Better Care, More Choice, Local Delivery The case for Worcestershire Acute Hospitals Trust to be involved in the management of community services

Our Proposal… Worcestershire’s Community Hospitals and Community- based Specialist Nurses to join Worcestershire Acute Hospitals NHS (Foundation) Trust

Key themes in our proposal Better for patients – simpler pathways Better for communities – they have a say in their local hospital Better for staff – potential for development around integrated pathways; keep doing what they do best, Terms and Conditions retained. Better for the Health Economy – reduced costs and increased productivity Better for the PCT – change at a pace we can afford (cost and risk)

Benefits for Patients Better care and a wider range of treatment options, closer to home, such as ‘mini MAU’, Dementia care More equitable access to Consultant-led and other specialist hospital care ‘Joined Up’ patient-centred healthcare, pathway managed by a single provider with fewer ‘hand offs’ We guarantee the future of community hospitals

Attends minor injury unit at Community Hospital. Seen by out-of-hours service which refers to A&E. Mrs Bradley has been feeling very poorly and has not been eating or drinking properly for some days Attends A&E and referred to medicine, she is dehydrated and generally feeling unwell Admitted to MAU, rehydrated and various tests ordered (e.g. bloods, Xray) because of the time needed for the tests she is admitted to a ward. After five days Mrs Bradley has had all of her results back and is discharged home Mrs Bradley’s Story (this week)…..

Mrs Bradley’s Story (May 2011)….. Mrs Bradley attends Urgent Care Centre at Community Hospital. Seen by geriatrician, bloods taken on site and sent to WRH 24-hour service. A chest x-ray is also taken. Assessed by MDT on site and discharged to Integrated Care Team with home I/V Blood results and chest X-ray report are made available (using IT systems accessed in the community hospital). There are no significant findings and it is decided that Mrs Bradley can go home. She is followed up by GP, who has information on her care through the electronic discharge summary. GP can refer to community hospital physician if s/he wishes

We have been asked by GPs To support them in providing more local care (e.g. a ‘mini MAU’ at Evesham) To consider providing ‘back office’ support To work with them to develop the role of community Hospitals (along the lines of Kidderminster joint group)

A joint hospital group GP members, Hospital Trust, Primary care rep More local services 80% Wyre Forest operations happen at KH 85% outpatients happen at KH New Services e.g. new fracture clinic Increased diagnostics Interhealth capacity to be used for more local activity Site based clinical lead Working together to find a solution to Urgent Care Kidderminster, working for the community

Benefits for Staff Recognises their skill and experience – potential to share with acute hospital services Secure future – TUPE applies fully, includes pension rights Training and development – opportunities for skill sharing High Quality Clinical Supervision – especially risk areas such as theatres and diagnostics

Embedded in the local community A Hospital Board Local GPs Trust managers Local FT members Possibly special interest groups (e.g. LoF) Possibly Local Authority Clinical leadership on site

PCT Commissioning Intentions Commission services that support local people Commission safe, high quality care, Commission care that is delivered promptly, as close to home as possible Improve integration between services and service providers Improve equity of access to services Commission services that are efficient, provide value for money and optimise capacity Ensure the integration of assessment and IT systems

Supporting QIPPP Quality – local care, integrated, increased potential for capital funds Innovation – working with GPs and local communities, dementia care, mini MAU, extended urgent care, 2500 more staff with ideas Productivity –length of wait, admission to local hospital not ALX/WRH, increases probability of acute hospital shrinkage Partnership – a marriage not a threesome Prevention – local care, local knowledge, local people

Our approach Consistent Standards Accountability Individual Site Identity Pathway management Consistent protocols Supported by specialists Clinical Site leadership Local governance Performance management structures and information

Decentralisation (devolution) Reducing the cost of the public sector Reduced management costs Fewer ‘hand offs’ Using lower cost services Care closer to home – incentivised by local governance arrangements (linked to GP commissioning budgets) More health service money in the local economy Choice – of local or acute hospital services Fit with emerging policy

Possible Service Distribution ServiceWAHTPrimary CareWMHPTWCC Occupational Therapy Physiotherapy Speech & Language Therapy Podiatry Dental Sexual Health Smoking Cessation Radiology (?Breast Screening ) Wheelchair Service District Nursing Night Nursing Twilight Nursing Health Visiting ? Integrated Children's Service School and Paediatric nursing ? Integrated Children's Service Specialist Nursing Specialist Nursing – Palliative Care ?Cancer Unit / Hospice Led Community Hospitals Prison Health Learning Disabilities? CAMHS? Integrated children's service

The PCO role Develop clinical teams in geographical locations Care closer to home Lead on LTC, End of Life, Health promotion WAHT will support PCOs wherever possible (e.g. back office)

Managing the risk Resources retained within Worcestershire, with further repatriation probable Opportunities for pilot schemes (?management contracts) Supports an integrated approach where care is managed along pathways WAHT expertise - manages similar or same services currently

Thank You for listening Any questions or comments?