACT
Social care
Mental health
SPA
(Daily)
Improving health outcomes across England by providing improvement and change expertise
Problems
1. GP practice DES – ensuring linkages and avoiding
duplication
2. Information Governance – sharing of information
• Data Analysis to inform design
• Service sharing of patient information
3. Workforce
• Geriatricians
• Radiography
• Community Matrons
Improving health outcomes across England by providing improvement and change expertise
Resilience Planning –
Current Priorities (ongoing)
• Emergency Inpatient MDT operating 7 days
(standard 3)
• Further diagnostics over 7 days (standard 5)
• Additional Community staff to support 7 days
(standard 9)
• Community Matrons
• Specialist Nurses
Improving health outcomes across England by providing improvement and change expertise