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Birmingham Better Care Improving Quality: 7 Day Service Team visit.

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1 Birmingham Better Care Improving Quality: 7 Day Service Team visit

2 10:00Arrival & refreshments 10:15Welcome & introductionsJudith Davis: Programme Director, Birmingham Better Care 10:30A patient & professional perspectivePerminder Paul: PM, Birmingham Better Care 10:457 day service: discharge hubPauline Mugridge: Group Manager, Acute Hospitals Mary Ring: General Manager, Out of Hospital Care, HoEFT 11:00Trusted Assessor, Trusted Assessment & Trusted Organisation Lorraine Thomas: Service Transformation Director, BCHC Dawn Lowe: Senior Manager, System Integration LA 11:15Comfort break 11:30Community standardsPerminder Paul: 7 Days Project Manager, Birmingham Better Care Lorraine Thomas: Director of Service Transformation, BCHC 11:45Photographs 12:00Networking lunchAll delegates and invited guests 1:057 day services: the acute perspectiveMatthew Cook: Deputy Medical Director, Strategy & Transformation, HoEFT 1:257 day services: the staff perspectiveDavid Byrne: Discharge Hub Clinical Team Leader 1:40Supported Integrated Discharge Team (SID)Julie Blake: Clinical Lead Promoting Independence Karen Lewis: Solihull hospital Therapy and Intermediate Care lead 2:007 day forward viewBarbara King: Accountable Officer, Birmingham CrossCity CCG 2:35Open Q & ABarbara King: Accountable Officer, Birmingham CrossCity CCG 2:50Closing remarksJudith Davis: Programme Director, Birmingham Better Care 3:00Close Agenda

3 Welcome and introduction Judith Davis: Programme Director, Birmingham Better Care

4 About the 7 day services collaborative The early adopter application was based on delivery of the Better Care programme. It has always been about changing the whole non-elective health and social care system rather than a focus on specific elements. 7 day services runs as a common thread through all of the schemes in the programme.

5 What is Birmingham Better Care NHS and social care services in Birmingham are now caring for people with increasingly complex needs and multiple conditions. We need to do things differently to make sure we can provide the best care both now and in the future. Birmingham Better Care is one of the most concrete steps ever towards making this change happen.

6 Estimated savings

7 What we will achieve: integration A more joined-up system which is easier to navigate An anticipatory system that focuses on prevention and keeping people well where they live A culture of trust where professionals work together and understand patient outcomes across an entire care journey A system fit for the future challenges it will face

8 Birmingham Better Care priorities 1.Keeping people well where they live 2.Making help easier to get 3.Better Care at times of crisis 4.Making the right decisions when people can no longer cope

9 Schemes within the programme Scheme 1: Developing and agreeing the case for change Scheme 2: Creating the impetus for change Scheme 3: Accountable community professional and defining new Primary Care Service delivery models Scheme 4: Equipment and technology Scheme 5: Discharge from acute setting and step up/ down care Scheme 6: Instigate 7 day health and social care services Scheme 7: Establish Combined point of access Scheme 8: Improve data sharing between health and social care Scheme 9: Dementia strategy

10 The aims of the collaborative Developing Acute standards Working at interface between hospitals and community health and social care services Working with NHSIQ to develop community standards

11 A patient and professional perspective Perminder Paul: Project Manager, Birmingham Better Care https://www.youtube.com/watch?v=O_Qw3tDEzUo

12 Good Hope Discharge Hub: one year on Improving Discharges 7 Days a week Pauline Mugridge: Group Manager, Acute Hospitals Mary Ring: General Manager, Out of Hospital Care, HoEFT

