Sue Page & others: Integration in Cumbria
0 likes1,015 views
Integration in Cumbria aims to improve health outcomes through closer collaboration between primary, community, and acute care services. Key steps have included forming a social enterprise to both commission and provide community services, giving clinicians leadership roles in localities, and devolving power to integrated care organizations. This approach has helped solve a historic health economy debt, improve quality scores, and establish new models of care like the "virtual community hospital" and integrated diabetes services. The integrated system also responded effectively to the 2009 Cockermouth floods.
Sue Page & others: Integration in Cumbria
- 1. Integration in Cumbria I t ti i C bi Sue Page g John Howarth Hugh Reeve Ros Fallon NHS Cumbria
- 2. Welcome to Cumbria CH H Cumbria profile CH CH 2,500 sq miles CH CH CH CH 500,000 people CH H 73 people p km2 p p per Urban/rural split H Wide health variations CH Huge travel times H
- 3. The way we were… Health H lth economy was b t – £36 7 hi t i d bt - bust £36.7m historic debt £100m deficit projected over 5 years People marching on the streets Efficiencies needed i acute sector Effi i i d d in t t Co Community se ces fragmented u y services ag e ed Standards of care inconsistent – systematic approach needed
- 4. Where are we now? Wh ? Debt solved (although pressures still exist!) Highest score in North West for WCC Closer to Home strategy Clinicians in charge in all 6 localities Devolution of power to ICOs This is plan A, there is no plan B A
- 5. Where does integration take place? Business Support Services Copelan d Allerdal e South Lakelan Furness Cumbria d Central Carlisle Eden
- 6. Sub locality Sub locality Integrated Care relationships Locality Locality Locality Locality Locality Locality Support Headquarters Clinical Senate (Clinical Executive Group) • Developing evidence based clinical pathways and service models • Peer support to localities to improve performance • Collaborating for commissioning and contracting • Working with key public sector partners Business functions HR, Contracting, Finance, Intelligence, Pathway design etc g , y g PCT (System Manager) £800m from DH Ensures public health is protected Contracts with HQ to improve health outcomes Intervenes in the event of whole system failure
- 7. Welcome to South Lakeland
- 8. DGH DGH
- 10. Westmorland P i W t l d Primary C Care C ll b ti Collaborative WPCC is 21 practices (list size 600 – 16,000) and all PCT community health services “Make or Buy” for 110,000 population Key priorities for next 5 years: Integrating services for older people L Long t term conditions (i l di supported self mx) diti (including t d lf ) High quality primary care Access to appropriate urgent care services Efficient and effective use of elective care services Working with others to p g promote healthy individuals y and communities
- 11. Progress Progress Agreement to form a social enterprise, from April1st, to both commission and in future provide services Company limited by shares, holding APMS contract with PCT – important for NHS p p pensions etc Leadership from GPs, nurses and therapists across all of primary care Taking on increasing proportion of the PCT budget – approx 50% this coming year A Board including lay members – bringing expertise not token representation Approach to public engagement building on existing structures (mainly non-health) ( y )
- 12. The “ i t l” community h Th “virtual” it hospital it l Step-up step-down unit in Kendal (51 beds) p p p ( ) Nearly 50% of admissions are step up Acute to a community focus - culture challenge Moving to nurse led with doctor support STINT service M Manage crises and early supported di h i d l t d discharge Health and social care input (joint funding) Nursing home support team Day Hospital Moving to co-location with wards g Coordination of physical and mental health services
- 13. Early discharge and rehabilitation The “virtual” community hospital: Team responsible for individuals undergoing a p g g crisis – cared for at home, stepping down to a community bed or supported early discharge Flexible roles – some staff who can work either on the wards or in the community – so can “flex” with pressures i th system in the t Co-location of all + common electronic clinical record
- 15. Integrated primary care information EMIS web “allows primary secondary and community healthcare primary, practitioners to view and contribute to a patient's cradle to grave healthcare record” In last 12 months: Installation of superfast local network connecting all health bases across the locality 20 of 21 practices now using EMIS (21st on the way!) All community nursing teams moving to EMIS by mid 2010 and using mobile b db d / netbooks i bil broadband tb k Specialist community teams – transfer almost completed GP OOHs, PCAS and step-up/step-down Unit have access to summary information from the GP record
- 16. Pharmacy H os pi ta Radiology Radiology PCAS, GP led wards lI nf o Report EMIS Web Hospital and GP OOHs EHR Radiology EHR Report EHR Lab EMIS EHR EHR Patient Info Patient Results DataReferral Data R Reports Rx InfoRx Path Lab Repository Guide Specialist Teams linesData and clinics EMIS Web Patient Info Data Streaming Data Streaming Reports epo ts Referral between local centres GP and Community Teams Guide and central repository lines Central Support Team
- 17. Long Term Conditions Cumbria Diabetes
- 18. The need Increasing prevalence of diabetes Evidence for high quality care in Cumbria HCC and QoF But... Poor patient education and high drug costs BUT variations in both quality and patient experience across C b i i Cumbria Fragmented and non aligned specialist service
- 19. The Cumbria Diabetes Model of Healthcare: Primary care Pi (core) Primary care setting Secondary and Tertiary care setting Primary care y (enhanced) Specialist support for Primary Care Complex care
