Service 19 TH JUNE 2014 /// SEPTEMBER 4, 2015 ALISON CLEMENTS

Presentation format UCLH Stratification of Care background Partnering with Healthcare at Home service model

UCLH Stratification of Care Acute Care = Daily access to consultant level advice & intensive nursing/therapy/diagnostic support Intermediate care – “hotel +” = Consultant oversight and “risk management” with community teams Hotel + ambulant care = Eg Cotton Rooms ‘patient hotel’ Hospital at home/Home IV/Outreach v In reach Augmented self care Self care

Background 30% of patients treated in acute care should be cared for in alternative settings In our physical acute beds, we should only have patients needing daily consultant review, and needing access to intensive nursing/therapy/diagnostics support 24/7. In all other circumstances we need to assess whether care can be facilitated or delivered in another, better value context for the patient and their carers. Increasing demand for our physical beds – high occupancy - delays Stratification of care – implementing the pathways that reduce acute hospital bed stays Working with CCGs, community health & social care providers, Internal service, Jubilee Ward, Evergreen Ward, OPAT HaH scoping work May 2013 – potential for 30+ beds worth of post acute patient care provided in patients’ own home – prior to final discharge to GP and/or community teams. Tender exercise, EB and Trust Board approval – partnership working with Healthcare at Home

A partner with expertise & experience The two leading specialists in acute home healthcare Recovery at Home services operating at 17 NHS acute trusts across England National coverage, local presence Comprehensive clinical governance framework 24/7 patient support Local requirements – partnership and integration

A partner with geographical reach.

Service Model Overview Care closer to home: Medically stable patients complete their acute care pathway in their own home Core service hours , 7 days per week Support to patients 24/7: Patient, carer & clinician access to a nurse lead 24hr telephone support centre Service works collaboratively with existing health and social care providers, and does not duplicate existing services Patients are discharged from the service to their GP / community services

Service Model Overview All clinical staff employed are jointly recruited through a UCLH value based recruitment process, undertaking UCLH assessment centre process. All clinical staff employed will comply with UCLH clinical governance arrangements and follow UCLH Clinical Policies and Procedures. UCLH hospital Consultants retain clinical responsibility of the patients and will be able to undertake virtual ward rounds as all clinical care given in the home is recorded electronically and will be available on the UCLH electronic patient record for the clinical team to view on a daily basis. On site nurse case finders will work with clinical teams to actively identify suitable patients for transfer to service Multidisciplinary field team will provide the care for patients in their own homes The service will be managed by the Integration Division to

Evidence from current services Healthcare at Home support produce good patient experience and outcomes: 98% patients report being satisfied or very satisfied with the service <2% unplanned transfer back rate whilst on service* <2% emergency 30 day re-admissions rate* Although difficult to quantify, improving patient flow by introducing a post acute care at home service can: Facilitate elective surgery work - Good Hope Hospital has seen cancelled operations reduce by 43% Improve management of ‘outliers’ – ie less patients have to be admitted to incorrect acute bed base, Reduce delays for patients being admitted from the emergency department Notes: * for University Hospital Southampton FT service Patient Outcomes

What the patients say…

Stakeholder Engagement Extensive clinical engagement within Trust clinical directors and lead consultants, junior doctors, senior nurses, matrons, nurse specialists, therapy staff, charge nurses Engagement with various supporting teams and departments e.g. discharge coordination, OPAT, bed management/operations, therapies/equipment, pharmacy, IT, communications, clinical coding, performance & information Engagement with Patients UCLH patient forum helping with patient leaflet design, attendance at local area patient groups Engagement with GPs, CCGs, community services, social services e.g. Camden and Islington GPs helping with discharge process design, district nursing, community rehab, specialist community nursing teams working with us to ensure seamless discharge to their services.