13 WHERE ARE WE UP TO? 13 Joint Planning & CollaborationDischarge hub open 7 days, mixed staff presence Enhanced awareness of roles within & across the interfaces of health, social care and independent/3 rd sector services Central point for complex discharge referrals & multiagency planning. ↓Duplication with TOC. More accurate reporting of delays/reasons Escalation arrangements slicker and more effective ADAT – multiagency planning for complex discharges – solution focused, enhanced working together, weekend plans discussed Front door REACT update: Capacity info available 7 days, having access to additional OOH services, close working with BCHC & being able to liaise and refer the more complex cases, access to hub & service info weekends Dedicated front door social worker & priority access to CU27 and rehab units from the front door Current ANP in reach service from BCHC Partnership working & commitment to D2A model 7 days week

14 WHERE ARE WE UP TO contd.. 14 Trusted/joint assessment New broker model for access to EAB beds 7 days week with trusted assessor service Future D2A model to be underpinned by trusted assessor support. Trusted assessor status extended to social workers in the Enhanced Assessment Units TA competency framework (in progress) Enablement / care available 7 days a week. Enhanced assessment beds available 7 days a week.

15 Going Forward Agree vision for 7 day working across the whole economy – staffing complement at weekend not equal to weekdays Joint assessments/trusted assessors REACT: - access to Carefirst; social workers 7 days per week; expansion of coverage, being able to assess for reablement packages BCHC – developing the Trusted Assessor Role/implementing and developing the community standards Development of early supported discharge. Use of Just Checking for assessment and care planning. 15

16 TOTAL NUMBER OF WEEKEND DISCHARGES FOLLOWING SOCIAL WORK ASSESSMENT DISCHARGES: PLANNED DISCHARGES JANUARY – DECEMBER 2014 WITHIN 2 WORKING DAYS CITY 26 GOOD HOPE 64 HEARTLANDS 80 MOSELEY HALL 6 SANDWELL 3 SOLIHULL 5 UNIVERSITY 60 WEST HEATH 4 TOTAL: 248 CITY 52 GOOD HOPE 97 HEARTLANDS 131 MOSELEY HALL 87 SANDWELL 5 SOLIHULL 5 UNIVERSITY 144 WEST HEATH 59 TOTAL: 580 Main Presenting Reasons: 1. Awaiting Treatment 3. Awaiting CHC Assessment 5. TTO’s 2. O.T. Assessment 4. Physiotherapy Assessment

17 Trusted Assessor, Trusted Assessment & Trusted Organisation Judith Davis: Programme Manager, Birmingham Better Care

18 Comfort break

19 Community standards Perminder Paul: 7 Days Project Manager, Birmingham Better Care Lorraine Thomas: Director of Service Transformation, BCHC

20 Approach Action from the Birmingham Collaborative to promote whole systems work around 7 day services Developed from Dudley CCG Collaboration with commissioners, providers and quality leads SDIP developed (service development implementation programme) self assessment and developing progression Achieved, Achievable, Aspirational Will form a suite of Out of hospital standards for all providers

21 Standards People referred for or requiring a review must be assessed for complex or on-going needs with 48 hours by members of a multi-disciplinary team (MDT) with the appropriate skills, 7 days a week. Where a palliative care or an end of life carer need is identified following an assessment, there needs to be a prioritised care management plan in place. For end of life care: within 4 hours. Palliative care: (non-urgent within 24 hours). People who require access to Assessments for an acute condition should be seen within 2 hours, by appropriate community care professionals, provided by integrated community services 7 days a week, through formal agreed networked protocols to meet people’s health needs Seven-day access to diagnostic services such as scans, x-ray and pathology. Completed reporting will be available seven days a week.

