1. Developing the model of care
July 2018

2. Welcome and Introductions
The national picture
Why we need to do things differently
Addressing the challenges and developing a new way of working (model of care)
Your thoughts
What happens next

3. The NHS is facing significant challenges
Nationally, stories are shared daily highlighting the ongoing challenges for hospitals, their staff, patients and the public. Rising demand and a shortage of specialist staff together with rising costs means it will be increasingly challenging to provide safe and effective care and treatment on time for our local communities. Unless we change how our hospitals work, more people will wait longer for treatment, and the quality and safety of care will deteriorate.

5. A collaborative programme…
Our Health Our Care
A collaborative programme…
Prevention and Early Intervention
Out of Hospital
In Hospital

6. Why we need to do things differently…

7. Some of our biggest challenges
Number of people over the age of 65 needing complex care set to increase by 33,000 by 2037
Large gaps in medical staff and a national shortage of specialist staff including nurses and doctors
A&E 4-hour performance achieved 60% of the time, against the national standard of 95%

8. Some of our biggest challenges
If you live in the most deprived areas of central Lancashire you are 51% more likely to die from cancer or a stroke
High cancellation rates due to lack of critical care beds and other factors impacting on Cancer waiting times
Despite these challenges, there are lots of examples of high quality and innovative care being provided by our staff
Planned surgery is being cancelled due to busy wards and increased demand. People are waiting longer for treatment

9. Examples of high quality care
TIA (Transient Ischaemic attack) Clinic
TIA is also known as a ‘mini stroke’
Clinic established to offer out-patient care 7 days a week
Consultant led service means a prompt review and treatment from senior clinician
One stop shop for patients who would have previously been admitted to hospital
Patients receive in-depth diagnostics and commence medication to prevent a further attack
Ambulatory Emergency Care
Established at the Chorley site
Whole system approach, with both hospital and GP/Community based care
Service led by senior clinicians who will undertake initial assessment, diagnosis and treatment on the same day, with ongoing clinical follow-up as required
Proving successful in providing rapid treatment and ongoing support which prevents people from being admitted into hospital unnecessarily

10. Examples of high quality care
Cancer Nursing
The team in our chemotherapy day case unit have been shortlisted for a national Nursing Times award in the category of “Cancer Nursing” for their work to improve experiences for patients
Over the past 12 months, the service has been expanded to provide care closer to home, including opening a chemotherapy unit at Chorley Hospital
Patient Safety Improvements
The Nutrition Nursing Team have been shortlisted for a national award for their work to develop a whole system approach to improving safety using small feeding tubes, used for short or medium term nutritional support.
Their work includes implementation of an e learning tool and has been shared as a free resource which a large number of other NHS organisations have now implemented.
Health Education England has also adopted it as a national programme of education.

11. We want to learn from what we are doing
well and do more of it by developing new ways of working
We need to make sure our services are sustainable for the future and can tackle the challenges we face

12. Working with our staff and clinicians
Doctors, Nurses and other clinical staff with expertise in these areas, started by identifying the main problems with the current system and the things that stop patients from receiving the best care
They then developed possible ways to tackle these problems to improve patient care, treatment and outcomes and deliver services that are safe, high quality and clinically and financially sustainable
We also gained input from patients and partner organisations across the health and care system

13. Developing a new Model of Care
These ideas have been brought together in an emerging ‘model of care’. Which is an outline description of how services may be structured and delivered differently in the future
A model of care describes how care can be provided not where it can be provided
The emerging model of care developed by clinicians does not name sites and could be delivered on a number of separate sites or all located on one site
It is guided by a number of principles

14. Model of Care Guiding Principles
Patient Centred Care
Supports safe, quality care for patients
Improved access to services
Ability to measure how well we are doing
Standardised treatment and outcomes
Encourages Innovation
Supports efficient use of resources
Supports integrated care

15. Our clinically-led emerging Model of Care
Single emergency and major trauma centre, delivering high quality emergency medical care 24/7
Single access booking and streaming of patients
A co-located Urgent Care Treatment Centre and a networked Urgent Care Treatment Centre
Standardised Ambulatory Care Unit(s)
Centralised, fully equipped Critical Care Unit.
Planned Care Centre with protected beds to prevent cancellations
Joined up pathways of care between Primary Care and the Hospital
Frailty Assessment Unit or enhanced virtual Frailty Assessment across Central Lancashire
Integrated partnership care with specialist support and advice to GPs and teams wrapped around the patient
Enablers such as IT and digital to transform services and support care closer to home

16. 5 areas of hospital care in focus
1. Acute Medicine - Immediate and early treatment by specialists, within the first hours of being admitted to hospital
2. Critical Care - Specialist care for patients whose conditions are life-threatening and require constant monitoring. Also known as intensive care
3. Surgery - Planned surgery procedures, carried out as a day patient or requiring a hospital stay
4. Speciality Medicine – Patients who are admitted to hospital as their care is likely to exceed 72 hours. Treatment of conditions affecting vital organs such as heart, lungs, kidneys, nervous system etc. or conditions such as cancer and diabetes
5. Emergency Care and Urgent Care - Emergency care for people who have life or limb threatening problems; and Urgent Care provided for
illnesses or injuries that needs prompt attention but are
not life or limb threatening

17. Acute Care

20. Verbal prompt: Early specialist review , quicker decision on test results, early test availability , lesser time off work and convenient predictable schedule despite unplanned admission. Less chasing up for urgent tests . No unnecessary stay in the Hospital.

21. What does it mean for me as a patient?
You will receive the right care at the right time and in the right place
You wont wait as long for appointments and surgery
You will be less likely to be admitted into hospital as you will receive care closer to home
You will spend a shorter amount of time in hospital
You will receive high quality care from clinical experts
You will have your planned surgery on time, and it won’t be cancelled because the hospital is too busy
Your experience of the care and service you receive at hospital will improve

22. Your thoughts
In your table groups: 1. Do you understand this model? 2. Do you think this will help address the challenges we face? If not, why not? 3. Is there anything missing?

23. What happens next…

24. Next steps
We will be sharing the information you have heard this evening throughout the coming weeks, speaking to staff, community groups and key stakeholders, and on tour with the Healthwatch ‘chatty van’. The slides will be on along with a questionnaire so you can tell us what you think
Feedback gathered during these engagement events will be shared with the clinical steering group and fed into the model of care, which will then be finalised.
We will then bring the model of care, estates, finance and workforce information together to develop a number of different ways the finalised model of care could be delivered in the future
This model of care and how it could be delivered will then be shared during formal consultation in the New Year.
We will be speaking to you again in the next few months

25. Share your experiences
Please take a survey to fill in or you can follow the link to complete it on line…

26. Chorley House, Centurion Way, Leyland
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Chorley House, Centurion Way, Leyland
Lancashire, PR26 6TT