programme for health services improvement tri partite board march 14 th 2008
TRANSCRIPT
Programme for Health Services Improvement
Tri Partite Board
March 14th 2008
Purpose
Context
Consultation Document Structure
Emerging Proposals for Consultation
Key Issues for Discussion and Agreement
Programme for Health Services Improvement
CommunityBased
Services
HospitalServices
Key principles
A shift of focus from illness to health Improve quality, safety and outcomes Right care, right time, right place, right
professional Focus on services and patient experience Maximise resources to achieve excellence
Working together as a health (and social care) community
Our Starting Point….
Current disparate services are not set up to provide optimal care
Current pathways are confusing for patients and professionals
Need to get “upstream” and focus on prevention and proactive management
Need to promote greater personal responsibility for health and wellbeing
Strategic Rebalancing…..
10 year programme of change Phase I – Building the Foundations
Strengthening primary and community services
Creating sustainable alternatives to hospital care: community services and rehabilitation & re-ablement services
Mental health Phase II
Acute services
The Consultation
What are we going to be consulting on?
“Building the Foundations for Sustainable Change in Population Health”
Getting it Right – Landscape NOT deckchairs
Physio
SocialWorker
Domiciliary Care
OT
Family
Diabet-ologist
Practice Nurse
CPN
Cardiol-ogist
GP
DistrictNurse
Podiatrist
RespiteCare
Voluntary
Transport
Getting it Right – Landscape NOT deckchairs
Physio
Domiciliary Care
CPN
OT
Family
Diabet-ologistPractice
Nurse
Social Worker
Cardiol-ogist
GP
DistrictNurse
Podiatrist
Voluntary
Transport
RespiteCare
Opportunities for change
Patient risk
Referral
Condition/Cohort
GP interest
Lifecycle Position
Invasiveness
Given current conditions, should this service be performed
closer to the community
Is there adequateDEMAND?
Can theTECHNOLOGY
required support
shift?
Can STAFFING &
SKILLS requirements support shift?
What are the SAFETY
considerations?
What OPERATIONAL
Issues should be considered?
Patient choice
Facilities
Separation of tasks
Equipment
Lifecycle Position
Training/CertificationAvailabilitySupport Staff
Access
From NHS Institute for Innovation and
Improvement
Laying the Foundations: Primary & Community services
Proposals which set out our plans, with particular reference to:
The models of care required to improve the delivery and integration services to meet local needs
The location and services to be provided in each locality across and the implications of these plans (noting previous consultation on C & E Cardiff)
Laying the Foundations: Rehabilitation & Re-ablement
Proposals which support sustainable, high quality services with particular reference to
community based services co-ordinated at a locality level the capacity required to meet need, including home, day
services, residential and inpatient requirements for specialist (tertiary) rehabilitation services
currently provided at Rookwood the future role of St David’s and Barry Hospitals, UHW
and Llandough and options for the replacement of Rookwood and Westwing
Structure of the Consultation Document
Section 1 Setting the scene
Section 2 How services are arranged now
Section 3 Reasons for change
Section 4 Vision for new models of care
Section 5 Proposals for rehabilitation services, including the reprovision of services in Westwing & Rookwood
Section 6 Specific proposals for the Vale of Glamorgan
Section 7 Specific proposals for West Cardiff
Section 8 Specific proposals for North Cardiff
Section 9 Specific proposals for Central & East
Section 10 Proposed Timetable for the developments
Section 11 How our proposals will affect the NHS Workforce
Section 12 Frequently Asked Questions
Section 1: Setting the Scene
What is not included (and why) Services for C&E Cardiff Adult and Older persons Mental health services Services for Women and Babies Community services in the Western Vale Detailed proposals for GP developments Details on the implementation of new, agreed care
pathways
Why we are consulting and why we want feedback
Section 2: How services are arranged now
Describes the 4 levels of care as per Designed for Life
Highlights role of primary and community services
Section 3: Why we need to change
Too much of the care we provide is in large
hospitals which can be difficult to get to
Services should be integrated and working to maintain individuals
health and independence
We have inadequate, poor quality buildings providing
primary, community and hospital services – this is no
longer acceptable for the delivery of modern care
Patients should be treated and cared for in buildings which support privacy and dignity, and which provide a positive
environment
More health services could be provided closer to where
people live
Too much of our care is provided reactively and by professionals who are not
able to work in an integrated way
We need to change
Many of our services are not provided equitably across
Cardiff and the Vale of Glamorgan
Services should be available equitably
based on need
Section 3 – Why We Need to Change
Today….