22 Domains Multi-disciplinary team Personalised Care Plan Shift handover Access to advice from senior doctors Access to urgent and non urgent diagnostics

23 Getting it right Do the standard compliment and support the delivery standard 9 of the Acute contract standards Diagnostics requirements to keep people out of hospital at weekends Bridging services Workforce

24 Photographs

25 Networking lunch

26 7 day services: acute perspective Matthew Cook: Deputy Medical Director, Strategy & Transformation, HoEFT

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28 Ten clinical standards have been identified: 1.Patient Experience 2.Time to first consultant review 3. Multi-Disciplinary Team (MDT) review 4.Shift Handovers 5.Diagnostics 6.Intervention/Key Services 7.Mental Health 8.On-going review 9.Transfer to community, Primary & Social care 10.Quality Improvement What's happening at HEFT right now? HEFT is an ‘Early adopter’! Evidence shows that the limited availability of some hospital services at weekends can have a detrimental impact on outcomes for patients, including raising the risk of mortality. Patients need the NHS every day! If you were a patient wouldn’t you want the same treatment every day of the week? A limited service can mean delays to diagnostics, interventions and support…..your treatment. ‘The Academy of Medical Royal Colleges’ have agreed a number of principles and Sir Bruce Keogh, NHS England's National Medical Director has set out a plan to drive 7 day services across the NHS over the next three years, starting with urgent care services and supporting diagnostics. 7 day services is now a main focus in the NHS ‘NHS Improving Quality (NHS IQ)’ is working in partnership with ‘NHS England’ to drive improvement and change expertise in the NHS and have developed a 7 day services improvement programme which includes a cohort of early adopter organisations. HEFT is part of the Birmingham, Solihull & Sandwell Collaborative which consists of a number of acute trusts (S&WB, HEFT and UHB), Birmingham and Solihull City Council and community and social care providers. With momentum from the Birmingham Better Care board the collaborative is developing a system wide approach across Birmingham, Sandwell and Solihull. Two questions regarding 7 day services have been posted on the intranet to get your opinion. We have been working with colleagues to complete the information needed in the 7 day assessment toolkit. BHH and GHH is now complete and SOL is soon to follow. We will be working with colleagues to gather further information to help further evidence whole system models of delivery A one page summary diagram and quarterly dashboard is in development to monitor our performance internally against the clinical standards currently and going forward. 2 clinical leads have now been appointed to drive 7 day services forward Produced by: Claire Jones – Project Analyst and 7 Day Services Support January 2015

29 Patients need the NHS every day! day services is now a main focus in the NHS Within five years early adopters are expected to: Be regarded as experts in delivering seven day services; - Delivering improved outcomes, including better experiences for patients, carers and the public - Tackling local cultural and organisational barriers - Realising savings and efficiencies Have demonstrated a range of approaches and models involving whole system approaches to the delivery of seven day services; Have demonstrated the scope to make rapid progress at scale and pace; Have overcome the barriers to delivering coordinated care and support across pathways – testing radical options for delivering care differently; Have accelerated learning locally, regionally and nationally; and Have improved the robustness of the evidence base to support and build the value of the case for seven day services across the health and social care system. Time Lines 2014/15 – High level action plans with service development and improvement plans 2015/16 – Clinical standards which have the greatest impact into National standard contract 2016/17 – All clinical standards incorporated Expectations from Early Adopters Produced by: Claire Jones – Project Analyst and 7 Day Services Support January 2015

