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Programme for Health Services Improvement Stakeholder Event March 20 th 2008.

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Presentation on theme: "Programme for Health Services Improvement Stakeholder Event March 20 th 2008."— Presentation transcript:

1 Programme for Health Services Improvement Stakeholder Event March 20 th 2008

2 Purpose Context Consultation Document Structure Emerging Proposals for Consultation Key Issues for Discussion and Agreement

3 Programme for Health Services Improvement Community Based Services Hospital Services

4 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

5 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

6 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

7 The Consultation What are we going to be consulting on? “Building the Foundations for Sustainable Change in Population Health”

8 Getting it Right – Landscape NOT deckchairs Physio Social Worker Domiciliary Care OT Family Diabet-ologist Practice Nurse CPN Cardiol- ogist GP District Nurse Podiatrist Respite Care Voluntary Transport

9 Getting it Right – Landscape NOT deckchairs Physio Domiciliary Care CPN OT Family Diabet -ologist Practice Nurse Social Worker Cardiol- ogist GP District Nurse Podiatrist Voluntary Transport Respite Care

10 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 adequate DEMAND? Can the TECHNOLOGY 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

11 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 of 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)

12 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

13 Structure of the Consultation Document Section 1Setting the scene Section 2How 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

14 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

15 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

16 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

17 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

18 Section 4: Our Vision - A New Landscape Community Services Hospital Services Tertiary Services Community Services Hospital Services Tertiary Services From To

19 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 community Rehabilitation Outpatients and Diagnostics Therapy services

20 Section 5: Rehabilitation Our proposals NB. Remember General & Specialist

21 Current Services  Mainly reactive (with notable exceptions)  Multiple pathways and points of entry  Hospital focused  Inequitable  Locality  Age  “ology”  Poor environments

22 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  Recognition of carers needs  Integrated services

23 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 Hospitals Reablement Respite Acute Hospital Rehab Intensive Inpatient Rehabilitation Active, slow stream Rehabilitation Long Term Care

24 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)

25 What Does This Mean for Our Capacity Planning? “BEDS” Cardiff LHBVale LHB Total C&V LHBs All Commiss ioners Do Nothing CENWC&E Acute 111137114149187698 10821418* Inpatient Community Rehab 3643444969241 360296* Domiciliary/ Alternative Care Setting 4450517192308 404246 Specialist Rehab 64 Figures based on 2014 demographic projections and agreed service model assumptions * NHS Beds

26 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 locality  New North Cardiff facility (co-located with new Locality Resource Centre) – North Cardiff rehab team, North Cardiff locality beds + local specialist rehabilitation beds (stroke, working age adults) +/- Vale, and tertiary rehabilitation (spinal/neuro)

27 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 beds local 50 beds regional Barry Hospital Rookwood - Specialist UHW - Specialist In reach (Spinal/Neuro) EMI Continuing Care

28 Key Issues to Resolve  Stroke rehab  Single specialist unit, or Vale/Cardiff Units?  EMI Continuing Care – clinical model not yet agreed  Cardiff LHB proposing transfer to non NHS/Nursing Home setting (50 beds)  Trust recognise scope for change, but also proposing the need for some purpose built re-provision potentially co- located with North Cardiff LHTC  Clearly defining the new “nursing home” specification  Capacity of “new facility” in light of the above

29 Primary and Community OUR PROPOSALS (….assuming emerging solutions for Rehabilitation are agreed….)

30 Foundations for the future…

31 (1) GPP’s

32 (2) CHRC’s

33 (3) LHTC’s

34 Section 6: The Vale Proposals for Consultation

35 The Vale Locality Health and Treatment Centre Barry Hospital Community Health Resource Centres Cowbridge (new build in progress) Dinas Powys (3 rd party scheme) Penarth Health Centre

36 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….

