Commissioning Update
Supporting Admissions Avoidance and
Effective Discharge
October 2013
Board of Governors Report
Fareham and Gosport CCG
South Eastern Hampshire CCG
Portsmouth CCG
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Key Messages
■ There has been good progress in developing out of hospital health and
care services in Portsmouth and South East Hampshire
■ The introduction of 111 and the re-procurement of OOH service has
created some demand, this is benchmarked to be significantly lower than
that experienced nationally
■ The growth in ED attenders does not appear to be higher than many other
Acute Trusts. Seen an increase in the number of minor conditions not
requiring admission
■ Whilst there is more to be done, the local health system performs well in
supporting the admissions avoidance and discharge of patients
■ The community is complex with a number of partners who have developed
excellent relationships with each other, acute and the commissioners.
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Statistics
■ The number of trust wide non-elective admissions have reduced by 3%
compared to last year (currently 5% below plan). This compares to a
national trend of 0.5% growth (SUS data)
■ Between 2007 and 2012 emergency admissions grew by only 3%
compared to 25% across the South of England and 29% across SHIP (Kings
fund review urgent and emergency care)
■ Higher % of 0-1 day emergency admissions than SoE average, but a
significantly lower % of emergency admissions with LOS over 7 days. (Kings
fund review urgent and emergency care)
■ The Trust has the second lowest % of bed days lost to delayed transfers
of care of all acute Trusts across Hampshire, Dorset, Surrey and Sussex
(1.02% of bed days lost against an average of 2.51%) (SUS data)
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Discharges
Delayed Transfer of Care Guidance
The national definition states that the delayed transfer of care occurs when a
patient is ready to depart and is delayed. A patient is ready for transfer when:
•
•
•
A clinical decision has been made that patient is ready for transfer AND
A multi-disciplinary team decision has been made that patient is ready for
transfer AND
The patient is safe to discharge/transfer
Medically Stable Discharge Ready Patients (MSDR)
The relevant Consultant Team has deemed the patient no longer requiring an
acute hospital bed. All tests required as an inpatient and that may affect the
medically stable status have been completed
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Who Provide Services in the Community?
•
Solent Healthcare Trust provide Community Nursing, Therapy, Mental health and
End of Life services to Portsmouth City and Southampton City residents
•
Southern Health Foundation Trust provide Community Nursing, Therapy,
Learning Disability, Mental Health, and End of Life services to all Hampshire
residents (5 CCG’s) and a walk in centre at GWMH
•
Care UK provide minor injuries units and walk in centre, diagnostics, Ultrasound,
X-ray and ECHO, Day surgery, orthopaedics, ophthalmology, general surgery and
gastroenterology and run a diabetic retinopathy screening program at St Marys,
Portsmouth and a GP surgery and walk in centre at Guildhall walk
•
Domiciliary care services provided by Hampshire and Portsmouth County
Councils
•
South Central Ambulance Service provide NHS 111
•
HDocs provide out of hours services
•
Third Sector providers (Macmillan, Rosemary Foundation, Rowans, plus others)
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Community Beds
Across Portsmouth and South East Hampshire there are a total of
152 Community Hospital beds provided by SHFT, Solent and PHT
and 34 Re-ablement/CHC beds provided by HCC and PCC
Portsmouth
Hampshire
Spinnaker Ward
Solent
16
Rowan Ward
SHFT
20
Jubilee House
Solent
25
Cedar Ward
PHT
22
Longdean
Solent
10
Sultan Ward
SHFT
21
Harry Sotnik
PCC
10
Ark Royal
PHT
18
Eden Vale
SHFT
10
Cams Ridge
GPA
6
Wenham Holt
GPA
4
Re-ablement
HCC
(various Nursing
homes)
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Work Streams to Support Admissions Avoidance (1)
•
Urgent Care Centre will be starting on 1st November 2013 – 4 days a week moving to 7
days within 2 months
•
GP in ED pilot commenced March / April 2013
•
NHS 111 provided by SCAS UK
•
OOH Service provided by Care UK/Hdocs
•
Ambulatory Care Centre increased provision to 7 days a week from January 2013 and
will introduce 6 new pathways on 11th November
•
3 Minor Injuries Units and walk in centres (GWMH, St Marys, Guildhall)
•
Community Assessment Lounge commenced April 2013
•
Community ED Team commenced 2012
•
GP non conveyance
•
SCAS provide a “safe place” at Guildhall at weekends for substance misuse
Work Streams to Support Admissions Avoidance (2)
•
9 Community Care teams providing virtual wards supporting patients in their
own homes
•
3 Rapid Assessment Units in Hampshire
•
1 Day Hospital in Portsmouth
•
Specialist Care Home Matron Team providing training and education to care
homes across all 3 CCG’s
•
Specialist Falls Teams, 3 Falls Co-ordinators being piloted in 3 localities
•
Specialist Heart Failure, Diabetes and Respiratory Teams
•
Specialist Continence, Palliative Care and Safeguarding Teams
Primary Care Engagement
•
Incentivising GP’s to provide additional medical support to nursing homes
•
Incentivising GP’s to register and treat patients who have fallen and have a
previous fracture
•
Re-viewing all current LES schemes
•
GP’s will be at the heart of the Integrated Community Care Teams supporting
community teams to keep patients at home longer
•
Practices are providing telephone triage and extended hours
Work Streams in Development to Support Admissions Avoidance
• Development of Integrated Community Care Teams (4 pilots have
started)
• Review of whole end to end Older persons pathway to develop an
integrated whole system pathway focused on any patient with
complex co-morbidities
• Reduction in LOS of Community Hospital Beds to increase throughput
for step up patients
• Development of 7 day community services
• 7 day Psychiatric Liaison Team in ED
• Review of Dementia Services
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Work Streams to Support Effective Discharge
•
Increased access to CHC Fast Track – reducing the number of CHC delays
•
Community in reach (Pull) discharge team commenced 7th October
• Focus on delivering an integrated approach to discharge for all complex
patients over 18 years old
• Led by Community Matron
• Includes Occupational Therapy, Physiotherapists & Social Care links
•
OPMH Liaison Team commences 29th October
• Focus is rapid specialist assessment and treatment of people with mental
health problems in QA
• Led by Nurse Team Leader
• Includes 8 PA’s of medical time
•
Dedicated CHC nurse based in PHT 5 days per week from November 2013
•
Non Weight Bearing Pathway – Commenced January 2012
Work Streams in Development to Support Effective Discharge
• 8- 10 additional discharge to assessment beds to be opened in
Hampshire to support CHC patients
• Review of End of Life Services
• Review of Community Bed Provision across Portsmouth and South
East Hampshire
• Introduction of 7 day imaging
Any Questions?
Contact: Melissa.way@hampshire.nhs.uk
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