30 Patients need the NHS every day! day services is now a main focus in the NHS Nursing staff 24/7 Therapy 7 day working: Physiotherapists, Occupational Therapists, Speech and Language, Therapists and Support Workers across all grades and specialties work their contracted hours over 7 days instead of 5 24/7 RAID service at BHH and GHH 12/17 at SOL SPA – Single Point of Access for patients with a Bham GP (BCHC) and Solihull GP (Solihull Community Services) SAFER care bundle: S - Senior Review, all patients should have a Daily Consultant Review (sick and identified discharge patients prioritised before 10am) A - All patients should have a Planned Discharge Date 14 days) Medicines Reconciliation by admitting Doctor should be done within 24Hrs of admission (however pharmacy is not available at weekends). Current 7 day services Integrated care 7 days a week *- A collaborative approach with GHH, BCC and BCHC to achieve optimal patient flow through the hospital including the following: Hospital based social workers 7 days per week*. Community Convalescent Unit *: At GHH for medically fit patients requiring convalescence. Quick Discharge*: A bridging service for up to 5 days before the full enablement package begins; providing home based domiciliary care that commences within 4 hours of referral. Recovery at home*: a form of virtual ward for patients that do not need an acute bed. These patients are cared for at home, with nursing and domiciliary services, they are also under the care of a hospital consultant. Re-ablement facility*: Cedarwood is located at Good Hope Hospital and developed in partnership with housing care provider Midland Heart, this purpose built re-ablement facility provides accommodation and domiciliary support for patients who are medically fit for discharge but need additional help for example with mobility aids, diet, nutrition or personal care before they can return home independently Produced by: Claire Jones – Project Analyst and 7 Day Services Support January 2015 Key:* = This information has been taken from the ‘Collaborative approach to providing integrated care 7 days a week …’ case study by Dawn Lowe (Senior Manager, System Integration, Birmingham City Council) and Julia Hughes (Team Manager Good hope and Solihull, Birmingham City Council ) and NHSIQ

31 Patients need the NHS every day! day services is now a main focus in the NHS The newly appointed Clinical Leads: David Byrne - Discharge Hub Clinical Team Leader and Rifat Rashid - Consultant Respiratory Medicine will be driving forward 7 days services both internally and system wide. Gap Analysis is underway and the Clinical leads will be meeting with each directorate to identify where their services are at in regards to 7 day services. This information along with the base lining that has already been carried out will provide the ‘Action Plans and service development and improvement plans’ due at the end of 2014/15. Some potential areas of focus at HEFT have already been identified which will be discussed in the clinical standards section. Gap Analysis and Potential areas of focus Clinical Standard Monitoring A quarterly dashboard is in development to monitor our performance internally against the clinical standards currently and going forward; this is a one page summary for each site to give a high level overview. This will be will be further developed into a directorate level Dashboard. Issues: During development of the dashboard it has become apparent that not all standards can be easily measured due to the limited data available and IT constraints. Clinical Dashboard - Snap shot View Produced by: Claire Jones – Project Analyst and 7 Day Services Support January 2015

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33 Patients need the NHS every day! day services is now a main focus in the NHS Clinical Standards Specialty Comments 1 Standard: Patient Experience Patients, and where appropriate families and carers, must be actively involved in shared decision making and supported by clear information from health and social care professionals to make fully informed choices about investigations, treatment and on-going care that reflect what is important to them. This should happen consistently, seven days a week. Supporting information: Patients must be treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty at all times. The format of information provided must be appropriate to the patient’s needs and include acute conditions. With the increasing collection of real-time feedback, it is expected that hospitals are able to compare feedback from weekday and weekend admissions and display publically in ward areas. Focus Area in 2015/16 We do not currently capture the views of 7 day services in our standard surveys however specific 7 day surveys within individual directorates may have been carried out. Action - 7DS experience implemented into standard survey - 7DS experience survey in those areas for which the standard is a focus 2 Standard: Time to first consultant review All emergency admissions must be seen and have a thorough clinical assessment by a suitable consultant as soon as possible but at the latest within 14 hours from the time of arrival at hospital. Supporting information: 1) All patients to have a National Early Warning Score (NEWS) established at the time of admission. 2) Consultant involvement for patients considered ‘high risk’ (defined as where the risk of mortality is greater than 10%, or where a patient is unstable and not responding to treatment as expected) should be within one hour. 3) All patients admitted during the period of consultant presence on the acute ward (normally at least ) should be seen and assessed by a doctor, or advanced non-medical practitioner with a similar level of skill promptly, and seen and assessed by a consultant within six hours. 4) Standards are not sequential; clinical assessment may require the results of diagnostic investigation. 5) A ‘suitable’ consultant is one who is familiar with the type of emergency presentations in the relevant specialty and is able to initiate a diagnostic and treatment plan. 6) The standard applies to emergency admissions via any route, not just the Emergency Department. 7) For emergency care settings without consultant leadership, review is undertaken by appropriate senior clinician e.g. GP-led inpatient units. Focus Area in 2015/16 Patients admitted as an emergency receive a consultant clinical assessment 7 days per week however this is at varying times. There also appear to be gaps in bullet point ‘3’. Also relevant medicines surgical expertise may not be delivered within the appropriate time frame for patients on outlying wards. Action - Explore the existing systems in place to ensure they are adequate. - extend dialogue with consultants and explore how input at weekends could be increased to improve discharge rates Please find below the Ten Acute Hospital Clinical standards. All standards will be worked towards however those which are presumed to have the greatest impact into the national standard contract will be implemented in 2015/16 and are priority focus areas.

