1. Cardiff Local Health Board Bwrdd Iechyd Lleol Caerdydd REHABILITATION WORKSHOP 10 TH JANUARY 2008 CARDIFF AND VALE OF GLAMORGAN LHBS COMMISSIONING PERSPECTIVE

2. Cardiff Local Health Board Bwrdd Iechyd Lleol Caerdydd REHABILITATION COMMISSIONING VISION LHB’s recognise that historic commissioning of current services has been an sequential process driven by access to short /fixed term funding This has resulted in a disparate spectrum of service provision with a number of service gaps within the 2 LHB boundaries e.g. ECAS for Cardiff only There are limited examples of joint health and social care services LHBs have developed commissioning proposals in response to “Framework for General Rehabilitation”

3. Cardiff Local Health Board Bwrdd Iechyd Lleol Caerdydd Current Services

4. Cardiff Local Health Board Bwrdd Iechyd Lleol Caerdydd CURRENT CONFIGURATION OF REHABILITATION SERVICES Admission avoidance e.g. ART Expert multi-disciplinary assessment service (ECAS) for Cardiff only Inpatient rehabilitation: 142 beds Inpatient rehab (LOS 6-8 weeks) 112 slow stream/CHC/CHC assessment beds 5 beds for respite for CHC eligible patients Day hospital service Discharge expediting services e.g. Community rapid re-ablement / support service /Stroke outreach service

5. Cardiff Local Health Board Bwrdd Iechyd Lleol Caerdydd STRENGTHS / WEAKNESSES OF CURRENT COMMISSIONING APPROACH Strengths Weaknesses Significant investment in place Disparate access points Many services are multi agency Inequality of access across and multidisciplinary 2 LHB boundaries Service “silos” Offers up to 100 bed equiv Short /fixed term funding Most models of rehab Many services not accessible in place 7 days /week Over dependence on hospital locations ie no community beds

6. Cardiff Local Health Board Bwrdd Iechyd Lleol Caerdydd FUTURE COMMISSIONING PRINCIPLES To commission care within improved and appropriate patient environments To protect acute hospital capacity for patients who require inpatient hospital care To commission cost effective care in a range of care settings To commission models of care across primary/secondary care interfaces

7. Cardiff Local Health Board Bwrdd Iechyd Lleol Caerdydd LHB COMMISSIONING VISION All non-hospital services to be accessed via single point To move significant proportion of current inpatient capacity to community beds to include CHC/CHC assessment and slow stream rehabilitation To commission three element rehabilitation service Access to 7 day expert assessment service across C&V boundaries Day service for elderly patients Reconfigure rehabilitation / intermediate care services utilising existing resources to develop five locality based Consultant led admission avoidance / rehabilitation teams to cover Cardiff and Vale of Glamorgan.Teams to incorporate social worker input. Commission inpatient episodes of care up to 42 days LOS

8. Cardiff Local Health Board Bwrdd Iechyd Lleol Caerdydd Future Services