Everyone counts: working together to tackle Delayed Transfers of Care HFMA West Midlands 2017: Competition to Collaboration Rosanne Furniss June 2017

Strictly Private and Confidential Agenda Introduction Working together – what does it mean? What impact could it have? Delayed Transfers of Care A practical step on “How to” Summary & Questions 15/11/2018 Strictly Private and Confidential

Strictly Private and Confidential Agenda Introduction Working together – what does it mean? What impact could it have? Delayed Transfers of Care A practical step on “How to” Summary & Questions 15/11/2018 Strictly Private and Confidential

Strictly Private and Confidential Working Together 15/11/2018 Strictly Private and Confidential

Strictly Private and Confidential Why does it matter? Examples of failure and of success from in and outside healthcare Bad example – the letters coming round from NHSI Ask the audience for an example, or a show of hands 15/11/2018 Strictly Private and Confidential

Strictly Private and Confidential Agenda Introduction Working together – what does it mean? What impact could it have? Delayed Transfers of Care A practical step on “How to” Summary & Questions 15/11/2018 Strictly Private and Confidential

The equivalent of 200 people spending the entire year in Hospital. DTOC A CLOSER LOOK WHY IS IT IMPORTANT The equivalent of 200 people spending the entire year in Hospital. People in Sheffield have spent 72,000 more days in Hospital over the last year than they needed to. With a cost to the system of more than £20M.

2 PATIENT PATHWAY WORKSHOPS WITH 50 STAFF DTOC A CLOSER LOOK 2 PATIENT PATHWAY WORKSHOPS WITH 50 STAFF Performance and Biggest Opportunities 200 CASES REVIEWED Process Analysis 500 DAYS OF PERFORMANCE AND FINANCIAL DATA Opportunity Matrix and Delivery Plan 2 IN-DEPTH SURVEYS 40+ ONE-TO-ONES Intensive, 2-week assessment process

REDUCING THE UNECESSARY DAYS PEOPLE SPEND IN SHEFFIELD HOSPITALS DTOC A CLOSER LOOK REDUCING THE UNECESSARY DAYS PEOPLE SPEND IN SHEFFIELD HOSPITALS 32% of those impacted by DTOC are waiting for a pathway to be allocated to them. 30% of those impacted by DTOC are on a pathway to either intermediate, nursing and residential care. 31% of those impacted by DTOC are waiting to go home with some extra support. Source: Weekly DTOC Snapshot Data 04/16-04/17 This is number of days not patients Over the last 12 months

20% ARE WAITING FOR A BEST INTEREST MEETING DTOC A CLOSER LOOK 35% 24% OTHER OF MEDICALLY FIT PATIENTS REMAIN IN A HOSPITAL BED WAITING FOR THEIR PATHWAY OUT OF HOSPITAL TO BE ALLOCATED. 16% 25% NRP HOME WITH SUPPORT BREAKDOWN OF THE 35% OTHER 60% 20% ARE WAITING FOR A BEST INTEREST MEETING RELATE TO A THERAPY INTERVENTION 200 cases reviewed

20% ARE WAITING FOR A BEST INTEREST MEETING DTOC A CLOSER LOOK 4 OTHER days 60% 8.5 20% ARE WAITING FOR A BEST INTEREST MEETING days RELATE TO A THERAPY INTERVENTION Days patient waiting

20% ARE WAITING FOR A BEST INTEREST MEETING DTOC A CLOSER LOOK 9,400 OTHER 60% 3,500 days 20% ARE WAITING FOR A BEST INTEREST MEETING days RELATE TO A THERAPY INTERVENTION 9,400 is around 13% of the total DTOC challenge. 3,500 is another 5%. Days lost over a year

20% ARE WAITING FOR A BEST INTEREST MEETING DTOC A CLOSER LOOK 9,400 OTHER 60% 3,500 days 20% ARE WAITING FOR A BEST INTEREST MEETING days RELATE TO A THERAPY INTERVENTION Reasons given: Meeting not required but still going ahead either due to lack of understanding the guidelines, or as a safety net. Lack of forward planning means the long lead-time to set-up is creating a delay. Reasons given: Waiting in a bed having completed therapy. Could have received the therapy somewhere other than an acute setting. Reasons given provided at workshops.

DTOC A CLOSER LOOK 35% of those impacted by DTOC are on a pathway to either intermediate, nursing or residential care. 54% 45% of the time, this was due to a reluctance by the decision maker to take a calculated risk with a more ‘independent’ solution. of these people could have benefited from a different setting of care. 90% 550 The number of extra people that could have gone home with support. of the time, the best place for these people was home with some extra support. 3,500 The number of bed days these 550 people would release back to us. 50+ patient cases

DTOC A CLOSER LOOK ROOT CAUSES Lack of trust and feeling of fear, both internally and externally Process centric, rather than a patient centric mindset and system Complexity –in the array of pathways and change initiatives History and ‘status quo’

DTOC SUMMARY OF SHEFFIELD £ GETTING READY FOR WINTER A CLOSER LOOK SUMMARY OF SHEFFIELD GETTING READY FOR WINTER 4,000+ people impacted each year 14,000 - 19,600 bed days could be avoided £3million+ annualised system wide savings PEOPLE OPERATIONS £ FINANCIALS 5,000+ people impacted each year 70,000 bed days could be avoided £22million+ annualised system wide savings BECOME THE SYSTEM LEADER

Strictly Private and Confidential Agenda Introduction Working together – what does it mean? What impact could it have? Delayed Transfers of Care A practical step on “How to” Summary & Questions 15/11/2018 Strictly Private and Confidential

What does it really mean day to day? Getting it right means that every person or organisation having their own interpretation, not just applying generic findings Doing this is hard… Talking in the language of clinicians. How many clinicians understand your job? 15/11/2018 Strictly Private and Confidential

Strictly Private and Confidential 15/11/2018 Strictly Private and Confidential

The Excellence Together programme will ensure that we… Make consistent decisions about the way we work Plan to have the right staff in the right place at the right time Support how we remove unnecessary processes and complications in our day-to-day work Are consistent in making sure we pay the right amount for what we use, and get paid correctly for the work we do As one team, we will create the right environment for change

The Clinically Led Approach Today 6 weeks time Opportunity Prioritise Plan Introduction 1 2 3 4 Blockers and solutions Data analysis Identify opportunities Form teams Implement improvement cycle Preparation Meetings Clinically-led project streams Consultant-led project streams Run meetings Own metrics Reporting and governance

Strictly Private and Confidential Model for Change Source: Efficiency opportunities through health and social care integration 15/11/2018 Strictly Private and Confidential

Strictly Private and Confidential Agenda Introduction Working together – what does it mean? What impact could it have? Delayed Transfers of Care A practical step on “How to” Summary & Questions 15/11/2018 Strictly Private and Confidential

Strictly Private and Confidential Summary There are plenty of examples of both success and failure when it comes to working together In the Healthcare context, working together has huge potential Looking at DTOCs for example, where busting the myth that all of the issues are caused by social care can open up the potential solutions to have a significant impact on reducing DTOCs Each area must have it’s own specific and relevant solutions Working together doesn’t happen overnight, building personal relationships and understanding each other’s roles is a key step 15/11/2018 Strictly Private and Confidential

Demand Better: How will working together change your patients’ experience in future? Questions? Rosanne Furniss Business Manager, Newton Europe