34 January 2015 Patients need the NHS every day! day services is now a main focus in the NHS Specialty Emergency 3 Standard: Multi-disciplinary Team (MDT) review All emergency inpatients must be assessed for complex or on-going needs within 14 hours by a multi-professional team, overseen by a competent decision-maker, unless deemed unnecessary by the responsible consultant. An integrated management plan with estimated discharge date and physiological and functional criteria for discharge must be in place along with completed medicines reconciliation within 24 hours. Supporting information: The MDT will vary by specialty but as a minimum will include Nursing, Medicine, Pharmacy, Physiotherapy and for medical patients, Occupational Therapy. Other professionals that may be required include but are not limited to: dieticians, podiatrists, speech and language therapy and psychologists and consultants in other specialist areas such as geriatrics. Reviews should be informed by patients existing primary and community care records. Appropriate staff must be available for the treatment/management plan to be carried out. Focus Area in 2016/17 MDT board rounds take place with the use of JONAH boards, however the MDT attending the board round varies and do not always meet the minimum for the specialty Action - Reinforce MDT board rounds with appropriate teams. 4 Standard: Shift handovers Handovers must be led by a competent senior decision maker and take place at a designated time and place, with multi- professional participation from the relevant in-coming and out-going shifts. Handover processes, including communication and documentation, must be reflected in hospital policy and standardised across seven days of the week. Supporting information: Shift handovers should be kept to a minimum (recommended twice daily) and take place in or adjacent to the ward or unit. Clinical data should be recorded electronically, according to national standards for structure and content and include the NHS number. Focus Area in 2015/16 The shift handover process will vary between departments. In some areas there appear to be gaps with evening provision by consultants (until the night shift begins), designated places and times for handovers overseen by a competent decision maker and keeping shift handovers to the minimum recommended. Action - Explore current practice within individual departments with a view to standardising handovers. Clinical Standards

