1. County Durham and Darlington Local Health and Social Care Economy

2. County Durham & Darlington profile Population base served – –@610,000 CD&D Patient group engagement 3 Clinical Commissioning Groups –North Durham, DDES &Darlington –82 GP practices County Durham and Darlington NHS Foundation Trust – integrated acute / community health care provider –2 Acute hospitals –Access to six community hospitals –Cross patch Community Service portfolio Tees, Esk and Wear Valley NHS Foundation Trust –Provides inpatient and community services including mental health Two local authorities –Darlington Borough Council –Durham County Council Key areas of 7 day development Urgent care Frail elderly / LTC Diagnostics

3. Baseline assessment against the Standards Clinical StandardGap Analysis 1. Patient ExperienceIn 2013 77% of patients felt involved enough in decisions about their care 2. Time to first Consultant Review Consultant assessment within 14 hours of admission - currently achieving approx 60% National Early Warning score - currently using EWS 3. MDT ReviewNo MDT team in place Expected date of discharge is not visable on all wards Medicines reconciliations are not always in place Primary and Community care records are not available to inform reviews 4. Shift HandoversNo Trustwide electronic solution to record handovers 5. Diagnostics Current 5 day/limited services include, Bronchoscopy, CT (pilot 7 day at UHND), Echocardiography, Histopathology, MRI and Ultrasound 6. Intervention/Key servicesLimited Interventional Radiology 7 days a week 7. Mental Health7 day service available however within the 1 hour timescale is not delivered 8. Ongoing ReviewNot every patient is reviewed everyday by a Consultant 7 days a week. 9. Transfer to Community, Primary and Social CareHELS, OT, Pharmacy, Physio and social services are not available 7 days Primary and Community do not always have access to senior clincial expertise eg via phone call 10. Quality improvement A system is needed to document all that are involved in patient care participate in the review of care

4. Bridging the Gap……….

5. Work commenced to date…. (Standard 2) NEWS SCORE – to be implemented by September 14 14hr assessment after admission – Qtr1 audit undertaken (Standard 3) MDT Pilot on 1 Acute site – looking at a PWC method called “Perform” – August 14 IT Portal (Standard 5) 7 day diagnostics – Pilot over winter (Standard 9) Additional Community staff 7 days – Pilot over winter

6. CDDFT Assessment Outcomes 1. Inform Resilience Planning 2. Inform 7DS future priorities Support for CD&D initiatives e.g. Frail Elderly MDTs Progressing the Baseline Assessment

7. Drivers for Change Frail elderly and over 75s identified as a priority in Darlington and increasing demographic shift Unscheduled care pressures Better Care Fund Prime Ministers Challenge Fund ‘Avoidable Admissions DES’ in Primary Care CCGs to identify £5 per head of population transform care/invest in additional services and prevent unplanned admissions

8. MDT development Mandate to proceed from all organisations (health, social care and voluntary sector) A detailed process flow is being developed Identifying links to ‘Primary Care Enhanced Service – Avoiding Unplanned Admissions’ –Ensure MDT is complimentary Developing ‘enabling’ functions (estates, IM&T, information governance, workforce)

9. Rapid Access Clinic - 7day Diagnostics - Front of House Co-ordinator – Community Matron Practice MDT (phase 1) GP Practice Nurses Community Nurses Social worker Specialist Nurses Third Sector (Monthly) Escalation MDT (Phase 2) Geriatrician RIACT Social care Mental health SPA (Daily) All in locality and managed by primary / community care 111, NEAS, A&E

10. Problems 1.GP practice DES – ensuring linkages and avoiding duplication 2.Information Governance – sharing of information Data Analysis to inform design Service sharing of patient information 3.Workforce Geriatricians Radiography Community Matrons

11. Emergency Inpatient MDT operating 7 days (standard 3) Further diagnostics over 7 days (standard 5) Additional Community staff to support 7 days (standard 9) Community Matrons Specialist Nurses Resilience Planning – Current Priorities (ongoing)