On average at least 80 people assessed as requiring long term care are in a hospital bed, rather than a home based setting (not just older people)
On average at least 100 people are in a hospital bed in Cardiff and the Vale who have been assessed as being ready to transfer but are experiencing a delay (excluding mental health)
Many patients are staying longer in hospital because we don’t have rehab/community capacity
Section 4: Our Vision - A New Landscape
Community Services
Hospital Services
Tertiary Services
Community
Services
Hospital Services
Tertiary Services
From To
Section 4: Our vision
Locality/Population Based Services to help maintain health & independence
New Locality Resource Centre for
West Cardiff
New Locality Resource Centre for
Central and East Cardiff*
Barry Hospital Developed as
Locality Resource
Centre for the Vale
New Locality Resource Centre for
North Cardiff
Substantial increase in services in the communityRehabilitation
Outpatients and DiagnosticsTherapy services
Section 5: Rehabilitation
Our proposals
NB. Remember General & Specialist
Current Services
Mainly reactive (with notable exceptions) Multiple pathways and points of entry Hospital focused Inequitable
Locality Age “ology”
Poor environments
Principles
Locality based multi-disciplinary teams (for local rehab)
Early identification of need Common framework for assessment Needs based (not aged based) service Community based, in-reach models Continuity of care – transfers of care NOT
discharge Integrated services
New Model – Rehabilitation
Early Access to appropriate Multi-
disciplinary Assessment
Timely access to appropriate care in the
appropriate setting
Locality/Specialist Multi-Disciplinary Rehabilitation
Teams taking responsibility for co-ordinating care in and
out of hospital settings
Day HospitalsReablement
Respite
Acute Hospital Rehab
Intensive Inpatient Rehabilitation
Active, slow stream Rehabilitation
Long Term Care
Where?
Home (includes residential home,
extra care housing etc.,)
Enhanced
Nursing Home
Acute Hospital
Community
Rehab Facility
Mabel is medically stable and able to manage at home with appropriate support (e.g. day hospital, reablement team, stroke outreach etc.,). (Under care of GP)
Mabel is medically stable, but can not manage at home, and requires nursing home level care +/- access to appropriate MDT input, she may need MDT assessment to plan for her long term care (Under care of GP)
Mabel is medically stable, and has been assessed as having the potential to benefit from intensive MDT rehab to enable her to maximise independence. (Day 14 – 42)
Mabel is not medically stable and/or requires early access to good MDT rehabilitation. Aim is to enable transfer of care to community setting, or community rehabilitation unit (Day 1 – 14)
What Does This Mean for Our Capacity Planning?
“BEDS” Cardiff LHB Vale LHB
Total C&V LHBs
All Commissi
oners
Do Nothing
C E N W C&E
Acute 111 137 114 149 187 698 1082 1558
Inpatient Community Rehab
36 43 44 49 69 241 360 263
Domiciliary 44 50 51 71 92 308 404 107
Specialist Rehab
64
Figures based on 2014 demographic projections and agreed service model assumptions
Proposed Solution for Inpatient Community Rehab
Barry Hospital –Vale rehab team with access to inpatient beds & community based services
St David’s Hospital – West Cardiff rehab team with inpatient beds/day care services supporting Central, East & West Cardiff, community based services also in CRI for Central and East
New North Cardiff facility – North Cardiff rehab team, North Cardiff locality beds + specialist rehabilitation beds (stroke rehab, working age adults) +/- Vale, and tertiary rehabilitation
What does this mean?
UHW/Llandough
West Wing
Rookwood - General
St David’s
Barry Hospital
@70 beds
(Vale)
St David’s
General Rehab
@ 100 beds
(Central/East/West)
Home based care
Including extra care,
residential and nursing home
care
New Rehab Facility
80-100 general*
50 specialist*
Barry Hospital
Rookwood - Specialist
UHW - Specialist
In reach
(Spinal/Neuro)
Key Issues to Resolve
Stroke rehab Single specialist unit, or Vale/Cardiff Units? Acute site, or community?
EMI Continuing Care – clinical model not yet agreed will impact on capacity available at St David’s and Barry Should we consider some EMI continuing care capacity in
the new facility in North Cardiff?
Clearly defining “nursing home” specification
Western Vale Assumptions
Capacity of “new facility” in light of the above
Primary and Community
OUR PROPOSALS
(….assuming emerging solutions for Rehabilitation are agreed….)
