1. Integration to avoid hospital admission: ITHAcA
Sarah Purdy on behalf of the HIT

2. Health Integration Team modus operandi of Bristol Health Partners
What is a HIT?
Health Integration Team
modus operandi of Bristol Health Partners
Should:
improve outcomes across the patient pathway
create an integrated whole health system approach
promote research
disseminate innovation and evidence
align with education/training

3. ITHAcA Aims to reduce avoidable hospital admissions across BNSSG
increase enablement of patients and carers
reduce complexity in urgent care system
develop capacity to use data and evaluate changes
optimise productivity and efficiency of existing and new interventions
Includes all BHP partners plus BCC and collaborators SP

4. Address priorities for BHP
NHS outcomes framework – reducing emergency admissions adults and children
Highest bed days for LTCs in South West
Admissions for COPD 25% above average
Rising population over 65 years of age - pressure on social and health care
Acute services redesign and integration priority for NHS partners JU
“Admissions should be
appropriate, focused and effective”

5. Challenges in urgent care: diagnosis
simplify systems in and OOH
match demand and capacity
expert early assessment
reduce LOS in bedded settings
address needs of high risk populations
JU - DH Emergency Care Intensive Support Team

6. Urgent care potential work streams
Key
Urgent care potential work streams
Operating Principles
End of Life Care planning
Preventative Escalation
1st June priority - top
Prevent
1st June priority - next
Public comms – GP 24/7
Urgent care centres – location and spec
NHS111 &
Directory of services – avoid multiple SPAs
Directory of Emergency Ambulatory Care/Hot Clinics (Professional SPA link)
Simplify
Existing work streams
Other Healthy Futures project/programme
Protocol for ambulance management of HCP calls with referrers
Match demand and capacity 7 days a week
Connecting Care – integrate information
Mental Health Liaison
Front
Load
Create
Reliability
See
and Sort
Early senior review at first point of contact
Benefits measurement – balanced scorecard approach
Minimise time in bedded settings
Invest in discharge enablers JU
Cultural
enablers
Flow
Enablers
Focus on reducing LOS – pull from front door, pull from back
Address financial disincentives through tariff changes and/or budget integration
Advice & Guidance
Urgent category transport (same day, 1 hour)
Alternatives
Enablers
Evidence-base – Health Improvement Teams/Partnership integration

7. Evidence based strategy targeting four areas
Using data to inform commissioning
Model patient flows – system dynamics
Risk profile severity at presentation
Increase understanding of triggers for admission using qualitative methods and case studies
Evaluate new interventions – start with NHS 111
Childhood asthma
Model patient flows
Inform development of interventions HE
Lots of data but lack of information
Admissions not reducing in line with anticipated benefits from local interventions
JSNA identified lack of intelligence around children's admissions

8. Evidence based strategy targeting four areas
Dementia and intercurrent illness
Ensure appropriateness of admission and discharge
Increase understanding of burden on carers with aim of increased support at home and reduced long term care placement
Develop living environments to sustain people with dementia who wish to live in the community
COPD
Optimise productivity and efficiency of existing interventions
Introduce and evaluate new evidence based approaches HE

9. Improving and integrating COPD care
Improve utilisation of smoking cessation
Map services
Increase pulmonary rehab uptake
Severity at presentation
Acute admission prevention strategy JC
Model flow
Evaluate BTS care bundles at NBT
Exemplar for other conditions
Short term 1-3 years

10. Other components of a COPD acute admission prevention strategy
Medium term (3-6 years)
Longer term (5-10 years)
Intensive education in self management with follow up
Earlier diagnosis
Increase expertise amongst community staff
New models of specialist/GP working JC
Specialist led care for all admissions
Develop and pilot new interventions

11. ITHAcA strengths
Strong existing links between senior individuals in all partner organisations around the problems to be addressed + underpins existing mechanisms
Expertise in research, clinical, social care and organisational development
Links to:
existing PPI groups
other proposed HITs
Pilot work to develop initial project funded and potential programme manager in post
SP - mention other collaborators – BCH, GWAS, BrisDoc
Other HITs

12. ITHAcA challenges and opportunities
Potentially huge agenda but a priority
NHS reconfigurations and reforms
Need for whole system changes and buy in
Robust evaluation has resource implications
NIHR HS&D Research Programme calls: New models of care for LTCs EOI Jan 2013
Sustaining impetus – HIT longevity an opportunity SP