Principal Community Pathways h Sunderland & South Tyneside

Principal Community Pathways A programme to design and implement new, evidence-based community pathways for adults and older people. Our ambition is high and is matched by the expectations of service users and carers. The new pathways will: Significantly improve quality for the patient Double current productive time of community services by redesigning current systems Enhance the skills of our workforce Improve ways of working and interfaces with partners Reduce reliance on inpatient beds and enable cost savings This is not achievable in isolation and to be successful we need it to be part of integrated work with partners

Principal Community Pathways – Timeline Jan 14 Design Test Implement Apr 14 July 14 Oct 14 Jan 15 Pre-engagement Apr 15 Tranche 2 – Northumberland & North Tyneside Tranche 3 – Newcastle & Gateshead Tranche 1 – Sunderland & South Tyneside

What will be different? Current Experience Our Commitment There are lots of confusing ways to access services Most non urgent services operate Monday to Friday 9 – 5, and there are waiting lists Treatment episodes cannot always be linked to an outcome or a nice guidance recommended treatment, staff often have to refer to others for treatment Patients can bounce around the system Staff time is taken up with typing, driving and admin Patients stay in services for a long time due to lack of joined up working and support to help them recover Patients don’t want to be discharged because it’s hard to get back into services Our Commitment There will be a single point of access for all referrals Most non urgent services will work from 8am – 8pm, and waiting lists will be minimal Treatment packages will be evidence based and staff will be trained to deliver a broader range of nice recommended interventions Principle of ‘no Bouncing’ Staff will have twice as much time to spend with patients Services will have a recovery focus from day 1. Integrated working will improve the quality of life for service users. Service users will be able to re access services easily and quickly if they need to.

Single Point of Referral Single Point of Access Urgent Routine Huddle Triage Team Single Point of Referral Non-complex Clinical Diary Complex 11 Triage & Action IRT Rapid Response Nurses UCT Home Based Treatment Assessment Gatekeeping

Sunderland Team Configuration Psychosis and Non-Psychosis Cognitive Learning Disabilities

Psychosis and Non-Psychosis Teams Sunderland x 3 teams South Tyneside x 1 team Psychosis Psychosis EIP EIP Shared Resource Step Up hub Step Up Step Up Non-Psychosis Non Psychosis PD PD Shared Resource Psychosis/Non Psychosis Clinical Leads

Cognitive & Functional Frail Teams Sunderland South Tyneside Community Team MPS Community Team YPD Challenging Behaviour Step-up / Day Service Step-up / Day Service Central Resource Cognitive & Functional Frail Clinical Leads

Learning Disability Teams Sunderland Challenging Behaviour Physical Health Mental Health Learning Disability Clinical Leads

Phased Transition Process May 14 Dec 14 Current State Future State Staffing Communication Clinical Risk and Continuity of Care Caseload Migration Performance Management Safety

Evaluating PCP

PCP Benefits Strategic Driver PCP Benefits Strategic Driver Improve QUALITY for the patient PCP Benefits Improved outcomes and experience Improved safety Improved outcomes and effectiveness: Substantially more evidence-based interventions; recovery focus; care pathways and packages; time well spent with patients Improved experience: patient and carer-centred services; care closer to home in the community; partnership approach; service user and carer involvement in design, collaborative ways of working, easy access and re-access of services Improved environments: good quality venues, accessible locations Strategic Driver Reduce COST PCP Benefits Reduced reliance on inpatient beds Efficient services Improved flow: Alignment of the pathway across community and inpatient services; fewer admissions; reduced length of stay; better discharge planning; better transitions & partner working; balanced flow of access and discharge Efficient clinical services: New systems and processes; IT revolution; reduced bureaucracy and waste Strategic Driver SUSTAINABLE services PCP Benefits Skilled workforce Partnership and integration Improved skills: Clinical skills development programme; evidence-based interventions Improved teams and team-working: Aligned to patient need; new systems and processes; MDT working; team resources aligned to demand Willing partners and integrators: This can only work well as part of an aligned whole system

What to expect - the Numbers (adult and older people) Current Future Community clinicians % direct time with patients % time non-patient activity % record keeping % Travel 20% 45% 25% 10% 49% 36% 5% The difference we can make by having more time with patients Contain patient risk; little opportunity for evidence-based interventions Focus on a range of evidence-based interventions that support recovery and improved outcomes System of Access for patients (non-urgent referrals) Variable system, team allocation meetings, bouncing Simple, standard system; early allocation of pathway; booked directly; no bounce Typical Waits To first contact Assessment to treatment 4-6 weeks 6 weeks (range 2-10 wks) 1 week < 2 weeks % split of resources Community to Inpatient 48% 52% 60% 40%

How will we know what difference has been made? Quality and Safety Data Suite Developed by senior clinicians to monitor and measure the impact of transformation across the Trust, designed to answer: Does the PCP model work? Have outcomes for patients improved? Do service users and carers think the service has improved? Are we delivering more evidence based interventions? Is there a greater recovery focus leading to reduced reliance on inpatient beds? Have waiting times reduced? Are clinicians spending more of their time with patients? Does the skill mix match demand for services? Is Transformation safe? Has there been an impact on out of area referrals? Has the number of readmissions and re-re-referrals changed? Are community services contributing to delayed discharges? Has the average length of stay changed? What is the impact on community workload? Has there been an impact on the proportion of incidents? What has the impact on staff – sickness, morale, vacancy rates?

How will we know what difference has been made? For Service user and Carers: Service User led narrative interviews. To be carried out over a longer period of time to assess cultural and behavioural changes including: recovery focus, collaboration, co-production, self-management Satisfaction with services. To assess service user and carer satisfaction with services as delivered at a point in time Current feedback sources: Points of You, Family and Friends Question For Staff: Staff Wellbeing evaluation. To understand the impact of the model on staff morale and well-being Satisfaction with services. To assess staff feedback on the PCP model covering efficiency, effectiveness, quality and safety of services Current feedback sources: Staff Survey, Family and Friends Question For Partners: Satisfaction with services. To assess the impact of the model on the range of partners we work with including Commissioners, GPs, Social Care and other health providers. To include ease of access to services, satisfaction with service response as well as overall satisfaction with services