North East Urgent and Emergency Care Network/Vanguard NHS organisations and providers across the North East

Introduction Large Scale Change Cooperation between many providers Will require cultural change Must be clinically led

Key principles The needs of the patient are above those of individual organisations As a system we can provide a higher standard of care than as individual organisations Patients and staff will be involved in the development and delivery of our programme Costs will be reduced by co-ordinated care focused on improving health We will work together to develop and meet our shared vision for urgent and emergency care We will involve partners in social care

Why do we need to change?

Higher hospitalisation rates

A&E Performance Quarterly Figures – 2014/15 Q4 Performance for Q4 as whole shows 91.8% on all types (compared to 92.6% in the previous quarter and 95.2% for the same quarter last year). There were 983 twelve-hour breaches this quarter (compared to 172 in the last quarter and 134 in the same quarter last year). The total number of attendances was 5,388,000 (less than 5,574,000 in the previous quarter and lower than 5,405,000 in the same quarter last year). There were 1,379,000 emergency admissions in the quarter (down from 1,402,000 in the previous quarter but higher than 1,360,000 in the same quarter last year). Yearly Figures – 2014/15 Performance for 14/15 shows 93.6% on all types (compared to 95.7% in the previous year). There was 1,239 twelve-hour breaches this year (compared to 240 in the previous year). The total number of attendances was 22,364,000 (more than 21,779,000 in the previous year). There were 5,483,000 emergency admissions in the year (up from 5,273,000 in the previous year).

7 Ambulance response (latest data unvalidated week end 6/12/2015) Following similar trend to 14/15, but below standard performance coming earlier in the year. Significant risks and challenges for winter 15/16. 15,000 patients failed to receive their constitutional right in Q2 2015/16, 3,000 more than in Q1.

Emergency admissions from A&E have grown for all age groups, especially oldest Source: HES data, Apr-Sep, each year

Most studies suggest that admissions can be avoided in 20-30% of >75 year old frail persons “Avoiding admissions in this group of older people depended on high quality decision making around the time of admission, either by GPs or hospital doctors. Crucially it also depended on sufficient appropriate capacity in alternative community services (notably intermediate care) so that a person’s needs can be met outside hospital, so avoiding ‘defaulting’ into acute beds as the only solution to problems in the community”. Mytton et al. British Journal of Healthcare Management 2012 Vol. 18 No 11

111 Social Care GPs Wards UCC Ambulator y Care A&E 999 community Social Care Patient transport Care homes Congestive Hospital Failure Demand Efficiency What happens at point “x”? 1) Patients outlying: (mortality ↑) inappropriate nursing inefficient ward round / treatment less senior input and DTOC 2) Increase beds numbers “isolated” escalation wards unfamiliar temporary / agency staff 3) Patients backing up in A&E majors cubicles and trolleys occupiedoverflow to other holding areas observation and care compromised ↑ focus on A&E at expense of wards congestion – diminished flow all patients 4) Ambulances queue to offload vehicle and crew utilisation goes down fewer vehicles available for 999 responses Long delays in responses and increased risk X

What will our Network look like? What do we need to deliver? New Payment Models

What do we need to deliver? Better self care Better use of pharmacists Better access to Primary Care Better information on Primary Care Enhanced care in care homes Better community and social care Improved MH crisis and Liaison Services

What do we need to deliver? An integrated 111 A clinical hub in 111/NEAS 111 access to GP appointment systems Access to GP records Direct GP Booking from 111 as a standard Flight Desk No clinician working in isolation Develop 999 ambulances so they become mobile urgent community treatment services, not just urgent transport services

What do we need to deliver? Acute hospital reconfiguration

The Vision The NEUCN vision is to reduce unwarranted variation and improve the quality, safety and equity of urgent and emergency care provision by bringing together SRGs and stakeholders to radically transform the system at scale and pace which could not be delivered by a single SRG alone.

2015/16 key schemes Summary Care Record Pharmacy First Flight Deck Improved DOS PERMSS Direct Appointment Booking Self care schemes Care homes EWS Communications Scoping for future projects –Mental Health –Intermediate Care beds –Emergency surgery and stroke

Programme structure

Working Groups Clinical reference Group IM&T Finance

Priorities for this winter 8 High Impact Interventions Patient education and use of pharmacists Better use of flight desk Better cooperation between FTs Concentrate on flu immunisation NEAS performance – 15 min handover in FTs NEAS diverts to make best use of 999 Vehicles

20 Flu Vaccine Uptake

MH Involvement Focus for 15/16 on extending coverage of all age Psychiatric Liaison Services (PLS) in ED 16/17 To continue to develop Core 24 Psychiatric Liaison, improve access and availability of CRHT, extend street triage, implement 24/7 Consultant Psychiatry Further consideration to be given to MHA assessment process particularly in relation to AMHP availability, Section 12 Drs and Transport Preparation for this winter Mental Health representation in local surge meetings Some increase in referrals but manageable at this point in time Daily staffing numbers for CRHT and PLS over Christmas/New Year period submitted to SRGs and will continue to be reviewed and monitored