Presentation on theme: "Principal Community Pathways h Sunderland & South Tyneside"— Presentation transcript:
1 Principal Community Pathways h Sunderland & South Tyneside
2 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 patientDouble current productive time of community services by redesigning current systemsEnhance the skills of our workforceImprove ways of working and interfaces with partnersReduce reliance on inpatient beds and enable cost savingsThis is not achievable in isolation and to be successful we need it to be part of integrated work with partners
3 Principal Community Pathways – Timeline Jan 14DesignTestImplementApr 14July 14Oct 14Jan 15Pre-engagementApr 15Tranche 2 – Northumberland & North TynesideTranche 3 – Newcastle & GatesheadTranche 1 – Sunderland & South Tyneside
4 What will be different? Current Experience Our Commitment There are lots of confusing ways to access servicesMost non urgent services operate Monday to Friday 9 – 5, and there are waiting listsTreatment episodes cannot always be linked to an outcome or a nice guidance recommended treatment, staff often have to refer to others for treatmentPatients can bounce around the systemStaff time is taken up with typing, driving and adminPatients stay in services for a long time due to lack of joined up working and support to help them recoverPatients don’t want to be discharged because it’s hard to get back into servicesOur CommitmentThere will be a single point of access for all referralsMost non urgent services will work from 8am – 8pm, and waiting lists will be minimalTreatment packages will be evidence based and staff will be trained to deliver a broader range of nice recommended interventionsPrinciple of ‘no Bouncing’Staff will have twice as much time to spend with patientsServices 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.
5 Single Point of Referral Single Point of AccessUrgentRoutineHuddleTriage TeamSingle Point of ReferralNon-complexClinical DiaryComplex11Triage & ActionIRTRapidResponse NursesUCTHome Based TreatmentAssessmentGatekeeping
6 Sunderland Team Configuration Psychosis and Non-PsychosisCognitiveLearning Disabilities
7 Psychosis and Non-Psychosis Teams Sunderlandx 3 teamsSouth Tynesidex 1 teamPsychosisPsychosisEIPEIPShared ResourceStep Up hubStep UpStep UpNon-PsychosisNon PsychosisPDPDShared ResourcePsychosis/Non PsychosisClinical Leads
8 Cognitive & Functional Frail Teams SunderlandSouth TynesideCommunity TeamMPSCommunity TeamYPDChallenging BehaviourStep-up / Day ServiceStep-up / Day ServiceCentral ResourceCognitive & Functional FrailClinical Leads
9 Learning Disability Teams SunderlandChallenging BehaviourPhysical HealthMental HealthLearning DisabilityClinical Leads
10 Phased Transition Process May 14Dec 14Current StateFuture StateStaffingCommunicationClinical Risk and Continuity of CareCaseload MigrationPerformance ManagementSafety
12 PCP Benefits Strategic Driver PCP Benefits Strategic Driver Improve QUALITY for the patientPCP BenefitsImproved outcomes and experienceImproved safetyImproved outcomes and effectiveness: Substantially more evidence-based interventions; recovery focus; care pathways and packages; time well spent with patientsImproved 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 servicesImproved environments: good quality venues, accessible locationsStrategic DriverReduce COSTPCP BenefitsReduced reliance on inpatient bedsEfficient servicesImproved 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 dischargeEfficient clinical services: New systems and processes; IT revolution; reduced bureaucracy and wasteStrategic DriverSUSTAINABLE servicesPCP BenefitsSkilled workforcePartnership and integrationImproved skills: Clinical skills development programme; evidence-based interventionsImproved teams and team-working: Aligned to patient need; new systems and processes; MDT working; team resources aligned to demandWilling partners and integrators: This can only work well as part of an aligned whole system
13 What to expect - the Numbers (adult and older people) CurrentFutureCommunity clinicians% direct time with patients% time non-patient activity% record keeping% Travel20%45%25%10%49%36%5%The difference we can make by having more time with patientsContain patient risk; little opportunity for evidence-based interventionsFocus on a range of evidence-based interventions that support recovery and improved outcomesSystem of Access for patients (non-urgent referrals)Variable system, team allocation meetings, bouncingSimple, standard system; early allocation of pathway; booked directly; no bounceTypical WaitsTo first contactAssessment to treatment4-6 weeks6 weeks (range 2-10 wks)1 week< 2 weeks% split of resources Community to Inpatient48% %60% 40%
14 How will we know what difference has been made? Quality and Safety Data SuiteDeveloped 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?
15 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-managementSatisfaction with services. To assess service user and carer satisfaction with services as delivered at a point in timeCurrent feedback sources: Points of You, Family and Friends QuestionFor Staff:Staff Wellbeing evaluation. To understand the impact of the model on staff morale and well-beingSatisfaction with services. To assess staff feedback on the PCP model covering efficiency, effectiveness, quality and safety of servicesCurrent feedback sources: Staff Survey, Family and Friends QuestionFor 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