35 January 2015 Patients need the NHS every day! day services is now a main focus in the NHS Specialty Emergency 5 Standard: Diagnostics Hospital inpatients must have scheduled seven-day access to diagnostic services such as x-ray, ultrasound, computerised tomography (CT), magnetic resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy and pathology. Consultant-directed diagnostic tests and completed reporting will be available seven days a week: Within 1 hour for critical patients Within 12 hours for urgent patients Within 24 hours for non-urgent patients Supporting information: It is expected that all hospitals have access to radiology, haematology, biochemistry, microbiology and histopathology Critical patients are considered those for whom the test will alter their management at the time; urgent patients are considered those for whom the test will alter their management but not necessarily that day. Standards are not sequential; if critical diagnostics are required they may precede the thorough clinical assessment by a suitable consultant in standard 2. Investigation of diagnostic results should be seen and acted on promptly by the MDT, led by a competent decision maker. Where a service is not available on-site (e.g. interventional radiology/endoscopy or MRI), clear patient pathways must be in place between providers. Seven-day consultant presence in the radiology department is envisaged. Non-ionizing procedures may be undertaken by independent practitioners and not under consultant direction. Focus Area in 2016/17 There is a good provision of imaging at weekends and the imaging team are developing a programme of work in this area. Actions will be developed later in 2015/16 6 Standard: Intervention / key services Hospital inpatients must have scheduled seven-day access to diagnostic services such as x-ray, ultrasound, computerised tomography (CT), magnetic resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy and pathology. Consultant-directed diagnostic tests and completed reporting will be available seven days a week: Within 1 hour for critical patients Within 12 hours for urgent patients Within 24 hours for non-urgent patients Supporting information: It is expected that all hospitals have access to radiology, haematology, biochemistry, microbiology and histopathology Critical patients are considered those for whom the test will alter their management at the time; urgent patients are considered those for whom the test will alter their management but not necessarily that day. Standards are not sequential; if critical diagnostics are required they may precede the thorough clinical assessment by a suitable consultant in standard 2. Investigation of diagnostic results should be seen and acted on promptly by the MDT, led by a competent decision maker. Where a service is not available on-site (e.g. interventional radiology/endoscopy or MRI), clear patient pathways must be in place between providers. Seven-day consultant presence in the radiology department is envisaged. Non-ionizing procedures may be undertaken by independent practitioners and not under consultant direction. Focus Area in 2015/16 Most interventions are in place however scheduled lists do not take place on a weekend. Action - Check if new endoscopy suite plans will help to address the issue. - If endoscopy suite will not address the issue, identify the volume of activity affected and create a business plan to achieve this standard. Clinical Standards

36 Specialty Emergency 7 Standard: Mental health Where a mental health need is identified following an acute admission the patient must be assessed by psychiatric liaison within the appropriate timescales 24 hours a day, seven days a week: Within 1 hour for emergency* care needs Within 14 hours for urgent** care needs Supporting information: Unless the liaison team provides 24 hour cover, there must be effective collaboration between the liaison team and out-of- hours services (e.g. Crisis Resolution Home Treatment Teams, on-call staff, etc.) * An acute disturbance of mental state and/or behaviour which poses a significant, imminent risk to the patient or others. ** A disturbance of mental state and/or behaviour which poses a risk to the patient or others, but does not require immediate mental health involvement. Focus Area in 2016/17 RAID (Rapid, Assessment, Interface and Discharge) for people aged over 16 years with mental health or substance misuse needs who access A&E departments in hospitals 24/7 in Birmingham and 12/7 in Solihull. Further work will be developed later in 2015/16 Actions will be developed later in 2015/16 8 Standard: On-going review All patients on the AMU, SAU, ICU and other high dependency areas must be seen and reviewed by a consultant twice daily, including all acutely ill patients directly transferred, or others who deteriorate. To maximise continuity of care consultants should be working multiple day blocks. Once transferred from the acute area of the hospital to a general ward patients should be reviewed during a consultant- delivered ward round at least once every 24 hours, seven days a week, unless it has been determined that this would not affect the patient’s care pathway. Supporting information: Patients, and where appropriate carers and families, must be made aware of reviews. Where a review results in a change to the patient’s management plan, they should be made aware of the outcome and provided with relevant verbal, and where appropriate written, information. Inpatient specialist referral should be made on the same day as the decision to refer and patients should be seen by the specialist within 24 hours or one hour for high risk patients (defined as where the risk of mortality is greater than 10%, or where a patient is unstable and not responding to treatment as expected). Consultants ‘multiple day blocks’ should be between two and four continuous days. Ward rounds are defined as a face-to-face review of all patients and include members of the nursing team to ensure proactive management and transfer of information. Once admitted to hospital, patients should not be transferred between wards unless their clinical needs demand it. The number of handovers between teams should be kept to a minimum to maximise patient continuity of care. Where patients are required to transfer between wards or teams, this is prioritised by staff and supported by an electronic record of the patient’s clinical and care needs. Inpatients not in high dependency areas must still have daily review by a competent decision-maker. This can be delegated by consultants on a named patient basis. The responsible consultant should be made aware of any decision and available for support if required. The trust has already made good progress in this area and so further development is not a priority however it is important to maintain existing levels of service at weekends. Continuous monitoring to ensure the clinical standard is maintained. January 2015 Patients need the NHS every day! day services is now a main focus in the NHS Clinical Standards

