1. Strategic Commissioning Approach to Improving Patient Flow Deborah Jones Chief Operating Officer NHS Highland

2. Highland Quality Approach

3. The Golden Thread National Programmes Local Delivery Plan Improvement and Co production Plan Operational delivery Plans Team Plans Individual Objectives LUCAP Strategic Commissioning

4. Why the Pressure? Week commencing 14 th July 2014 saw a significant increase in patient flow pressures in Raigmore Hospital

5. Delayed Discharges Current NHS Highland Delayed Discharge Position

6. Opportunity Cost of Delays 24,000 bed days lost to delayed discharge equates to circa £8m OPPORTUNITY COST

7. 2013/14 Care @ Home Position Hospital unmet need 40 people @ 10 hours per week around 400 hours per week / £322k per annum Community unmet need: 246 people @ 10 hours per week 2,460 hours per week / £2m per annum –Estimated cost of current unmet need is £2.3m p.a. –Market split 60% (in house) / 40% (independent sector) –In-house provision more expensive –Competition between providers to recruit –Not all geographical areas of operation sustainable –Inconsistent (and some poor) quality of provision

8. 2013 Care Homes Position 59 care homes for older people / 1,741 beds In-house - 12% of beds / average size of 13.5 beds IS - 88% of beds / average size of 35 beds Average occupancy of 95% 39% of care home beds during 2013 adequate or less December 2013: 63% of vacant care home placements were unavailable due to quality Low or no respite, intermediate or palliative care beds Lack of trained and experienced staff; poor quality care resulting from a high turnover of staff Not all care homes have en-suite

9. So what?

10. Strategic Commissioning Integrated through lead agency approach Establishment of joint commissioning approach with third and independent sector colleagues Co-produced strategic commissioning plan – led by third and independent sector colleagues Co-chairmanship of adult commissioning group with CEO of an independent care provider Risk management and cultural change required amongst our staff

11. Care @ Home 2014 Level playing field, means commissioning across sectors, not protecting in house service. Collaborative zoning, means providers can access cost effective “runs”, not scattered provision Paying (75p) to achieve compliance with Living Wage Developing a single tariff for all providers which can be enhanced for rurality and complexity

12. Market Changes Quality of Provision

13. North Highland Changes in Provision

14. 2014 Care Homes Position By 2019 95% all provision to be grade 4 or above A range of models (eg intermediate care / step up/ down/ supported accommodation) –Flexible and responsive services Through Establishment of service improvement lead to support independent sector care homes Development of quality standards to be included in all contracts Commissioning short term re-abling care, as an alternative to hospital; New models of care such as housing with support Collaboration on workforce issues to ensure a sustainable pool of sufficiently trained and qualified staff; Collaboration with communities on alternative models to meet local needs.

15. Raigmore This is now… We are Implementing… Daily Quality and Patient Safety Huddle in Raigmore but includes a whole system approach Ambulatory Care Changes to Out of Hours (impact Raigmore PCEC) Reconfiguring Beds

16. LUCAP Key Workstreams Making The Community The Right Place and Developing the Primary Care Services Community Pull Falls and Frailty Care @ Home Capacity Reduce A&E Attendance Flow and the Acute Hospital Flowology through our Hospitals Ambulatory Care Promoting Senior Decision Making Review of Medical Rotas Review of exiting model for medical receiving Assuring Effective and Safe Care 24/7 at the Hospital Front Door Front Door Services Increase Consultant Capacity in A&E Cross Cutting Themes Modern Apprenticeships Transport Co-Ordinator Increase Emphasis and Alternative Roles (Workforce) Information Management

17. Thank You Any questions?