Urgent Care Birmingham Health Overview and Scrutiny Committee 30 October 2013

What is urgent care? “Urgent care is defined as health and care services provided to people who require – or who perceive the need for – urgent advice, care, treatment or diagnosis.” Department of Health

Public perception Recognition of public interest from recent media coverage in response to perceived crisis and MP involvement in campaigning for walk-in-centres

What’s happened since June Local pilots on the ground - Acute Medical Clinics at Heart of England NHS Foundation Trust – longer opening hours - Urgent Care/Walk-in Centres – contracts being reviewed for consistency - Primary care audit to manage demand - Working with the West Midlands Ambulance Service to treat at scene where possible - Home visits within 5 days to elderly patients

RAID model Enhanced psychiatry service Reduction in admissions 8.9% Length of stay reduced 0.6 days most marked in patients with learning disabilities Savings to whole system BK

Our approach Production of strategic approach for Birmingham and Solihull - Front door to urgent care - Enables patients to be seen in right place and by appropriate person - Complex situation - Needs more detailed options appraisal Changing landscape, NHS111, out of hours provider GP contract

Relative Activity, Unit Cost and Spend 2010/11 Urgent Care Costs Relative Activity, Unit Cost and Spend 2010/11 Activity Unit Cost Emergency Admissions Urgent Ambulance Journeys A&E Attendances Out of Hours, Face- to-face Contacts Walk-in Centre Attendances Same Day GP Consultations NHS Direct Calls 0.4% 22.5% 1.6% c. £560m 1.3% GR Two points; There aren’t many emergency admissions, but they cost a fortune. In comparison, GP is as cheap as chips and better for your health! 9.4% 56.1% 8.6%

Government winter funds for A&E £9m for Heart of England and Sandwell and West Birmingham Trusts to benefit whole city - to help meet national four-hour waiting time and 15-minute ambulance turnaround targets Marker of whole system Investment in social and community healthcare There is agreement where we have City wide services (Community Trust and Social Care) the schemes focus will be City wide   Solihull - £1.42m Birmingham - £8.18m (Includes children)

Key schemes Seven-day working in acute providers, community and social care Increased bed base Focus on in patient hospital flows Elderly care physician in Single Point of Access

Increased beds Heartlands: 34 bed winter flex, 20 home care packages Good Hope:  recovery at home 26 care packages Birmingham Community Healthcare:  4 beds opened in re-ablement ward at Good Hope 16 beds at Moseley Hall 3 early supported discharge for stroke patient beds 21 virtual beds in the community Increase in community bed base 140 -161

Increased beds Local Authority: 10 additional specialist dementia patient beds 41 additional care home beds 7 sheltered housing short term re-ablement beds. University Hospitals Birmingham: to a trajectory of 41 healthcare at home beds for trauma and medicine These are now underpinned by plans to deliver the increased capacity by the middle of November. The highest risk is around the recruitment of staff for the BCHC beds and capacity. Phil is going to monitor progress of this and we have agreed gateways to the release of the winter funding. Should the staff not be recruited, we will have enough notice to ensure we can put in place a plan around spot purchasing care home bed provision with physiotherapy and OT support.

Patient and public involvement Erdington Patient User Group Selly Oak ward meeting Engagement at local university freshers’ fairs Regular bi-monthly stakeholder updates Face-to-face meetings with local MPs and Councillors

Urgent and Integrated Care Board To work collaboratively Membership acute providers, commissioners and Local Authority Looking to constitute as a sub committee of Health and Wellbeing Board Focus on whole system approach

Next steps Complete primary care audit by December Pilot of GP at the front door at City, evaluated end March 2014 Different GP pilot at UHB, complex health needs, complete January 2014 NHS111 step-in by WMAS, re-procurement to national specification March 2015 Ongoing patient and public involvement