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DVD 1: Introduction
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Right First Time 24/7
Staff workshop 14 February 2014
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Sue Jacques
Chief Executive
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Purpose for today
Discuss our evolving clinical strategy
Share work being done NOW to drive it forward
Consider what this could mean for you, your
service, and the Trust
Discuss with the Executive and Senior Clinical
Leadership team
Make new friends and influence people!
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Share your questions, thoughts and ideas…
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Right first time 24/7
Our evolving clinical
and quality strategy
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The story so far…
2011: Integrated hospital and
community services
2012/13: Discussions with staff
and stakeholders around key
services as an integrated provider
2013/14: “Getting care
right for the emergency
patient, especially the
frail elderly, must be the
priority”
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The case
for change
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“there are patients,
usually frail elderly,
who are admitted to
hospital unnecessarily…
because services are not
organised to respond to
their needs at an early
stage.”
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“There are days when the
95% target for A&E 4 hour
wait is not achieved.
Multiple ambulances can be
waiting outside A&E to
hand over patients.”
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“Patients are regularly
boarded onto surgical
wards.
Patients are waiting in A&E
for beds to become available
for them to be admitted.”
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“Many of our rotas at
both junior and
senior level are
supported by locum
staff, which impacts
on continuity of care
and consistency of
quality.”
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“Recent surveys of
medical trainees show
that the Trust is not a
placement of choice
for junior doctors.”
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“We are experiencing
difficulties in recruiting to
nursing vacancies, where we
want to make ward managers
and team leaders
supernumerary and strengthen
teams.”
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“The Francis report
revealed a tolerance of
poor standards and risks
to patients.
We cannot take for
granted that similar
problems could not
happen here.”
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In addition, there are issues
from :
• HSMR data
• Incidents
• Coroner reports
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National financial context
£30bn gap
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Local context: Better Care Fund 2015/16
D/ton
DDES
N Durham
Total
Total Fund
Contribution
£7.2m
£22m
£17.2m
£46.4m
Supporting Existing
Health Services
£3.9m
£11.9m
£9.2m
£25.1m
Impact on acute
services at CDDFT
£3.1m
£6.2m
£6.3m
£15.6m
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Local context: Better Care Fund 2015/16
D/ton
DDES
N Durham
Total
Total Fund
Contribution
£7.2m
£22m
£17.2m
£46.4m
Supporting Existing
Health Services
£3.9m
£11.9m
£9.2m
£25.1m
Impact on acute
services at CDDFT
£3.1m
£6.2m
£6.3m
£15.6m
We are also seeing the impact of new commissioning
arrangements, especially on Health and Wellbeing
services.
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“Our reserves can only be
spent once, so it is important
that we do so wisely, on
investments and capital
schemes that will help us
achieve our vision.”
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“Our reserves can only be
spent once, so it is important
that we do so wisely, on
investments and capital
schemes that will help us
achieve our vision.
“However, pressures on
services means reserves
for investment are being
eroded.”
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Right first time 24/7
How do we respond?
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Our vision
Right person
Right place
Right time
First time
24/7
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Our principles
Deliver core acute specialties across
both acute sites
Specialty departments delivering care
across two acute sites and beyond
Consultant delivered care
Patients in homes not hospital,
clinicians to patients
Care closer to home where safe,
effective and efficient
Older person at the heart of service
delivery, supported in the community
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A cultural shift is
required:
“We need to stop thinking
of ourselves as a group of
small acute hospitals,
merged with community
services, and really create a
vision of one large
progressive integrated
provider.”
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A cultural shift is
required:
“Services organised
so that consultant
review, clinical staff
and diagnostic and
support services are
readily available on
a 7-day basis.”
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A cultural shift is
required:
“We need to ensure that
steps to keep patients
out of hospital and
support them in the
community are
clinically effective and
cost efficient at a time
when there are
pressures on budgets.”
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A cultural shift is
required:
“We need to respond to
the challenge to improve
service quality and
outcome. This will
require new models of
care that are more
efficient than those we
currently operate.”