Section 6: The Vale
Proposals for Consultation
The Vale
Locality Health and Treatment CentreBarry Hospital
Community Health Resource CentresCowbridge (new build in progress)Dinas Powys (3rd party scheme)Penarth Health Centre
Vale Locality Health & Treatment Centre (Barry Hospital)
Local outpatient services
@ 80 inpatient
rehab beds
Treatment suite
Minor Injuries Unit (extended
hours)
Diagnostic services
Therapy services
Community/ NHS Dental
Services
Integrated day
hospitals
Integrated Community Rehabilitation Services
Primary Care Out of
Hours
Visiting “mobile” services
Voluntary Sector
Services
Including….
Central Vale – What does this mean?
UHW/Llandough
Broad Street
Calcott
Amy Evans
Vale LHTC
(at Barry
Hospital)
Hood Road
Barry Hospital
Highlight Park
Cadoxton
Potential base
For
CMHT?
Waterfront
MHSOP
Assessment
to Llandough
Continuing Care
To alternative
setting
Vale – What does this mean?
Closure of Calcott and Cadoxton Clinic Closure of Broad Street (or alternative
use) Transfer of @ 20 continuing care beds to
alternative setting EMI/Non EMI (? Partnership scheme with LA)
Transfer of older persons mental health assessment beds to Llandough
Key issues
What do we say about Broad Street?- Potential base for CMHT (Amy Evans not
fit for purpose) Which services go to Barry Hospital, which to
Highlight Park, Waterfront and Hood Road? EMI Continuing Care Capacity Scope to extend minor injuries unit at Barry Western Vale?
Section 7: North Cardiff
Proposals for Consultation
North Cardiff
Locality Health and Treatment CentreNorthern Meadows
Community Health Resource CentresGabalfa areaLlanishen area
North Cardiff Locality Resource & Treatment Centre
Local outpatient services
@ 80 general inpatient rehab
beds
Treatment suite
North Cardiff
CMHT base
Diagnostic services
Therapy services
GMS Practice
Base
Integrated day
hospitals*
Integrated Community Rehabilitation Services
Specialist Rehab
beds @ 60
Visiting “mobile” services
Voluntary Sector
Services
Including…..
? EMI complex
cont. care
North Cardiff – What does this mean?
UHW
West Wing CRI
Llanishen HC
Rhiwbina Clinic ?
North Cardiff
LHTCRookwood *–
General & Specialist
Gabalfa Clinic
New CHRC
Developments
Continuing Care
To alternative
settings
Whitchurch
Therapies
*Aim would be to transfer all clinical
services from Rookwood site e.g.
ALAS to enable optimal co-location
North Cardiff – What does this mean?
Reprovision of Gabalfa and Llanishen to be agreed in context of future proposed primary care developments
North CMHT to transfer to new LHTC
North Cardiff Key issues
Further discussions needed with Primary Care to identify opportunities for CHRC
Supporting natural patient flows to East & West
Scope to enable transfer of all key clinical services from Rookwood
Implications of outcome of rehab/continuing care options
Timeframe to support de-commissioning of Whitchurch
Section 8: West Cardiff
Proposals for Change
West Cardiff Cardiff
Locality Health and Treatment Centre
Park View St David’s
Integrated working across 2
sites
West Cardiff Resource & Treatment Centre
Local outpatient services
Treatment suite (PV)
West Cardiff CMHT Base
(PV)
Diagnostic services
Therapy services
GMS Practice
Base (PV)
Integrated Community Rehabilitation Services (StD)
Integrated sexual health services (PV)
Visiting “mobile” services
@ 80-100 general rehab
beds (StD)
MHSOP Team & Day Hospital
(StD)
Specialist Community Children’s
Services (StD)
West Cardiff – What does this mean?
UHW
Riverside
West Cardiff
LHTC
Park View
Rookwood
Continuing Care
To alternative
settings
St David’s
West Cardiff
LHTC
St David’s
Westwing
Enables GMS
Practice
Development
Pendine
West Cardiff – What does this mean?
