Frimley Park Hospital NHS Foundation Trust’s
Acquisition of Heatherwood and Wexham Park Hospital
Clinical Vision Development
3rd April 2014, 9am to 1:30pm
Agenda
•
Introduction
•
Setting the scene
•
Commissioners’ emerging 5yr strategy
•
Joint view
•
Individual key messages
•
The enlarged Trust emerging clinical strategy
•
Breakout groups
•
•
Emergency care
•
Care of the elderly
•
Planned care
•
Quality at FPH and HWPH
Feedback and next steps
2
Setting the Scene
3
Acquisition of Heatherwood & Wexham Park
Why do this?
• HWP catchment population. Bolster the
continuation of hyper acute services at Frimley
e.g. vascular and heart attack
• Adds weight to the enlarged organisation
becoming one of 40-70 super A&Es
• Avoids a third party based at Heatherwood
running elective services
• Provides additional space for development of
services
Map of enlarged trust
(Showing 30 min drive time and 90% of GP referrals)
New catchment population estimated as over 800 thousand people
5
Acquisition Heatherwood & Wexham Park
• FPH to submit FBC May 2014 subject to
agreeing terms with DoH/NHS England on:
• Capex
• Deficit support
• Transitional funding
• Revenue support
•
OFT case submitted - March 2014
•
Transaction date 1 August, subject to FPH
Board, CoG and Monitor approval
Key principles
All three sites, Frimley Park, Wexham Park and Heatherwood Hospital will be maintained
There will be a single, Trust-wide, executive team
The Board will be of the minimum size necessary to effectively manage the Trust and to maintain rapid
and flexible decision making
Integrated management structure across all 3 sites
The corporate centre will be of the minimum size necessary to effectively manage the Trust and with
responsibilities devolved to local business units where possible
Effective clinical leadership will be at the core of the design, to deliver upper quartile performance
outcomes and excellence in patient care
There will be single, Trust-wide, policies, systems and processes
There will be clear and harmonised roles, responsibilities and accountabilities across the enlarged Trust
We will not over-burden reporting and line management responsibilities
Maximum efficiency will be created through removing duplication, centralisation and using economies of
scale
7
Acquisition Heatherwood & Wexham Park
Key opportunities:
• Stroke and possibly pPCI on both acute sites
• Cancer services aligned, IOG compliant, single cancer
centre for WP
• Radiotherapy on WP site
• New elective centre at Heatherwood
• Improved vertical integration of services
•
Consultant-delivered 7 day services across all sites
•
Improved care standards/performance for HWP patients
•
Improved standards at Frimley
Commissioners’ 5 yr strategy
9
The enlarged Trust clinical strategy
10
Map of enlarged trust
(Showing 30 min drive time and 90% of GP referrals)
New catchment population estimated as over 800 thousand people
11
12
Key Services
•
A and E
•
Cardiology
•
Vascular
•
Stroke
•
Spinal
•
Orthopaedics and Plastics
•
Cancer Services
13
Heatherwood
Possible services on-site:
•
Orthopaedics
•
Day Case
•
Endoscopy
•
Ophthalmology
•
Breast
•
Private
14
Breakout Groups
15
Breakout Groups
•
Emergency care – Helen Coe
•
Care of the elderly – Tim Ho
•
Planned care – Daryl Gasson
•
Quality at FPH and HWPH – Andrew Morris
16
Emergency Care
17
The Vision for Emergency Care
The whole of the enlarged catchment will benefit from:
•
Excellent quality care (in all 5 quality indicators)
•
Streamlined patient flows
•
24/7 Consultant-delivered care
•
A ‘Major Emergency Centre’ within The Trust
•
‘Decide to Admit’ system
•
The best training experience in the country
•
Closer integration with the community:

Shared IT

Admission avoidance

Ambulatory care pathways

Combined performance
dashboard
18
Emergency Care at Wexham Park
Issues at HWPH
Improvement Opportunities
Poor performance metrics
Robust clinical governance
Patient flows
Pathway redesign
Internal specialty referrals
System-wide approach
Staffing mix
Investment in training and up-skilling
Quality of accommodation / space
Investment in the department
Consultant cover
Consultant-delivered service
19
Elderly Care
20
Clinical Model for Care of the Elderly
The Vision:
Specific interventions:
 To work with local health providers to take a
greater responsibility for the whole of the older
adult journey
1.
Proactive management of
higher risk patients, with
risk based assessment
 Become a National Centre of Excellence for the
treatment of older people, in line with the latest
guidance from the King’s Fund, as we have done
with the management of acute stroke
2.
Front-door Care of the
Elderly Physicians, with a
7-day “discharge to assess
model”
 To champion new models of holistic and
integrated care to support older adults to live
longer and better in their own homes
3.
Improved Hospital Care,
with treatment pathways
specifically for older adults
 To deliver high quality secondary care in the
community to prevent hospital admissions, as we
have done with our Outpatient Parenteral
Antibiotic Therapy (OPAT) Service
4.
Early Supported
Discharge with community
team support
21
Reduced Admissions
1. Proactive
management of higher
risk patients
2. Front-door Care of
the Elderly
Physicians

GP-led risk-based
assessment identifies frail
patients at risk.


Integrated care services
team provides support and
advice, led by community
geriatricians – early access
to geriatrician expertise

Patients are proactively
managed, preventing
admissions.

Out of hospital
rehabilitation therapy
support

7-day ‘discharge to
assess’ model supports
hospital at home models
of care (incl virtual wards
and day attendances).
Dedicated elderly care
assessment beds.

Holistic and appropriate
care plans initiated from
the start

Out of hospital
rehabilitation therapy
support
Accelerated Hospital
Care
+
3. Improving Hospital
Care
=
Reduced
Bed
Days
4. Early Supported
Discharge

‘Decide to admit’ refers
patients to the right team
1st time

‘Wraparound’ community
care team gives intensive
MDT support.

Standardised treatment
pathways ensure consistent
high quality care.

Robust protocols monitor
and identify failing
discharges.

Proactive discharge
planning, higher frequency
ward rounds and more
specialty geriatricians.

Named ‘interface’
geriatricians maintain links
with community and
continuity of care on
discharge.

Team-based care for older
patients with minimised
ward transfers.
Enablers to realise the strategic vision:
• IT link with primary care providers.
• Short term and flexible social care packages.
• Collaboration and closer communications with GPs, including specialty consultant-held advice telephones.
22
Planned Care
23
The Vision for Planned Care
The whole of the enlarged catchment will benefit from:
•
Improved patient choice
•
Streamlined patient experience
•
Enhanced communications with Primary Care
•
Local access
•
Heatherwood elective centre
24
Planned Care: New Ways of Working
•
Pathway approach – MSK, eyes, pain, derm, etc
•
1-stop shops
•
Demand management, efficiency and performance
management
•
Use of technology and specialty advice for GPs
•
Collaboration with Commissioners
25
Breakout Discussions
•
Mixture of commissioners and provider on each table
•
Choose 1-2 topics to discuss
•
Agree shared vision
•
Capture key points
•
Provide feedback of top-3 areas for each topic
26
Feedback
27
Next Steps
•
Future meetings
28