1. Using Intermediate Care Beds for Symptom Control and End of Life Care Connect Meeting 13 th June 2012

2. Runcie Wing “21 day” generic rehab pathway “42 day” stroke rehab pathway Medical management of chronic disease eg. Parkinson’s medication reviews Medical and nursing management of frailty eg. Trial of therapy that would be unsafe at home alone

3. Subacute treatment of deterioraton in chronic stable disease eg. diuretic management of decompensated chronic cardiac failure Assessment and management planning of patients for continuing health care

4. Many of these…...lead to Short Stay “End of Life Care” In an environment that is already familiar and where patients and families feel supported and safe

5. Access to beds Gatekeeping is by a coordinator based at WGH Admissions are vetted by a SPOC at SACH Requests for stepup admission are passed from ICT, GPs and hospital-based doctors to the SPOC at SACH who decides priority

6. Stepup vs. Stepdown The proportion of patients admitted from home has fallen from 30-50% to 10-20%

7. Model under discussion The PCT only commission HCT to provide “21 day” generic rehab pathway “42 day” stroke rehab pathway And HCT have noticed that this is not what they are doing

8. End of Life Care Does not figure in this model at all Many old people die in secondary care by default It is a very poor environment and cannot meet their needs

9. The choice… …. will soon lie with the commissioning groups Rehabilitation Model Vs. Flexible Treatment