Change of use of Riverside
Enables redevelopment for GMS
Closure of Radyr Health Centre
Closure of Pendine
West Cardiff – Key Issues
Need to engage with General Practices to establish scope for linkages with Park View Development
Links between St David’s and CRIE.g. day hospital
EMI continuing care model Recognising St David’s has Cardiff wide
role for specialist community child health
Section 9: Central & East Cardiff
Proposals for Consultation
Central & East Cardiff
Locality Health & Treatment CentreCardiff Royal Infirmary Site
Community Health Resource CentresMaelfaButetown/Loudon SquareRumney/Llanrumney
Central & East Cardiff Locality Health & Treatment Centre (CRI)
Local outpatient services
GMS Practice
Base
Treatment suite
Services for Vulnerable
Groups
Diagnostic & Therapy services
Community paeds
services
Community/ Dental
Services
Integrated day
hospitals
Integrated Community Rehabilitation Services
Primary Care Out of
Hours
Visiting “mobile” services
Voluntary Sector
Services
Integrated sexual health
services
Including….
Central & East
Previous consultation has confirmed: Transfer of adult therapy services from Splott
Clinic Transfer of adult therapy services from
Roath Clinic Detailed work to support the development of
services in Central & Eastern Cardiff have identified a number of additional opportunities for service improvement
C&E Cardiff – What does this mean?
UHW
Splott
Trowbridge
Grangetown
Health Centre
C&E Locality
Health &
Treatment Centre
Rumney/
Llanrumeny
CHRC
CRI Services
Butetown CHRC
Maelfa CHRCPentwyn &
Llanedeyrn
Roath
Enables GMS
Practice
Development
Enables GMS
Practice
Development
New consultation issues
Closure of Splott Clinic Base for new GMS practice?
Transfer of services from Grangetown Health Centre to Butetown base for GMS Practice?
Transfer of services, and closure of Trowbridge health centre to new CHRC
Closure of Roath Clinic Disposal of Llanrumny (empty)
Section 10: Timetable & Implementation
Timetable & Implementation
10 year plan..
Clear phasing to support rebalancing…
Not just capital dependent….
LEARN FROM MENTAL HEALTH
Cardiff
Phase 1 – transfer of appropriate continuing care capacity and establishment of new community services enabling closure of Westwing
Phase 2 – development of new inpatient rehab capacity enabling closure of Rookwood and transfer from UHW linked to planned reduction in acute capacity
Implementation - Vale
Phase 1 – Transfer of continuing care capacity and MHSOP assessment enabling establishment of new community rehab services at Barry
Phase 2 –Planned reduction in acute capacity in UHW and Llandough
Continuing Care transfers toAlternative Care Settings
Released Capacity in Community Hospsis used for Rehabilitation
ACUTE HOSPITAL CAPACITYIS RELEASED
Alternative Care Settingsare provided in the Community
Prevention, Early Intervention and Maintenance =
Less admissions
Supported Discharge =Shorter LoS - Acute & Rehab
What about Acute Services?
Llandough/UHW Profiles
LlandoughAcute medical admissions
(Vale and W Cardiff)General MedicineAll intermediate surgeryGynae oncologyElective orthopaedics (adult)Midwifery unitEMI assessment
Supported by appropriate diagnostic & support services including rationalised labs etc.,
UHWA&E/TraumaAcute medicine (Central &
East Cardiff)General MedicineAll emergency surgeryAll complex surgerySpecialist/tertiary servicesAll inpatient paedsObstetrics/MLU Cancer
Surgical Centre….
UHW/Llandough
Planned reduction in acute capacity over 3-5 yearsReducing levels of occupancy Enabling remodeling of accommodation
including increase in single roomsRelease of staff resources to support new
community based models Review of configuration of acute services
across two sites to support new models
Financial Framework
Financial Framework
CapitalProposals fully in line with CPIP
• @ £20m for primary care developments• @ £70m for rehab development
RevenueNeed to identify pump-primingFinancial model as per mental health
Summary
Summary
Foundations for better health 10 year programme of change Commitment to rebalance care,
including shift of resources Significant clinical consensus on
director of travel Some areas of tension….
Issues for Consideration
Pace of change Managing the tension between 2008/09
pressures and developing sustainable solutions that have public/political/clinical support
Clinical engagement Broad agreement on models of care (not
EMI continuing care), but not on implementation
Some concerns from Primary Care re. commitment to new patterns of investment
Issues for Consideration
Social Care/Partner Engagement Clear commitment through HSC&WB
Strategies to develop integrated solutions, but need firmer plans
Organisational Change Risks associated with anticipated
consultation on NHS Wales organisational structures – how to manage?
Potential impact on capacity.
So What?
Resource Shift
Workforce Shift
Patient Expectation
Shift
Organisation Shift
CULTURAL SHIFT