Integrated Management and Proactive Care for the Vulnerable and Elderly – IMProVE Julie Stevens – Commissioning & Delivery Team

Today’s presentation About us Our IMProVE Challenge What we did What we have achieved so far On-going work

About us We are an NHS organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services We are responsible for planning the right services to meet the needs of local people, buying local health services including community health care and hospital services, and checking that the services are delivering the best possible care and treatment for those who need them South Tees CCG – covers geographical area of 300 square km and a population size of around 274,000 We have 40 GP member practices

Our Challenge Variations in quality and outcomes of care There are inequalities across South of Tees with regard to life expectancy, access to services and deprivation South Tees ranks higher than the England average for almost all disease prevalence Gap between most deprived and least deprived for men: 11.7 years and for women 12 years. ONS statistics from 2012 total

Future trends magnifying the problem Demand for care and support, particularly for residential care for older people, continues to increase as people are generally living longer due to medical advances, and the transition into old age of the baby boom generation In 2012 population was 273,742 of which 48,689 were over the age of 65. Estimated that by 2021 the population of over 65s will increase by approx 20% at around 56,800 and by 3.2% for over 85s at 8,451 Current spending projections in the NHS suggest significant financial pressures on services for the next 20 years

Delivery system not fit for the future – heavy reliance on hospital and bed based services Delayed discharge from hospital, particularly from community beds - Research shows, bed rest in older people in hospital can lead to a range of harms (Knight et al 2009a,2009b, Nigam et al 2009). Even in healthy older adults, 10 days of bed rest can lead to a 14% reduction in leg and hip muscle strength and a 12% reduction in aerobic capacity: the equivalent of 10 years of life (Kortebein et al 2008). High numbers of avoidable emergency admissions compared to other areas regionally and nationally – high percentage of people admitted as an emergency are over the age of 65 Health and social care services not adequately ‘joined’ up leading to delays in accessing appropriate services and duplication of effort An Independent Survey across South Tees carried out before we made changes showed: 49% of patients in a community bed did not need to be in there and could have been appropriately supported by other services 33% of patients in an acute bed did not need to be there

We are bound by history of where hospitals were built which can reduce flexibility and be a barrier to improvement Community hospitals were under-utilised and varied across sites Running and maintenance costs of Community Estate were high - Void space was costing us around 1.9 million pounds Some of the community hospital estate required significant investment to bring up to modern standards

Our Vision ‘More people who can be treated in the community will be and those who do require a hospital stay for medical reasons will be given the additional support they need to regain independence’ Putting people before premises!

What we did Extensive engagement to develop some options and then formally consulted Recommended an incremental change programme – putting patients before premises!

Centralisation of stroke rehabilitation services to Redcar Primary Care Hospital by April 2015 Closure of the two minor injury services in East Cleveland and Guisborough Primary Care Hospitals.  Consolidation and enhancement of minor injury services onto one single site (Redcar Primary Care Hospital) by April 2015 Closure of Carter Bequest Hospital and transfer of services within the community by April 2015 alongside the progression of improved community infrastructure Part closure of Guisborough Primary Care Hospital (main building), removal of the bed base subject to implementation of improved community infrastructure by April 2016 Redevelopment of the Chaloner building in Guisborough to house transferred services as well as additional community based services by April 2016

What we have achieved so far We said we going to reinvest any savings made as a result of the project. The CCG released £3.6M from 2015/16 community contract which has allowed us to invest in community infrastructure £300,000 into increasing capacity of pulmonary rehabilitation by delivering from a number of community venues. £300,000 into the Stroke Early Supported Discharge Team £137,000 has been reserved for starting up the community assessment hub £1.5m into expansion of community therapies (including 7 day working with the primary care hospitals) Increased services at Redcar Primary Care Hospital – day case, x-ray and out-patients Delivery of Intravenous therapies in patient’s own homes New investment - £5.3M funding via NHS England & NHS Property Services for new build at Guisborough Putting patients before premises

Improved outcomes for patients

Data Source: England data from NHS England, Emergency Admissions Quarterly Time Series (Total emergency admissions) South Tees CCG data as produced by North of England Commissioning Support Unit's RAIDR (Secondary Care Dashboard, Emergency Admissions POD)

On-going work – Still lots to do! The IMProVE programme has been a catalyst for strengthening partnership working – Integration Executive Group Better Care Fund – Joint budget Single Point of Access – 2nd phase Integrating Health and Social Care Rapid Response Teams Training investment into care homes More ‘out of hospital work’ – Regional work (Better Health Programme) and local development of ‘community hubs’