37 January 2015 Patients need the NHS every day! day services is now a main focus in the NHS Specialty Emergency 9 Standard: Transfer to community, primary and social care Support services, both in the hospital and in primary,community and mental health settings must be available seven days a week to ensure that the next steps in the patient’s care pathway, as determined by the daily consultant-led review, can be taken. Supporting information: Primary and community care services should have access to appropriate senior clinical expertise (e.g. via phone call), and where available, an integrated care record, to mitigate the risk of emergency readmission. Services include pharmacy, physiotherapy, occupational therapy, social services, equipment provision, district nursing and timely and effective communication of on-going care plan from hospital to primary, community and social care. Transport services must be available to transfer, seven days a week. There should be effective relationships between medical and other health and social care teams. Focus Area in 2016/17 This standard is under development with the community. Actions will be developed later in 2015/16 10 Standard: Quality improvement All those involved in the delivery of acute care must participate in the review of patient outcomes to drive care quality improvement. The duties, working hours and supervision of trainees in all healthcare professions must be consistent with the delivery of high-quality, safe patient care, seven days a week. Supporting information: The review of patient outcomes should focus on the three pillars of quality care: patient experience, patient safety and clinical effectiveness. Attention should be paid to ensure the delivery of seven day services supports training that is consistent with General Medical Council and Health Education England recommendations and that trainees learn how to assess, treat and care for patients in emergency as well as elective settings. All clinicians should be involved in the review of outcomes to facilitate learning and drive quality improvements. Focus Area in 2015/16 Actions - Dialogue with Junior Doctors and consultants to ensure current training is in line with the standard of 7 days services. - Keep up to date with contract negotiations regarding staff training and working patterns in relation to seven day services. Clinical Standards

38 7 day therapy services: a staff perspective David Byrne: Discharge Hub Clinical Team Leader and 7 day services clinical lead

39 Therapies Directorate 150 Physiotherapists 100 Occupational Therapists 70 Dietitians 15 Speech and Language 50 Support Workers 3 Site 1,200 beds

40 The Journey Scoping: Jan 2010 Staff Consultation Informal then Formal: Aug- Dec 2010 Phased Implementation: Jan- April 2011 Formal Review: March 2012 and March 2014 Whole System- next step

41 The Aims- Patients Reduce length of stay Achieve more discharges at the weekends Achieve timescales for assessment of patients who had suffered a stroke Improve patient safety

42 The Aims- Staff Harmonise the reimbursements in line with Agenda for Change Define when therapists are carrying out routine work, on call or emergency duty Harmonise core hours Improve the rota’s for staff Equity across all sites

43 The Challenges Cost- restructure rather than additional Staffing- 5 days over 7 Managing complex rota’s Staff Engagement Changing the Culture Time

44 Weekend Culture Only urgent patients seen Only minimum input to patients to “get through to Monday” Too many junior staff on duty without access to enough support On call support of seniors is rarely accessed so of little value Sense of helplessness with those staff who are on duty

45 Staff Concerns Work life balance Ability to manage week day caseload Complexity of rota’s “Not what we signed up for”

46 Staff Story- Ward Based OT Initial: “I was reluctant to change. I enjoyed my weekends and was concerned about child care” The change: “The process felt uncomfortable but I understood that 7 day working was best for the patient” Now: “I am happy with my work life balance. I would not want to change back. Patients get a much better service”

47 Staff Story- Ward Based Physio Initial: “I was concerned about how we would staff the week days” Change: “After some teething problems we were able to adapt the rota to ensure we had adequate staffing 7 days a week…the therapy bank really helped” Now: “The patients get much better care”