- 20. Description of services Register Delivers holistic annual review (care planning) ( g) for patients with Type 2 diabetes Complete QoF measures Adheres to agreed guidelines Refers to DESMOND Partnership with Cumbria diabetes Primary care Pi Work t W k towards improving quality d i i lit (core) Primary care setting Primary care y Secondary and (enhanced) tertiary care setting Specialist support for Primary Care Complex care
- 21. Description of services Provides core care Named clinical lead Identify high risk/ use tools Primary care Pi and interventions (core) Stepped approach to Primary care setting glucose lowering Care planning and on going Primary care y Secondary and management in patients ti ti t tertiary care setting with Type 1 diabetes (enhanced) Insulin initiation / on going Specialist support support in Type 2 for Primary Care Complex care Address learning needs with spec support team Registers of housebound / high risk Care for house bound / vulnerable groups Specific needs of women of child bearing age Work to max’n QOF points
- 22. Description of services Primary care Pi (core) Primary care setting Primary care y Secondary and (enhanced) tertiary care setting Specialist support for Primary Care Complex care Reviews newly diagnosed Type 1 before referring to Enhance Care Provides a structured Type 1 support service Provides staff training both formally and informally Coordinates/provides patient education and Type 1 post education support Ad hoc specialist advice to other professionals Locality based individual case discussion with specialist team Contributes to developing clinical g p g guidelines Supports development with Core Primary Care Practices to become enhanced practices Provides enhanced services to core practices Co ordinates the specialist support services for Primary Care eg nutrition, psychology, retinal screening
- 23. Description of services Provides care to individual patients with complex needs Provide/coordinates multi specialty services eg Pregnancy, renal, eyes, vascular, heart and feet Provides transition and young adult services Provides inpatient care Primary care Pi (core) Primary care setting Primary care y Secondary and (enhanced) tertiary care setting Specialist support for Primary Care Complex care
- 24. Financial resource Local authority (Health) resource Personalised The population individual care Primary care is the HUB through (healthy, high risk and commissioning, facilitating, undiagnosed) understanding and providing Biomedical Policy intervention determinant s Community s engagement to maximise local assets Self S lf management t Maintaining registers Risk factors Relevant information Routine review Awareness raising Care planning p g Personalised care Social marketing Linking with planning community and Reducing inequalities support services Contact point to NHS Healthy cities, schools, stadia etc Helping to build resourceful Helping to build resourceful individuals communities
- 25. Progress Challenges of identifying lead p g y g provider Now sitting with Primary Care WPCC Allstaff (incl consultant lead) moving to primary care Cumbria wide education Daphne, p Desmond and Walking away from g y Diabetes Other long term conditions following Incl paediatrics, elderly care
- 26. Cockermouth Floods 2009
- 27. Cockermouth Floods 17th November 2009 November 2009 was the wettest on record in the UK (over 8 inches i th month) ( i h in the th) Over 12 inches fell in 24 hours on the fells above Cockermouth 10 out of 11 bridges damaged or destroyed 880 h houses and 190 b i d businesses fl d d flooded Our health model in action!
- 30. Collapsed Bridge Workington PC Bill Barker died
- 31. 13 whole team meetings to co-ordinate the co- recovery and manage risk d i k
- 32. Priorities for the health services: To avoid excess mortality and morbidity y y Measures to avoid diarrhoeal disease Measures to prevent severe respiratory illness M t t i t ill (crowding in church halls and reception centres) Re-establishment Re establishment of normal health services for long term conditions asap especially the re- establishment of pharmacy services and systems Boosting p y g psychological support g pp
- 33. Reducing risk: Identified ll t i k l Id tifi d all at risk vulnerable patients and proactively bl ti t d ti l contacted them e.g. Severe COPD, palliative care, frail elderly. Established heightened surveillance for diarrhoea cases – every case was investigated by the seconded infection control nurse Gave public health information/lectures to rescue workers and all staff and displaced at the reception centres on hand hygiene and diarrhoea prevention prevention. Vaccinated 1000+ at risk in reception centres and 350 rescue workers against swine flu and seasonal flu in the first week
- 34. Reducing risk: Rapidly b ilt R idl rebuilt GP t l h telephone and IT systems d t (within 24 hours) Re-established pharmacy services ( p y (within 24 hours) Provided extended GP opening 24 hours for first day then 8am-8pm every day for the next 2 weeks including weekends Rapidly established additional counselling services i l di d i including drop i services in i Dug the foundations for a 26 room temporary building within 5 days of the floods g y
- 35. Longer Term: Adolescent Health Programme with school and pupils Centre for the Third Age – co-locating third sector, health, social care, memory clinics, dementia expertise etc d i i Harnessing the whole community response to health – cheer up teas street angels etc teas,
- 36. Doing more with less Cockermouth H C k th Hospital - 300% i it l increase i in throughput 2006-9 Length of Stay down from 36 days to 11 days £250,000 reduction in annual nurse costs from 2006 to present Nurse wte reduced from 23.4 to 13 Cost per admission reduced by more than half 19% reduction in non elective bed days spent in Acute Trust in 2008-9 2008 9
- 37. Policy Issues P li I Practice based commissioning has been central to our approach Based on building relationships with GPs more than the li itself th policy it lf Trusting clinicians and handing over real responsibility (+accountability) has been crucial Transforming Community Services - vertical integration v horizontal integration Social S i l enterprises and pension i i d i issues PBR and Foundation Trusts