37 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

38 Vale – What does this mean?  Closure of Calcott and Cadoxton Clinic  Closure of Broad Street (or alternative use)  Transfer of @ 20 continuing care beds from Barry Hospital to alternative setting (? Partnership scheme with LA)  Transfer of older persons mental health assessment beds to Llandough

39 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?

40 Section 7: North Cardiff Proposals for Consultation

41 North Cardiff Locality Health and Treatment Centre Northern Meadows, Whitchurch Community Health Resource Centres Gabalfa area Llanishen area

42 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

43 North Cardiff – What does this mean? UHW West Wing CRI Llanishen HC Rhiwbina Clinic? North Cardiff LHTC Rookwood *– 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

44 North Cardiff – What does this mean?  Reprovision of Gabalfa and Llanishen to be agreed in context of future proposed primary care developments  Increased capacity for primary care services in Whitchurch area  Relocation of current therapy services at Whitchurch to new LHTC  North CMHT to transfer to new LHTC  ? Future of Rhiwbina depending on location of CHRCs

45 North Cardiff Key issues  Further discussions needed with Primary Care to identify opportunities for CHRCs  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

46 Section 8: West Cardiff Proposals for Change

47 West Cardiff Cardiff Locality Health and Treatment Centre Park View St David’s Integrated working across 2 sites

48 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)

49 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

50 West Cardiff – What does this mean?  Change of use of Riverside  Enables redevelopment for GMS  Closure of Radyr Health Centre  Closure of Pendine

51 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 CRI E.g. day hospital EMI continuing care model Recognising St David’s has Cardiff wide role for specialist community child health

52 Section 9: Central & East Cardiff Proposals for Consultation

53 Central & East Cardiff Locality Health & Treatment Centre Cardiff Royal Infirmary Site Community Health Resource Centres Maelfa Butetown/Loudon Square Rumney/Llanrumney

54 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….

55 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

56 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 CHRC Pentwyn & Llanedeyrn Roath Enables GMS Practice Development Enables GMS Practice Development

57 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)

58 Section 10: Timetable & Implementation

59 Timetable & Implementation 10 year plan.. Clear phasing to support rebalancing… Not just capital dependent…. LEARN FROM MENTAL HEALTH

60 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

61 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

62 Applying the new principles…

63 So…What about Acute Services?

64 Llandough/UHW Profiles Llandough Acute medical admissions (Vale and W Cardiff) General Medicine All intermediate surgery Gynae oncology Elective orthopaedics (adult) Midwifery unit EMI assessment Supported by appropriate diagnostic & support services including rationalised labs etc., UHW A&E/Trauma Acute medicine (Central & East Cardiff) General Medicine All emergency surgery All complex surgery Specialist/tertiary services All inpatient paeds Obstetrics/MLU Cancer Surgical Centre….

65 UHW/Llandough Planned reduction in acute capacity over 3-5 years Reducing levels of occupancy Enabling remodeling of accommodation including increase in single rooms Release of staff resources to support new community based models Review of configuration of acute services across two sites to support new models

66 Financial Framework

67 Capital Proposals fully in line with Capital Programme @ £20m for primary care developments @ £70m for rehab development Revenue Need to identify pump-priming Financial model as per mental health

68 Summary

69 Foundations for better health 10 year programme of change Commitment to rebalance care, including shift of resources Significant clinical consensus on direction of travel Some areas for resolution….….

70 Issues & Risks Pace of change Managing the tension between short term pressures and developing sustainable solutions that have public/political/clinical support Social Care/Partner Engagement Ensuring options maximise opportunities for integrated solutions

71 Issues and Risks Organisational Change Risks associated with anticipated consultation on NHS Wales organisational structures – how to manage? Partnership with Independent Sector Ensuring capacity and quality of care providers Opportunities for new partnership approaches e.g. with housing associations, voluntary sector, not for profit Public (and professional) confidence

72 So What? Resource Shift Workforce Shift Patient Expectation Shift Organisation Shift CULTURAL SHIFT

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