48 How The Staff Were Supported Use Change Management Policy Discussion and engagement- different type Audit and feedback Adapt solutions to individual areas Give teams autonomy- particularly rotas Separate the personal problems from the clinical hurdles Personal issues can be overcome with; consultation, time, Human Resource (HR) support Involve HR, Staffside and Staff Reps Identify training and ensure skill mix

49 The Outcome Level 3 Service Admissions avoided by 7 day REACT services is between 40 and 50 each weekend across sites. Weekend discharges enabled due to therapy presence in excess of 60 each weekend across sites 2013/14 New in-patients assessed over weekends totals 5, /14 Follow up in-patients seen over weekends totals 21,037

50 Changing Staff Attitudes 1 st year 72% Good for patients 75% happy with frequency and availability of rota 58% happy with work life balance 2 nd Year 87% Good for Patients 80%happy with frequency and availability of rota 67% happy with work life balance

51 Therapy Comments- Patient “We are now meeting guidelines of assessment of strokes” “New patients picked up quicker, gives a head start for week” “We have been able to commence diet and fluids earlier, rather than having to wait till the following week” “Good to see patient’s relatives at the weekend”

52 Therapy Comments- Staff “Nice to have days off in week to spend with children” “It gives me the opportunity to do things during the weeks, e.g. going to the bank etc” Majority of comments supported weekend working either for personal reasons or for the benefit of the patient even if they personally did not like working them.

53 My Journey- Clinical Lead Seen varying levels of 7 day services Patients deserve 7 day services Whole systems approach Flow and capacity Utilise learning from Therapies experience Excited to be able to make a difference

54 Any Questions?

55 Supporting Integrated Discharge Team (SID) Julie Blake: Clinical Lead Promoting Independence Karen Lewis: Solihull hospital Therapy and Intermediate Care lead Heart of England NHS Foundation Trust Birmingham City Council Solihull Metropolitan Borough Council

56 Our Drivers for Change Length of Stay Patient Experience Patient Outcomes Organisational relationships Financial Challenge Professional relationships

57 Service Experience pre–SID https://vimeo.com/nhsmediahub/review/ /6c80b4163b

58 What did we do? Partnership Steering Group Shared vision, objectives and values Prepared to take a risk Challenged traditional organisational and professional boundaries Developed integrated pathway Co-ordination of therapy (acute) and personal care (social) services Workforce redesign and development Therapists trusted assessors for social care Role enhancement

59 What does it mean for our patients? https://vimeo.com/nhsmediahub/review/ /6c80b4163b

60 What does it mean for our workforce? https://vimeo.com/nhsmediahub/review/ /6c80b4163b

61 What was important for success? “Think like a patient, act like a tax payer” Simon Stevens – NHS CEO Right thing to do for patients – not finance driven Commitment to deliver change for our people Willingness to take organisational risks and trust each other True Partnership Working – integrated model

62 7 Day Services Considerations Aim of the Service, hours that service is required for effective delivery Staffing resource. Is there enough in all professions and roles? What can be done to start 7 day working on a voluntary basis for a trial; How is on call used? Management cover; Absence cover, lone working HR support; Requires resilience; fortitude; vision; commitment; energy and leading by example.

63 Seven day SID Health Established SID rota through additional staffing and redesign of traditional weekend rotas in hospital and community. Training and utilisation of flexible working patterns to expand number of therapists experienced in SID model 1 qualified therapist and 1 support worker each weekend with rest days in week

64 Seven day SID Social care Do you want to add something in here Julie about what you provide and plans to expand/difficulties with taking this forward?

65 Why is the SID Service an HSJ Award Winner? “Its improved outcomes for the whole system” “Its how our staff want to work” “Its what our patients want”

66 Questions?

67 7 day forward view Barbara King: Accountable Officer, Birmingham CrossCity CCG

68 Open Q & A Barbara King: Accountable Officer, Birmingham CrossCity CCG

69 Closing remarks Judith Davis: Programme Director, Birmingham Better Care

70 Thank you


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