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Getting involved
Today’s event!
One hour roadshows
Meetings with the project team
Service transformation
Clinical reference group…
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Proposed
Workstreams
Clinical reference
group
Executive and
clinical leaders
Clinical strategy
steering group
Community
care/Care closer to
home
Unplanned
care/Acute and long
term conditions
Planned
care/Surgery and
diagnostics
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Proposed
Workstreams
Clinical reference
group
Executive and
clinical leaders
Clinical strategy
steering group
Interested? Why not
sign up over coffee?
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Community
care/Care closer to
home
Unplanned
care/Acute and long
term conditions
Planned
care/Surgery and
diagnostics
What do our stakeholders say?
Clinical Programme Board priority areas…




Elderly/frail elderly
Urgent Care
Long Term Conditions
Mental Health and Dementia
“Ambulances need to become places of
treatment”
“Voluntary sector will build more
provision into community services”
“More emphasis on independence
and self management”
“Effective care closer to home will require excellent
case management and more carer support”
“Disinvestment: There are some hard
decisions we need to take together”
“We need to learn lessons quickly!”
Right First Time Stakeholder Event, 6 February 2014
(15%)
“Achieve strategic shift
acute
activity to outside of hospital via
transformational schemes”
Right First Time Stakeholder Event, 6 February 2014
acute services
We need credible alternatives
to hospital admission
Everybody up!
The15%
challenge
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Working with your Valentine:
What skills will our workforce need
with 15% of work shifting out of an
acute setting?
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Coffee
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DVD2: Front of house
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Doing things differently:
Unscheduled care – Derek and Stuart
Intermediate care – Debbie and Linda
Surgery and diagnostics – Janet and Ian
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DVD3: Surgical CDU
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Discussions questions
Care closer to home: intermediate care
How do we take advantage of new intermediate care
arrangements to keep patients out of hospital and
reduce length of stay?
What will it mean for our patients and their families?
How will it change our acute services?
What will it mean for community services?
How does this contribute to the 15% challenge?
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DVD4: Care co-ordination centre
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DVD5: CREST
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ALTC: unscheduled care
The action plan
Work being done in ED
ECIST
Discussion
How can we support the action plan for unscheduled care within our
services
How can this contribute to 15% challenge
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Surgery and diagnostics
Focus on surgical specialties and what they are doing to support
unscheduled care
CDU and the no pyjamas pathway
CT pilot – removing unnecessary waits
Reference to business case as route in to centres of excellence
Discussion
Are there other area where we could be removing unnecessary waits
Are there other areas where we could assess before we admit
How can this help the 15% challenge
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Feedback by ACOOs
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Lunch
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Friends and
Family Test
“How likely are you to
recommend us to your friends
and family if they needed similar
care or treatment?”
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Friends and family test…
Would you recommend your
friends and family to be treated
in your service?
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Ask not…
what your country
can do for you…
Ask…
what you can do for
your country.
Getting better all the time…
What can I do to improve my
service?
What could my team do to
improve our service?
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Getting better all the time…
What can I do to improve my service? –
personal pledge for the pledge board
What could my team do to improve my
service? – take to your team meeting
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Introducing the senior team…
Questions and answer forum
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DVD6: Prevention first
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Taking Action in 2014/15
Care groups have been working on their plans
We have to submit 2 and 5 year plans over the next few
months
We need a robust “winter” surge plan
2014/15 is a big year in terms of activity, big year in
terms of change
15% challenge
What are our breakthroughs for 2014/15?
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Tea
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Care group “huddles”
What are our breakthroughs?
What are the priorities for 2 and 5 years
What are our priorities for the “winter” surge plan?
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Feedback
Breakthrough areas from each care group
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Next steps
Staff workshops and roadshows
Working with partners on Better Care Fund proposals
Submitting 2 year and 5 year plans
Developing a robust winter plan for 2014/15
Meeting required national and local standards (SeQuIHS)
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